Chapter 26: Antepartal testing Flashcards
a ______ risk factor originates from the mother or fetus and impacts the development or function of the mother/ fetus
biophysical
maternal conditions that would require antepartum testing
HTN Renal disease cardiac disease diabetes lupus
when does antepartum testing usually begin
32/34 weeks
a _______ is a noninvasive test that monitors fetal movement
daily fetal movement count
daily fetal movement count is commonly used to monitor the fetus in pregnancies that are ______
complicated by conditions that affect fetal oxygenation
during the third trimester the fetus makes about _____ gross motor movements in an hour. Mommy can recognize ______ % of these
30; 70-80%
a count of _____ fetal movements or less in an hour warrants further testing
3
what test is done if fetal movements are less than 3 in an hour
nonstress test or contraction test and a complete or modified biophysical profile.
______ is the use of high frequency sound waves to produce an image of organs or tissues
ultrasonography
Standard ultrasonography in second and third trimesters looks for: (5 major things)
AFV, cardiac activity, placental position, fetal growth, number of fetuses
______ ultrasonography are performed to determine a specific piece of information about the pregnancy such as AFV
limited
fetal heart activity can be heard at about six weeks when using ________ ultrasound
transvaginal
what do they measure with an ultrasound to determine gestational age in the first trimester
crown-rump length
what do they measure with an ultrasound to determine gestational age after the first trimester
biparietal diameter, head circumference, abdominal circumference, and femur length
a __________ screening uses ultrasound to measure the fluid in the nape of the fetal neck between 10-14 weeks to identify fetal abnormalities
nuchal translucency (NT)
a fluid collection of more than _____ mm on a nuchal translucency is abnormal
3mm
elevated NT (nuchal translucency) indicates:
chromosomal abnormalities including trisomy 13, 18, and 21
______ uses systolic/diastolic flow ratios and resistance to estimate blood flow in arteries
doppler blood flow analysis
a fundal height that is small for gestation and a fetus that is easily palpated suggests:
oligohydramnios (decreased AFV)
fundal height that is large for gestational age and a fetus that cannot be palpated or that is ballotable suggests:
polyhydramnios (hydraminos)
pockets of amniotic fluid less than 1 - 2 cm indicates:
oligohydramnios
pockets of amniotic fluid measuring more than 8 cm indicates:
polyhydramnios
how is amniotic fluid index measured
vertical depths in all four quadrants surrounding the maternal umbilicus get totaled together
An AFI of _____ is oligohydramnios
less than 5 cm
an AFI of ______ is polyhydramnios
25
oligohydramnios is associated with what conditions:
congenital defects and pre-labor ruptured membranes
polyhydramnios is associated with what conditions:
multiple fetuses, fetal hydrops,
________ is a noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease
biophysical profile
Biophysical profile (BPP) consists of: 1. 2. 3. 4. 5.
- AFV
- FMB (fetal breath movements)
- fetal movements
- fetal tone
- FHR reactivity via non-stress test
desired results of a modified biophysical profile
reactive non-stress test and a single deepest vertical pocket of amniotic fluid measuring more than 2 cm
which score of biophysical profile suggests the fetus is at risk for chronic asphyxia
a score 6 or below
which score of biophysical profile STRONGLY suggests chronic asphyxia
0-2- deliver fetus regardless of gestational age
3D ultrasonography sometimes ordered for:
visualization of placental blood flow
4D ultrasonography sometimes ordered for:
evaluation of fetal brain morphology and brain lesions
_______ is used to assess placental perfusion and vasculature of the cord
artery doppler flow
_________ is a radiography used to scan tissues and organs
MRI
MRI is good for looking at:
fetal anatomy and abnormalities
amniocenteses is possible after _______ weeks of pregnancy
14
indications for amniocentesis include: 1. 2. 3. 4.
- prenatal diagnosis of genetic disorders
- congenital abnormalities
- assessment of pulmonary maturity
- sometimes diagnosis of fetal hemolytic disease
chorionic villus sampling is done at ______ weeks
10-12 or 13 weeks
__ % chance of fetal loss with CVS
7
__ % of women experience bleeding after CVS
10
__ % of fetal loss with Amniocentesis
1% when done after 15 weeks and 2-5% if done before 15 weeks
high a-fetoprotein levels in amniotic fluid confirms the diagnosis of:
neural tube defects
______ involves the insertion of a needle directly into a fetal umbilical vessel
percutaneous umbilical blood sampling
______ involves the insertion of a needle directly into a fetal umbilical vessel at ______ weeks
percutaneous umbilical blood sampling; 11
when is PUBS usually indicated
when something abnormal shows up on amniocentesis or CVS
increasing levels of alpha fetoprotein are detectable at ___ weeks gestation
7
what is diagnostic of NTD
amniocentesis
what is screening for NTD
maternal alpha fetoprotein levels
if maternal levels of serum alpha fetoprotein are elevated, what is the next step?
ultra sound to determine number of fetuses and confirm gestational age
in Trisomy 21, _____ and _____ are elevated while ______ is lower than normal
hCG; Nuchal Translucency measurement; pregnancy-associated plasma protein A (PAPP-A)
in trisomy 13 and 18 _____ and ______ are lower than normal in the first trimester
hCG; PAPP-A
decreased ADAM 12 in the first trimester is indicative of __________
trisomy 21
what does the quad test screen for
trisomy 21 and trisomy 18
when is QUAD test performed
15-21 weeks
low maternal AFP and estriol during quad test indicates:
trisomy 21
increased hCG and inhibin A in quad test indicates:
trisomy 21
what is the triple marker
AFP, hCG, and estriol calculated with maternal age to detect trisomy and NTD
________ is a NTD in which the infants intestines’ or other abdominal organs are outside of the body
omphalocele
during a _______ test, fetal heart rate is monitored in response to fetal movement, uterine contractions, or stimulation
non stress test
in a normal fetus _______ is associated with movement during a non-stress test
accelerations
for a reactive non-stress test:
fetal HR increases at least 15 beats per minute above the fetal heart rate baseline twice within 20 minute period
what is a tocodynometer
measures uterine activity
what is a fetal transducer
measures fetal HR
next steps if there is a nonreactive non-stress test
try to wake baby up and retest (cold, Leopold maneuvers, drink juice), and perform further testing such as biophysical profile
the desired contraction stress test is:
negative
_________ uses auditory stimulation to assess fetal wellbeing using EFM after a nonreactive non stress test
Vibroacoustic Stimulation
