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OB > Fetal Diagnostic Testing (unit 3) > Flashcards

Fetal Diagnostic Testing (unit 3) Flashcards

1
Q

diagnostic testing

A
  • used to evaluate fetus for genetic/congenital disorders

* genetic screening, amniocentesis, etc

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2
Q

antepartum testing

A
  • done AFTER problem is detected and goal is to evaluate how fetus is tolerating
  • NST, kick counts, U/S, etc
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3
Q

ultrasound

A

•produces image based on echos
•visualization of fetus and surrounding structures
•dark spots= fluid
•white spots= tissue
•transabdominal or transvaginal
*need full bladder for transabd. if < 20 wk

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4
Q

best U/S for viewing internal organs

A

•2D

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5
Q

biggest risk of U/S

A

•missing something

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6
Q

benefit of 3D U/S

A

•identifying cleft lift and palate

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7
Q

standard U/S

A

•general survey of fetus, amniotic fld.

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8
Q

specialized U/S when…

A

•abnormalities exist on basic U/S
•MSAFP
*hx of congenital abnormality

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9
Q

limited U/S when…

A
  • need specific info needed
  • emergency
  • testing BPP, AFI, fetal weight, fetal position, confirmation of cardiac activity
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10
Q

1st trimester U/S

A 
•transvaginal- uterus, gest. sac (6-8 wk), embryo
•used to 
-detect ectopic (transvag)
-multifetal
-confirmation (FHR @ 6-7 wk)
-gestational age (BPD)
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11
Q

2nd trimester U/S

A 
*standard U/S
•trasnabdominal
•confirm GA/fetal viability
•evaluate fetal anatomy
•locate placenta
•detect congenital abnormalities
•assist w/ PUB or amnio
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12
Q

3rd trimester U/S

A
  • confirm viability
  • detect macrosomia/IUGR
  • fetal position
  • AFV, fetal breathing/activity
  • amnio or BPP
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13
Q

fetal sex determination via U/S

A

•after 18 wks

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14
Q

GA assessment via U/S

A

•most accurate if done early (1st trimester)

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15
Q

how does 2nd trimester U/S compare to LMP

A

•not very accurate at that point b/c there can be a difference of 1-2 wks

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16
Q

when is crown to rump embryo length most accurate

A

•7-12 wk

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17
Q

positioning U/S

A
  • wedge under hip in late trimesters

* lithotomy for transvag

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18
Q

screening tells us…

A

•there is a RISK of an issue

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19
Q

diagnostic tells us…

A

•there IS an issue

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20
Q

Alpha-Fetoprotein Screening (MSAFP)

A

•fetal liver protein (AFP) produced in predictable amnt. until 20 wks
•maternal serum tested for anomolies @ 16-18 wks
*key mom blood determinant screening

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21
Q

MSAFP anomalies

A
  • 80% open NTD and open abd wall defects

* 33% trisomy 21

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22
Q

factors that influence MSAFP results

A
  • GA (validity affected if really off on dates)
  • maternal weights
  • race
  • maternal dz
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23
Q

what does MSFP detect

A
  • spina bifida

* ancephaly

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24
Q

anecephaly

A
  • no brain
  • folic acid supp prevent
  • 95% fatal
  • organ donor
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25
Q

triple marker test

A
  • MSAFP+hCG+Estriol
  • 80% detection ONTD
  • 60% detection trisomy 21
  • 50% detection trisomy 18
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26
Q

quad screen

A

•maternal AFT (fetal liver protein)
•hCG (placenta hormone)
•unconjugated estriol (uE3)- fetus/placenta protein
•inhibin A (ovaries/placenta protein)
*anomalies associated w/ preterm, IUGR, preeclampsia, fetal loss

27
Q

nunchal transluscency

A
  • 1st trimester screening (10.5-13.5 wk)
  • looking for free hCG/PAPP-A levels
  • combined w/ fld. collection from fetus neck
  • screening test- NOT diagnostic
28
Q

elevated AFP d/t…

A
  • **open neural tube defect
  • mutifetal gestation
  • abd. wall defect
  • renal anomalies
  • maternal IDDM
29
Q

low AFP d/t…

A
  • overestimation of GA
  • trisomy 21
  • hydatiform mole
30
Q

what happens if MSAFP abnormal

A
  • lots of false neg. so need further/other testing

* further testing w/ specialized U/S, genetic specialists, etc

31
Q

amniocentesis

A 
•needle inserted into uterus and amniotic fld. withdrawn
•used if
-maternal age > 35
-family/past hx of genetic disorder
-abnormal AFP/EDC
-PG after 3+ SAb
*done after 14 wk
32
Q

risks w/ amniocentesis

A
  • ROM, labor, miscarriage
  • fetal cord injury
  • infection
  • abruption
  • fetal death (rare)
  • Rh isoimmunization
  • amniotic fld. embolism
33
Q

what amniocentesis detects

A
  • fetal karyotype
  • fetal AFP or AChE
  • fetal Rh sensitization
34
Q

3rd trimester amniocentesis

A
  • assess fetal lung maturity if delivery considered before 38 wks
  • diagnose fetal hemolytic dz d/t maternal Rh sensitization
35
Q

fetal lung maturity

A
  • L/S 2:1 (3:1 in diabetic mom) AND PG positive = mature

* PG neg = RDS

36
Q

diagnosing fetal hemolytic dz

A
  • done if mom antibody 1:8 or more

* high levels of bili in amnio fld. if positive

37
Q

RN consideration amniocentesis

A 
•supine w/ hip wedge
•bladder EMPTY
•monitor fetal status
***Rhogam after if needed
•karyotype takes weeks
•educate s/sx of infection/bleeding
•encourage fld intake
38
Q

chronic villus sampling

A
  • 1st tri alternative to amniocentesis
  • genetic testing @ 10-12 wks (earliest)
  • sample from fetal placenta
  • higher risk than amnio (limb defect)
  • need FULL bladder
  • Rhogam post procedure if Rh-
  • transabdominal or transvaginal
39
Q

Percutaneous umbilical blood sampling (PUBS)

A

•collecting fetal blood by fetoscope via umbilical vein under U/S guidance
*normally have to do in OR b/c often have to get baby out ASAP

40
Q

indications for PUBS

A
  • blood/chromosomal disorders

* evaluate isoimmune fetal hemolytic anemia/need for transfusion

41
Q

Cordocentesis (blood studies)

A
  • PUBS method
  • Kleihaur Betke test- ensures blood from fetus
  • CBC
  • IC for Rh
  • blood gases
  • karyotyping
42
Q

PUBS risks

A
  • preterm labor
  • amnionitis
  • cord laceration
43
Q

third trimester testing

A
  • goal to evaluate whether intrauterine environment is supportive to fetus
  • if not, deliver baby ASAP
44
Q

nonstress test (NST)

A 
•primary means of EFM fetal surveillance if increased risk of UPI
•used if 
-IDDM mom
-PIH
-IUGR
-previous stillbirth 
-post term
-dec. fetal movement
*report as reactive or non-reactive
45
Q

healthy fetus w/ intact CNS will have…

A
  • accels w/ movement

* indicates CNS fxn

46
Q

reason for NST false non-reactive

A
  • fetal immaturity
  • sleep cycles
  • medications
  • chronic smoking
47
Q

Reactive (normal) NST

A

•normal FHR w/ avg. variability
•> 32 wk- at least 2 FHR acc. of 15 bpm lasting 15 sec w/in 20 min
•28-32 wk- at least 2 FHR acc of 10 bpm lasting 10 sec w/in 20 min
*may have to wake baby w/ vibroaccoustic stim

48
Q

Non-reactive (abnormal) NST

A

•doesn’t meet FHR acc. criteria in 2 attempts (40 min)
•requires further testing in L&D
-CST or BPP
•may have to induce

49
Q

contraction stress test (CST)

A 
•assesses FHR response to stress
•requires EFM and induction of ctx
-pitocin
-nipple stimulation 
•more accurate than NST
*invasive
50
Q

negative (normal) CST

A

•no late decelerations
•minimum of 3 tx for 40-60 sec duration over 10 min
*reassurance that fetus will likely survive labor and that labor will occur in 1 wk

51
Q

positive (abnormal) CST

A

•late decels in 50% of > ctx
•indicates UPI
•requires induction/c-section (baby out ASAP)
*POSITIVE=PROBLEMS

52
Q

CST contraindications

A 
•preterm
•placental malplacement
•multiple gestation
•prior C/S w/ classic incision (vertical)
-r/o uterine rupture
53
Q

biophysical profile (BPP)

A 
•U/S and EFM
•accurate indicator of impending fetal death
•5 parameters
-FHR (NST)
-fetal breathing movements
-fetal tone
-amniotic fld. vol. (AFV)
*less invasive than CST
54
Q

fetal hypoxia leads to…

A

•alteration in movement, breathing, HR

55
Q

scoring of BPP

A 
•0 OR 2 for each of the 4 parameters
-FHR (NST)
-fetal breathing movements
-fetal tone
-amniotic fld. vol. (AFV)
•normal indicates CNS fxn and no hypoxia
•abnormal and low fld. means labor needs to be induced
56
Q

BPP numerical interpretations

A
  • 8/8- normal BPP didn’t do NST
  • 8/10- normal BPP and non-reactive NST
  • 10/10-normal BPP and reactive NST
57
Q

equivocal BPP

A

6

*repeat 24 hr

58
Q

abnormal BPP

A

4 or less

*induce/c-section

59
Q

amniotic fluid index (AFI)

A
  • fluid pocket measurement

* detects polyhydramnios & oligohydramnios

60
Q

polyhydramnios

A 
•AFI > 25
•d/t 
-NTD
-GI obstruction
-twins
-hydrops
-DM
*r/o PTL, ROM -> cord prolapse
61
Q

oligohydramnios

A 
•AFI < 5
•associated w/ ROM
•r/o
-renal abnormalities
-IUGR
-cord compression
-deformity
-hypoplastic lungs
62
Q

doppler blood flow analysis

A

•see how well baby being perfused

63
Q

fetal kick count instructions

A

•eat
•lay on side peacefully
*should feel 10 movements in 2 hrs
*no move w/in 12 hrs warrants further testing

OB (17 decks)

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