OB Exam 1 Flashcards
What shape is the uterus? How would you describe the muscle?
pear like
hollow, smooth muscle with rythmic contractions
What is the difference between the myometrium and the endometrium?
myo= muscle
endometrium= effects hormones
How can your pt know she is ovulating?
thick, sticky, egg white like discharge “Spinnbarket”, decrease in BBT (basal body temperature) and then spikes up half a degree, positive for LH
What hormone decreases to trigger her period?
Progesterone
What is the area most likely to be damaged during childbirth?
perineum
1st degree perineal tear
1st= superficial, goes thru the skin
2nd degree perineal tear
2nd= skin and muscle
3rd degree perineal tear
3rd= all the way into the anal sphincter
4th degree perineal tear
4th= all the way to the rectal wall
A mom at 6 weeks of pregnancy asks why she has to urinate so often, what do you say?
your bladder is right behind the uterus, so the uterus is pressing on your bladder all the time
What is the primary mechisms to stop hemorrhage from the uterine arteries after childbirth (postpartum hemorrhage)?
contraction of the uterine smooth muscle that compresses the arteries (d/t oxytocin)
What is counted as the first day of the menstrual cycle?
1st day of last menstrual period
How long after intercourse could a woman get pregnant?
however long the sperm lives, it be 3-6 days
wrap it before you tap it bc the spermies linger
How long after ovulation could a woman get pregnant?
24 hours, egg is only viable for that long and then it decomposes
How does fertilization happen?
ovum +sperm, chromosomes combine
fertilization occurs in outer 1/3 of tube, forming zygote
zygote travels the length of the tube to the uterus in 3-4 days, cleavage
16 cell** morula** “solid ball of cells” gives rise to blastocyst with a hollow cavity
What 2 structures is the blastocyst made up of?
embryoblast- becomes embryo
trophoblast- becomes placenta
On average, how long does implantation take after fertilization?
6-10 days
What surrounds vessels in the umbillical cord?
whartons jelly
fetal circulation to get oxygenated blood from mom to baby
oxygenated blood from placenta enters
umbillical vein
bypasses liver
ductus venosus (a shunt)
inferior vena cava
right atrium
foramen ovale
left atrium
left ventricle
aorta
out to the body
fetal circulation for deoxygenated blood
blood returning from body
right atrium
right ventricle
ductus arteriosus
aorta (bypassing lungs)
placenta through the umbillical arteries
do arteries carry blood to or away from the baby?
arteries= AWAY
veins= to
What do I mean when I say that the arterous venous is a shunt?
allows blood to bypass the liver and lungs bc the liver isnt neccesary yet and the lungs dont work until born
what is vernix cassiosa? what is languo?
cheesy like white substance covering the baby, teeny fine hairs
What reproductive system physiological changes happen to mom during pregancy?
uterine wall thinkens (early pregnancy) and then thins (late pregnancy)
aerolas darken and breasts increase in size (to support lactation)
uterize size changes from 50-1000g
What are the cardiac phsyiological changes of mom during pregnancy?
CO increases
Blood volume increases to meet the greater metabolic needs
HR increases during pregnancy (w5) and peaks at w32
Heart muscles enlargen 10%
What is a common complaint of pregnant woman in regards to blood flow? How do you alleviate the discomfort?
legs cramps, calcium
hypocalcemia causes leg cramps during pregnancy
What mineral is common for pregnant women to lack? Why does it happen?
Iron, mom is producing extra blood volume but they are not taking in enough iron. they are not going to have enough blood cells
Clotting is common in pregnant women. Why?
there is an increase in clotting factors, especially post partum. encourage ambulation!!
Physiological changes GI for pregnant women
Heartburn (progesterone relaxes the esophageal sphincter so all the stomach acid creeps back up)
N/V
Constipation
Physiological changes Renal in pregnant women
filtration increases
urine production remains the same but frequency is common d/t pressure
Skin changes in pregnant moms
chloasma: increased facial pigmentation
linea nigra: dark line of pigmentation from umbillicus to pubic area
striae gravidarum: stretch marks
Musculoskeletal changes in pregnancy
healthy weight increase 25-30 lbs
pelvic joint relaxes and tilts forward (lordosis)
gait change d/t relaxin relaxing pelvic joints
encourage light excercise during pregnancy
Common pregnancy discomforts include..?
N/V and Heartburn
Backache and round ligament pain
Frequency
Varicosities and leg cramps
Constipation and hemorrhoids
How would you educate your patient who was experiencing 1st trimester N/V and heartburn?
eat small frequent meals and try to keep something on your stomach, eat ginger root, preggy pops like sour candies
avoid spicy foods, stay sitting up for at least 30 minutes after eating
NO zofran or phenergan for pregnancy
What are some patient education points for backache and round ligament pain during pregnancy?
backache: swimming, stretching excercises, yoga, gentle excercises
round ligament pain: pregnancy support belts (supports the belly and takes pressure off)
Patient education for urinary frequency in pregnancy?
not much you can do here, try to avoid sweet tea, coffee (drinks that are diuretics) but drink enough water to stay hydrated
What are some danger signs during pregnancy?
Facial edema, blurred vision, floaters, edema in hands, HEADACHES, epigastric pain (s/s of HTN condition and preecalmpsia)
1^ burning during urination
hyperemesis gravidarum
2^ Diarrhea/ fever/ chills
Abdominal cramping or pain/ vaginal bleeding/ gush of fluid from vagina
fetal activity changes
hyper/hypoglycemia
1^ UTI can send you into preterm labor
2^ bacterial and viral infections can cause long term defects of the fetus
Can insulin cross the placental barrier?
NO!
babies have to make their own insulin, so even if we get moms blood sugar down, baby’s pancreas is still trying to get the high glucose level managed with its own insulin
moms blood sugar is babies blood sugar
moms insulin is not babies insulin
The fundus is 8 cm above the umbillicus, how far along is mom?
28 weeks
Pregnant mom is 24 weeks pregnant, but her fundus is only at the height of the umbillicus. What should the nurse do?
Investigate, contact the provider. Baby is not progressing as expected
What is colostrum?
1st little bit of breast milk, thick and yellow in consistency, full of antibodies, antibacterials. secreted around 16 weeks
What does it mean when a baby is in the occipus anterior position on an ultrasound? Occipus posterior?
occipus anterior: baby is looking at moms back, good for birthing
occipus posterior: baby is looking at moms front and back of babies head is gliding down moms spine as it comes out, painful and slower birth
if the baby is OP, have mom give birth on her hands and knees
What are some foods high in folic acid?
spinach, cereals, seeds, nuts, artichokes, liver
sslanc
What are neural tube defects?
birth defects of brain, spine, and spinal cord which happens within the first month of pregnancy.
How can neural birth defects be prevented?
taking folic acid before and during pregancy
How do you obtain a chorionic villus sampling?
Take part of the chorionic villi near the placenta tissue where it implants and tests for DNA matter. Can be performed abdominally or vaginally but its more common vaginal.
because the placenta has the same genetic makeup of the baby. the placenta is the trophoblast out of the embryoblast
What is the earliest genetic testing? What does the patient need to perform it? What are the risks?
chorionic villus sampling, 10-13 weeks, a full bladder, infection and fetal tests
What is an amniocentesis? What are the risks?
invasive procedure, sample amniotic fluid. can be performed 15 weeks to birth. risks are fetal limb loss, fetal death
What is Alpha-fetoprotein (AFP)? What does a high or low result mean?
screening tool to test maternal blood (15-18 weeks)
high = neural tube / abdominal defect
low = down syndrome
Level 2 ultrasound/ targeted ultrasound is…?
complete scan of fetal anatomy (after 18 weeks)
Placenta previa is what?
placenta covers cervix
What are the 4 different types of placenta previa?
low lying (lower segment of uterus, can still pass baby)
marginal (covering half of the cervical outlet)
partial (partially covering)
complete (covers entire cervix)
What are the signs and symtpoms of placenta previa?
painless, bright red vaginal bleeding
When a woman comes in with placenta previa, the nurse can expect that the baby will be?
in a breeched, oblique, or transverse laying position
When does placenta previa typically occur?
2nd or 3rd trimester
What are some risk factors for placenta previa?
previous previa
uterine scarring
mom is >35
multifetal pregnancy
multiple gestations
smoking
smoking bc it causes vasoconstriction
With placenta previa, will the fundus be lower, higher, or at an expected height?
higher
The nurse should prepare for the patient to deliver their baby in what way when mom has placenta previa?
c-section
What should the nurse avoid doing what with any woman who is having abornmalities with a pregnancy?
stick things in the vagina
A woman comes in with placenta previa. She asks her nurse why is she bleeding with no pain. How should the nurse respond?
the placenta tears as the cervix opens
What are some nursing interventions for a placenta previa?
do not put anything in the vagina, give IV fluids, blood and bethamesasone (steroid to develop the babies lungs), encourage bed rest
A placenta previa can result in what during the 3rd timerster of pregnancy?
bleeding as the cervix begins to dilate and efface
what is a placental abruption?
placenta detaches prematurely and basically explodes
What are s/s of placental abruption? What are nursing interventions?
sudden onset of intense, localized uterine pain, pain may diffuse over the uterus, boardlike abdomen with dark red blood, hypertonicity contractions, fetal distress
boardlike d/t constant contractions d/t so much blood in the uterus
What are the nursing interventions for a placental abruption?
palpate uterus for tenderness, serial monitoring of fundal height, FHR monitoring, emotional support
What is the only management for a placental abruption?
delivery
What is the leading cause of maternal death?
abruptio placentae
What are risk factors for placental abruption?
trauma
cocaine
maternal hypertension
hx of abruption
smoking
premature rupture of membrane (water bag broke, labor has not started)
multifetal pregnancy
anything that causes vasoconstriction
What is an etopic pregnancy?
“tubal pregnancy”, fertilized ovum is outside the uterus, account for 9% of all pregnancy related maternal death
What will be shown on the transvaginal ultrasound if a woman has an ectopic pregnancy?
absolutely nothing , baby isnt in uterus, its somewhere else
A woman who potentially has an ectopic pregnancy is getting a vaginal and bimanual examination. What should the nurse do?
use caution
A women has a suspected ectopic pregnany. How should the nurse perform treatment?
RAPIDLY
What are the s/s of an ectopic pregancy?
bleeding, spotting, unilateral stabbing pain where the fallopian tube is, refered pain up the shoulder
What is the drug of choice to treat a non ruptured ectopic pregnancy?
methotrexate, its a chemo drug that inhibits cell division and embryo enlargement, dissolving the pregnancy
baby will be dead
What is the procedure to treat a nonruptured ecotopic pregancy?
salpingostomy , salvages the fallopian tube
What is the treatment of a ruptured ectopic pregnancy?
laparoscopic salpingectomy, removal of the tube after it has ruptured
What are presumptive signs of pregnancy?
Period absent (amenorrhea)
Really tired
Enlargened breasts
Sore breast
Urination increased
Movement percieved (quickening)
Emesis and nausea
What are probable signs of pregnancy?
Postive pregnancy test
Returning of fetus when utrus pushed with fingers (Ballottement)
Outline of fetus palpated
Braxton Hicks contractions
A softening cervix (Goodells sign)
Bluish color vulva, vagina, cervix (Chadwicks)
Lower uterine segment soft (Hegars)
Enlarged uterus
What are positive signs of pregnancy?
Fetal movement felt by examiner
Electronic device detects heart tones
They delivery of the baby
Utrasound detects baby
See visible movement (examiner)
FETUS
What is a nonstress test?
noninvasive, monitors FHR to fetal movement, takes 20-30 minutes. Mom presses a button attached to the monitor whenever she feels the baby move, which is noted on the tracing. Two transducers attached to the bottom left of moms stomach and at the fundus
What is a reactive stress test?
2 or more accelerations within a 20-minute period
What is a nonreactice stress test?
lower than 2 accelerations in a 40 minute
What is an contraction stress test?
Aka, oxytocin test that analyzes the FHR response to contractions (which decreases placental blood flow
How do you administer a contraction stress test?
Hook patients up to monitor and we stimulate contractions either by nipple stimulation or if that doesn’t work, oxytocin infusion (can be difficult to stop contractions with oxytocin which leads to. Preterm labor). Causing contractions just to see how baby will respond, however you can start labor without be able to stop it
What are some adverse effects of a contraction stress test? What should you avoid when administering?
Can cause infection if water breaks and mom is dilated. Avoid hyperstimulation (uterine contractions longer than 90 min or 5 or more contractions in 10 min)
What is a contraindication of a contraction stress test?
placenta previa, preterm labor, multiple gestations, previous classing incision from C-section, reduced cervical competence
What is a positive contraction stress test? Negative?
Positive= babies HR slows down and stays slow after contraction
Negative= babies HR doesnt stay slow after contraction
What is a BPP?
Biophysical profile, uses ultrasound to visualize physical characteristics of fetus, combination of FHR monitoring and fetal ultrasound
When is a BPP ordered?
ordered when there is suspected poly/oligohydramnios, fetal hypoxemia, NST results come back as nonreactive
What does a BPP assess?
FHR (110-160) and 2 accels in 20 minutes
Fetal breathing (breathining mimicking)
Body movements (are they coordinated, are they moving at all)
Fetal tone (flaccid in tone versus skilled coordinated reflex)
amount of amniotic fluid ***on the exam
What is the score range for a BPP and what does it mean?
8-10 normal, low risk of chronic fetal asphyxia
4-6: abnormal, suspect; abnormal
less than 4, strong suspect
How long does gestation last for?
40 weeks
What is the preembryonic stage?
conception to day 14
What is the embryonic stage?
day 15- 8 weeks
What fetal development stage is the most critical iin the development of organ systems and the most vulnerable to environmental teratogens?
embryonic
By what week are all organ systems present?
8 weeks
What is the fetal stage?
9 weeks gestation till pregnancy ends. Eyes ears nose and mouth recognizable, heart beat detected by doppler
trust
is to mistrust
What is amniotic fluid? What is its purpose?
cushions against impacts to the maternal abdomen, maintains a stable environment, allows symmetric development, prevents membranes from adhering to developing fetal parts, allows room and buoyancy for fetal movement
Does the baby drink water in the womb?
No!! Baby drinks and excretes sterile urine
What is quickeing? When is it felt?
fetal movements felt by mom at 20 weeks. feels like fluttering or gas bubbles
Monozygotic twins
identical from 1 ovum and 1 sperm, share a placenta
What are the r/f monozygotic twins?
Risks include high rates of miscarriage, preterm birth, low birth weight, dysplasia, growth restriction, perinatal morbidity, and mortality for mom
Dizygotic twins
fraternal from 2 ova and 2 sperm
What are r/f for dizygotic twins?
gestational diabetes
What is the endometrial cycle?
Menstrual days 1-6
Proliferative days 7-14 (most fertile)
Secretory 15-25
How long does the menstrual cycle last?
1st day of period to 1st day of next period. avg is 28 days
How long can sperm remain viable in the reproductive tract?
3-6 days
What is the ovarian cycle?
follicular
ovulation
luteal
How does estrogen impact the menstrual cycle?
matures the egg follicle
How does progesterone impact the menstraul cycle?
SMOOTH MUSCLE RELAXANT, thickens endometrium redy for zygote, relaxes uterus to maintain pregnancy, promotoes growth of the lobes, lobules, and alveoli
What happens to the hormones in the body if you do not get pregnant?
both hormone levels drop off, letting endometrium decompose and shed, resulting in the bledding
How do prostaglandings impact the mestrual cycle?
help release of egg in ovulation, increases labor contractions and opening of the cervix for birth. Pro- pregnancy hormone because it keeps everything relaxed
What hormone is produced during pregnancy?
Human chorionic gonadotropin (HcG)
What that placenta do?
Prevent direct contact between fetal and maternal blood (placental barrier)
Transfers oxygen and nutrients an antibodies
Removes waste products and CO2
Makes hormones (Chorionic gonadotropic, prolactin, estrogen, progesterone, relaxin)
The umbical cord is the ________ for a fetus?
lifeline
How do you calculate a due date using Naegles rule?
First day of LMP + 9 months + 7 days
OR
First day of LMP - 3 months + 7 days (add a year if needed)
How else do you calculate a due date?
measured in cm from symphysis pubis to top of fundus. At 20 weeks the top of the fundus will be at the umbilicus (halfway mark)
How to calculate GTPAL?
G= gravidity (currently pregnant or has been pregnant)
T= #term deliveries (>37week)
P= # preterm deliveries (<37 week)
A= # abortuses <20week or <500g
L= # living children
What is supine hypotension? How do you alleviate it?
compression of the inferior vena cava when mom is laying supine, shift mom to left lateral position to alleviate pressure
HTN–> preeclampsia –> eclampsia
Progression
Gestational HTN BP level
BP >140/90
When does gestational HTN begin and does it end?
begins after 20 weeks, ends 12 weeks postpartum
How do you diagnose gestational HTN?
mom comes in twice in a week at least 4-6 hours apart and BP is recorded
Preeclampsia may have what in the urine?
protein, pt will also have HTN
pt will have had neither protein in urine or HTN before preeclampsia
What is the cause of preeclampsia?
unknown! something to do with abnormal placental invasion, immune response, genetics, dietary
whos your daddy? cuz he may have given you preeclampsia
What does a focused assessment for preeclampsia include?
dereased liver perfusion , neurocomplications, hyperreflexia, RUQ pain and headache
do a manual BP
What lab will you need to monitor with preeclampsia?
elevated liver enzymes d/t impaired liver function
What are some r/f for preeclampsia?
family member had it before, age extreme, AA descent, multifetal gestation
What is mild preeclampsia?
possible prtoein, headache, etc >140/90`
What is severe preeclampsia?
severe, COGNITIVE EFFECT “spots, floaters, blurry vision, RUQ and epigastric pain”, BP> 160/110, peripheral edema
What lab will be elevated with severe pre eclampsia?
elevated blood creatinine d/t kidney dysfunction d/t HTN and proteinuria (protein in urine means baddd kidney damage)
HELLP syndrome r/t preecalmpsia
hemolysis, elevated liver enzymes, low platelets
What precautions will you put a patient with preeclampsia on?
seizure , nonstim environment, emergency meds avaliable (hydralazine)
What is the key difference between preeclampsia and eclampsia?
new onset of seizure activity
When does eclampsia occur?
usually 48 hours after delivery , can happen during labor, pushing, postpartum
Seizure precautions
do not leave the bedside, turn pts on their side, keep airway patient, protect with padded side rails, suction at the bedside
What is magnesium sulfate used for?
seizure prevent
What are the s/s of mag toxicity?
lethargy and muscle weakness, decreased or absent DTRs, double vision and slurred speech, maternal hypotension, decreased RR
extreme vasodilator
What is the antidote for mag sulfate?
calcium gluconate
Nursing interventions for mag sulfate
continuous fetal HR monitoring, I&O , monitor LOC
What other medications can you give for eclampsia/ gestational HTN?
methyldopa (antiHTN), nifedipine (calcium channel blocker), hydralazine (vasodilator), labetalol (beta blocker)
What mneumonic is used for Mag sulfate toxicity?
Blod pressure decrease
UO decreased
RR <12
Patella reflex absent
What is the normal range for amniotic fluid?
10-25
What is polyhydramnios? What does it indicate?
excessive amniotic fluid in sac, gestational diabetes
d/t fetal hyperglycemia, the baby will excrete more urine causing excessive fluid
What is oligohydramnios? What can it effect?
too little amniotic fluid in the sac, can effect fetal development
fluid helps grow lungs, provide a cushioning environment to move limbs, and developes kidneys. this is why with less, you have these fetal issues
What is hyperemesis gravidarium? How do you treat it?
excessive vomiting during pregnancy, relaxation of the smooth muscle with increasing estrogen, progesterone, and Hcg
What are r/f for hyperemesis gravidarium?
age <30 yrs, multifetal gestation, high levels of stress, diabetes, GI disorders, family hx. of hyperemesis, thyroid issues (all bc of too many hormones for the body to handle)
What are some nursing interventions for hyperemesis gravidarium?
look at albumin levels
daily weights
I&O
monitor for electrolyte imbalances
hormone levels
thyroid levels (hormones cause them to be much sicker)
give fluids
keep them NPO if severe
if not keep something light on their stomach
What are the medications used to treat hyperemesis gravidarium?
LR, vitamin B6 (pyridoxine), antiemetic (metoclopramide )
What are some pt teaching points for hyperemesis gravidarium?
advance diet once vomiting has stopped, frequent small meals, enteral feeding TPN
What is gestational diabetes?
discovered during pregnancy
Class A1 gestational diabetic
no meds, diet controlled
Class A2 gestational diabetic
meds needed
What is the diagnostic test for gestational diabetes?
oral gluose tolerance test (1 and 3 hr)
What week do you give an oral glucose tolernce test?
24-28
What does the patient have to do for a 1 hour glucose test?
50g drink, must keep it down, HgA1c is checked an hour later
With GD, the fetus will display these characteristics
macrosomia, birth trauma, electrolyte imbalances, hypoglycemia
What diagnostics will be used to assess a fetus when mom has GD?
BPP, nonstress test, amniocentesis
What is a natural way to go into preterm labor ?
sex
semen contains prostaglandins
What are some r/f for a spontaneous abortion?
chromosome abnormalities
mom is sick
being older than 35
premature dilation
chronical maternal infections
maternal malnutrition
trauma
substance abuse
What are common expected findings with an abortion?
abdominal cramping, rupture of membranes, dilation, fever, s/s of hemorrhage
What are therapuetic procedures for an abortion?
ultrasound, cervical exam, D&C or D&E, Prostaglandins (naturally found in semen) and oxytocin
What are some nursing interventions for an abortion?
perform a pregnancy test (blood test)
observe color and bleeding
avoid vaginal exams
determine how much tissue has been passes
assist with termination of cervix
don’t use the term “abortion”, use the term “miscarriage”
provide emotional support and education
What are some patient education points for an abortion?
notify provider of heavy, bright red vaginal bleeding
report high temp, or foul smelling vaginal discharge
small amt of discharge is normal for 1-2 weeks
take prescribed Abx
refrain from tubs, sex, placing anything in vagina for 2 weeks
A woman just had an abortion. She wants to go take a relaxing bath after such a stressful time and reconnect intimacy with her partner. What should the nurse say?
Avoid baths, sex, and putting anything in the vagina after an abortion.
A woman just had an abortion and she notices a foul smelling discharge. What should the nurse do?
Call the provider, as this is abnormal
A family experienced an abortion a year ago. They are now trying to get pregnant. What should they do before getting pregnancy?
discuss grief and loss with the provider
What are the characteristics of a threatened abortion?
mild cramps, slight spotting, no passed tissue, cervix is closed
What are the characteristics of an inevitable abortion?
mild to moderate cramps, moderate bleeding, no tissue passed YET but its inevitable, cervix is usually dilated, 1st trimester so baby is small but they will lose it
Incomplete abortion
severe cramping, heavy or profuse bleeding, tissue is apssed, dilated with tissue in the cervical canal
What is a DNC/DNE?
(Dilation and curettage) Dilate and evacuate everything from the utrus
What is a complete abortion?
mild cramping, minimal bleeding, lots of tissue passed, cervix closed after the tissue passed or slightly
What is a missed abortion?
no cramping, no bleeding or spotting, cervix is closed
its like a ghost came thru and took the baby
Septic abortion
cramps may vary, various malodorous discharge, tissue passed varies, usually dilated
varies varies varies varies nasty blood
Recurrent abortion
cramps and bleeding vary, tissue is passed and is usally dilated. mom may have cervical problem with recurrent abortions
Women with ____ are commonly known to have an ectopic pregnancy.
IUD
If a baby does grow outside of the fallopian tube, can the baby survive? Can we move the baby and put it in the uterus?
NO!! We do not have the science for that.
What is cerclage?
a stitch to sow cervix up, used for cervical insufficiency
What do you need to teach a patient who has a cerclage?
put NOTHING in the vagina, go to provider immediately you feel any s/s of labor. if that stitch tears, you will have a lot of vascular damage
How does pregnancy affect blood pressure in the first trimester?
with the increase in progesterone, blood pressure will likely decrease.
progesterone relaxes smooth muscle and vasodilates
How does pregnancy affect BP during the second trimester?
meh it stabilizes, blood volume increases
How does pregnancy affect BP in the 3rd trimester ?
HTN d/t increased vascular resistance and pressure of the uterus. body prepares for birth
Pregnancy cat A
no risk in human studies
Pregnancy cat B
no risk in animal studies
Pregnancy cat C
cant be ruled out, be cautious
Pregnancy cat D
risk to fetus
Pregnancy cat X
contraindicated
When does the fundal height decrease?
30 weeks as baby and body prepare for labor
What is fetal demise?
death of baby in womb
What is intrauterne fetal demise (IUFD) assosciated with?
hyperglycemia, DKA, congetial anomolies, infections, postdates
Fetal monitoring (daily kick count and nonstress test 2x/week) occurs in late pregancy to monitor for this condition.
fetal demise, if tests are unsuccessful then it has occured
