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N352: Practice of Nursing I > OB Module 4: Fetal Surveillance > Flashcards

OB Module 4: Fetal Surveillance Flashcards

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1
Q

What are the two patients we truly take care of in OB

A

mother

child

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2
Q

What tests are included under Ante Partum Fetal Surveillance

A

Fetal Movement Assessment

Nonstress Test

Contract Stress Test

BPP (Biophysical Profile)

Umbilical Artery Doppler Velocimetry (done via ultrasound)

Ultrasound

Amniocentesis

Chorionic Villi Sampling

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3
Q

What are some maternal conditions that may warrant fetal surveillance

A

Antiphospholipid syndrome

Hyperthyroidism (poorly controlled)

Hemoglobinopathies (hemoglobin SS, Sc, or S-thalassemia)

Cyanotic heart disease

Systemic lupus erythematosus

Chronic renal disease

Type 1 diabetes mellitus

Hypertensive disorders

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4
Q

What are some pregnancy related conditions that may warrant fetal surveillance

A

Pregnancy-induced hypertension

Decreased fetal movement

Oligohydramnios

Polyhydramnios

Intrauterine growth restriction

Postterm pregnancy

Isoimmunization (moderate to severe)

Fetal anomalies

Previous fetal demise (unexplained or recurrent risk)

Multiple gestation (especially with significant growth discrepancy)

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5
Q

Oligohydramnios

A

Low amount of amniotic fluid

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6
Q

Polyhydramnios

A

High amount of amniotic fluid

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7
Q

Isoimmunization

A

rH incompatabilities

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8
Q

What test is the lowest level of fetal surveillance

A

Fetal Movement Assessment

AKA: Fetal Kick Counts

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9
Q

What is done in a Fetal Movement Assessment

A

the mother counts the fetal “kicks” as a means of antepartum fetal surveillance

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10
Q

When should a fetal kick count be done

A

after dinner with the mother resting on her side ideally

it is done for up to 2 hours then or anytime the baby tends to kick

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11
Q

A mother should not do what within 2 hours prior to a fetal movement assessment

A

smoke d/t diminished oxygen flow

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12
Q

What are the ideal results for a fetal movement assessment

A

She should have at least 10 movements in a 2 hour period

if she feels that before 2 hours are up she is done and set to go

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13
Q

What is important to keep in mind about the timeline of a fetal movement assessment

A

infants can sleep up to 45 minutes so that may be why there is no kicking

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14
Q

Advantages of the Fetal movement assessment

A

low tech

done as a daily assessment

can be done on all pregnancies

reassuring for the mother

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15
Q

Major disadvantage of the fetal movement assessment?

A

it is done at a very busy time of day

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16
Q

What are some methods of electronic fetal monitoring?

A

External monitoring

internal fetal monitoring

IUPC - intrauterine pressure catheter

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17
Q

What is the basic way electronic fetal monitoring works

A

Two belts go on mother

top one monitors contractions - toco transducer- detects tone in the abdomen that detects contraction (it is on top since the contraction pulls up)

the lower one detects fetal heart tones assuming the baby is in a normal spot

the lowest are optimal anterior

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18
Q

How does an internal fetal monitor to check the scalp work?

A

to get the internal monitor in the cervix must be dilated, membranes ruptured, and you need to be able to palpate the bony prominences of the infant (not placing it on the fontanelle or something else)

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19
Q

What are the three important parts of EFM (electronic fetal monitoring) interpretation>

A
  1. Baseline (For FHR)
  2. Variability (Jaggedness to Lines)
  3. Periodic Changes (Increases and Decreases)
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20
Q

How are FHR electronic monitoring results categorized?

A

It is a three tier system with 3 categories

Category I - Normal
Category II - Suspicious
Category III - Ominous

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21
Q

EFM: Variability

A

reflects the health of the nervous system, chemoreceptors, baroreceptors, and cardiac responsiveness

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22
Q

What is Variability indicative of in EFM

A

the health of the parasympathetic nervous system (is it intact, oxygenated, functional) if it is 5-10 bpm above baseline

the health of the sympathetic nervous system if it is 10-25 bpm off the baseline

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23
Q

How many BPM off the baseline of a FHR is indicative of the health of the PNS

A

5 to 10 bpm

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24
Q

How many BPM off the baseline of an FHR is indicative of the health of the SNS

A

10 to 25 bpm

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25
Q

What is acceleration of the EFM

A

an increase in amplitude of 10-25 bpm off the baseline indicative of the health of the SNS

should only occur once in a while

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26
Q

What does the fetal heart rate snapshot about a child?

A

how they are doing and what is happening neurologically

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27
Q

What does prematurity do to EFM variability

A

it decreases variability so there will be little rate fluctuation before 28 weeks!

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28
Q

When should variability in EFM be present

A

after 32 weeks

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29
Q

What, other than prematurity can decrease EFM variability

A

fetal hypoxia

congenital heart anomalies

fetal tachycardia

systemic pain medications - temporarily

fetal metabolic acidosis

CNS depressants

fetal sleep cycles

preexisting neurological abnormalities

betamethasone

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30
Q

Why is there little fluctuation in FHR/EFM before 28 weeks

A

because the neurological system must be developed enough to allow and spot changes

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31
Q

What are the variability changes (amplitude/BPM) in EFM for the following:

Absent

Minimal

Moderate

Marked

A

Absent - amplitude range undetectable

Minimal = <5 BPM

Moderate - 6-25 BPM

Marked- >25 BPM

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32
Q

What appears to be the most significant intrapartum sign of fetal compromise?

A

Persistently minimal or absent FHR variability

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33
Q

While persistently low variability is an ominous sign…

A

the presence of good FHR variability may not always be predictive of a good outcome

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34
Q

Betamethasone

A

a drug given to accelerate infant lung maturity

can decrease EFM variability though

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35
Q

What is important to keep in line about looking at the variability of a monitor?

A

it is always slightly exaggerated so with something like absence it is even worse than it appears!

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36
Q

What may cause some temporary drops and declines in variability?

A

movement where the babies heart rate is outside the detection of the monitor

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37
Q

What is the normal baseline for FHR

A

120-160 BPM

Often this is on the high end for prematurity

they tend to be within 140-160 or 130-250 area

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38
Q

Fetal bradycardia

A

baseline HR <120 BPM

If 100-120 BPM with normal variability it is not associated with fetal acidosis

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39
Q

What are some etiologies for Fetal bradycardia

A

heart block (if little or no variability)

occiput posterior or transverse position

serious fetal compromise

if the neurological system is maturing and the baby goes post date then it is common to go low as well

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40
Q

Why does a premature baby tend to have a faster heart beat

A

because the neurological and cardiac systems are less mature and not coming down as easy

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41
Q

Fetal Tachycardia

A

fetal baseline HR >160 BPM

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42
Q

Fetal Tachycardia is considered a ___ pattern

A

nonreassuring (ominous)

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43
Q

When is Fetal Tachycardia considered mild? severe?

A

Between 160-180 BPM for mild; >180 BPM for severe

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44
Q

Why might a fetus have a HR of >200 BPM?

A

it is usually fetal tachycardia due to fetal tachyarrhythmia or a congenital anomaly rather than hypoxia

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45
Q

Persistent Fetal Tachycardia

A

a consistent >180 BPM HR that often occurs in conjunction with fetal hypoxia, fetal anemia, and maternal fever

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46
Q

What does persistent fetal tachycardia with fetal hypoxia, fetal anemia, or maternal fever suggest?

A

Chorioamnionitis - infection of the uterus

May have occurred if the cervix dilated and bacteria went up

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47
Q

Category I Fetal heart Rate Tracing

A

“Normal” FHR Showing All of the Following:

Baseline FHR 110-160 BPM

Moderate Variability

Accelerations Present or Absent

No Late or Variable Decelerations

May Have Early Decelerations

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48
Q

What is a Category I Tracing predictive of?

A

Normal Acid Base Status at the time of observation and typical routine care to be done

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49
Q

Category II Fetal Heart Rate Tracing

A

A FHR tracing showing any of the following: (Drops in baseline and variability changes)

Tachycardia

Bradycardia w/out Absent Variability

Minimal Variability

Absent Variability w/out Recurrent Decelerations

Marked Variability

Absence of Accelerations After Stimulation

Recurrent Variable Decelerations w/ Min/Mod Varia.

Prolonged Decelerations >= 2 min but less than 10min

Recurrent :ate Decelerations w/ Moderate Variability

Variable Decelerations w/ Other Characteristics such as slow return to baseline and “overshoot”

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50
Q

What is Category II FHR Tracings NOT Predictive of?

A

Abnormal Fetal Acid Base Status

BUT it does require continued surveillance and reevaluation

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51
Q

Category III FHR Tracing

A

Fetal Heart Tracing Showing EITHER of the following:

  1. Sinusoidal Pattern

OR

  1. Absent Variability w/ Recurrent Late Decelerations, Recurrent Variable Decelerations, or Bradycardia
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52
Q

What is Category III FHR Tracings Predictive Of?

A

Abnormal fetal Acid base status at the time of observation

Depending on the clinical situation, efforts to expeditiously resolve the underlying cause of the abnormal FHR should be made - such as rapid induced delivery

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53
Q

Sinusoidal Pattern

A

an abnormal category III FHR pattern

also called “Saw Tooth” pattern with it very equal going up and down

indicative of fetal hypoxia from anemia or O2 disruption

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54
Q

Periodic FHR tracing changes include both __ and __

A

accelerations and decelerations

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55
Q

What sort of pattern do we want to see on an FHR tracing, and what could hypothetically sometimes happen?

A

We want to see baseline range with some jaggedness that changes giving variability - hopefully that variability is an acceleration in HR

Sometimes we get decelerations but we must consider what they occur in relation to - if a contraction just occurred then we know some squeezing temporarily cut off O2 and would lead to that

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56
Q

Decelerations on FHR Tracings are Classified as…

A

Early

Variable

Late

Prolonged

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57
Q

Early Decelerations are due to …

A

head compression

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58
Q

Early and Late Decelerations tend to have what shape

A

A Subtle U shape

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59
Q

Variable Decelerations tend to have what shape

A

A Very Deep V or W shape

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60
Q

Why is head compression so important to know about with FHR tracings?

A

Head compression is a mirror image of contraction rate and depending on compression severity or duration we may lose variability gradually if the baby cannot make it thought

We may see this coming as the head makes it through the ischial spine region

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61
Q

Why are late decelerations in FHR so concerning

A

they are an ominous sign of placental insufficiency (inadequate blood flow)

as the uterus contracts, placental blood flow will cut off and if the placenta is already compromised there is even worse blood flow compromise

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62
Q

How can induction of labor cause late decelerations in FHR?

A

Never sure how responsive the uterus will be so we can cause severe and strong contractions without much of a rest period in between

When occurring progressively less blood flow will get to the baby and cause late decelerations

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63
Q

When will late decelerations begin and end in reference to contraction?

A

It will start toward the peak of contraction and will recover at the end of a contraction

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64
Q

What causes variable deceleration

A

Cord Compression - and depending on where the cord is this may or may not occur with contractions

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65
Q

When will variable decelerations correspond with contractions?

A

If the cord is around the shoulder or neck

OR

With specific maternal positions that move the cord

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66
Q

Why can variable decelerations be very significant or intermittent?

A

90% of women will have variable decelerations in the second stage as the baby comes down the vaginal vault because of cord pinching - recovery and potential for overshoot should be looked for however

67
Q

Reassuring Pattern of FHR

A

Baseline FHR 120-160 BPM

Preserved FHR beat to beat and there is long term variability

Accelerations last for 15 or more seconds above baseline and peak at 15 or more BPM

68
Q

Saltatory Pattern of FHR

A

Wide and more marked variability

The oscillations of FHR are above and below the baseline exceeding 25 BPM

It is all over the place and the bottom graph (contractions) will have a bell curve shape at times of contraction

69
Q

Early deceleration is associated with …

A

head compression

70
Q

Early Decelerations are described as “Mirror Image,” Why?

A

The onset and return of the deceleration coincide with the start and the end of the contraction giving this characteristics subtle U shape that repeats

71
Q

If there is a low variability and early decelerations what may that mean?

A

the baby may have been in labor for a long time and is losing some reserve

72
Q

Late Decelerations are caused by …

A

reduced placental exchange

73
Q

What are some examples of reduced placental exchange causing late decelerations

A

excessive uterine contractions

maternal hypotension (maybe due to a sedative)

maternal hypoxemia

hypertensive disorders

diabetes

IUGR

abruption

COVID-19 resp effect and Hgb effect causing maternal hypoxemia

Anything that can affect the health of the placenta

74
Q

Late decelerations are ___ shaped and occur when?

A

U shaped and occur late in contraction toward the peak of one (when O2 is cut off)

So as the contraction hits the top of the bell curve shape that’s when early deceleration would occur - a late deceleration occurs as it returns toward the contraction line baseline and ends after the contraction is done for a bit

75
Q

What is a late deceleration with loss of variability indicative of?

A

ominous pattern

reflects uteroplacental insufficiency and immediate delivery is needed (C Section ASAP)

76
Q

Variable deceleration is associated with …

A

umbilical cord compression with pre and post accelerations (“Shoulders”) that occur before and after the contraction

77
Q

What shape is a variable deceleration

A

V or W shaped and reaches its nadir in 30 seconds

78
Q

Nadir

A

lowest point

79
Q

___% of women have variable decelerations in the second stage of labor

A

90

80
Q

What does a severe variable deceleration with overshoot say?

A

With variability preserved this represents and acute episode in a fetus with good reserve

these are longer decelerations that are slower to return to baseline that also overshoot (overcompensate)

If a first time mom we may need to consider C Section

81
Q

Overshoot

A

overcompensation of deceleration indicating hypoxia in a newborn

82
Q

If a distress pattern does not cease, vaginal birth is not imminent, bradycardia (<120) is present, non-average variability is present/absent and things are not reassuring indicates what?

A

C Section

If the bradycardia is present without vaginal birth imminent and the distress pattern will not cease with intervention = C Section

If variability is not average and it is not reassuring with the other things then it also = C Section

Fetal Distress = C Section Delivery

83
Q

Nursing Interventions for Fetal Distress to try and prevent need for C section`

A

Reposition the patient

turn off pitocin

increase IV rate

administer O2

assess labor progress/scalp stimulation

assess for cord prolapse

notify provider

prepare for delivery and resuscitation (right there - sterile field, etc)

84
Q

How can position change help with fetal distress

A

sometimes it helps the baby rotate to correct head compression

it can also optimize blood flow to placenta or ge the baby off the cord

85
Q

Why stop Pitocin with fetal distress

A

it induces contractions which will worsen fetal blood flow`

86
Q

How much O2 is administered in Fetal Distress

A

8-10 L O2 via non rebreather in order to max saturate Hgb

87
Q

Scalp Stimulation

A

Noogie-ing the baby through the cervix with a finger to see if there if fetal response recovery

88
Q

Non Stress Test

A

period of electronic fetal monitoring done IN THE ABSENCE OF CONTRACTIONS

done before labor to see how the baby will deal with the main stressor (contractions) of labor and everyday life without contractions present

non invasive

89
Q

How should the FHR change with fetal movement in a non stress test

A

it should temporarily accelerate with fetal movement

90
Q

Heart Rate Reactivity in a non stress test is believed to be a good indicator of what?

A

normal fetal autonomic function

91
Q

What is loss of reactivity commonly associated with during a non stress test? What are some abnormal uncommon associations?

A

Commonly its due to a fetal sleep cycle

It can occur from any cause of CNS depression including fetal acidosis which is concerning

92
Q

What are the results we wish to see during a fetal non stress test

A

Accelerations, a stable baseline, absence of recurrent/massive decelerations and some variability

93
Q

__ Accelerations within ___ minutes lasting at least ___ seconds and at least ___ BPM ___ baseline is the ideal non stress test result

A

2 accelerations within 20 minutes lasting at least 15 seconds and at least 15 BPM Above Baseline

94
Q

Why is a non stress test not done in pre term babies?

A

Not done d/t a lack of neurological variability

95
Q

Barring anything abrupt, the non stress test is usually indicative of a baby that will stay good..

A

for at least 48 hours (2 days)

96
Q

What is a reason relating the placenta that it may be important to do a non stress test 2-3 times a week?

A

Placenta is supposed to last 40 weeks but it can degrade early from different things - so if we monitor pregnancies we can continue to watch for needed interventions and compromises early

97
Q

Results of a nonstress test are classified as __ or __

A

reactive or nonreactive

98
Q

What is a reactive result of a nonstress test

A

If there are 2+ fetal heart rate accelerations of 15 beats for 15 seconds within a 20 minute period, with or without fetal movement perceived

99
Q

What is a nonreactive result of a nonstress test

A

one that lacks sufficient fetal heart rate accelerations over a test 40-minute period

the bottom graph may have a spike of fetal movement but there are no accelerations in the top graph (FHR)

“Non Reactive to Fetal Movement”

100
Q

In a FHR tracing, what does the top graph show and what does the bottom graph show?

A

Top is the FHR

Bottom shows uterine activity (a spike would indicate fetal movement or contraction - corresponds with an increase in the top graph)

101
Q

What to do next if there is a nonreactive nonstress test result?

A

extend 30 minutes - if there is another nonreactive result extend another 30 minutes - if non reactive again then you do diagnostic ultrasound and CST or BPP or induced delivery

102
Q

What to do if there is a nonreactive result with no accelerations and spontaneous decelerations?

A

diagnostic ultrasound and CST or BPP or induced delivery

103
Q

After an initial non reactive nonstress test result what may be asked of the mother?

A

Did they smoke within the last 2 hours

When did she last eat and what did she have (baby needs calories) - she may be given cold fruit juice to stimulate the fundus and baby

Stimulation of the baby like rubbing abdomen//bumping head between fingers/talk loud to wake baby and have it respond

104
Q

In a worst case scenario you may need to do acoustic stimulation, what is this?

A

Vibratory stimulation after a non reactive nonstress test result

it is put over the fetal head and set off for only 3 seconds to aggressively stimulate the baby

105
Q

Why may we do a contraction stress test after non reactive nonstress test results?

A

to check the baby for reactions to diminished blood flow

106
Q

BPP may tell us what after nonreactive nonstress test results

A

indicators of wellbeing

107
Q

Contraction Stress Test

A

involves assessment of the FHR on electronic fetal monitoring in response to uterine contractions that are induced

contractions (3 of them) are made over 10 minutes and we monitor for responsiveness

108
Q

If the baby is not well oxygenated (non reactive), what will occur during a contraction stress test?

A

uterine contractions with transiently WORSEN the fetal condition

result will be a fetal Heart rate pattern of late decelerations

109
Q

What may uterine contractions provoke or accentuate?

A

accentuate a pattern a variable decelerations caused by fetal umbilical cord comrpession

110
Q

If we create a situation with a contraction stress test with 3 contractions and a baby cannot handle that with FHR changes, then that means what?

A

they have a low survival chance of surviving hours of contractions in L&D

111
Q

Relative contraindications to the contraction stress test

A

Things that are associated with an increased risk of preterm L&D, uterine rupture, or uterine bleeding including:

Preterm labor or certain patients at high risk for preterm labor

preterm membrane rupture

history of extensive uterine surgery or classic C section

known placenta previa (across the cervix)

112
Q

Contraction stress test is interpreted by the presence of absence of…

A

late fetal heart rate decelerations - which are defined as decelerations that reach their nadir after the peak of contraction and that usually persist beyond the end of the contraction

113
Q

What are the result categories of the contractions stress test

A

Negative

Positive

Equivocal Suspicious

Equivocal Hyperstimulatory

Unsatisfactory

114
Q

Negative Contraction Stress Test

A

No late or significant variable decelerations

In the test “negative” is a good thing

115
Q

Positive Contraction Stress Test

A

Late decelerations following 50% or more of contractions (even if the contraction is frequency is fewer than 3 in 10 minutes)

Ominous signs may mean quit early before 10 minutes or 3 contractions

116
Q

Equivocal-suspicious Contraction Stress test

A

intermittent late decelerations or significant variable decelerations

this may be less than following 50% of contractions - or more

117
Q

Equivocal Hyperstimulatory Contraction Stress Test

A

FHR decelerations that occur in the presence of contractions that are more frequent than every 2 minutes or last longer than 90 seconds

118
Q

Unsatisfactory Contraction Stress Tests

A

Fewer than 3 contractions in 10 minutes or a tracing that is not interpretable

may look ominous but we caused it - may be creating a situation of prolonged or too frequent compression of blood vessels

119
Q

Umbilical Artery Doppler Velocimetry (UADV) (Doppler Blood Flow Studies)

A

Doppler ultrasonography is used to assess the umbilical artery blood flow

Done antepartum

Checks quality of blood flow going to the fetus - and it shows a ratio of how much systolic to diastolic pressure we should be seeing

120
Q

What is UADV believed to show?

A

it is believed that flow velocity waveforms in the umbilical artery of fetuses with normal growth differ from those of fetuses with growth restriction - ex: diminished growth or circulatory issues

121
Q

With extreme intrauterine growth restrictions how may umbilical artery flow (UADV)) differ and what may this be associated with

A

the flow may be low, absent or even reversed

this is associated with a high perinatal mortality rate among such pregnancies

122
Q

With utero-placental blood flow as the mom’s heart beats …

A

more pressure is pushed in, but even between heart beats (rest) we should still see blood flowing through the cord to the baby

123
Q

Advantages of Doppler Blood Flow Studies

A

Non invasive

Can be scheduled at regular intervals for women at risk

measures blood flow changes in maternal and fetal circulation

allows for assessment of placental function

done regardless of whether mom and baby are at risk or not

124
Q

With a doppler blood flow study what result do we look at

A

Systolic:Diastolic Ratio

125
Q

A doppler flow study can be initiated at __ to __ weeks

A

16 to 18 weeks

126
Q

What is a Normal doppler flow study result at 26 weeks? At term? What is high and shows an increase in placental bed resistance?

A

26 Weeks: 2.6

term - 3

High - 5

127
Q

The basic thing to know about doppler blood flow study results is …

A

we look at blood flow through the cord and monitor for changes in that that can help us evaluate risk for pregnancies and change

128
Q

What are some reasons Ultrasound is used in pregnancy

A

Confirm Pregnancy and Fetal Position

Evaluate FHR and Fetal Respiration

Identification of more than one embryo or fetus

For examination of anatomical fetal structures (NT) -

Estimated gestational age, fetal weight, fetal growth

Location of the placenta and amniotic fluid volume

Accompanying invasive procedures (ex: amniocentesis)

to determine placental grading

detection of fetal death

129
Q

When are structures checked first for via ultrasounds?

A

18-20 weeks when large and shaped enough

130
Q

Serial Ultrasound Benefit

A

You can watch fetal growth overtime

131
Q

What is the rule regarding estimated gestational age via ultrasound

A

the earlier you can get one done the better

132
Q

Benefits of Ultrasound

A

can assess the fetus over a period of time, allowing midwives or physicians to study the gestation serially

Noninvasive and painless

non radiating to both the woman and her fetus

it has no known harmful effects

the nurse provides an opportunity for the woman to ask questions

the nurse can act as an advocate at this time

done on an unborn baby

can assess a baby over time when done serially

133
Q

Ultrasound scanning permits…

A

visualization of the fetus in utero

134
Q

Standard ultrasound visual of something like the face does not…

A

does not have sharp imagery to

135
Q

What is the known safety regarding 3D and 4D ultrasounds>

A

they are newer and use different levels of ultrasounds so there is greater ultrasound wave exposure but it is unknown how unsafe or safe this is

136
Q

What is 3D and 4D ultrasound for?

A

not just visualizing the baby, it is to determine physical abnormalities and the location of the cord

137
Q

Biophysical Profile (BPP)

A

Consists of non-stress test and 4 observations made via real time ultrasonography

checks fetal wellbeing

138
Q

What 4 things are observed in the BPP

A

Fetal Breathing Movements

Fetal Movement

Fetal Tone

Determination of the Amniotic Fluid Volume

139
Q

How should breathing be in a BPP

A

intermittent, not continuous

140
Q

How should fetal tone be in a BPP

A

flexed

141
Q

How are the 4 observations scored in BPP

A

either as 2 points (normal or present) or 0 points (abnormal, absent, insufficient) - no partial points

142
Q

What do we see with amniotic fluid in a BPP? What is unique about this though?

A

We do not get an estimate of amount of fluid, we just want to see if there is a single cm pocket of amniotic fluid

diminished amniotic fluid could exist but it still would get the full 2 points

143
Q

What does a composite BPP score of 8 or 10 mean

A

normal results

144
Q

What does a composite BPP score of 6 mean

A

equivocal

145
Q

What does a composite BPP score of 4 or less mean

A

abnormal

146
Q

What will warrant further evaluation regardless of composite BPP score

A

Oligohydramnios (lower than normal amniotic fluid levels)

the amniotic fluid tells us the health of the placenta but also wellness of the baby since it drinks and excretes it

147
Q

Amniocentesis

A

Invasive needle procedure into the uterine cavity to obtain amniotic fluid

Allows us to test the amniotic fluid and provide genetic information about genetic disorders early in pregnancy or if done late in pregnancy to check fetal health or lung maturity

148
Q

Amniocentesis can screen for what genetic issues?

A

Down Syndrome (Trisomy 21) d

Trisomy 18 and neural tube defects (NTDs)

Can provide information about fetal lung maturity

149
Q

Amniocentesis helps..

A

to evaluate fetal health

150
Q

What needs to be done concurrently when doing an amniocentesis?

A
  1. Very good sterile technique
  2. Ultrasound in order to find fetal structures and where there is a pocket away of amniotic fluid - put the needle in carefully at a depth and take some fluid without hitting the baby
151
Q

The Triple Test and Quadruple Screen

A

Amniotic Fluid Analysis

Measures substances in the amniotic fluid and information can help identify fetal anomalies

Can allow growing cells and study chromosomes - takes several days

Can allow us to see lung maturity

152
Q

Fetal Lung Maturity is determined by what 3 things

A
  1. Lecithin/Spingomyelin Ratio
  2. Presence of Phosphatidylglycerol
  3. Level of Lamellar Body Counts
153
Q

Lecithin

A

A surfactant

154
Q

How does the amount of amniotic fluid available in the womb change lecithin levels?

A

A high amount of fluid can give false low lecithin levels

A low amount of fluid can give erroneously high lecithin

155
Q

How do we account for how amniotic fluid changes levels of lecithin falsely

A

we use a constant - sphingomyelin

156
Q

Sphingomyelin

A

a substance released from skin cells

we use it to take away the variability potential of amniotic fluid on lecithin

157
Q

Phosphatidylglycerol

A

An indicator of fetal lung maturity

158
Q

When is a Phosphatidylglycerol level test done?

A

We do Lecithin:Sphingomyelin ratio first since it is inexpensive and faster

If the lungs are on the cusp of being immature, we order PG levels but they are more expensive and lab intensive

159
Q

What Licithin:Sphingomyelin ratio indicates for us to look at Phosphatidylglycerol levels?

A

If the ratio is less than the normal 2:1 L:S

160
Q

When are fetal lung maturity indicator tests like L:S ratio and PG levels warranted and why?

A

For at risk pregnancies where we may need to do a C section or induce labor because damage could occur to mom or baby

We do these to test if the babies lungs are mature enough incase we must

161
Q

Chorionic Villus Sampling

A

Invasive/catheter procedure done transabdominally or transcervically between weeks 10-12 for first trimester diagnostic studies

takes some placental tissue

162
Q

Advantages of Chorionic Villus Sampling

A

Allows for early detection of fetal disorders

Short waiting time for results compared to other tests

163
Q

Disadvantages and Risks of Chorionic Villus Sampling

A

Increased risk of injury to fetus

Inability to detect neural tube defects

Potential for repeated invasive procedures

Risk for failure to obtain placental tissue

Risk of contamination of specimen

risk of leakage of amniotic fluid

Risk for intrauterine infection

Risk for Rh alloimmunization (if mom is Rh- and baby is + and accidentally introduced)

Harmony and Maternit21 are better tests in some cases

164
Q

Harmony and Maternit 21 Tests

A

Mother blood tests that can screen for some of the defects looked for in chorionic villus sampling

can end up being preferable as it is less invasive

N352: Practice of Nursing I (14 decks)

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