Part 3 - TBN: Mother Baby Flashcards
A non-invasive way to assess fetal wellbeing, specifically their heart rate and movements
Nonstress Test (NST)
What is considered as reactive in NST?
2 accelerations in 20 minutes
What does a reactive NST indicate?
- Indicates fetal well being
- Accelerations have been noted and are associated with movement
What are the reasons for nonreactive NST?
- The fetus is sleeping
- Certain medications (Example: narcotics)
- Maternal smoking
- Fetal malformations
Also called oxytocin challenge test (OCT).
A test to assess the fetal responses to contractions.
Contraction Stress Test (CST)
What does negative (negative for decelerations) mean in CST?
3 contractions in 10 minutes
What does positive (positive for decelerations) mean in CST?
Repetitive decelerations occurring for at least 50% of contractions, EVEN if < 3 occur in 10 min span
What happens if there is unsatisfactory or suspicious result during CST?
Test must be repeated within 24 hours
A noninvasive test that combines a nonstress test (NST) and a fetal ultrasound to assess fetal movements, fetal breathing movements, muscle tone, amniotic fluid index, and nonstress test?
Biophysical Profile (BPP)
What is the normal score for biophysical profile (BPP)?
8-10
What does the <8 score indicate in biophysical profile (BPP)?
Fetal Hypoxia
Fetal movements:
> 3 body/limb movement in 30 minutes
Score = 2
Fetal breathing movements (FBM):
> 1 episode of breathing movements of >30 seconds
Score = 2
Muscle tone: > 1 extension/fl exion
Score = 2
Amniotic fluid index (AFI): AFI > 5 cm or Pocket of fluid > 2 cm
Score = 2
Fetal movements:
< 3 body/limb movement in 30 minutes
Score = 0
Fetal breathing movements (FBM): No breathing movements or < 30 seconds of sustained breathing movements
Score = 0
Muscle tone: No movement, extension or flexion
Score = 0
Amniotic fluid index (AFI): AFI < 5 cm or No pockets of fluid > 2 cm
Score = 0
A needle is inserted through the abdomen into the uterus under direct visualization through ultrasonography. Amniotic fluid is withdrawn from the uterus (amniotic fluid contains fetal cells).
Amniocentesis
When is amniocentesis done?
After 14 weeks
Why is amniocentesis done?
- Testing for genetic disorders/congenital anomalies (Example: neural tube defects)
- Assessment of fetal lung maturity (for amniocentesis)
A needle is inserted (transcervical or transabdominal) to obtain a tissue sample from the fetus.
Chorionic Villus Sampling (CVS)
When is chorionic villus sampling (CVS) done?
10-13 weeks
Why is chorionic villus sampling (CVS) done?
Only done if there is a genetic concern.
Pathology: During pregnancy, the baby’s blood does not typically enter the mother’s circulatory system and does not mix with her blood.
Rh Incompatibility during pregnancy
Pathology: A rare condition where there is a benign proliferation of trophoblasts. Trophoblasts are normally what develops into the placenta.
Hydatidiform Mole (Molar Pregnancy)
A molar pregnancy that:
- Comes from a fertilized egg, but the nucleus was lost or inactivated.
- Has no fetal parts, amniotic sac, or membranes
Complete Mole
A type of molar pregnancy that:
- Comes from one normal ovum that is fertilized.
- Has fetal parts & an amniotic sac
Partial Mole
Early sign of Molar Pregnancy
Asymptomatic
Later signs of molar pregnancy
- Vaginal bleeding
- Excessive nausea & vomiting (due to increased hCG)
- Anemia (from blood loss)
- Abdominal cramping
- Preeclampsia
Placenta attaches too deep into the uterine wall (A little penetration of the myometrium).
Placenta Accreta
Myometrium is Invaded (Deep penetration of the myometrium).
Placenta Increta
Myometrium is penetrated. Placenta grows through uterine wall & may attach to anything on the other side (bladder/intestines) (Perforation of the uterus) .
Placenta Percreta
Abruptio Placenta characteristics
- Detachment issue
- Dark red blood
- May be concealed bleeding
- Abdominal pain & uterine tenderness
- Fetal distress (placenta has come off the uterine wall)
Placenta Previa Characteristics
- Attachment issue (the placenta attaches low in the uterus)
- Bright red blood
- Visible bleeding
- Painless and nontender uterus
- Typically will have a normal fetal heart rate
Pathology: Hypertension & proteinuria after 20 weeks gestation in a pregnant
woman who previously had a normal blood pressure.
Preeclampsia
Triad signs of preeclampsia
Proteinuria
Rising BP
Edema
Signs and symptoms of proteinuria
- Severe headache
- RUQ or epigastric pain
- Visual disturbances
- ↓ Urine output
- Clonus (hyperactive reflexes)
- Rapid weight gain
Medication to prevent eclampsia (seizures)
Magnesium sulfate
Risk factors for developing preeclampsia
- History of:
Preeclampsia in previous pregnancies
Family that had preeclampsia - 1st pregnancy
- Obesity
- Younger (< 18) & older (> 35)
- Medical conditions
(Chronic HTN, renal disease,
diabetes, autoimmune disease)
What is the cure for preeclampsia?
Preeclampsia will resolve after the placenta has been expelled.
Signs of False Labor
- Contractions are IRREGULAR
- Stops with walking/position change (Stops with comfort measure)
- Felt in the the abdomen above the umbilicus
- No significant changes in: Effacement, Dilation
- In posterior position: baby’s head facing mom’s front of belly
Signs of True Labor
- Contractions are REGULAR (they get stronger, longer & closer together as time goes on)
- More intense with walking (Continues despite the use of comfort measures)
- Felt in lower back
- Significant changes in:
- Effacement
- Dilation
- Can cause bloody show
- In anterior position: baby’s head facing mom’s back
