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Kol- OB > Start here Exam 2 Assessing Fetal Wellbeing > Flashcards

Start here Exam 2 Assessing Fetal Wellbeing Flashcards

1
Q

when do we do age assessment with ultrasound? what are we measuring?

A

1st trimester: before week 14

fetal crown/rump length measurement

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2
Q

why use an ultrasound for fetal assessment

A

• gestational age measurement, # of fetuses, fetal anomalies, assess amniotic fluid volume, assess if bleeding , cardiac activity

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3
Q

What 2 visualization studies are being done in 3rd trimester specifically?

A

biophysical profile, doppler flow studies

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4
Q

If there is vaginal bleeding during any trimester use an _______

A

ultrasound

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5
Q

Why use a 3 or 4 dimensional ultrasound?

A

assess for cardiac or facial anomaly

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6
Q

Is the doppler blood flow study invasive?

A

no

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7
Q

which test assesses resistance to blood flow in placenta? (placental perfusion assessment)

A

doppler blood flow study

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8
Q

what kind of fetal heart rate variability do we want to see?

A

moderate!

little bit of variability –> CNS functioning correctly

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9
Q

what do we do if we see minimal fetal heart rate variability?

A

= okay, fetus sleeping
‣ give preggo snack/sugar and baby will wake up and be more active for nonstress test
‣ Vibroacoustic stimulation = initiate acceleration when fetus is asleep

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10
Q

what does it mean if there is absent variability in fetal heart rate?

A

issue with CNS (still have Heart Rate but not seeing any changes)

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11
Q

re fetal heart: what is it called when changes in heart rate mirror contraction period(due to head compression)

A

early decelerations

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12
Q

re fetal heart: what is it called when gradual onset of decrease in fetal heart rate after contraction has peaked?

A

late decelterations

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13
Q

early or late decelerations associated with placental insufficiency?

A

late

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14
Q

when is a nonstress test done what are we looking for? ?

A
  • done when there is no contraction

* looking at fetal heart rate with movement to show adequate blood flow and autonomic nervous system

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15
Q

is a nonstress test invasive?

A

no

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16
Q

what does client do during a nonstress test?

A

• client pushes a button whenever they feel baby move

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17
Q

during which trimester is a nonstress test done?

A

3rd

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18
Q

reactive stress test- what results are we hoping to see? how long does the test take?

<32 weeks? >32 weeks?

A

what we hope to see 110-160 fetal heart rate with moderate variability
◦ assess for 20-40 minutes. looking for increase in HR on 15 beats for at least 15 seconds in 20 minutes

◦ <32 weeks: 10 beats for 10 seconds in 20 minute
◦ > 32 weeks : Accelerations 15beats for 15seconds in at least 2 times in 20 minute period

◦ Normal baseline
◦ Moderate variability

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19
Q

nonreactive stress test- what results do we see? what we gonna do about it?

A

do not see 2 qualifying accelerations in 20 minutes

◦ further assessment needed –> contraction stress test or BPP

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20
Q

which has risk of preterm labor- nonstress test or contraction stress test?

A

contraction stress test

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21
Q

Why do a contraction stress test?

A
  • Determines for fetus will tolerate stress of labor
  • has non reactive nonstress test
  • high risk preg
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22
Q

2 types of ways to do a contraction stress test?

A
  1. Nipple stimulation to release oxytocin
    ◦ brush palm against nipple for 2 minutes. Stop when contraction beings. Repeat stimulation again in 5 minutes.
    • avoid uterine tachysystole by only stimulating one nipple + rest periods
  2. Oxytocin stimulated contraction test aka Oxytocin Challenge Test
    ◦ use if nipple stimulation fails to work
    ◦ IV oxytocin to induce contractions
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23
Q

What are the results we want to see from contraction stress test?

A

no late decels in 10 minutes period w/ 3 contractions

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24
Q

When doing a contraction stress test, what does the nurse need to do?

A

‣ have topolytics to stop contractions! (want no more than 5 uterine contractions in 10 minutes)
‣ ensure bedrest for patient during procedure
‣ observe for 30 minutes after procedure to make sure labor does not begin

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25
Q

do we want to have a negative or positive contraction stress test?

A

Negative!

= ◦ Normal
◦ No late decelerations in 10 min period with 3 uterine contractions

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26
Q

what does a positive contraction stress test mean?

A

◦ Abnormal results
◦ Late decelerations with 50% of contractions
»>Therefore fetus not able to tolerate labor

27
Q

When do we teach preggo to start doing daily kick count?

A

28 weeks

28
Q

What are instructions for doing daily kick count (how many in what amount of time?)

A

• lay on side and count # of kicks
◦ 2 hours approach- feel for 10 fetal movements in 2 hours
◦ 1 hour approach- feel for at least 4 movements in 1 hour

29
Q

this test combines a nonstress test with an ultrasound observation for 30 minutes and is done in 3rd trimester

A

biophysical profile

30
Q

Re BPP: Reactive vs nonreactive: HR?

A

• Fetal heart rate
◦ Reactive (NST) = 2
◦ Nonreactive = 0

31
Q

Re BPP: Fetal breathing movements

A

• Fetal breathing movements
◦ At least 1 episode of greater than 30 second duration in 30 minutes = 2
◦ Absent or less than 30 second duration = 0

32
Q

Re BPP: Gross body movement?

A

◦ At least 3 body/limb extensions with return to flexion in 30 minutes = 2
◦ Less than 3 episodes = 0

33
Q

Re BPP: Fetal Tone

A

◦ At least 1 episode of extension with return to flexion = 2

◦ Slow extension and flexion, lack of flexion, absent movement= 0

34
Q

Re BPP:Qualitative amniotic fluid volume

A

◦ At least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2
◦ Pockets absent or less than 2 = 0

35
Q

What is the score we want for BPP?

A

8-10!

36
Q

What does score of 4-6 for BPP mean?

A

abnormal - suspect chronic fetal asphyxia

37
Q

What does score of <4 for BPP mean?

A

strongly abnormal - strongly suspect chronic fetal asphyxia

38
Q

what is it called when we aspirate amniotic fluid with direct ultrasound guidance through client abdomen

A

amniocentesis

39
Q

indications for doing an amniocentesis?

A
  • check for x linked/genetic disorders (down syndrome)
  • history of neural tube defects
  • AFP level
  • lung maturity
  • fetal hemolytic disease
40
Q

When doing an amniocentesis >20 weeks- do we want bladder full or empty?

A

empty

41
Q

What med might we need to admin before amniocentesis related to blood?

A

Rhogam in preggo is Rh-

42
Q

What do High AFP mean?

A

neural tube defects, can also be present with normal multifetal preg

43
Q

What does Low AFP mean?

A

chromosomal disorders like down syndrome or hydatidiform mole

44
Q

What organ makes AFP?

A

liver

45
Q

2 ways to check AFP?

A
  • routine lab tests

- amniocentesis

46
Q

Indication for doing fetal lung tests?

A

If baby is <37 weeks/reuptured membranes, preterm labor, or complication resulting in c section

47
Q

If lungs are not mature administer ______

A

betamethasone

48
Q

What does a L/S ration mean?

A

indicates fetal lung maturity

49
Q

What is the L/S ratio we want? what about if diabetes is present?

A

regular - 2:1

diabetes- 2.5: 1 or 3: 1

50
Q

What does a PG test look at? What does it mean if there is an absence of PG?

A

respiratory distress = absence of PG

51
Q

Circling back- what are the 2 things we look at for fetal lung tests?

A

L:S Ratio

PG test

52
Q

Percutaneous umbilical blood sampling- what is it? why do it?

A
  • aspirate from umbilical vein
  • can also use for transfusion
  • hemotological, metabolic, infection, genetic testing
53
Q

Test we can do in first trimester instead of amniocentesis?

A

Chorionic villus sampling

• assess a portion of developing placenta

54
Q

Quad marker screening looks at what 4 things

A

AFP, hCG, Estirol, Inhibin A

55
Q

down syndrome- what are levels we see of hCG, Inhibin A, AFP, Estirol ?

A

• Down syndrome = high hCG, high Inhibin A, low AFP, low Estirol

56
Q

Maternal serum alpha-fetoprotein looks for what?

A
  • look for neural tube defects

* recommended for all pregnant women

57
Q

high vs low levels of Maternal serum alpha-fetoprotein

A

• High = neural tube defects, Low = down syndrome

58
Q

during first trimester where is amniotic fluid made by?

A

amniotic membrane

59
Q

during 2nd and 3rd trimester where is amniotic fluid made by?

A

fetal kidney

60
Q

too little amniotic fluid=

A

Oligohydramnios

61
Q

too much amniotic fluid =

A

Polyhydramnios

62
Q

cause of Polyhydramnios

A

• neural tube defects, GI obstruction, multifetal

63
Q

cause of Oligohydramnios

A
  • due to decrease in placental funcrtion

* higher risk of fetal congenital kidney problem

64
Q

function of amniotic fluid

A

cushion, allow fetal movement, prevent fetus from sticking to membrane, consistent thermal environment in preggo

Kol- OB (20 decks)

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