Start here Exam 2 Assessing Fetal Wellbeing

Question 1

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

Answer 1

1st trimester: before week 14

fetal crown/rump length measurement

Question 2

why use an ultrasound for fetal assessment

Answer 2

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

Question 3

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

Answer 3

biophysical profile, doppler flow studies

Question 4

If there is vaginal bleeding during any trimester use an _______

Answer 4

ultrasound

Question 5

Why use a 3 or 4 dimensional ultrasound?

Answer 5

assess for cardiac or facial anomaly

Question 6

Is the doppler blood flow study invasive?

Answer 6

no

Question 7

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

Answer 7

doppler blood flow study

Question 8

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

Answer 8

moderate!

little bit of variability –> CNS functioning correctly

Question 9

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

Answer 9

= 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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

early decelerations

Question 12

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

Answer 12

late decelterations

Question 13

early or late decelerations associated with placental insufficiency?

Answer 13

late

Question 14

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

Answer 14

• done when there is no contraction

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

Question 15

is a nonstress test invasive?

Answer 15

no

Question 16

what does client do during a nonstress test?

Answer 16

• client pushes a button whenever they feel baby move

Question 17

during which trimester is a nonstress test done?

Answer 17

3rd

Question 18

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

<32 weeks? >32 weeks?

Answer 18

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

Question 19

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

Answer 19

do not see 2 qualifying accelerations in 20 minutes

◦ further assessment needed –> contraction stress test or BPP

Question 20

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

Answer 20

contraction stress test

Question 21

Why do a contraction stress test?

Answer 21

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

Question 22

2 types of ways to do a contraction stress test?

Answer 22

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

Question 23

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

Answer 23

no late decels in 10 minutes period w/ 3 contractions

Question 24

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

Answer 24

‣ 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

Question 25

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

Answer 25

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

Question 26

what does a positive contraction stress test mean?

Answer 26

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

Question 27

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

Answer 27

28 weeks

Question 28

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

Answer 28

• 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

Question 29

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

Answer 29

biophysical profile

Question 30

Re BPP: Reactive vs nonreactive: HR?

Answer 30

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

Question 31

Re BPP: Fetal breathing movements

Answer 31

• 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

Question 32

Re BPP: Gross body movement?

Answer 32

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

Question 33

Re BPP: Fetal Tone

Answer 33

◦ At least 1 episode of extension with return to flexion = 2 | ◦ Slow extension and flexion, lack of flexion, absent movement= 0

Question 34

Re BPP:Qualitative amniotic fluid volume

Answer 34

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

Question 35

What is the score we want for BPP?

Answer 35

8-10!

Question 36

What does score of 4-6 for BPP mean?

Answer 36

abnormal - suspect chronic fetal asphyxia

Question 37

What does score of <4 for BPP mean?

Answer 37

strongly abnormal - strongly suspect chronic fetal asphyxia

Question 38

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

Answer 38

amniocentesis

Question 39

indications for doing an amniocentesis?

Answer 39

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

Question 40

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

Answer 40

empty

Question 41

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

Answer 41

Rhogam in preggo is Rh-

Question 42

What do High AFP mean?

Answer 42

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

Question 43

What does Low AFP mean?

Answer 43

chromosomal disorders like down syndrome or hydatidiform mole

Question 44

What organ makes AFP?

Answer 44

liver

Question 45

2 ways to check AFP?

Answer 45

- routine lab tests | - amniocentesis

Question 46

Indication for doing fetal lung tests?

Answer 46

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

Question 47

If lungs are not mature administer ______

Answer 47

betamethasone

Question 48

What does a L/S ration mean?

Answer 48

indicates fetal lung maturity

Question 49

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

Answer 49

regular - 2:1 | diabetes- 2.5: 1 or 3: 1

Question 50

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

Answer 50

respiratory distress = absence of PG

Question 51

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

Answer 51

L:S Ratio | PG test

Question 52

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

Answer 52

* aspirate from umbilical vein * can also use for transfusion * hemotological, metabolic, infection, genetic testing

Question 53

Test we can do in first trimester instead of amniocentesis?

Answer 53

Chorionic villus sampling | • assess a portion of developing placenta

Question 54

Quad marker screening looks at what 4 things

Answer 54

AFP, hCG, Estirol, Inhibin A

Question 55

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

Answer 55

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

Question 56

Maternal serum alpha-fetoprotein looks for what?

Answer 56

* look for neural tube defects | * recommended for all pregnant women

Question 57

high vs low levels of Maternal serum alpha-fetoprotein

Answer 57

• High = neural tube defects, Low = down syndrome

Question 58

during first trimester where is amniotic fluid made by?

Answer 58

amniotic membrane

Question 59

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

Answer 59

fetal kidney

Question 60

too little amniotic fluid=

Answer 60

Oligohydramnios

Question 61

too much amniotic fluid =

Answer 61

Polyhydramnios

Question 62

cause of Polyhydramnios

Answer 62

• neural tube defects, GI obstruction, multifetal

Question 63

cause of Oligohydramnios

Answer 63

* due to decrease in placental funcrtion | * higher risk of fetal congenital kidney problem

Question 64

function of amniotic fluid

Answer 64

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