Start here Exam 2 Assessing Fetal Wellbeing Flashcards
when do we do age assessment with ultrasound? what are we measuring?
1st trimester: before week 14
fetal crown/rump length measurement
why use an ultrasound for fetal assessment
• gestational age measurement, # of fetuses, fetal anomalies, assess amniotic fluid volume, assess if bleeding , cardiac activity
What 2 visualization studies are being done in 3rd trimester specifically?
biophysical profile, doppler flow studies
If there is vaginal bleeding during any trimester use an _______
ultrasound
Why use a 3 or 4 dimensional ultrasound?
assess for cardiac or facial anomaly
Is the doppler blood flow study invasive?
no
which test assesses resistance to blood flow in placenta? (placental perfusion assessment)
doppler blood flow study
what kind of fetal heart rate variability do we want to see?
moderate!
little bit of variability –> CNS functioning correctly
what do we do if we see minimal fetal heart rate variability?
= 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
what does it mean if there is absent variability in fetal heart rate?
issue with CNS (still have Heart Rate but not seeing any changes)
re fetal heart: what is it called when changes in heart rate mirror contraction period(due to head compression)
early decelerations
re fetal heart: what is it called when gradual onset of decrease in fetal heart rate after contraction has peaked?
late decelterations
early or late decelerations associated with placental insufficiency?
late
when is a nonstress test done what are we looking for? ?
- done when there is no contraction
* looking at fetal heart rate with movement to show adequate blood flow and autonomic nervous system
is a nonstress test invasive?
no
what does client do during a nonstress test?
• client pushes a button whenever they feel baby move
during which trimester is a nonstress test done?
3rd
reactive stress test- what results are we hoping to see? how long does the test take?
<32 weeks? >32 weeks?
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
nonreactive stress test- what results do we see? what we gonna do about it?
do not see 2 qualifying accelerations in 20 minutes
◦ further assessment needed –> contraction stress test or BPP
which has risk of preterm labor- nonstress test or contraction stress test?
contraction stress test
Why do a contraction stress test?
- Determines for fetus will tolerate stress of labor
- has non reactive nonstress test
- high risk preg
2 types of ways to do a contraction stress test?
- 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 - Oxytocin stimulated contraction test aka Oxytocin Challenge Test
◦ use if nipple stimulation fails to work
◦ IV oxytocin to induce contractions
What are the results we want to see from contraction stress test?
no late decels in 10 minutes period w/ 3 contractions
When doing a contraction stress test, what does the nurse need to do?
‣ 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
do we want to have a negative or positive contraction stress test?
Negative!
= ◦ Normal
◦ No late decelerations in 10 min period with 3 uterine contractions
what does a positive contraction stress test mean?
◦ Abnormal results
◦ Late decelerations with 50% of contractions
»>Therefore fetus not able to tolerate labor
When do we teach preggo to start doing daily kick count?
28 weeks
What are instructions for doing daily kick count (how many in what amount of time?)
• 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
this test combines a nonstress test with an ultrasound observation for 30 minutes and is done in 3rd trimester
biophysical profile
Re BPP: Reactive vs nonreactive: HR?
• Fetal heart rate
◦ Reactive (NST) = 2
◦ Nonreactive = 0
Re BPP: Fetal breathing movements
• 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
Re BPP: Gross body movement?
◦ At least 3 body/limb extensions with return to flexion in 30 minutes = 2
◦ Less than 3 episodes = 0
Re BPP: Fetal Tone
◦ At least 1 episode of extension with return to flexion = 2
◦ Slow extension and flexion, lack of flexion, absent movement= 0
Re BPP:Qualitative amniotic fluid volume
◦ At least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2
◦ Pockets absent or less than 2 = 0
What is the score we want for BPP?
8-10!
What does score of 4-6 for BPP mean?
abnormal - suspect chronic fetal asphyxia
What does score of <4 for BPP mean?
strongly abnormal - strongly suspect chronic fetal asphyxia
what is it called when we aspirate amniotic fluid with direct ultrasound guidance through client abdomen
amniocentesis
indications for doing an amniocentesis?
- check for x linked/genetic disorders (down syndrome)
- history of neural tube defects
- AFP level
- lung maturity
- fetal hemolytic disease
When doing an amniocentesis >20 weeks- do we want bladder full or empty?
empty
What med might we need to admin before amniocentesis related to blood?
Rhogam in preggo is Rh-
What do High AFP mean?
neural tube defects, can also be present with normal multifetal preg
What does Low AFP mean?
chromosomal disorders like down syndrome or hydatidiform mole
What organ makes AFP?
liver
2 ways to check AFP?
- routine lab tests
- amniocentesis
Indication for doing fetal lung tests?
If baby is <37 weeks/reuptured membranes, preterm labor, or complication resulting in c section
If lungs are not mature administer ______
betamethasone
What does a L/S ration mean?
indicates fetal lung maturity
What is the L/S ratio we want? what about if diabetes is present?
regular - 2:1
diabetes- 2.5: 1 or 3: 1
What does a PG test look at? What does it mean if there is an absence of PG?
respiratory distress = absence of PG
Circling back- what are the 2 things we look at for fetal lung tests?
L:S Ratio
PG test
Percutaneous umbilical blood sampling- what is it? why do it?
- aspirate from umbilical vein
- can also use for transfusion
- hemotological, metabolic, infection, genetic testing
Test we can do in first trimester instead of amniocentesis?
Chorionic villus sampling
• assess a portion of developing placenta
Quad marker screening looks at what 4 things
AFP, hCG, Estirol, Inhibin A
down syndrome- what are levels we see of hCG, Inhibin A, AFP, Estirol ?
• Down syndrome = high hCG, high Inhibin A, low AFP, low Estirol
Maternal serum alpha-fetoprotein looks for what?
- look for neural tube defects
* recommended for all pregnant women
high vs low levels of Maternal serum alpha-fetoprotein
• High = neural tube defects, Low = down syndrome
during first trimester where is amniotic fluid made by?
amniotic membrane
during 2nd and 3rd trimester where is amniotic fluid made by?
fetal kidney
too little amniotic fluid=
Oligohydramnios
too much amniotic fluid =
Polyhydramnios
cause of Polyhydramnios
• neural tube defects, GI obstruction, multifetal
cause of Oligohydramnios
- due to decrease in placental funcrtion
* higher risk of fetal congenital kidney problem
function of amniotic fluid
cushion, allow fetal movement, prevent fetus from sticking to membrane, consistent thermal environment in preggo
