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186 Cards in this Set
- Front
- Back
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What is the risk for SAB ?
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15-20% of all documented pregnancies end in Ab. 80% of those are in the first 12 weeks and more than 50% of them are chromosomal aberrations
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What is the risk for SAB from 12-28 weeks?
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If under 30, 1%. If over 30, 2%
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What percentage of SAB in first 12 weeks have PCOS?
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20-40% so watch these pregnancies more closely
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How many women died in childbirth in early 1900's?
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1 in 100
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What was the infant mortality rate per 1000 in the US (1997)? Maternal?
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7 in 1000 (infant)
8 in 100,000 (maternal) |
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When is the perinatal period?
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20 weeks gestation to 4 wks postpartum
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The term "birth" refers to fetuses born weighing at least what?
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500 g
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How many grams are in a lb?
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454 g/lb
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How does the maternal mortality rate of African-American women compare to Caucasian women?
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4 times as high
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What 3 categories change during pregnancy?
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physiologic, biochemical, anatomic
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How is the heart position changed in pregnancy?
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Displaced upward and to the left, rotated on long axis, apex is laterally downward. Consider this when listening to heart sounds!
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Other than position, what else happens to the cardiovascular system in pregnancy?
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Heart rhythms, EKG changes, murmurs and splits more common
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How much bigger does the heart get in pregnancy?
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About 12%
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How much does CO increase by 20-24 weeks pregnant?
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Increases by about 40% and will stay up until term
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Summarize the hemodynamic changes of pregnancy
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-Plasma volume increases 10-15%
-Retention of sodium -6-8 liters of water -Plasma renin activity -Atrial natriuretic peptide |
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CO is comprised of what?
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Heart rate and stroke volume. Stroke volume is determined by preload, afterload, and contractiltiy
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**What is the goal of a healthy pregnancy?**
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Maximize oxygenation
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What factors contribute to the hemodynamic changes of pregnancy?
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Size of the woman, multiples, parity
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What is physiological anemia of pregnancy?
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Since plasma increases in pregnancy, this hemodilutes the mother causing anemia
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Why do pregnant women retain more fluid?
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Due to sodium retention
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Why do pregnant women have pre-tibial edema?
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Due to alteration in venous pressure, this is normal. Tends to increase after birth b/c the fluid volume has not been mobilized yet
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What is the normal blood flow to the non pregnant uterus? Pregnant uterus?
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200-300 ml/min in non-pregnant state. Increases to 500-800 ml/min in pregnancy.
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How much blood leaves the heart in pregnancy?
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7-8L/ min, up to 13L/min in labor
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How much blood do the breasts get in pregnancy? The kidneys?
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200 ml/min
400 ml/min |
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How does the uterus and breast engorgement affect respiratory performance?
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reduces functional residual capacity
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Describe the changes to the pulmonary system during pregnancy?
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-Capillary dilatation throughout the respiratory tract
-Diaphragm elevated 4 cm -Rib cage is displaced upward and widens -Abdominal muscles less active as pregnancy progresses, breathing is more diaphragmatic |
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How do respiratory measurements change in pregnancy?
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***Increase in minute to minute ventilation to keep paCO2 down (27-32 mm Hg), lower than in non pregnant state, PaO2 (O2 on pulmonary side) is 104-108, don't want to see this low
-Tidal volume increases -Total lung capacity is reduced -Functional residual capacity decreases -Increase in alveolar ventilation |
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Summarize the hematologic changes of pregnancy
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-Blood volume (45-50%), RBC mass (33%) and plasma volume all increase
-Need for iron increases b/c fetus takes it |
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If a woman is anemic during pregnancy, what are the risks?
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Preterm birth, SAB
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How does oncotic and hydrostatic pressures change in pregnancy?
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Hydrostatic pressure (pushing) increases, oncotic pressure stays the same and there is an imbalance. **This is why there is an increased risk for pulmonary edema in normal pregnancy**
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What happens with platelets?
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Increase in production and progressive consumption of platelets
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Why is it harder to detect infection in a pregnant woman?
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WBC's increase in normal pregnancy, so cannot depend on this to detect infection
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Why does the risk for blood clots increase?
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Clotting factors increase in pregnancy (4X that or OC)
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At what point does the uterus become an abdominal organ?
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12 weeks
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How much does the uterus weigh?
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50-70 grams, reaching 800-1200 grams
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What kind of tissue makes up the cervix? How does it change in pregnancy?
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85% of the cerix is fibrous connective tissue. Cervix changes position, soft and mushy like your chin. When not pregnant it is firmer.
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What is the isthmus?
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Area above cervix, lowermost portion of the fundus
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How does the vagina changes with pregnancy?
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-Vaginal mucosa thickens
-Discharge of whitish, acidic material -Increase in vascularity-Chadwick's sign -Hypertrophy of the musculature -Gradual softening of surrounding connective tissue -Hormones responsible for growth |
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What is Chadwick's sign?
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When the cervix looks blue in pregnancy due to increased vasculartiy
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What does relaxin do?
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hormone that increases in pregnancy. Influences joints, ligaments, thickening of vaginal wall
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How does uterine blood flow change with pregnancy?
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-Increases from 30-40 ml/min to 500
-At term less than 5% to myometrium, 10-15% to the endometrium, 80-85% to the placental tissues -Pressure dependent |
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How does blood flow through the uterus?
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Blood turns over several times a minute, travels through spiral arteries, through uterus into placental bed (holds about 150ml)
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Describe the maternal immune response
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-Maternal tolerance of the fetal allograft
-Anecdotal observations -Systemic immunity remains largely intact -Local immunity appears altered in utero. Leukocytes differ, immune function is similar in pregnant and nonpregnant -Maternal immune response contributes to fatigue, decreased and suppressed in 1st trimester |
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Whould all moms have the flu vaccine?
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YES! Season is Nov-March 31st
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How much does CO increase?
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30-50%
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What happens to BP in pregnancy?
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Systolic and diastolic drop early in pregnancy, followed by a nadir at 20-28 wks
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Why does minute ventilation increase in pregnancy?
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Because of increased tidal volume
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Do plasma volume and red-cell mass increase in pregnancy?
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Yes
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Why does BP drop in pregnancy?
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Due to vasodilation effects of progesterone at beginning of 2nd trimester
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Why do you want a woman to be off OC for one month prior to pregnancy?
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To better date the pregnancy
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What is measured when a US is done for dates?
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Transvaginal US for crown/rump length. Can be off by 7 days
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What is important in US at 5 weeks? HCG?
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Predict viability early in pregnancy. Should see gestationional sac and HCG should be around 1500
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What will you see on US at 6 weeks? HCG?
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Fetal pole, HCG around 5200
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What will you on US at 7 weeks? HCG?
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Cardiac motion, HCG around 17,000
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What will you see on US at 8 weeks?
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For sure cardiac motion. Maybe wait until now to send people to be sure
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What is a biochemical pregnancy?
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Presence of hCG in blood of a woman 7-10 days after oculation, occurs in women who get period as expected. If was not testing for this, wouldn't know.
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What percentage of all documented pregnancies end in SAB?
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10-15%
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What do trophoblasts produce?
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progesterone, estrogen, HPL, human chonadotropin
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What are trophoblasts?
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cells forming the outer layer of the blastocyst, which provides nutrients to the embryo and develops into a large part of the placenta
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What do trophoblasts synthesize?
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TSH and ACTH
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What does the corpus luteum produce? What takes over?
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Corpus luteum is producing estrogen and progesterone until placenta fully matures, develops and takes over. At this time the corpus luteum goes through atresia, not before 12 weeks and not fully until 14 weeks
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What is placental production dependent on?
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Precursors derived from placental and maternal circulation
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What does human chorionic gonadotropin do?
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-Maintains corpus luteum
-Similar to LH -Induces ovulation |
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Should you do a quantitative hCG? When?
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Yes, do this on day of pregnancy confirmation so have a baseline to compare the rest of the tests
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What is the rate of hCG increase? When does it plateau?
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Doubles every 2.2 days in a healthy pregnancy. Peaks around 12-13 weeks and plateaus at 20 weeks. NOTE that if multiple pregnancy the levels might be higher and there is a theory that more hCG increases n/v
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What lab should you follow if a woman has an ectopic pregnancy or fetal demise?
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hCG. Must follow her after the event until value is 0
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When does n/v usually start?
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6-7 weeks. If very sick earlier, get an US to rule out molar pregnancy or multiples
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When is hCG is first detectable?
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6-8 days after ovulation. Titer less than 5 IU/L is considered negative. Above 25 is positive, if between 6-24 this is equivoval, retest in 2 days
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What does human placental lactogen do?
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-Has lactogenic activity and immunochemical, similar to human growth factor
-Promotes maternal lipolysis |
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When can human placental lactogen be detected?
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6th week. Rise early and in late pregnancy reach a high concentration
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human placental lactogen promotes what?
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maternal and fetal metabolism
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How does human placental lactogen affect insulin?
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Anti insulin affect and this is what causes the peripheral resistance to insulin, seen early in pregnancy. This is what makes them more hypoglycemic in 1st trimester. Increased maternal inslulin promotes protein synthesis which ensures the fetus gets the amino acid it needs.
-Physiologic antagonist of insulin -Anti-insulin effect -Increased level of maternal insulin |
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Does human placental lactogen affect breasts?
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Prepares breasts for lactation, may leak as early as 5-6 months
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All women of childbearing age should be on prenatal vitamins with how much folic acid? Why is it especially important if on birth control?
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1 mg folic acid
Extra important b/c OCs decreases the absorption of folic acid |
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How much folic acid should a woman take if there is family hx of neural tube defect?
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4 mg
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How much calcium per day? What is high in calcium? What kind of calcium should she not take?
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1200 mg of calcium per day. Skim milk has about 320 mg and has more than whole milk. Not oyster calcium b/c that is a bottom feeder
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Who needs preconception care?
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Any woman with reproductive capability
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What is the most accurate way to determine ovulation?
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Day 21 of cycle if regular
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What are the benefits of preconception counseling?
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Educates women to make informed decisions about their reproductive future, decreases the incidence of perinatal morbidity and mortality, assists women in obtaining an optimal pregnancy outcome
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What aspects of psychological readiness should be considered with preconception care?
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-Motivation for childbearing
-Explore alternatives (work, education) -Discuss timing of pregnancy -Evaluate stress and coping mechanisms -Evaluate potential for domestic violence |
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What should be included in preconception history?
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General health hx, family hx, reproductive hx, sexual hx
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General health history and ROS for preconception should include what?
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-Standard history and physical including history or connective tissue disease (lupus, RA), endometriosis, endocirine disorders
-Diet and weight -Exercise -Sleep |
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At what level of weight gain does the risk for preterm labor decrease?
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16 pounds
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What is the average weight gained in pregnancy?
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27 pounds
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What can happen in pregnant women with endocrine disorders?
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preterm labor, preterm birth
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What is PICA? Geophagia?
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Craving and eating of nonedibles. Might be cultural. Includes ashes, freezer frost, clay, corn starch, grass, paper.
Geophagia- the eating of soil or clay. These both can result in malnutrition and risk for ingesting microbials |
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What diseases can be carrier screened?
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Tay-Sachs, Thalassemia, sickle cell anemia, cystic fibrosis
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What is the standard of care regarding cystic fibrosis?
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Offer woman a screening, can be done at any time in pregnancy
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What is the ultra screen?
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First trimester blood test and US for trisomies (including downs)
-US looking for nuchal translucency (NT) in fetus **11 weeks to 12 and 6** |
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What is the false positive rate for both first and second trimester screen?
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5%
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What should be included in reproductive history?
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-gravidity/parity
-losses/terminations -pre-term labor/ deliveries -infertility -uterine anomalies/abnormalities -DES exposure -cervical procedures/surgery -STIs -Contraceptive hx -Menstrual history |
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What should be included in menstrual hx?
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-interval and length of cycles
-history/suspicion of anovulation -mittelschmerx -mid-cycle lubrication |
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What should be included in sexual hx?
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-frequency of intercourse
-hx of dyspareunia (painful intercourse -timing of intercourse |
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What infections diseases are important to ask about?
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Rubella, varicella, toxoplasmosis, TB, cytomegalovirus, hepB, HIV, chlamydia, gonorrhea, syphilis, HSV
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Pregnant women should d/c or modify known teratogenic drugs. What does this include?
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antibiotics, anticonvulsants, antiocoagulants, antihypertensives, OCs
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What are known industrial and environmental teratogens?
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carbon monoxide, methyl mercury, lead, polychlorinated biphenyls, methyl chloride
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What health promotion is important in preconception care?
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close medical supervision for chronic health concerns, stress importance of compliance with health care plan, dental care, mammography, exercise, diet, sleep, lifestyle changes
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At 16 weeks, where will be fundus be located?
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about halfway between the pubic bone and umbilicus
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When do you start assessing fundal height?
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at 20 weeks
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When do you assess fetal presentation?
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After about 36 weeks
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Estimated fetal weight at 36-37 weeks has what percentage error?
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10-15%
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Can pregnant women have a tetanus shot? flu shot? Varicella-zoster?
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Yes and yes, no. Should have tetanus shot within 10 years and should have flu shot. No to varicella-zoster (can draw IgG titer in pre-conception and immunize)
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Can a pregnant woman get a measles shot?
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no, it is contraindicated b/c it is a weakened virus. May get in preconception period and then not conceive for 3 months to prevent teratogenic effects
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What does the indirect coombs test? Direct coombs?
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Both test for Rh antibody. Indirect tests the mother, direct tests the baby.
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When and how is rhogam given?
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At 28 weeks and within 72 hours of delivery, deep IM, chart lot number. Only if both mother and father are Rh negative. TennCare does not cover it
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If indirect coombs is postive, do you give rhogam?
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No, mother has already made antibodies
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What does it mean if a S/S of pregnancy is presumptive, probable, or positive?
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-Presumptive- s/s frequently reported
-probable- s/s that may be reliable indicators, often noted on teh physical exam or with labs -positive- s/s noted when absolute confirmation of pregnancy is made |
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Name some presumptive s/s of pregnancy
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-amenorrhea
-n/v (6-7wk) -breast tenderness and tingling -urinary frequency and urgency (bladder still right on uterus) -constipation -fatigue (early) -quickening -weight gain -metabolic effects -elevation of body temp -skin pigmentation |
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When does quickening usually occur?
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Primips- 20 weeks
Multips- 18 weeks |
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How much weight should an underweight women gain?
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35 lbs
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How should weight gain progress through pregnancy?
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Gain .8-1 lb/wk after 20 wks, gain is usually 10 lbs at 20 wks
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What are some probable signs of pregnancy?
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-Abdominal enlargement
-Hegar's sign (compressibility and softening of isthmus) -Goodell's sign (softening of vaginal portion of the cervix) -uterine enlargement -braxton-hicks contractions -positive pregnancy test -palpation of fetal contours -Chadwick's sign (bluish cervix) |
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What are some positive signs pregnancy?
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-Auscultation of fetal heart tones
-Palpation of fetal movements -x-ray of fetal skeleton -US verification of gestation |
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Where do you hear fetal heat tones best?
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Through the fetal back
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What are some options to dx pregnancy?
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-Elevation of basal body temp for longer than 2 weeks
-Lab tests (serum or urine) -Radio immunoassay |
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What is nagele's rule?
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Way to estimate EDC, based on 28 day cycle. LMP + 1 year - 3 months + 7 days
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What percentage of babies are born on due date?
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4%
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What is a term birth?
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37 completed weeks utnil 42 and 1
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What increases after 40 weeks?
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Incidence of morbidity and mortality, less fluid, more nuchal cords
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How much fluid is present at 38 wks? 40? 41?
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1000
800 250 |
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When does fundal height have a good correlation to gestational age?
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18-36 weeks. A lot of practitioners keep measuring anyway
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What happens at the initial prenatal visit?
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-Confirmation of pregnancy
-History (medical, psychosocial, family, reproductive) -Physical exam -Lab tests -Risk assessment -Prenatal education materials -Exercise during pregnancy -Sexuality during pregnancy -Schedule follow-up visits |
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How long is the normal cervix?
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3-4cm
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What lab tests will you do on pregnant woman?
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-OB profile (Rh, blood type, hepB, RPR)
-Urine culture -HIV -Quantitative hCG for baseline -TSH -Herpes select |
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What are the routine tests to be performed on all pregnant women?
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ABO/Rh, antibody screen, CBC with differential, Rubella titer, syphillis screening, HIV screening, hepatitis screening, urinalysis, pap test, group B strep, gonorrhea screen, chlamydia screen, TSH, TB, sickle cell
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What is the normal schedule of prenatal visits?
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Every 4 weeks until 28 weeks, then every 2 until 36, then every week. Totals about 14 visits
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When will you test for group B strep?
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About 35-36 weeks
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What question should you ask of everyone, including gyn visits?
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family history of blood clots
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What are some of the minor discomforts of pregnancy?
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Breathelessness, backache, morning sickness, ptyalism (excessive salivation), leukorrhea (vaginal discharge), urinary symptoms, heartburn, constipation, hermorrhoids, breast tenderness, HA, ankle swelling, varicose veins, leg cramps, abdominal pain, fatigue
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Why should pregnant women not stand for a long period of time?
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drops CO
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What are some drug options for syncope morning sickness?
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phenergan, reglan, zofran (comes in oral disintegrating tablets), vit b-6
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Do pregnant women have acidosis or alkalosis?
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Compensated respiratory acidosis
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What can they take for constipation?
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omega 3, flaxseed oil, colace
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For hemorrhoids?
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Aneusol suppositories, prep H. Some cortisone is okay, steroids are not contraindicated in pregnancy and reduce a lot of inflammation
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Why do pregnant women get HA?
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Increased vascularity, vassal dilation due to progesterone. Can take narcotics, Mg pills, tylenol
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What can they take to decrease leg cramps?
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bump up Mg and Ca
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When should you be concerned about abdominal pain? What might cause it?
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**Be conservative**
At 18-19 weeks it is round ligament pain. By 24-25 weeks the low cramping is no longer ligament pain. Now would have to check them (but be careful b/c digital stimulation of cervix can release prostaglandin and stimulate contractions) -Have women call when pain is persistant |
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What happens to the uterus if the woman is dehydrated?
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it becomes irritable
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Why might a woman have contractions after intercourse?
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b/c orgasm and prostaglandin in semen. If persists, might have to reevaluate
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What are some prenatal issues?
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Nutrition, supplemental minerals and vitamins, salt restriction, weight control, dental care, travel, intercourse and vaginal hygiene, breastfeeding, smoking, medications, employment, danger signals, bathing, immunizations, onset of labor
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How many extra calories does a pregnant women need? If BF?
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300 extra, 500 extra
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Should a pregnant woman restrict salt?
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NO!
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Why is dental care important?
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Gingivitis is associated with preterm labor due to inflammatory mediators released in body, triggering cytokines and contractions
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When can a woman no longer fly? Cruise?
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36 weeks (airline cut off), must start cruise under 24ish weeks
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What is the problem with inverted nipples?
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Might be difficult for breastfeeding. Can get cups that the woman will wear in her bra after 34 weeks to help with BF. Talk to mom about this and must assess for it
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What are danger signals?
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Bleeding, pain that persists that does not go away with walking or laying down, sharp pain (could be an abruption)
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What will happen at the week 12-16 prenatal visit?
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-Genetic testing (quad screen)
-Triple screen (alpha-fetoprotein) looking for neural tube defects and downs -CF carrier testing (at any time) |
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What will happen at the weeks 16-20 prenatal visit?
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-Assess for fetal movement
-US evaulation (20-22 weeks) -Enroll in prenatal classes |
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What will happen at the weeks 24-28 prenatal visits?
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-If Rh negative, reevatulat the antibody titer
-glucose screening (but if think pre-disposed, test at 12 weeks and again here) -RhoGam as indicated -Restest hemoglobin and hematocrit -Evaluate for risk of preterm labor -Optional cervical assessment |
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What will happen at the weeks 28-32 prenatal visit?
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-ID pediatrician
-Assess breasts and discuss preparation for BF -Daily fetal movement |
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What will happen at the weeks 34-36 prentatl visits?
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-Review s/s of labor
-obtain vaginal/anorectal culture for GBS (most virulent in anus) -begin weekly cervical cultures for active HSV in those with + hx -retest for chlamydia and gnorrhea in those with infections earlier in pregnancy |
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What will you do weekly after 35 wks?
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Leopold's maneuvers to determine fetal presentation and position
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What will happen at the weeks 36-40 prenatal visit?
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-Assess fetal position and presentation
-Review and negotiate the client's birth expectations -Forward a copy of prenatal records to L&D -Cervical exam -Supressive antiviral therapy for HSV |
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What will happen at the week 40+ visits?
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-cervical assessment
-institute fetal surveillance such as US, NST and biweekly office visits -Check via US for amniotic fluid volume |
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**What are the categories for drugs in pregnancy and lactation?**
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A: no risk
B: studies fail to demonstrate risk C:teratogenic or embryocidal effects in animals D: positive evidence of human fetal risk X: animal/human studies have demonstrated fetal abnormalities |
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What are symptoms of an ectopic pregnancy?
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Amenorrhea, uterine bleeding, sharp abdominal pain and backache, 60% hx of abnormal menses and infertility, 10% collapse and shock
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What is hydatidiform mole?
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-Degenerative disorder of the chorion of unknown cause, 1/1500 pregnancies in the US, 1-18wks
-Excessive n/v occur in greater than 1/3, with uterine bleeding (beginning at 6-8 weeks in all cases)40% have uterine enlargement greater than expected at stage of pregnancy -abnormal form of pregnancy, unviable embryo |
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Other than ectopic pregnancy and hydatidiform mole, what are some complications of pregnancy in the 1st and 2nd trimester?
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-Choleycystitis and choledocholithiasis
-UTI -STI -GBS -TB, rubella, varicella -toxoplasmosis -history of SAB -history of pre-term delivery -multiple pregnancy |
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What are some complications of late pregnancy?
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-3rd trimester bleeding (5-10%). Might be placental (placental previa, abruptio placentae) or non-placental
-Umbilical cord prolapse (1/200) -Previous c-section (21% repeat with 1 prior) -Pre-eclampsia/eclampsia -DM (2-3%) -Gestational diabetes |
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What is the goal of antepartum testing?
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Reduction of fetal demise in high risk populations
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What 1999 bulletin changed some of how we interpret testing?
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ACOG practice bulletin on antepartum surveillance
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What happens in hypoxemia and acidemia?
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-Redistribution of fetal blood flow in response may result in diminshed renal perfusion and oligohydramnios
-ID of suspected fetal compromise provides the opportunity to intervene before progressive metabolic acidosis can lead to fetal death -Fetal compensatory mechanism- when fetus has hypoxemia, shunts blood to more important organs -Fetus can exist at low oxygen due to adaptations (ductus ovale, etc) |
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What is a common cause of oligohydramnios?
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Kidneys of fetus getting less blood
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What are some antepartum testing indications?
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Decreased fetal movement, HTN, diabetes, oligohydramnios, IUGR, postdates, chronic renal disease, lupus, maternal cyanotic heart disease, hemoglobinopathies, previous IUFD, multiples with disocrodancy, hyperthyroidism
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What is the gold standard of antepartum surveillance?
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contraction stress test
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What is the technique for contraction stress test?
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-semi-fowlers position with lateral tilt (important for any woman after 12 weeks when uterus becomes an abdominal organ)
-FHR monitoring, US transducer -UC monitoring- tocodynamometer -Determine baseline FHR |
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What do you need to see in contraction stress test?
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3 uterine contractions (palpable), 40 seconds in duration per 10 minutes.
Stimulate nipples or pitocin to get contractions |
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What is a negative contraction stress test?
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No late decelerations
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What is a positive contraction stress test?
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late decels with 50% of UCs
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What is a suspicious/equivocal contraction stress test? Unsatisfactory?
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-intermittent late or significant variable decels
-unsatisfactory if less than 3 UCs in 10 minutes, poor quality tracing |
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What are the contraindications for contraction stress test?
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PTL, PROM, classical uterine scar, known placenta previa
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What is the technique for NST?
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-position in semi-fowlers with lateral tilt
-external transducer -looking for 2 15 beats/min above baseline lasting 15 seconds accelerations in 32 week fetus. If less than 32 weeks want 10 by 10 in 20 minute period -test may be continuted for 40 minutes, want at least 20 |
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When is an NST reactive? nonreactive?
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-Reactive if 2 or more FHR accelearations within 20 minutes, fetal movement detection by mother
-Nonreactive if doesn't meet criteria. Without sufficient FHR accelerations in a 40 minute period |
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What are the effects of time, glucose, manual manipulation, light, vibration, and vibroacoustic on NST?
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Time- up to 80 minutes
Glucose- may increase fetal breathing movements, no effect on FHR reactivity Manual manipulation- no effect Light- no effect Vibration- effective Vibroacoustic-fetal hearing may not develop until 26-28 weeks |
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When is the earliest you would probably do an NST?
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28 weeks
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What is the affect of acoustic stimulation on NST?
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May reduce NST testing time, induced accelerations appear to be valid in the prediction of fetal well-being
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What do accelerations in FHR tell you?
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Good O2 and glucose at the cellular level, rule out metabolic acidosis. Sick baby cannot have accelerations
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What is fetal acoustic stimulation? What do you expect?
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-Apply over fetal vertex, 3-5 second pulse, up to 3 stimuli
-Adjunct to NST -Intrapartum- acid/base assessment -fetal admission test - <26 weeks- 10-20% reactive >26 weeks- 90-100% reactive Don't overstimulate b/c fetus might habituate and not react enough even though it is healthy |
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What do you know about the brain if baby has accelerations?
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Medulla and brain stem are working
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What are some factors taht would affect fetal response to fetal acoustic stimulation?
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-maternal body habitus/ application pressure
-stimulus intensity |
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What is included in the modified biophysical profile?
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NST, amniotic fluid volume
- good predictor of fetal well being |
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What does amniotic fluid volume tell you?
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Evaluates long term uteroplacental function
Reflects fetal urine production Placental dysfunction may result in diminished fetal renal perfusion oligohydramnios |
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What does an NST tell you?
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short-term indicator of fetal acid-base status
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What is included in a full biophysical profile?
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-NST
-Fluid volume -Fetal tone- body, limb movement -Fetal breathing movement- expect 1 for 30 seconds - Fetal movement- 3 distinct body limb movements Rate each of these a 0 (abnormal) or 2 (normal). total of 8-10 is normal, 6 is equivocal, less than 4 is abnormal |
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What might impact the BPP?
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normal periodicity, hypoxia, sound drugs, labor, infection, acidemia, fetal malformation, maternal glucose level
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What is PUBS?
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Percutaneous umbilical blood sampling
Indicated for rapid karotyping, isoimmunization, fetal infection, maternal ITP, medication administration |
