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30 Cards in this Set

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Standard-during 2nd or 3rd trim, presentation, amni fluid volume, placenta placement, cardiac activity, fetal biometry, and anatomic survey.
Ultrasound
yolk visualized (double ring) at 5.5 weeks, the earlier its done, the more accurate it is. After 2nd trimester, greater margin of error. Embryo seen at 6-1/2 weeks
ultrasound
done at 11-13 weeks for down syndrome
nuchal translucency testing by ultrasound
18-24 wks ideal time for
ultrasound
Usually felt around 28 wks.
fetal movmnt assesmt
NOT DONE BEFORE 28 wks. Usually at 32-34 wks.
CST
). At least 3 ctx (last 40 sec) in 10 minutes. Ctx most commonly induced by oxytocin or nipple stimulation. Moms in semi fowlers, side lying. EFM placed on babys back or chest. Uterinc CTX with toco, nurse records baseline measu. Including BP, fetal activity, variations in FHR, and spon ctx. THEN ctx are stimulated.
CST
Indications: IUGR, DM, postdates 42 or more gestation, nonreactive NST, abnormal or suspicious biophysical profile.
CST
Contraindi: 3rd trimester bleeding (placenta previa), marginal abruptio, unex vag bleeding, previous c-sec with classical uterine incision,
intances in which the risk of preterm labor outweighs the advantage of the CST including PROM, Incomp cervix, multiple gestation.
CST
3 ctx lasting 40-60 occur in a 10min period.
cst
Which means absence of LATE 0R VARIABLE DECELS
NEG RESULTS DESIRED!!
PRESENCE OF LATE DECELS (A symmetrical decrease in FHR beginning at or the peak of CTX and returning to BL after the CTX has ended for 50% of the CTX.) not receiving enough O2uteroplacental insufficiency.
POSITIVE NOT WANTED!!=
intermittent late decels/variable decels

OR

FHR decels during CTX that occur more frequently than every 2minutes or that last longer than 90 seconds, shld be restested after hydration and rest
equivocal, SUSPICIOUS THEN HYPERSTIMULATORY

REPEAT THIS TEST AT 24 HRS
DOPPLER FLOW STUDIES
3RD TRIM
DONE AT 15-20 WKS for genetic purposes
DONE at 30-35 for Lung maturity
AMNIOCENTESIS
Later in pregnancy (30-35wks) can be done for lung maturity studies such as ecithin/sphingomyelin ratio and presence of phosglycerol (seen at 35 wks or before 35 if diabetes) and phoscholine
AMNIOCENTESIS
BIOPHYSICAL STUDIES
3RD TRIMESTER
FHR (assesed with NST), fetal breathing, mvmnts, tone, fluid volume.
Identifies compromised fetus and confirms healthy fetus.
Time frame of 30 min (babies sleep cycle), but usually completed in 4 min.
Indications same as CST & NST. Nonreactive stress test, preterm labor, diabetes, IUGR, PROM, postterm.
2 MOST IMPORTANT: NST (FHR accele) and Amniotic fluid vol index (indentifies kidney perfusion).
bio profile
Score method, highest is 10. Score of 2 for normal components. If 8/10 + abnormal fluid, induce birth.
Amniotic fluid volume:
Normal: AFI greater than 5 (pocket less than 2cm)
Abnormal: less than 5 (largest pocket less than or equal to 2)
bipohys pro
NORMAL if afi is more than 5cm, and NST is reactive
ABNORMAL: if EITHER NST is nonreactive or AFI is 5 or less.
TIP* functioning of placenta is important b/c a poorly functioninf placenta may result in diminshed renal perfusion oligohydramnios.
modified profile
Needle inserted into uterine cavity thru abdomen
Can make chromosomal &biochemical abnorms (enzyme anal, AlphaFetalProtein meas. for neural tube defects, blood typing, cytogeninc, metabolic or DNA testing)& can validate abnormalities detected by ultrasound.
amniocentesis
Indications: 35 or older b/c of down syndrome, couple who have had a child with a birth defect, family hx of birth defects, abnormal gentic results.
amniocentesis
Woman shld be in left lateral tilt (ensure adequate palcental perfusion), needle insertion site most important to avoid baby, placenta, cord, bladder, uterine arteries
amnio
8-12 wks
CHORIONIC VILLUS SSAMPLING
Increased risk or spontaneous abortion, and prego loss, and fetal limb reduction, especially if performed beofre 9.5 wks.
CHO VILL SAMP
Disadvantage: if woman later has an abnormalitie msapf test indicating a ntd, she will then have to undergo an amniocentesis thus being put at risk again.
CHO VILL SAMP
Procedure: woman asked to drink fluids, ultrasound for uterine pos. Catheter contents into dish
Nurse monitors for vaginal bleeding, fluid leakeage, excessive cramping, VS.
Normal cvs does not ensure a healthy infant
CHO VILL SAMPLING
excreted from fetal yolk sac a t6 weeks, if there is a NTD, afp is elevated.
Alpha fetal protein
can be screened at 15-22 weeks
Using Ultrasound and MSAFP
qUADRUPLE CHECK, ntd, down syndrome21, and tri 18
previous NTD, AGE LESS THAN 20 greater than 35, primiparitym grandmultyparity, poor w nutritional problens, irish decent, folate deficincy
risk factors for NTDs