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102 Cards in this Set
- Front
- Back
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What is considered reassuring with fetal kick counts?
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10 movements or more within 2 hours OR 4 movements or more within 1 hour is considered reassuring
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Is the fetal kick counts a screening test or a diagnostic test?
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Screening
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What action should mom take if she notes too few fetal kick counts?
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Contact her provider because further evaluation is indicated. Probably a non-stress test or biophysical profile.
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What are we trying to accomplish with antenatal tests?
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We are trying to rule out any kinds of problems with the pregnancy.
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What information can we gain from ultrasound?
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Fetal activity, gestational age, abnormal vs. abnormal fetal growth, visual assistance for the performance of tests, helps us analyze placenta anatomy & can be reassuring about fetal well being.
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What are the two methods to perform Ultrasonography?
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Abdominal
Vaginal Probe Method |
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What are the advantages of ultrasound?
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Non-invasive
No exposure to radiation No know side effects to mom/baby |
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What gestational age would you use the abdominal sonogram vs. the vaginal probe method?
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Abdominal - after 1st trimester (when uterus us up/out of pelvis) Vaginal Probe Method - 1st trimester.
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What is the advantage of vaginal ultrasound?
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We can visualize things early in the pregnancy & can detect abnormalities early in gestation, can detect extra-uterine pregnancies, or tumors that produce hCG which could cause false positive pregnancies.
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What are the 3 levels of ultrasounds?
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1 - Limited
2 - Standard 3 - Targeted |
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When would we use a limited ultrasound?
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When we need to know what part of the fetus is presenting in the pelvis, when we cannot find FHR through doppler, to detect fetal cardiac movement (in case of fetal demise)
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What would be the primary purpose of standard ultrasound?
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To detect fetal viability, to determine gestational age, locate the placenta, to examine the fetal anatomy for malformation, to determine amt of amniotic fluid.
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What is another name for a targeted ultrasound?
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A Level 2 Ultrasound
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When would we use a targeted ultrasound?
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When there is suspected anatomical or physiological abnormality of the fetus.
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When would we use Doppler Ultrasound Blood Flow Assessment?
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Suspicion of Intra Uterine Growth Restriction (IUGR) - to determine how severe the situation is & whether or not the baby would have a better chance outside the uterus then being left inside the uterus.
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What is the typical reason for cause of Intra Uterine Growth Restriction (IUGR)
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Insufficient placenta. The baby is not receiving the blood, oxygen & nutrients that it needs to grow properly.
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What would cause the placenta to not be fully functioning?
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Smoking
Malnutrition Medications mom might need Hypertension Diabetes |
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When would we not perform a Doppler Ultrasound Blood Flow Assessment (aka Umbilical Artery Doppler Flow)
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If the baby has not reached the point of viability outside the womb.
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What are the five criteria that are used in a biophysical profile?
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1 - Fetal movement
2 - Fetal tone 3 - Fetal breathing movement 4 - FHR activity 5 - Amniotic Fluid Indices (AFI) |
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What is the typical fetal tone of a healthy baby?
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Flexed. Chin down, hands clenched, elbows bent, drawn towards the thorax, hips flexed, knees bent, thighs drawn up to the abdomen
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What is the fetal tone of an unhealthy baby
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Very flaccid. Not flexed
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Does a baby breathe while in-utero? If so, what do they breath? Why?
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Yes. Amniotic Fluid. Helps prepare the baby for breathing air by practicing. Rib cage expands, builds muscles used for expanding & relaxing.
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When amniotic fluid goes down, is the baby able to grow symmetrically?
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No.
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Of the 5 criteria used in BPP, which 4 are determined by Ultrasound?
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Fetal Tone, Fetal Movement, Fetal Breathing, Amniotic Fluid Indices
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How is the 5th criteria (FHR) in BPP determined?
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By electronic fetal monitoring via a NST.
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How is the scoring of the BPP determined?
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each criteria receives either a score of 0 or 2 for a total of up to 10 points maximum
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What test would you use if you suspect IntraUterine Growth Restriction?
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The Doppler Ultrasound Blood Flow Assessment (aka Umbilical Artery Doppler Flow)
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What score on the BPP is considered reassuring?
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8-10; however retesting is done in 3 days.
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What occurs with a BPP score of 6?
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The patient is put on continuous surveillance on a fetal monitor on an in-patient status.
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What occurs if the BPP score is 4 or below?
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The patient is immediately admitted and delivery is anticipated.
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When is a BPP indicated?
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In pregnancies involving increased risk of fetal hypoxia & placental insufficiency. Basically, we suspect fetal sickness.
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What is the screening test that is completed prior to a BPP?
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A modified biophysical profile.
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Why is a modified biophysical profile done prior to a BPP?
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Because the BPP is time consuming & they can use the MBPP to determine who really needs the BPP. If they fail the MBPP screening then they get a BPP.
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What does the Modified Biophysical Profile look at?
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Determines if the Amniotic Fluid Indices is sufficient via Ultrasound & looks at FHR via NST.
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Would we do a BPP or an MBPP on a patient that is prior to 20 wks gestation?
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No. The baby must be considered at a level of viability first.
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What is the goal of an Electronic Fetal Heart Rate Assessment?
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To determine if the intra-uterine environment continues to be supportive of the fetus.
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What does intra-uterine insufficiency mean?
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The uterus is no longer an environment to support the pregnancy in a healthy manner.
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What two tests are considered Electronic Fetal Heart Rate Assessments?
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Non-Stress Test
Contraction Stress Test |
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Is the Non-Stress Test or the Contraction Stress Test a Diagnostic Test or a Screening Test?
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Screening
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What are the advantages of the Non-Stress Test
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Easy to perform
Has no known contraindication Relatively inexpensive Non-invasive |
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Is a Modified Biophysical Profile a screening test or a diagnostic test?
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Screening test
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What is hypoxia?
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a deprivation of adequate oxygen supply
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What are the disadvantages of a non-stress test?
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High false positive rate
Has less sensitivity to fetal compromise. |
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Can fetal monitoring detect intra-uterine fetal hypoxia?
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No. Because baby could be sleeping and you would not get a normal increase in heart rate response out of a sleeping baby.
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Is a non-stress test ever done alone?
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No. Because of its known disadvantages it is always performed with an AFI (meaning a MBPP)
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What are you trying to determine with a contraction stress test?
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The response of the fetus to the stress of contractions.
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How often is a Contraction Stress Test used?
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Not used very often anymore but it is still considered a national standard.
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What does oxytocin do to the body?
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It overrides the relaxation of progesterone and causes contraction in smooth muscle.
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What are two ways to introduce oxytocin to the body?
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1 - via IV & infusion pump
2 - breast/nipple stimulation |
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When would we not want to do a CST?
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When contraindicated: Previous Cesarean (particularly vertical incision), history of pre-term labors, mom is bleeding & we don't know why.
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If the non-stress test is non-reassuring, what do you do next?
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A full BPP.
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In a contraction stress test, if the baby's heart rate drops with each contraction, is that considered reassuring or non-reassuring?
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Non-reassuring. You do not want to see the baby's heart rate drop during contractions. If it drops, then the baby is not handling the stress of the contraction.
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Why would the babies heart rate drop during a contraction?
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Because the placenta is no longer providing the oxygen and nutrients that it needs.
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If a non-reassuring Contraction Stress Test, what do you do next?
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A full BPP.
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What do we do if the baby could be asleep during a stress test?
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Vibroacoustic stimulation
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What does the baby detect with Vibro Acoustic Stimulation?
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Sound
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If we see an acceleration with the burst of sound delivered using Vibro Acoustic Stimulation are we assured or non-reassured?
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Assured
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What is a possible exception to a non-reassuring Vibro Acoustic Stimulation test.
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Babies that have deformities of the ear and missing the nerve in the ear that accepts sound.
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Is vibro-acoustic stimulation a diagnostic test or a screening test?
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Screening test.
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What is done if a non-reassuring Vibro Acoustic Stimulation test?
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A full BPP.
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What are the biochemical assessments used?
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Amniocentesis
Percutaneous Umbilical Blood Sampling (PUBS) Chorionic Villi Sampling (CVS) Maternal Assays (bloodwork) |
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What is a definitive test?
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Absolute.
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What are the safety concerns with Amniocentesis?
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Amnionitis
Pregnancy Loss Needle injuries to mom/fetus |
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Is Amniocentesis a diagnostic tool or a screening tool?
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Diagnostic
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When is the safest time to do Amniocentesis?
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After 14 weeks. Prior to 14 weeks is greater risks.
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What potential defect is associated with Amniocentesis?
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Club Feet
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How accurate is Amniocentesis?
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99.4% correct. Little chance for false positives or false negatives.
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What are the indications for Amniocentesis?
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Detection of chromosomal abnormality; Assessment of Fetal Lung Maturity; To determine Intrauterine Infection; To identify Iso-Immunized Woman; Hydramnios
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Define Hydramnios
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Excessive Amniotic Fluid; aka Polyhydramnios
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Does Amniocentesis required an Informed Consent form?
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Yes.
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What is done with the patient postprocedure to Amniocentesis?
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4 hour monitoring for: 1 - onset of contractions; 2 - bleeding; 3 - to determine if the fetus tolerated the procedure.
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At what gestation can you perform Amniocentesis?
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From 14 - 37 weeks.
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What are the safety concerns in performing Percutaneous Umbilical Blood Sampling (PUBS)?
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Fetal bradycardia; Fetal bleeding; Cord hematoma formation; Failed procedure & infection
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What would be considered Bradycardia in a fetus?
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< 110 bpm
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What are the maternal safety concerns for PUBS?
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Pain; Contractions (could result in pre-term labor); Anxiety; If mom Rh- chance of Iso-Immunization
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What are the indications for PUBS?
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Detection of inherited blood disorders; Detection of fetal infection; Chariotyping of the fetus; IUGR - to look at acid-base balance; Twin-to-twin transfusions; Immune Deficiencies
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What can determine Fetal Hypoxia?
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Acid-Base balance of the fetus' blood as determined by PUBS.
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What is the most common reason PUBS is performed?
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When a woman has been Iso-Immunized because the baby usually suffers from a severe anemia.
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How do you treat an in-utero baby with severe anemia.
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Usually through a blood transfusion. This procedure is performed about every month to give the baby the blood it needs to transport oxygen to its growing tissues.
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When can Chorionic Villus Sampling (CVS) be performed?
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At 9-12 weeks gestation.
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What are the safety concerns related to Chorionic Villus Sampling (CVS)?
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Spotting/Bleeding; Fetal Loss; Infection; Rupture of Membranes (ROM); Fetal Maternal Hemorrhage; Risk for Short Limb Defect
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What are the indications for Chorionic Villus Sampling (CVS)?
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For women of advanced maternal age (if they choose); Family history of genetic defects.
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What defect is at increased risk for moms of advanced maternal age?
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Down syndrome.
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What is the accuracy of CVS?
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99.4% accurate.
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What do the earlier results received from CVS allow?
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Counseling if there are genetic defects or for earlier termination of the pregnancy (if they so choose)
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Which tests are considered diagnostic in nature?
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Amniocentesis; Chorionic Villi Sampling; Magnetic Resonance Imaging; Percutaneous umbilical blood sampling; Ultrasonography
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Which tests are considered Screening Test?
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AFI; BPP; Contraction Stress Test; Daily Kick Counts; Multiple marker screenings - Alpha Fetoprotein screening, triple marker, quad marker; NST; Ultrasonography; Umbilical Artery Doppler Flow; Vibroacoustic Stimulation
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Is alpha fetoprotein ever done alone?
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No. It is always in combination with triple screen or quad screen.
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What is tested in a Quad Screen?
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Maternal Syrum Alpha-fetoprotein; Unconjugated estriol; hCG; & Placental protein A &/or Inhibin A
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When is the AFP test the most accurate?
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When it is performed between 16-18 weeks gestation. Because of the narrow window, we have to be confident of the gestation.
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What is done prior to an AFP if the woman is unsure of the date of her LMP?
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An Ultrasound is the next best way to determine gestation.
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Is AFP offered to high-risk pregnancies or all pregnancies?
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All pregnancies. The woman has the right to choose whether she wants this test or not in consideration of risks.
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What do increased levels of alpha fetoprotein indicate?
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Increased levels are associated with defects such as NTD's
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What do decreased levels of alpha fetoprotein indicate?
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A chance for Trisomy 21 (Down Syndrome)
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What levels of AFP; Unconjugated estriol; and hCG & inhibin A indicate Trisomy 21?
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AFP & Unconjugated Estriol are low; hCG & Inhibin A or Placental Protein A are elevated.
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Is maternal assay a definitive test?
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No.
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So if we get a quad screen back that says that MSAFS is high, but unconjugated estriol, hcg & others are normal, what would we suspect?
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NTD
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What follow-up test would we perform if the quad screen/triple screen indicated a possibility of a NTD?
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A Level 2 Ultrasound.
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If a triple/quad screen indicated a possibility of a trisomy defect. What would the definitive test be?
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An amniocentesis (which is most accurate after 16 weeks).
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What are considered electronic tests?
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Fetal monitoring, Non-stress test, Contraction stress test
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What biochemical tests are considered definitive?
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CVS; Amniocentesis; PUBS
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Which biochemical test is considered non-definitive?
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Maternal Assays including: Quad screens/Triple screens/AFP
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