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N113 Fetal Assessmen
N113 - Assessment of fetal well being
| Question | Answer |
|---|---|
| Transabdominal Ultrasound | Can detect gestational sac at 4-6 weeks. Must have full bladder. |
| Endovaginal ultrasound | Useful for early embryonic development, fetal heart beat and visualizing intrapelvic structures. |
| Ultrasound uses | Fetal age & growth, gestational age, congenital abnormalities, placental location |
| Functions that can be seen on ultrasound | Breathing, movement, urination, eye movement, cardiac activity |
| Level 1 ultrasound | Basic screening - gestational age, # of fetuses, fetal death, status of placenta |
| Level 2 ultrasound | Comprehensive screening - looking for specific abnormalities |
| Biophysical profile (BPP) | Used to assess intrauterine compromise. Done as follow up to ultrasound if there are fetal concerns. |
| Biophysical variables of fetus | Breathing movement, body movement, tone (flexion of extremities), amniotic fluid volume, FHR reactivity. |
| Fetal heart rate reactivity | Is tested with a non-stress test |
| Fetal Movement | Kick count done by mom. Fetal alarm sign if there is no movement for 12 hours. Count kicks for 60 minutes should feel >3 movements during that time. |
| Non-stress test | Observing for acceleration of fetal heart rate with movement. Shows intact central and autonomic nervous systems. |
| Non-stress test = Reactive | Means at least 2 accelerations of FHR with fetal movement. |
| Non-stress test = Non-reactive | Accelerations not seen or accelerations were not wide enough (>15 beats per min). |
| To encourage fetal movement | Pushing on abdomen, music or vibratory device. Eating something isn't recommended, baby may be reacting to increased sugar level. |
| Contraction stress test | Used to evaluate placental/fetal reserve. Observation of fetal heart rate to stress of uterine contractions. |
| Reasons to do a stress test | High risk pregnancy, IUGR (intrauterine growth restriction), diabetic mother, non-reactive NST, abnormal biophysical profile. |
| Reasons to NOT do a stress test | Bleeding (placental previa or abruptio), classical c-section, risk of pre-term labor. |
| Procedure for stress test | Spontaneous or induced contractions lasing 40-60 seconds 3 times in 10 minutes. Induced - Pitocin or Nipple stimulation |
| Positive stress test results | No late decelerations |
| Negative stress test results | Late decelerations with contractions. Discontinue test if there are 3 or more late decels & notify MD. |
| Amniocentesis | Can't be done before 16 weeks, not enough amniotic fluid. |
| Early amniocentesis | Done to detect chromosome & biochemical abnormalities - Down's syndrome |
| Late amniocentesis | Done to detect lung maturity - for fetal viability |
| Fetal lung maturity | L/S ratio (Lecithin & Sphingomyelin - components of surfactant), 30-32 weeks L=S, 35+ weeks L>S = respiratory distress unlikely |
| Cortisol & fetal lung maturity | In some types of fetal distress, cortisol is produced by the fetus and will result in more mature lungs in younger fetus. |
| Phosphadyglycerol | Second most abundant phospholipid in surfactant. Appears around 36 weeks, indicates fetal lung maturity. |
| Amniocentesis procedure | Ultrasound is used to locate fetus, cord, fluid & placenta. Withdrawal of 15-20 cc of fluid, fluid is shielded from light to prevent breakdown of bilirubin. Fetal & maternal VS monitored, Rhogam given to Rh negative mother. |
| Amniocentesis complications | Can trigger early labor - #1 reason why women refuse. Bleeding, transfer of Rh factor, infection, fetal distress. |
| Alpha-fetoprotein (AFP) | Blood test - not diagnostic! Maternal blood test done at 16-18 weeks, gestational age accuracy is important |
| Increased levels of alpha-fetoprotein | May indicate neural tube defects, anencephaly or abdominal wall defect. Would follow up with level 2 ultrasound. |
| Low levels of alpha-fetoprotein | May indicate fetal chromosome abnormalities such as Down's syndrome. Would follow up with amniocentesis if mother agrees. |
| Possible abnormal AFP level results | Can be caused by multiple gestation, incorrect gestational age, dead fetus, abdominal wall defect, Rh sensitization, fetal distress |
| Triple-marker test | Maternal blood test done at 16-18 weeks, gestational age accuracy is important. AFP, conjugated estriol & hCG in combination with maternal age to calculate risk. |
| Maternal serum AFP & ungonjugated estriol | These levels are low while hCG is elevated when a fetus has Down's syndrome. More accurate than AFP alone. |
| Chorionic villi sampling | Done for the same reasons as amniocentesis, but can be done earlier at 8 weeks. |
| Fetoscopy | Used to directly view the fetus, only done in a few places, can view more detail of fetus. Risk of premature labor. Can be used to do intrauterine surgery. |
Created by:
jrb265
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