Fetal well being

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For mother, high risk status arbitrarily extends through

puerperium (30 days after childbirth)

Leading causes of maternal mortality
in the United States

Pregnancy-induced hypertension
Pulmonary embolism
Hemorrhage

leading cause of neonatal death

Congenital anomaly

Ultrasonography

Fetal well-being
Amniotic fluid volume
Doppler blood flow analysis
Biophysical profile
Nursing role
Counseling and education regarding the procedure

First Trimester Transvaginal ultrasonography often used

Lithotomy position
Transvaginal probe inserted through the vagina
Typically takes 10-15 minutes

During 1st trimester measurement of the
_____________ is the most reliable indicator of gestational age

crown-rump length of the embryo

Fetal viability can be determined as early as

38 days

Second and Third Trimesters Transabdominal ultrasonography is common

Maternal position is supine with head and knees supported by pillows
After 20 weeks head should be elevated and body turned slightly to one side with a wedge
During the 2nd trimester a full bladder may be needed

The true gestational age must be determined when screening for

MSAFP

Oligohydramnios

ROM
Congenital anomalies
Renal agenesis (fetal kidneys fail to develop
Intrauterine growth restriction (IUGR)
Fetal distress in labor

Polyhydramnios

Neural Tube Defects
Fetal obstruction of GI tract
Multiple fetuses
Fetal hydrops (edema of the fetus)

Used in adjunct to manage high risk pregnancies associated with hypertension, IUGR, diabetes mellitus, multiple fetuses, preterm labor

Doppler Blood Flow Analysis

Elevated S/D ratios associated with

IUGR
Post-term pregnancy
Chromosomal abnormalities
Trisomy 13 and 18
Maternal lupus erythematosus
Smoking

Biophysical Profile

Non-invasive dynamic assessment
Fetal breathing movements
Fetal movement
Fetal tone
Fetal heart rate patterns (NST)
Amniotic fluid volume
Reveals central nervous system function

biophysical profile score (BPS) includes

A score of 8 or 10 is considered normal. A score of 0 or 2 is never considered normal. Scores of 4 and 6 are worrisome

Amniocentesis

Aspiration of amniotic fluid from the amniotic sac for examination
Performed during 2nd or 3rd trimester
2nd trimester amniocentesis is performed for fetal genetic abnormalities and is best performed between 15-20 weeks

a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother

Abruptio placentae

Purpose of second trimester amnio is to examine

identify chromosomal or biochemical abnormalities
detect high levels of AFP
Evaluate fetal condition when the woman is sensitized to Rh positive blood
Diagnose intrauterine infection
Test amniotic fluid AFP when MSAFP is abnormal and cause cannot be determined

Third trimester amnio is usually performed to determine

fetal lung maturity
Diagnose fetal hemolytic disease

Diagnose fetal hemolytic disease

Determination of fetal bilirubin concentration, it reflects the amount of fetal RBC destruction that occurs when maternal antibodies destroy Rh positive fetal RBCs

variation when excess amniotic fluid is removed and discarded

Reduction amniocentesis

Percutaneous umbilical blood sampling (PUBS) or cordocentesis

Direct access to fetal circulation
Fetal blood sampling
transfusions
Insertion of needle directly into a fetal umbilical vessel under ultrasound guidance

Chorionic villus sampling (CVS)

Removal of small tissue specimen from fetal portion of placenta
Used for diagnosis of fetal chromosomal, metabolic or DNA abnormalities between 10 and 12 weeks gestation

Cannot be used to diagnose anomalies for which amniotic fluid is essential

Chorionic villus sampling (CVS)

CVS is recommended for

women who are at high risk for an infant with genetic anomalies that can be diagnosed from fetal cells
Women >35 years, history of previous fetus with anomalies, or couples who exhibit genetic defects
Can be useful to identify the Rh type of a fetus at risk

Following the Chorionic villus sampling (CVS) procedure

the fetal heart motion and maternal vital signs are assessed
Heavy bleeding or the passage of amniotic fluid, clots or tissue suggest possible miscarriage and should be reported
Women rest at home several hours after the procedure

Following the transvaginal Chorionic villus sampling

RhoGam should be administered to all unsensitized Rh negative women following the procedure

Maternal serum levels screened for neural tube defects (NTDs)

Alpha-fetoprotein (AFP)

Test for Rh incompatibility
Detects other antibodies for incompatibility with maternal antigens

Coombs' test

Electronic Fetal Monitoring Indications

Fetal responses to hypoxia and asphyxia
Variability
Nonstress test (fetal activity determination)
Procedure
Interpretation
Vibroacoustic stimulation

Contraction stress test (CST)
Procedure

Procedure
Nipple-stimulated contraction test
Oxytocin-stimulated contraction test
Interpretation
Provides a warning of fetal compromise earlier than NST

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