Assess Fetus Part 2

THINKING POINT: Are the fetal surveillance methods considered screening or diagnostic tests?

Fetal surveillance is screening

Oxygen is carried from the environment to the fetus along a pathway that includes the maternal lungs, heart, vasculature, uterus, placenta, and umbilical cord. When is antepartum fetal surveillance done?

24-32 weeks in high risk preg.

If a mother has severe hypertension this will interrupt oxygenation. Elevated blood pressure causes ______ in both maternal and placental vasculature. If there is an insufficient  oxygen  exchange  between  mom  and  fetus,  the  fetus  will  respond ___ because it is not adequately being oxygenated.

vasoconstriction, negatively

THINKING POINT: If a fetus is not being adequately oxygenated, what might we see on the fetal monitor strip?

tachycardia

 

If we identify a mother who has high blood pressure, we can treat her with hypertensives and reverse the process to for allow improved blood flow to the fetus so adequate oxygen exchange can take place. However, If this goes on and is not treated (if the oxygenation pathway is continuously interrupted) it can lead to what?

 

neuro injury, death of baby, still birth

Maternal perception of 10 distinct movements in a 1-2 hour period is reflective of what?

non hypoxic fetus

Fewer fetal movements than expected suggests what?

Reduced placental perfusion w/ fetal hypoxia

What specific fetal position might make it more difficult for a woman to recognize fetal movement?

breech

What specific placental position might make it more difficult for a woman to recognize fetal movement?

anterior

What is uteroplacental insufficiency

Inability of placenta to exchange oxygen, co2, nutrients, waste products

What do we want to see during an NST?

Increase in fetal heart rate when fetus moves

What is an acceleration?

Increase in fetal HR

What do accelerations indicate? Are accelerations good or bad

Good, intact central nervous system 

PROCEDURE: Where can an NST be performed

hospital or clinic (non invasive)

INTERPRETATION: What does a “Reactive” NST consist of

assuring, two or more fetal hr acclerations in 20 mins period

INTERPRETATION: How is a “Non-Reactive” NST defined?

Not assuring, tracing doesn’t show the required characteristics of a reactive tracing in 40 mins

What maternal actions can affect fetal movement

Narcotics, smoking, drinking alcohol

Where is the vibroacoustic stimulator applied?

abdomen

How long can vibroacoustic stimulation be applied for? AND how often can it be repeated if no response is elicited?

1-2 seconds, 3 times

what would be the expected result from the fetus after vibroacoustic stimulation is applied

Responds by showing acceleration In fetal HR

In preparing a pregnant patient for a nonstress test (NST), which of the following should be included in the plan of care?

Position the patient for comfort

adjusting the monitor belt to locate FHR

A patient at 36 weeks gestation is undergoing a nonstress (NST) test.
The nurse observes the fetal heart rate baseline at 135 beats per minute
(bpm) and four no episodic patterns of the fetal heart rate reaching 160
bpm for periods of 20 to 25 seconds each. How will the nurse record
these findings?

C. NST reactive, reassuring

CST: This test examines how the fetal heart rate (FHR) responds to what?

uterine contractions

During a contraction, what happens to blood flow to the placenta?

Interrupted as resulted of blood vessels compress

In a compromised fetus, a brief interruption in oxygenation can result in what type of decelerations

Late decelerations could be hypoxia

Are late decelerations good or bad? Why?

BAD. If late decelerations continue, the fetus progressively deteriorates

defined as a gradual FHR decrease (> or equal to 30 seconds) from the FHR baseline with the nadir (lowest part of the deceleration) occurring after a contraction peaks, followed by a gradual recovery to baseline after a contraction ends. What is the term for this?

Late Decelerations

Why is a Contraction Stress Test only performed in a hospital setting? in case of what?

Immediate delivery or c section

TEST CRITERIA: 3 spontaneous contractions should be present within a 10 minute period. The duration of each contraction should be_____ seconds or longer. When adequate contractions are not present, ______ _____ or nipple stimulation is required.

40, INCREASE OXYTOCIN

When should an NST NOT BE PERFORMED

Pt in which vaginal delivery is not recommended : placenta previa, preterm , multiple fetuses,  or c section

INTERPRETATION: Describe a Negative CST.

REASSURING, We want this!

INTERPRETATION: Is a Negative CST a REASSURING finding that indicates fetal well-being?

YES, IT MEANS HR IS STABLE, NOT DECELLS, NOR DECREXEASE

INTERPRETATION: What happens if the CST is positive?

ABMORMAL intermittent late decelerations of significant variable decelarations, talk management, do we need to deliver now

Equivocal in CST

decelerations in the presence of contractions that are more frequent than every 2 mins or last longer than 90 secs

Unsatisfactory in CST

Fewer than 3 contractions in 10 mins or a tracing that can not be interpreted

Biophysical characteristics are a reflection of the central nervous system and allow us to evaluate what?

oxygenation

The components of the BPP are a combination of short and long term indicators of fetal well being and sufficient oxygenation. Identify each component below as either a short OR long term indicator. FHR, Fetal Breathing, movement, tone, amniotic fluid

FHR…short

Breathing…short

Movement…short

Tone…short

Amniotic Fluid…long term

What prompts the fetus to DECREASE their biophysical activities?

Disruptions in oxygenation leading to period of hypoxia, in order to preserve energy and oxygen

For how long are the biophysical characteristics evaluated via ultrasound?

20/30 mins

BPP: All 5 components are totaled together. Each component receives either a

______ or a _____.

0,10

INTERPRETATION: What is the term that refers to amniotic fluid volume that is less than expected for gestational age? SCORE OF 8/10 IS NORMAL UNLESS?

OLIGIO-HYRDRAM-MINIOS

INTERPRETATION: A score of 6 IS _____if there is NORMAL fluid. It is suspicious for fetal asphyxia if there is ABNORMAL fluid.

EQUIVICIAL

INTERPRETATION: A score of 0-4 usually results in what?

IMMEDIATELY DELIEVER,

RECALL: NST’s are ____ term indicators of how well a fetus is oxygenated and amniotic fluid is a ____term reflection of adequate oxygenation.

short, long

Why might a modified test be performed? (hint: think of time)

Not as time consuming, shorter

How is amniotic fluid volume assessed?

NST with ultrasound of amniotic fluid;

Normal: NST reactive, oligohydramnios measurement of amniotic fluid

Abnormal: non reactive NST, oligohydramnios or both

Amniotic fluid volume totals GREATER than ____what are REASSURING?

 greater than 5 cm and less than 24-25 cm is generally considered reassuring

Oligohydramnios: AFI < _____ Hydramnios

(excess amniotic fluid): AFI____>

5, 24

Fetal doppler ultrasound is for what??

ABNORMALITIES IN BLOOD, ACTUALLY: ASSESSMENT OF PLACENTAL CONDITION

In what type of pregnancies might a fetal doppler be used? (hint: low-risk or high-risk?) Examples?

 

SGA

HIGH RISK, HTN, FETAL GROWTH RESTRCITION, iUGR (intrauterine growth restriction)

Fetuses that are NOT growth restricted will have normal high velocity diastolic flow. Absent and/or reversed findings usually indicate poor outcomes including

still birth