Assessment of Pregnancy and Fetal Well-Being

Ultrasonography indications

Fetal heart activity, growth, anatomy, genetic disorder

Placental position and functioning

Adjunct to other invasive tests

Cervical thickness and length

Doppler blood flow analysis

use of ultrasound for noninvasive measurement of blood flow in the fetus and placenta

Oligohydramnios

Too little amniotic fluid (AFI <5)

- Baby swallows fluid but maybe isn't peeing enough back out

- Could indicate kidney insufficiency or fluid leakage

Polyhydramnios

Too much amniotic fluid (AFI >25)

- Blockage in baby's GI so it can't swallow the fluid

Biophysical profile

A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction

Normal fetal breathing movements

At least one episode of fetal breathing movements

Normal muscle tone

1 or more episodes of active extension/flexion of limbs, etc. (i.e. opening and closing a hand)

Normal fetal movement

at least 3 trunk/limb movements in 30 minutes

Normal amniotic fluid

1 or more adequate pockets of fluid

Normal non-stress test

reactive

Daily Fetal movement count (kick count)

maternal assessment of fetal movement by counting fetal movement in a period of time to identify

- movement is generally a sign of health

- once a day for 60 min or count until 10 movements (should be within 2 hours)

- Less than 3 movements per hour warrants further evaluation

- No movement in 12 hours = fetal alarm system (call provider)

Amiocentesis

a procedure in which a syringe is inserted through a pregnant female's abdominal wall into the amniotic fluid surrounding the developing fetus to obtain fluid for testing

- Genetic disorders

- Congenital anomalies

- Assessing lung maturity

Can be done after 14 weeks

amniocentesis maternal complications

Hemorrhage

Infection

Labor

Abruptio placentae

Damage to intestines or bladder

Amniotic fluid embolism

amniocentesis fetal complications

Death, hemorrhage, infection, direct injury from needle

Chorionic villus sampling

removal of a small piece of chorion for genetic analysis

Percutaneous Umbilical Blood Sampling (cordocentesis)

Insert needle into fetal umbilical vessel for fetal blood sampling and transfusion

Alpha-fetoprotein (AFP)

screens for neural tub defects between 14-34 weeks

Multiple marker screens

detects chromosomal abnormalities

increased risk for trisomy 21

Coombs' test

Rh incompatibility

Detects other antibodies for incompatibility with maternal antigens

Electronic fetal monitoring

To determine if the intrauterine environment is supportive to the fetus

Nonstress test

Determines fetal activity

-FHR monitored for 20-30 and tracing is observed for signs of fetal activity and concurrent acceleration in FHR

-Makes sure baby is getting enough oxygen from placenta

reactive nonstress test

2 accelerations in 20 minutes each lasting 15 secs and 15 bpm above baseline

-Accelerations happen when baby moves

Contraction stress test

Identify jeopardized fetus that is stable at rest, but compromised with stress

-Contractions stimulated with nipple stimulation or oxytocin until 3 contractions lasting 40-60 sec in 10 mins)

-FHR monitored

-Toco (contraction monitor) senses when mom contracts

-Tracing observed to see how baby responds to contractions

Negative contraction stress test

(Normal) A negative result is represented by no late decelerations of fetal heart rate (FHR).

External fetal monitors

Ultrasound transducer: monitors fetal heart rate

Uterine Tocotransducer: monitors uterine contractions

- Cannot report strength of contractions

Internal monitors

fetal scalp electrode: pokes into baby's head to collect heartbeat

intrauterine pressure catheter: similar to TOCO but can tell us contraction strength

- Membranes must be ruptured and cervix must be dilated enough

fetal heart rate

Baseline heart rate = 110 - 160 bpm (for full term fetus)

Variability - irregular fluctuations (normal)

- Moderate variability fluctuates 6-25 bpm

Acceleration

abrupt increase in FHR above baseline

- Positive thing to tell us baby is moving and placenta is working

Early decelerations

Caused by head compression usually as head gets lower in cervix: typically a good sign

- Mirror image of contraction

Variable decelerations

Caused by cord compression: more than 1 not good

- Happen with or without contraction

- Abrupt deep and wide section below baseline

- Give O2, fluid, and change position

Late decelerations

caused by uteroplacental insufficiency: NOT GOOD

- happens after contraction

- need to give O2, fluid, and change position

- notify provider

Prolonged decelerations

Dips down and stays down with decreased variability

- After a few minutes of this, usually head to C-section

VEAL CHOP

V- Variable C- Cord Compression

E- Early Decels H- Head Compression

A- Accelerations O - OK

L-Late Decels P - Placental insufficieny