Term
| What are indication for fetal diagnostic testing? |
|
Definition
1. Biophysical-risk factors that originate within the mother
or fetus-affect the development or function of either
2. Psychosocial-risks comprised of maternal behaviors
and adverse lifestyle that have a negative effect on
the health of the mother and/or fetus
3. Sociodemographic-risks arise from the mother and her family and place the mother and fetus at risk
4. Environmental-risks include hazards of the workplace
and the woman’s general environment |
|
|
Term
| What are examples of environmental risks to a fetus? |
|
Definition
a. infections
b. radiation
c. chemicals
d. therapeutic drugs
e. illegal drugs
f. industrial pollutants
g. smoke, stress, diet |
|
|
Term
| What are examples of Sociodemographic risks to a fetus? |
|
Definition
a. low income
b. lack of PN care
c. age
d. parity
e. marital status
f. residence
g. ethnicity |
|
|
Term
| What are examples of Psychosocial risks to a fetus? |
|
Definition
a. smoking
b. caffeine
c. alcohol
d. drugs
e. psychologic status
-h/o physical/verbal abuse
-inadequate support systems
-noncompliance with cultural norms
-situational crises
-unsafe cultural, ethical, or religious practices |
|
|
Term
| What are examples of biophysical risks to a fetus |
|
Definition
a. genetics
-defective genes
-inherited disorders
-chromosomal anomalies
-multiple pregnancies
-ABO incompatibility
b. nutritional status
-teen moms, vegans
-3 pregnancies in last 2 years
-tobacco, alcohol, or drug use
-inadequate or excessive weight gain
-Hct less than 33%
c. medical or obstetric
-chronic HTN
-PIH
-GDM or IDDM
-h/o PTL
-AMA
-h/o stillborn, fetal death
-sickle cell
-heart disease
-HIV
-bleeding problems |
|
|
Term
| What are nursing interventions for some of the fetus damage risk factors? |
|
Definition
1. Complete PN interview with history
2. Offer access to services for health promotion
3. Discuss reasons for health diet and lifestyle practices
4. Emphasize need to keep PN visits and do lab work
5. Educate patient/partner to play an active role in
health of the mother and fetus |
|
|
Term
| What is a daily fetal movement count? |
|
Definition
a. simple, noninvasive, done at home
b. can be affected by fetal sleep cycle or maternal
drug use
c. presence of fetal movement is generally a sign
of good health
d. < 10 movements in 3 hours, CALL MD
e. 2 hours after a meal and still < 4, CALL MD
f. follow up with NST, CST, or biophysical profile |
|
|
Term
| What can a mom do to help promote fetal movement? |
|
Definition
|
|
Term
| What are indicators to use ultrasound? |
|
Definition
-gestational age
-multiple gestations
-fetal growth patterns
-fetal congenital anomalies
-placental position and maturity
-affects of disease process on the fetus
-assess fetal responses to intrauterine environ.
-assist with amniocentesis, CVS, fetoscopy, etc. |
|
|
Term
| What helps to lift up the uterus during an ultrasound? |
|
Definition
|
|
Term
| How does an ultrasound work? |
|
Definition
| reflections of echoes that are produced when sound waves are dispersed to and absorbed by tissues being scanned, there are no apparent risks to the baby or mother |
|
|
Term
| What are the advantages of a transvaginal probe U/S and when is it used? |
|
Definition
1. allows for better visualization of pelvis
2. good to use on obese patients
3. allows pregnancy to be determine earlier
4. well tolerated, no full bladder
5. helps detect ectopic pregnancies
6. used in adjunction with abdominal
scan to R/O PTL in 2nd & 3rd trimesters |
|
|
Term
| What are the advantages of abdominal scan U/S and when is it used? |
|
Definition
1. full bladder helps move uterus up
2. may be hard to use on obese pts.
3. more useful after 1st trimester
-fetal heart activity by 6-7 week by echo scanner |
|
|
Term
| How is gestation age determined by U/S? |
|
Definition
1. gestational sac dimensions-8 weeks
2. crown-rump length-7-14 weeks
3. biparietal diameter (BPD)-12+ weeks
4. femur length-12+ weeks |
|
|
Term
| When should the first U/S be conducted? |
|
Definition
|
|
Term
| What should be checked in the amniotic fluid (AFI or AFV) with U/S? |
|
Definition
1. ck fluid-filled pockets without fetal parts or cord
2. AFI-depth of fluid in all 4 quads
< 5cm=oligo
5-19 cm=normal
over 20 cm=poly
3. decreased AFV-largest pocket of fluid is <2 cm
4. increased AFV-multiple large pockets of fluid > 12 cm |
|
|
Term
|
Definition
noninvasive, no known effect on fetus
1. evaluate fetal growth
2. evaluate fetal structure
3. evaluate placental growth, position
4. AFV
5. maternal structures
6. biochemical status
h. soft tissue, metabolic, or functional malformations |
|
|
Term
| How and when is an Amniocentesis performed? |
|
Definition
a. transabdominal insertion of a needle into uterus
b. done after week 14 when uterus is in the abd. |
|
|
Term
| What are the indications for an Amniocentesis? |
|
Definition
-PN diagnosis of genetic disorders
collection of fetal cells in fluid
karyotype done
↑ AFP level-possible neural tube defect
-congenital anomalies
-assessment of lung maturity
L/S ratio of 2:1 or +PG or LBC >50,000 cts/UL
-dx fetal hemolytic disease |
|
|
Term
| What are complications that can arise from an Amniocentesis? |
|
Definition
-less than 1% of cases
-PTL/miscarriage
-infection
-hemorrhage(Rh – moms get Rhogam)
-amniotic fluid embolism
-injury to fetus/fetal death |
|
|
Term
| What is PUBS and when is it used? |
|
Definition
| PUBS-percutaneous umbilical blood sampling also known as cordocentesis (insert needle into fetal vessel using U/S) is used during 2nd or 3rd trimester for blood sampling or a transfusion, diagnosis of fetal blood disorders, karyotyping, blood typing or COOMBS |
|
|
Term
| What should be monitored when PUBS is conducted? |
|
Definition
| Assess FHR for 1 hour and rescan in 1 hour |
|
|
Term
| What is CVS and when is it done? |
|
Definition
chorionic villus sampling is done at 10-12 weeks, 90% done on >35 years old or greater
It consists of removing small tissue from fetal portion of placenta (transcervical or transabdominal approach)
Used to determine fetal genetic makeup
Because it is done so early neural tube defects cannot be detected. |
|
|
Term
| What are complications that can arise from CVS? |
|
Definition
| abortion, infection, bleeding |
|
|
Term
| What is given to Rh(-) mothers during pregnancy? |
|
Definition
|
|
Term
|
Definition
A test for Rh incompatibility, it also determines the severity of fetal anemia from hemolysis
-indirect=amt. of Rh+ antibodies in mom’s blood
-direct=presence of antibody-coated Rh+ RBCs |
|
|
Term
| What is the baseline for FHR? |
|
Definition
| Range of FHR in a 10 minute period in the absence of or between U/C’s 110-160 bpm |
|
|
Term
| What can cause variability in FHR? |
|
Definition
-result of fetal sympathetic/parasympathetic nervous systems
-can be affected by fetal sleep cycle, maternal analgesics, prematurity, congenital anomalies
-decrease in variability-possible sign of fetal distress or profound compromise |
|
|
Term
| What is fetal bradycardia? |
|
Definition
| FHR below 110 bpm for 10 minutes or more, indicative of fetal hypoxia |
|
|
Term
| What is fetal tachycardia? |
|
Definition
| FHR over 160 bpm for 10 minutes or more |
|
|
Term
| What is marked fetal tachycardia? |
|
Definition
|
|
Term
| What are causes to fetal tachycardia? |
|
Definition
-prematurity -mild hypoxia
-tocolytic agents -maternal fever
-maternal anemia -fetal activity |
|
|
Term
| What are the changes in FHR? |
|
Definition
-accelerations-usually assoc. with + FM
-decelerations-early, late, variable |
|
|
Term
| What is important to check before the baby leaves the hospital? |
|
Definition
|
|
Term
| What can cause bradycardia? |
|
Definition
|
|
Term
| What is the nurses role when a patient begins labor? |
|
Definition
a. record information on strip if unable to chart
b. vaginal exams
c. assess if ROM
d. VS assessments
e. position changes when needed
f. oxygen via mask
g. medications
h. emesis control
i. assess need for internal monitors |
|
|
Term
| What are FH early deceleration patterns? |
|
Definition
-rarely below 110 bpm
-periodic decels R/T intense fetal head compression
-uniform shape, mirror image of U/C |
|
|
Term
| What are FH late deceleration patterns? |
|
Definition
-uniform-reflects shape of contraction
-onset after peak of U/C
-repetitious |
|
|
Term
| What is the cause of late deceleration patterns? |
|
Definition
-hypotension -PIH
-hypertonic contractions -uteroplacental insufficiency
-abruptio -postmaturity
-IUGR -DM |
|
|
Term
| What action should be conducted when late deceleration patterns are observed? |
|
Definition
-oxygen -position change
-stop pitocin drip -IV hydration
-assess other S & S |
|
|
Term
| What are variable deceleration patterns? |
|
Definition
-U or V shaped
-with or without U/C
-R/T cord compression
-usually transient, changeable |
|
|
Term
| What action should be conducted when variable deceleration patterns are observed? |
|
Definition
change to side lying oxygen
external fetal manipulation SVE
knee-chest position
amnioinfusion if ROM |
|
|
Term
|
Definition
|
|
Term
| What determines the severity of variable deceleration patterns? |
|
Definition
| If it is at the end of labor it is not a big deal but if it is at the beginning it is a problem |
|
|
Term
| What is a Nonstress test- (NST)? |
|
Definition
| The nonstress test is a simple, noninvasive way of checking on a baby's health. The test records the baby's movement, heartbeat, and contractions. It notes changes in heart rhythm when the baby goes from resting to moving, or during contractions if in labor. |
|
|
Term
| What will a healthy fetus with an intact CNS show on a NST? |
|
Definition
90% will have FHR accelerations with gross body movements
Reactive if:
-normal baseline rate
-2 or more accelerations (15X15) in 20 min.
-moderated variability |
|
|
Term
| What causes blunted, nonreactive, or unsatisfactory NST results? |
|
Definition
hypoxia, acidosis, drugs, fetal sleep
-need further monitoring, consider CST/BPP |
|
|
Term
| What is an advantage to a Contraction stress test vs NST? |
|
Definition
| provides a warning of fetal compromise earlier than NST. |
|
|
Term
| What do contractions do to fetal circulation? |
|
Definition
Decrease uterine blood flow/placental
perfusion-hypoxia to fetus=deceleration in FHR |
|
|
Term
| How long is the fetal heart rate monitored in a CST? |
|
Definition
|
|
Term
| What does a nipple-stimulated contraction performed? |
|
Definition
1. Massage the nipple until contraction is elicited
2. Desire 3 U/C’s/10 minutes/lasting 40-60 sec |
|
|
Term
| How is a oxytocin-stimulated CST conducted |
|
Definition
1. IV infusion of oxytocin to start U/C’s
2. increased in 0.5 mU/min increments |
|
|
Term
| What are negative results in a CST? |
|
Definition
|
|
Term
| What are positive results of a CST? |
|
Definition
| Persistent and consistent late decels with more than half the contractions |
|
|
Term
| How might monitoring fetal oxygen saturation be helpful? |
|
Definition
1. FSpO2 may be helpful in differentiating fetal hypoxia.
2. normal FSpO2 may prevent unnecessary interventions when a nonreassuring FHR pattern is identified
3. May indicate need for ROM
4. May be used in adjunct to EFM |
|
|
Term
| What is the normal FSpO2 during labor? |
|
Definition
|
|
Term
| What might cause the FSpO2 to have an error? |
|
Definition
| if improperly placed, too hairy, or too much vernix |
|
|
Term
| What are 5 variables when assessing a fetus? |
|
Definition
1. fetal breathing movements
-normal (2):
one or more episodes in 30 min lasting > 30 seconds
-abnormal (0):
absent or no episode matching requirement above
2. gross body movements
-normal (2):
3 or more movements/30 min
-abnormal (0):
none or less than 3/30 min
3. fetal tone
-normal (2):
1 or more active extension with return to flexion
-abnormal (0):
slow extension with return
4. reactive fetal heart rate
-normal (2): 2 or more accels with +FM/20 min
-abnormal (0): less than requirement
5. qualitative amniotic fluid volume
-normal (2): 1 or more pockets of fluid > 1 cm in
2 perpendicular planes
-abnormal (0): pockets absent or below needed |
|
|
Term
| What do the different Fetal Assessment scores mean? |
|
Definition
normal = 8-10 if AFI ok
equivocal = 6
abnormal = <4 |
|
|
Term
| What is the role of the nurse in fetal assessment testing? |
|
Definition
1. support person when the woman is undergoing exams
such as U/S, amnio, PUBS, CVS, etc
2. in some settings, the RN will perform the NST, CST,
BPP, and basic U/S
3. patient teaching
-preparation for procedure, interpreting the findings, providing psychosocial support PRN |
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