fetal assessment
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Fetal Assessment
Presented by:Ann Hearn RNC, MSN
2010
Ultrasound
Definition -- an instrument which uses reflective sound waves as they travel in tissue to visualize structures in the body
Purposes of an Ultrasound
Placental location Assessment of gestational age Determining structural
abnormalities of the fetus Confirming an ectopic pregnancy or
hydatiform mole Determining multiple gestations
Ultrasound
It is a non-invasive and painless procedure
Results are immediate
Allows the mother and family to “see” the baby
Ultrasound -- Nursing Care
Make sure that the patient has a full bladder
Place patient on back with a towel roll under one hip -- allowing better perfusion of the placenta
The test requires about 20 - 30 minutes
Amniocentesis
Removal of amniotic fluid by insertion of a needle through the abdominal and uterine wall into the amniotic sac
Amniocentesis
An invasive procedure Requires a consent form to be signed Performed about 14 - 16 weeks
gestation Patient must be informed of possible
complications– Trauma– Infection – Hemorrhage– Preterm labor
Amniocentesis
Purporses:– Genetic disorders– Fetal health – Triple test
alpha-fetoprotein (AFP) human chorionic gonadotrophin (hCG) unconjugated estriol (UE3) Diameric Inhibin-A (soon to be added)
– Fetal lung maturity L/S ratio
Amniocentesis
Preparation– Vital Signs and FHT’s– Empty bladder– Abdominal prep and scrub– Ultrasound
Area of insertion is anesthesized and a needle inserted into the amniotic cavity
15 - 20 cc of fluid withdrawn for analysis
Amniocentesis
Amniocentesis
Post care / Discharge Teaching– Monitor V/S, FHT’s and UC’s – Observe for leakage of fluid from site– Teach patient to report –
Fetal hyperactivity or lack of fetal movement
Vaginal discharge: clear or bleeding Uterine contractions or abdominal
pain Fever or chills
L/S Ratio Lecithin /Sphingomyelin
Ratio
Lecithin and Sphingomyelin are two components of Surfactant.
Assesses Fetal Lung Maturity
L/S Ratio Lecithin /Sphingomyelin Ratio
As surfactant increases in the lungs, the levels of lecithin should also increase.
Lecithin become 2 - 3 times > spingomyelin by about 35 weeks
Fetal maturity = L/S ratio 2 : 1
Karyotyping
Determine sex of the fetus
Normalcy ofChromosomes
Karyotyping
Indications:– Maternal age 35 or > at time of birth (AMA)– Pervious child born with a chromosomal
abnormality– Mother carrying an X-linked disease– Parents carrying and inborn error of
metabolism– Both parents carrying an autosomal
recessive disease– Family history of neural tube defects
Karyotyping
Trisomy Monosomy
Alpha - Fetoprotein AFP
Measurement of a protein produced by the yolk sac and fetal liver
Elevated levels of AFP may be indicative of open neural tube defects because the AFP leaks out of the fetal circulation into the amniotic fluid
Low level associated with Down syndrome
Chorionic Villus Sampling
CVS Removal of small tissue specimen
from the fetal portion of the placenta
Tissue obtained about 8 - 12 weeks gestation
Chromosomal studies performed
Trans-cervical Chorionic Villus Sampling
Chorionic Villus SamplingCVS
Risks:– Failure to obtain tissue– Rupture of amniotic membranes– Leakage of amniotic fluid– Vaginal bleeding – Intraurterine infection– Rh Alloimmunization– Maternal tissue contamination of the
specimen– Increased risk of spontaneous abortion
Chorionic Villus SamplingCVS
Nursing interventions– Monitor :
vital signs FHR uterine contractions/cramping vaginal discharge
– Administer Rhogam if indicated– Teach patient to report:
Change in fetal movement Uterine contractions Vaginal discharge
Non-Stress Test (NST)
Assessment of fetal status Observation of fetal heart rate
associated with fetal movement. The FHR should increase or
accelerate with fetal movement FHR accelerations indicate an
intact CNS and adequate oxygenation
Procedure for an NST
Electronic fetal monitor is applied Fetal movements are documented Compare the FHR with the fetal
movements Results:
– Reactive -- at least two accelerations of FHR with fetal movement of 15 BPM, lasting 15 seconds or more, over 20 minutes.
– Nonreactive -- the reactive criteria are not met. Indication of need for further assessment
Non-Stress Test - Reactive
Contraction Stress Test - CST
A means of identifying the fetus that is at risk for intrauterine asphyxia. Usually shows if there is utero-placental insufficiency.
Procedure for an CST
Electronic fetal monitor attached IV oxytocin stimulation started Goal -- 3 contractions of good quality,
lasting 40-60 seconds over a 10 minute period
Results:– Negative -- 3 contractions in 10 minutes with
NO signs of late decelerations– Positive -- repetitive persistent late
decelerations occurring with more than half the contractions
Positive CST
Contraction Stress Test
Post OST Monitoring– FHR– Labor– SROM
Discharge instructions– Notify HCP for the following:
Regular painful contractions Leakage of amniotic fluid Decrease or increase in fetal movement Vaginal bleeding
Fetal AssessmentNon - Stress Test
Reactive Non - Reactive
Repeat in 1 - 2 weeks Reactive Stimulate
Non- ReactiveContraction Stress Test
Negative Positive
Repeat in 24 hours Further Evaluation
Negative Possible Delivery
NST in 1 week
Try This!
Which of the following is NOT an indication of fetal distress?A. A reactive NSTB. Non-reactive NSTC. A positive CSTD. A negative CST
Biophysical Profile
Comprehensive assessment of five biophysical variables:1. Fetal breathing movement2. Fetal movements of body or limbs3. Fetal tone (extension and flexion of
extremities)4. Amniotic fluid volume – visualized as
pockets around the fetus5. Reactive FHR with activitity (reactive
NST)
Biophysical Profile
By combining these five assessments, the BPP helps to
identify the compromised fetus and to confirm the
healthy fetus
Since it combines several assessments, it is a better
indicator of fetal well-being
Biophysical Profile
A score of 2 is assigned to each normal finding for a maximum score of 10.
Scores of 8-10 are considered normal
Lower scores are associated with a compromised fetus and warrant further assessment and possible delivery of the fetus.
BiophysicalVariable
Normal(Score = 2)
Abnormal(Score = 0)
Fetal breathing movements
1 or more episodes of >20 s within 30 min
Absent or no episode of >20 s within 30 min
Gross body movements
2 or more discrete body/ limb movements within 30 min (episodes of active continuous movement considered as a single movement)
<2 episodes of body/limb movements within 30 min
Fetal tone 1 or more episodes of active extension with return to flexion of fetal limb(s) or trunk (opening and closing of hand considered normal tone)
Slow extension with return to partial flexion, movement of limb in full extension, absent fetal movement, or partially open fetal hand
Reactive FHR
2 or more episodes of acceleration of >15 bmp* and of >15 s associated with fetal movement within 20 min
1 or more episodes of acceleration of fetal heart rate or acceleration of <15 bmp within 20 min
Qualitative AFV
1 or more pockets of fluid measuring >2 cm in vertical axis
Either no pockets or largest pocket <2 cm in vertical axis
Kick Counts
Non-invasive Goal: 10 kicks in < 2 hours
The End
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