1. Determination of Estimated Birth Date
It is impossible to predict the day of birth.
Estimated date of birth - EDB, EDD or EDC.
280 days - 38 to 42 weeks in length.
Nagele’s rule:
1st day of last menstrual period.
Count back 3 months and add 7 days.
Normal variations - if ovulation and fertilization occurs early or late in the menstrual cycle the pregnancy may be 2 weeks before or 2 weeks after the EDD.

3. Fetal Growth and Development
Nurses responsibility
signed consent form with information on the procedure and possible risks
scheduling the procedure
explaining the procedure to the woman and support person
preparing the woman physically and psychologically
providing support during the procedure
assessing both fetal and maternal responses to procedures
provide follow up care
manage equipment and specimens

4. Fetal Growth and Development
Estimated Fetal Growth:
McDonald’s rule - method of determining, during mid pregnancy, that the fetus is growing in utero by measuring fundal (uterine) height.
Distance from fundus to symphysis in centimeters is equal to the week of gestation between week 20 to 31.
Measure from the notch of the symphysis pubis to over the top of the fundus with woman lies supine.
This becomes inaccurate in 3rd trimester because the fetus is growing in wt. than height.
Milestones:
12 weeks- over symphysis pubis
20 weeks at umbilicus
36 weeks xiphoid process

5. Fetal Growth and Development
Assessing Fetal Well-Being:
Fetal movement - quickening week 18 to 20
peaks at week 28 to 38
healthy fetus moves 10 times a day.
Ask mother to lie in left recumbent position after a meal and record number of fetal movements in next hour.
2 times in 10 minutes
fewer than 5 in 1 hour - notify the doctor.

6. Assessing Fetal Well-Being
Fetal Heart Rate:
120 to 160 beats per minute throughout pregnancy.
Week 10 to 11 heart sounds can be heard and counted with a doppler.
Rhythm Strip Testing:
baseline fetal heart rate per minute and long and short term variability.
Place woman in semi-fowlers (prevents supine hypotension syndrome).

7. Assessing Fetal Well-Being
Monitors are attached abdominally and recorded for 20 minutes (mother in fixed position)
Short term variability- beat to beat variability- denotes small changes in rate from second to second if parasympathetic nervous system is receiving adequate O2 and nutrients.
Long term variability - denotes the differences in heart rate that occur over 20 minutes (fetus moves 2x/10 min) increases with movement.

8. Assessing Fetal Well-Being
This reflects fetal sympathetic nervous system.
Nonstress Testing:
measures response of fetal heart rate to movement.
Monitors are attached to abdomen
mother pushes a button attached to the monitor when she feels the fetus move.
FHR should increase 15 beats/ min and remain elevated for 15 seconds.

9. Assessing Fetal Well-Being
Decreases when fetus quiets. If no increase is noticeable with movement poor O2 perfusion of fetus id suggested.
Test lasts 10 to 20 minutes.
If no fetal movements in 20 minutes fetus may be sleeping.
Orange juice or carbohydrate may increase blood glucose level which stimulate the fetus. Also loud noise may stimulate fetus.

10. Assessing Fetal Well-Being
Vibroacustic Stimulation:
Acustic stimulation (artificial larynx) applied to abdomen to produce a sharp sound, startling and waking the fetus.
80 dB frequency of 80 Hz.
Contraction Stress Testing:
FHR is analyzed in conjunction with contractions.
Mother stimulates the nipple which releases oxytocin which initiates uterine contractions

11. Assessing Fetal Well-Being
External uterine contraction and FHR monitors are applied
3 contractions with duration of 40 seconds or more present in a 10 minute period.
Normal (negative) when no FHR decelerations are present with contractions.
Abnormal (positive) 50% or more contractions cause a late deceleration (dip in FHR) toward the end of a contraction and continues after the contraction.
Woman waits 30 min after the test.

12. Assessing Fetal Well-Being
Ultrasound:
response of sound waves against objects.
Diagnose pregnancy at 6 weeks gestation
confirm presence, size, and location of placenta and amniotic fluid.
Establishes fetal growth, gross defects
Establish presentation and position (sex)
Predict maturity by biparietal diameter
Mother has to have a full bladder ( drink a full glass of water q 15 min. in 1 1/2 hours

13. Assessing Fetal Well-Being
Place a towel under the right buttock to tip uterus away from the vena cava.
Gel applied to abdomen (room temperature)
Transducer is applied intravaginal or abdominal
Picture of sonogram
Biparietal Diameter:
measures side to side measurement of fetal head (8.5cm or more infant weighs > 2500g 5.5 lb) 40 week gestation.

14. Assessing Fetal Well-Being
Also measures head circumference and femoral length.
Doppler Umbilical Velocimetry:
Measures velosity at which RBC and vessels are traveling.
Placental Grading:
amount of calcium deposits in base of placenta.
Amniotic Fluid Volume Assessment:
average index is 15 cm between wks.

15. Assessing Fetal Well-Being
ECG at week 11 of pregnancy (inaccurate before week 20 because fetal electrical conduction is week).
MRI used to diagnos ectopic pregnancy or trophoblastic disease.
Maternal Serum Alpha-Fetoprotein is a substance produced by the fetal liver that is present in amniotic fluid and maternal serum. Begins to rise at week 11.
Detects Down Syndrome, open spinal or abdominal defects.

16. Assessing Fetal Well-Being
Triple Screening - analysis of 3 indicators:
Maternal serum Alpha-fetoprotein
unconjugated estriol
hCG
used for Downs syndrome
Chorionic Villi Sampling (CVS)
biopsy and analysis for chromosomal analysis done at week 10 to 12.

17. Assessing Fetal Well-Being
Amniocentesis:
aspiration of amniotic fluid from the uterus for examination.
Week 12 to 13
1 mL of fluid is needed
3 to 4 in 20 to 22 gauge spinal needle
woman rest for 30 minutes after the procedure
constant monitoring for FR and contractions
if Rh-neg. blood give RhoGAM

18. Assessing Fetal Well-Being
Amniocentesis:
color of water or slight yellow tinge
strong yellow- bilirubin
green- meconium
lecithin/ sphingomyelin ratio
protein components of lung enzyme surfactant that alveoli form week 22-24
phosphatidyl glycerol and desaturated phosphtidylcoline
found in surfactant

19. Assessing Fetal Well-Being
Bilirubin Determination
must be blood free to analyze bilirubin
Chromosome Analysis
uses fetal skin cells for karyotyping
Fetal Fibronectin
glycoprotein that helps placenta attach to the uterine decidua ( preterm labor).
Inborn Errors of Metabolism
inherited diseases from inborn errors

20. Assessing Fetal Well-Being
Alpha-Fetoprotein
Percutaneous Umbilical Blood Sampling
aspiration of blood from the umbilical vein for analysis
Amnioscopy
visual inspection of amniotic fluid through the cervix and membranes with a small fetoscope (detects meconium).
Fetoscopy
visualizing the fetus with fetoscope

21. Assessing Fetal Well-Being
confirms intactness of spinal column
biopsy of fetal tissue and blood sample
surgery
photos
done week16 to17 at the earliest
risks-premature labor, infection .

22. Assessing Fetal Well-Being
Biophysical Profile (fetal Apgar)
combines 4 to 6 parameters into one assessment
fetal movement and breathing, fetal tone, amniotic fluid volume, placental grading
fetal heart reactivity.
more accurate in predicting well being than any single assessment.
a score of 4 to 6 denotes a fetus in jeopardy.