3 UltrasoundDefinition -- an instrument which uses reflective sound waves as they travel in tissue to visualize structures in the body
4 Purposes of Performing an Ultrasound Validate the pregnancyDetermine how advanced the pregnancy isDetect congenital anomalies and problemsLocalize the placentaAssess fetal viability – heartbeat, breathing movementsDiagnose cardiac problemsDetect fetal presentation, number of fetus
5 Ultrasound It is a non-invasive and painless procedure Results are immediateAllows the mother and family to “see” the baby
6 Ultrasound Nursing Care Make sure that the patient has a full bladderPlace patient on back with a towel roll under one hip -- allowing better perfusion of the placentaThe test requires about minutes
7 Alpha - Fetoprotein AFP Measurement of a protein produced by the yolk sac and fetal liver. Main protein in fetal plasma. Diffuses from fetal plasma to fetal urine, excreted in amniotic fluid.Measured via maternal serum or amniocentesisElevated levels of AFP may be indicative of open neural tube defects because the AFP leaks out of the fetal circulation into the amniotic fluid and chromosome abnormalities.
9 Chorionic Villi Sampling Removal of small tissue specimen from the fetal portion of the placentaTissue obtained about weeks gestationChromosomal studies performed
10 Chorionic Villus Sampling Advantage – can be done earlier than an amniocentesis to detect problems.Disadvantage – spontaneous abortion
11 Collection of Amniotic Fluid for Testing AMNIOCENTESIS9Collection of Amniotic Fluid for Testing
12 Amniocentesis An invasive procedure Requires a consent form to be signedPerformed about weeks gestationPatient must be informed of possible complicationsTraumaInfectionHemorrhage
13 Amniocentesis Preparation Procedure Post care / Discharge Teaching Permits signedVital Signs and FHT’sAbdominal prep and scrubProcedureArea of insertion is anesthesized and a needle inserted into the amniotic cavity and ml of fluid withdrawn for analysisPost care / Discharge TeachingVital signs and FHT’s normalNo leakage of fluid from siteTeach patient to report -- lack of fetal movement, discharge or bleeding, abdominal pain, or fever
14 Amniocentesis Why is an Ultrasound performed as part of the procedure? To detect placement of the placenta
15 Amniocentesis Tests Performed Triple TestAFPhCGUnconjugated estriolGenetic studiesMost commonly used to diagnose DownsFetal Lung MaturityL/S ratio – lecithin-sphingomyelin ratio
16 L/S Ratio Lecithin / Sphingomyelin Ratio Lecithin is a major constituent of surfactant. As surfactant increases in the lungs, the levels of lecithin should also increase.Lecithin should become times greater than sphingomyelin by about 35 weeksFetal maturity is attained when the L/S ratio is 2 : 1Assesses Fetal Lung Maturity
17 Karotyping and Cell Enzyme Studies Determinesex of thefetusNormalcyofChromosomes
19 Non-Stress Test Evaluation of Fetal Status Observation of fetal heart rate associated with fetal movement.With movement of the fetus, the FHR should increase, or accelerateThis test is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are accelerations of FHR with movement.
20 Procedure for the NST Electronic fetal monitor is applied As the NST is done, fetal movements are documentedCompare the FHR with the fetal movementsResults:Reactive -- two accelerations of 15 BPM lasting 15 seconds, associated with fetal movement. This is an indication of fetal well-beingNonreactive -- no accelerations of FHR. Indication of need for further assessment
21 Non-Stress TestExample of a reactive non-stress test (NST). Accelerations of 15 beats per minute lasting 15 seconds with each fetal movement (FM). Top of strip shows FHR; bottom of strip shows uterine activity tracing. Note that FHR increases (above the baseline) at least 15 beats and remains at that rate for at least 15 seconds before returning to the former baseline.
22 Non-Stress TestExample of a nonreactive NST. There are no accelerations of FHR with FM. Baseline FHR is 130 beats per minute. The tracing of uterine activity is on the bottom of the strip.
23 NST Management Scheme***If test is non-reactive, woman is re-tested. If continues to remain non-reactive, will schedule an OCT.
25 Contraction Stress Test CST Oxytocin Challenge Test OCT A means of identifying the fetus that is at risk for intrauterine asphyxia.Usually shows if there is placental insufficiency.
26 Procedure for an OCT Oxytocin (Pitocin) stimulation started IV Electronic fetal monitor attachedGoal -- have 3 contractions in 10 minutesResults:Negative -- 3 contractions in 10 minutes with NO signs of late decelerationsPositive -- repetitive persistent late decelerations occurring with more than half the contractions
27 Oxytocin Challenge Test Example of a positive contraction stress test (CST). Repetitive late decelerations occur with each contraction. Note that there are no accelerations of FHR with three fetal movements (FM). The baseline FHR is 120 beats per minute. Uterine contractions (bottom half of the strip) occurred four times in 12 minutes.
29 Biophysical Profile Comprehensive assessment of five Biophysical variables:Fetal breathing movementFetal movements of body or limbsFetal tone (extension and flexion of extremities)Amniotic fluid volume – visualized as pockets around the fetusReactive FHR with activitity (reactive NST)
30 Biophysical ProfileBy combining these five assessments, the BPP helps to identify the compromised fetus and to confirm the healthy fetusSince it combines several assessments, it is a better indicator of fetal well-being
31 Biophysical ProfileA score of 2 is assigned to each normal finding for a maximum score of 10.Scores of 8-10 are considered normalLower scores are associated with a compromised fetus and warrant further assessment and possible delivery of the baby.
32 Kick CountsThe mother should assess fetal movements called “kick counts” each day.Fetal movement is associated with the condition of the fetus.