1. Assessment of
Fetal Well-Being

2. Ultrasound
Ultrasound

3. Ultrasound
Definition -- 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 pregnancy
Determine how advanced the pregnancy is
Detect congenital anomalies and problems
Localize the placenta
Assess fetal viability – heartbeat, breathing movements
Diagnose cardiac problems
Detect fetal presentation, number of fetus

5. Ultrasound It is a non-invasive and painless procedure
Results are immediate
Allows the mother and family to “see” the baby

6. 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 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 amniocentesis
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 and chromosome abnormalities.

8. Chorionic Villi Sampling

9. Chorionic Villi Sampling
Removal of small tissue specimen from the fetal portion of the placenta
Tissue obtained about weeks gestation
Chromosomal 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
AMNIOCENTESIS 9
Collection of Amniotic Fluid for Testing

12. Amniocentesis An invasive procedure
Requires a consent form to be signed
Performed about weeks gestation
Patient must be informed of possible complications
Trauma
Infection
Hemorrhage

13. Amniocentesis Preparation Procedure Post care / Discharge Teaching
Permits signed
Vital Signs and FHT’s
Abdominal prep and scrub
Procedure
Area of insertion is anesthesized and a needle inserted into the amniotic cavity and ml of fluid withdrawn for analysis
Post care / Discharge Teaching
Vital signs and FHT’s normal
No leakage of fluid from site
Teach 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 Test
AFP
hCG
Unconjugated estriol
Genetic studies
Most commonly used to diagnose Downs
Fetal Lung Maturity
L/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 weeks
Fetal maturity is attained when the L/S ratio is 2 : 1
Assesses Fetal Lung Maturity

17. Karotyping and Cell Enzyme Studies
Determine
sex of the
fetus
Normalcy of
Chromosomes

18. Non-Stress Test
NST

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 accelerate
This 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 documented
Compare the FHR with the fetal movements
Results:
Reactive -- two accelerations of 15 BPM lasting 15 seconds, associated with fetal movement. This is an indication of fetal well-being
Nonreactive -- no accelerations of FHR. Indication of need for further assessment

21. Non-Stress Test
Example 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 Test
Example 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.

24. Oxytocin Challenge Test
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 attached
Goal -- have 3 contractions in 10 minutes
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

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.

28. Biophysical Profile

29. Biophysical Profile Comprehensive assessment of five
Biophysical variables:
Fetal breathing movement
Fetal movements of body or limbs
Fetal tone (extension and flexion of extremities)
Amniotic fluid volume – visualized as pockets around the fetus
Reactive FHR with activitity (reactive NST)

30. 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

31. 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 baby.

32. Kick Counts
The mother should assess fetal movements called “kick counts” each day.
Fetal movement is associated with the condition of the fetus.

33. The End