health promotion and maintence.docx

health promotion and maintence.docx - Assessment Antepartum...

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Assessment - Antepartum Fetal The goal of fetal surveillance is to prevent fetal death and to help ensure the best possible fetal outcome Antenatal assessment o First and second trimesters: emphasis is on diagnosis of fetal congenital anomalies o Third trimester: emphasis is on determining the quality of the intrauterine environment for the maturing fetus First Trimester Assessments: Chorionic villi sampling (CVS) o Typically performed between 10 and 12 weeks gestation o Used to obtain a fetal karyotype o Involves obtaining a sample of chorionic villi from the placenta via a syringe/needle o Allows a woman earlier/safer timing for pregnancy termination as results are obtained quickly Basic ultrasound screening o Performed transvaginally (a lubricated transducer probe is placed in the vagina) or abdominally (after application of a transmission gel) depending on gestation o Can be performed in the outpatient or inpatient setting in all three trimesters o A full bladder enhances visualization when abdominal ultrasound is performed o Confirms viability age of the pregnancy o Determines
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the number of gestational sacs the size of the gestational sac location of gestational sac o Identifies uterine abnormalities rule out an ectopic pregnancy locate the presence of an intrauterine contraceptive device o Indicates fetal presentation o Measurements can be taken to confirm/estimate gestational age o Identifies morphologic anomalies Second Trimester Assessments: Quad marker screening (also called maternal serum expanded alpha-fetoprotein [AFP] screening) o A screening test performed at 16 weeks gestation to assess risk for chromosomal anomalies and neural tube defects o Maternal blood sample is drawn and sent out for analysis o Measure blood serum levels of: maternal serum alpha fetoprotein (MSAFP), human chorionic gonadotropin (HcG), unconjugated estriol (UE), and inhibin A MSAFP = a protein produced by the baby's liver HcG = a hormone produced by the placenta UE = a protein produced in both the placenta and the baby's liver inhibin A = a hormone produced in the placenta o Does not indicate absolutely that abnormalities are detected, only the further investigation is recommended Amniocentesis o May be performed as early as 12 weeks gestation
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o A procedure performed to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes, development, viability and lung maturity o Performed under ultrasound guidance o Rh negative mother must receive RhoGAM® immediately after the procedure to prevent isoimmunization o Risks include: amnionitis spontaneous abortion preterm labor/delivery premature rupture of membranes o Recommended for women 35 years of age or older and any pregnant woman with an abnormal quad marker screening o Frequently performed late in pregnancy to provide information about fetal lung maturity lecithin and sphingomyelin are protein components of surfactant, a lung
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Christopher Reinemann
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