OB TEST THREE SG - REAL (003) (3).docx - 1 OB TEST THREE Chapter 19 Assessment of fetal well being Indications for Testing Age of mom \u2013 under 16 or

OB TEST THREE SG - REAL (003) (3).docx - 1 OB TEST THREE...

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OB TEST THREE Chapter 19: Assessment of fetal well being Indications for Testing Age of mom – under 16, or above 35 Maternal conditions – DM, preeclampsia, heart disease, HTN Rh Isoimmunization – if (-) factor Hx. Of Stillbirth or babies with anomaly IUGR (in previous or this preg) Less than 42 weeks gestation – applies to people without prenatal care (don't let them past 42 weeks) Amniotic fluid concerns – oligohydramninos or polyhydramnios Multiples Abnormal test results during pregnancy - ex. Gestational DM Assessment of Fetal Well-Being in the First Trimester Viability (is she pregnant, is pregnancy alive) o Quantative beta hCG testing (blood test) In maternal blood 8-11 days’ post-conception Peaks at 2-3 mos of gestation Stable or decrease level = possible ectopic or miscarriage Should be doubling every day or two days for first few weeks Progesterone level testing o Secreted by the corpus luteum until the 8 th week and then placenta takes over Levels more than 25 = normal Levels between 5-25 = inconclusive Less than 5 = nonviable Ultrasound (can do every trimester, just looking for different things) 1
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o Sonogram = picture produced by the U/S o Modes of ultrasound Motion (M) = cardiac activity (HR by 6 weeks) Brightness (B) = produces a 2-dimensional image, or 3-dimensional o Methods of Ultrasound Transabdominal Requires full bladder Use after 1 st trimester (when uterus big enough) Time – 20-30min Safe and non-invasive Decrease anxiety by explanation and visualization Risks – not known Transvaginal – in first trimester because the baby is so small Invasive Does not require a full bladder Useful when patient is obese/poor visualization Can identify structures (cardiac activity) Useful in first trimester (ectopic preg dx, identify abnormalities, determine gestational age – crown-rump length) 3 rd trimester – evaluate for preterm labor Translabial – occurs on L+D to see which part is going to present (head or butt), or is placental previa and cervical length Doppler 2
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Non-invasive External Measures velocity of RBCs in uterine and fetal vessels Useful for assessing IUGR , poor placental perfusion , at risk preg (HTN, DM, multiples, and PTL) Benefits and Risks of Ultrasound Benefits : o Positive pregnancy verification by 6 weeks o Verify multiples o GA determination o Anomaly detection – esp. anencephaly (no brain or spinal cord), IUGR, hydrocephalus o Poly or oligo hydramnios o Determination of amniotic fluid pocket size (areas of amniotic fluid surrounding baby should be at least 1-2cm. If <1 cm. associated with perinatal death – if <2cm. associated with oligohydramnios) o Placental location and grading (increased placental maturity = increased placental calcification. Lung maturity = grade 3 placenta) Risks = none known *Leopolds manuvers = positing the baby through palpation Gestational Age 3
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o Methods LMP Uterine size (measuring fundal height) Audible fetal heart tones (6w on U/S, 10-12w on Doppler, 16-18w on scope) Quickening (16- 20w ) U/S Nuchal Translucency Testing (11-13w)
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