Naegeles Rule

count backward 3 calendar months from the first day

of the LMP and add 7 days.

Ex. LMP May 15 (April 15, March 15, February 15) 15 + 7

= 22. Date of Birth: February 22

ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT

metabolic or chromosomal disorder supporting structures such as placenta or cord do not form normally
environmental influences.

ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT

Much information about the size and

health of the unborn child can be gathered through a variety of assessment techniques.

Nursing responsibilities for assessment procedures include:

Signed consent

Scheduling the procedure

Explaining the procedure Preparing the woman physically and

psychologically Providing support during the procedure Assessing both fetal and maternal responses to the procedure Providing any necessary follow-up care Managing equipment and specimens

HEALTH HISTORY
Like all assessments, fetal assessment begins with health history. Ask specifically about:
Nutritional intake Personal habits i.e. smoking, recreational drug use,

exercise Any accidents or experienced intimate partner abuse

ESTIMATING FETAL GROWTH

McDonalds Rule a symphysis-fundal height measurement A common method of determining during mid-pregnancy, that a fetus is growing in the utero Typically, the distance from the uterine fundus to the symphysis pubis in centimetres is equal to the week of gestation between the 20th and 31st weeks of pregnancy McDonalds rule becomes inaccurate during the third trimester because fetus is growing more in weight than in height. Fundal height much greater than the standard suggests multiple pregnancy, a large-for-gestational-age infant, hydramnios or possibly even a hydatidiform mole

ESTIMATING FETAL GROWTH

Fundal height, or

McDonald's Rule, is a measure of the size of the uterus to assess fetal growth and development.

ESTIMATING FETAL GROWTH

Determining and recording that the

fundus has reached typical milestone measurement, such as: Over the symphysis pubis = 12 weeks At the umbilicus = 20 weeks at the xiphoid process = 38 weeks

ASSESSING FETAL WELL-BEING

Fetal Movement fetal movement can be felt by mother (quickening) at 18 to 20 weeks of pregnancy and peaks at 28 to 38 weeks.

ASSESSING FETAL WELL-BEING

Sandovsky method mother lies in a left recumbent position after a meal and record how many fetal movements she feels in the next hour. Normally, fetus moves a minimum of twice every every 10 minutes or an average of 10 to 12 times an hour If less than 10, the mother repeats the test for the next hour.

ASSESSING FETAL WELL-BEING

Cardiff method the mother records the interval it takes for her to feel 10 fetal movements.
Usually this occurs within 60 minutes. Make sure to instruct the woman that

fetal movements do vary, especially in relation to sleep cycles of the fetus and the mothers activity during the observation time.

ASSESSING FETAL WELL-BEING

FETAL HEART RATE FETAL HEART BEATS 120 to 160

beats per minute throughout pregnancy. Fetal heart sounds can be heard and counted as early as 10th to 11th week of pregnancy using a Doppler technique. Fetal heart beat of less than 90 bpm is high risk for miscarriage at 5 to 8 weeks of pregnancy.

ASSESSING FETAL WELL-BEING

RHYTHM STRIP TESTING
Assessment of the fetal heart rate for

whether a good baseline rate and long-and-short term variability are present. Baseline reading refers to the average rate of the fetal heartbeat per minute.

ASSESSING FETAL WELL-BEING

RHYTHM STRIP TESTING
Short-term variability (Also called

beat-to-beat variability) denotes the small changes in rate that occur from second to second if the fetal parasympathetic nervous system is receiving adequate oxygen and nutrients.

ASSESSING FETAL WELL-BEING

RHYTHM STRIP TESTING
Long-term variability denotes the

differences in heart rate that occur over the 20-minute time period.

ASSESSING FETAL WELL-BEING

RHYTHM STRIP TESTING PROCEDURE: Woman is placed in a semi-Fowlers position to prevent the uterus from compressing the vena cava causing supine hypotension syndrome during the

test. External fetal heart rate and uterine contraction monitors are attached abdominally. Fetal heart rate is then recorded for 20 min

ASSESSING FETAL WELL-BEING

RHYTHM STRIP TESTING
Average fetus moves about twice every 10

mins. and movement causes the heart rate to increase. There will typically be two or more instances of fetal heart acceleration in a 20-minute rhythm strip.

ASSESSING FETAL WELL-BEING

NONSTRESS TESTING Measures the response of the FHR to fetal movements. PROCEDURE: Position similar to rhythm strip Woman pushes a button attached to the monitor whenever she feels the fetus move. A dark line marks the paper tracing at this point. When the fetus moves, the FHR should increase about 15bpm and remain elevated for 15 seconds. It should decrease to its average again as the fetus quiets.

ASSESSING FETAL WELL-BEING

NONSTRESS TESTING If no increase in beats per minute is noticeable in fetal movement, poor oxygen perfusion of the fetus is suggested. This test is done for 10 to 20 minutes. The test is said to be reactive if two accelerations of FHR (by 15 beats or more) lasting for 15 seconds occur after movement within the chosen time period.

ASSESSING FETAL WELL-BEING

NONSTRESS TESTING Both rhythm strip and nonstress testing are noninvasive procedures and cause no risk to either mother or fetus, they can be used as screening procedures in all pregnancies.
If a nonstress test is nonreactive, additional fetal

assessment, such as contraction stress test or a biophysical profile test, will be scheduled.

ASSESSING FETAL WELL-BEING

VIBROACOUSTIC STIMULATION
A specially designed acoustic (sound) stimulator is

applied to the mothers abdomen to produce a sharp sound of approximately 80 decibels at a frequency of 80 Hz, startling and waking the fetus. If a spontaneous acceleration has not occurred within 5 minutes, this could be repeated again at the end of 10 minutes if no spontaneous movement occurs.

ASSESSING FETAL WELL-BEING

CONTRACTION STRESS TESTING Nipple stimulation as a source of oxytocin is used for contraction stress testing Gentle stimulation of the nipples releases oxytocin in the same way as happens with breastfeeding. With external uterine contraction and fetal heart rate monitors in place, the baseline FHR is obtained.

ASSESSING FETAL WELL-BEING

CONTRACTION STRESS TESTING 3 contractions with a duration of 40 seconds or longer before the test can be interpreted. The test is negative (normal) if no FHR decelerations are present with contractions. It is positive (abnormal) if 50% or more of contractions cause a late deceleration (a dip in FHR that occurs toward the end of a contraction and continues after the contraction).

COMPARISON OF NONSTRESS & CONTRACTION TESTS

ASSESSMENT What is measured NONSTRESS Response of FHR in relation to fetal movements 2 or more accelerations of FHR of 15bpm lasting 15 sec.or more following fetal movements in a 20min period Woman should not lie supine to prevent supine hypotension syndrome CONTRACTION Response of FHR in relation to uterine contractions produced by nipple stimulation No late decelerations with contractions

Normal findings

Safety considerations

In addition to preventing supine hypo.. Observe woman for 30 min afterward to see that contractions are quiet and preterm labor does not begin

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY
Ultrasound is a technique that uses sound waves to show a

picture of a baby (fetus) in the uterus. Because it uses sound waves instead of radiation, ultrasound is safer than X-rays. Ultrasound provides important information about the health of the fetus and conditions in the uterus. This information can guide a health care provider's plans for a pregnant woman and improve the outcome of pregnancy.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY
It can be used for the following purposes: To diagnose pregnancy as early as 6weeks of gestation To confirm the presence, size, and location of the placenta and amniotic fluid To establish that a fetus is growing and has no gross anomalies, such as hydrocephalus, anencephaly (congenital absence of all or major part of the brain), or spinal cord, heart, kidney, and bladder defects To establish sex if a penis is revealed To establish the presentation and position of the fetus To predict maturity by measurement of the biparietal diameter of the head

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY
It is also used to discover complications of pregnancy, such as

the presence of an intrauterine device, hydramnios or oligohydramnios, ectopic pregnancy, missed miscarriage, abdominal pregnancy, placenta previa, premature separation of the placenta, coexisting tumors, multiple pregnancy, or genetic abnormalities such as Down syndrome. Fetal anomalies such as neural tube disorders, diaphragmatic hernia, or urethral stenosis can also be diagnosed. Fetal death can be revealed by a lack of heartbeat and respiratory movement. After birth, a sonogram may be used to detect a retained placenta or poor uterine involution in the mother.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY
Intermittent sound waves of high frequency are projected

toward the uterus by a transducer placed on the abdomen (TRANSABDOMINAL) or in the vagina (TRANSVAGINAL). The sound frequencies that bounce back can be displayed on an oscilloscope screen as a visual image. The frequencies returning from tissues of various thickness and properties present distinct appearances. A permanent record can be made of the scan.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY The intricacy of the image obtained depends of the type of process used. B-MODE SCANNING most frequently used and produces what people generally refer to as Sonogram. This mode allows patterns to merge and form a picture, similar to a black and white television picture (gray-scale imaging). REAL-TIME MODE involves the use of multiple waves that allow screen picture to move, and even movement of the extremities, such as bringing a hand to the mouth to suck a thumb, can be seen. A parent who is in doubt that her fetus is well or whole can be greatly reassured by viewing a real-time sonogram.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY PROCEDURE: Before an ultrasound examination, a woman needs a good explanation of what will happen and reassurance that the process does not involve x-rays. It is also safe for the father of the child to remain in the room during the test. For the sound waves to reflect best and the uterus to be held stable, it is helpful if the mother has a full bladder at the time of the procedure. Mother should drink a full glass of water every 15 minutes beginning 90 minutes before the procedure and should not void before the procedure.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY PROCEDURE: For the actual procedure, the mother lies on an examining table and is draped for privacy, but with her abdomen exposed. (To prevent supine hypotension syndrome, place a towel under her right buttock to tip her body slightly so that the uterus will roll away from the vena cava). A gel is applied to her abdomen to improve the contact of the transducer. (Be certain that the gel is at room temperature or even slightly warmer, or it can cause uncomfortable uterine cramping). The transducer is then applied to her abdomen and moved both horizontally and vertically until the uterus and its contents are fully scanned.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY BIPARIETAL DIAMETER Ultrasonography may be used to predict fetal maturity by measuring the biparietal diameter (side to side measurement) of the fetal head. In 80% of pregnancies in which the biparietal diameter of the fetal head is 8.5 cm or greater, the infant will weigh more than 2,500 g (5.5 lb). A biparietal diameter of 8.5 cm indicates a fetal age of 40 weeks.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY BIPARIETAL DIAMETER Two other measurements made by sonography are: head circumference (34.5 cm indicates a 40-week fetus) femoral length -- Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY DOPPLER UMBILICAL VELOCITY Measures the velocity (speed or rate) at which red blood cells in the uterine and fetal vessels are traveling. Assessment of the blood flow through uterine blood vessels is helpful in determining the vascular resistance present in women with diabetes or hypertension of pregnancy and whether resultant placental insufficiency has occurred. Because it will limit the number of nutrients that can reach the fetus, decreased velocity is an important predictor of poor neonatal outcome.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY PLACENTAL GRADING Based particularly on the amount of calcium deposits in the base of the placenta, placenta can be graded by ultrasound as: 0 = a placenta 12 to 24 weeks 1 = a placenta 30 to 32 weeks 2 = 36 weeks 3 = 38 weeks
A grade 3 placenta suggests that the fetus is mature

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY AMNIOTIC FLUID VOLUME ASSESSMENT The amount of amniotic fluid present is an important fetal assessment, for a portion of the fluid is formed by fetal kidney output. If a fetus is becoming stressed in utero because the circulatory and kidney functions are failing, urine output, and consequently the volume of amniotic fluid also will decrease. A decrease in amniotic fluid volume puts the fetus at risk for compression of the umbilical cord and consequent interference with nutrition.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY AMNIOTIC FLUID VOLUME ASSESSMENT For gestations of less than 20 weeks, the uterus is hypothetically divided along the linea nigra into two vertical halves. The vertical diameter of the largest pocket of amniotic fluid present on each side is measured in centimeters The amniotic volume index is the sum of the two measurements For gestations of 20 weeks or more, the uterus is divided into four quadrants, using the linea nigra again as the vertical dividing line and the level of umbilicus as the horizontal dividing line. The vertical diameter of the largest pocket of fluid in each quadrant is obtained, and the four values are then added to produce the amniotic fluid index.

ASSESSING FETAL WELL-BEING

ULTRASONOGRAPHY AMNIOTIC FLUID VOLUME ASSESSMENT The average index is approximately 12 to 25 cm. between 28 and 40 weeks. An index greater than 20 to 24 cm. indicates hydramnios (excessive fluid, perhaps caused by inability of the fetus to swallow); And index less than 5 to 6 cm. indicates oligohydramnios (decreased amniotic fluid, perhaps caused by poor perfusion and kidney failure)

ASSESSING FETAL WELL-BEING

ELECTROCARDIOGRAPHY
Fetal ECGs may be recorded as early as the 11th week of

pregnancy. But ECG is inaccurate before the 20th week, because fetal electrical conduction is so weak that it is easily masked by the mothers ECG tracing. It is rarely used unless specific heart anomaly is suspected.

ASSESSING FETAL WELL-BEING

MAGNETIC RESONANCE IMAGING
MRI may be used to assess fetus.
The technique caused no harmful effects to the fetus or

mother MRI has the potential to replace or complement ultrasonography as a fetal assessment technique It may be most helpful is diagnosing complications such as ectopic pregnancy or trophoblastic disease because later in a pregnancy, fetal movement can obscure the findings.

ASSESSING FETAL WELL-BEING

MATERNAL SERUM ALPHA-FETOPROTEIN
Alpha-fetoprotein (AFP) is a substance produced by the liver

that is present in amniotic fluid and maternal serum. Traditionally assessed at the 15th week of pregnancy, between 85 to 90% of neural tube defects and 80% of Down syndrome babies can be detected by this method. The level is abnormally high in the maternal serum (MSAFP) if the fetus has an open spinal or abdominal defect, because the open defect allows more AFP to appear. Although the reason is unclear, the level of AFP is low if the fetus has a chromosomal defect such as Down syndrome. MSAFP levels begin to rise at 11 weeks gestation and then steadily increase until term.

ASSESSING FETAL WELL-BEING

TRIPLE SCREENING
Analysis of three indicators: MSAFP, unconjugated estriol,

hCG may be performed in place of AFP testing alone to yield more reliable results. As with the measurement of MSAFP, it requires only a simple venipuncture of the mother.

ASSESSING FETAL WELL-BEING

CHORIONIC VILLI SAMPLING
CVS is a biopsy and chromosomal analysis of chorionic villi

that is done at 10-12 weeks of pregnancy. Coelocentesis transvaginal aspiration of fluid from the extraembryonic cavity, is an alternative method to remove cells for fetal analysis.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS
From the Greek word amnion for sac and kentesis for puncture Aspiration of amniotic fluid from the pregnant uterus for

examination Procedure can be done at the physicians office or in an ambulatory clinic Typically scheduled between the 14th and 16th weeks of pregnancy to allow for a generous amount of amniotic fluid to be present. The technique can be used again near term to test for fetal maturity.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS
Amniocentesis is an easy procedure, but it can be

frightening to a woman. It involves penetration of the integrity of the amniotic sac, there is also a risk for the fetus, although this risk is low (less than 0.5%) It can lead to hemorrhage due to penetration of the placenta, infection of the amniotic fluid, and puncture of the fetus. It can lead to irritation of the uterus, causing premature labor.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS

PROCEDURE: Ask the woman to void to reduce bladder size, thus preventing inadvertent puncture Place her in a supine position on the examining table and drape her appropriately, exposing only her abdomen. Place a folded towel under her right buttock to tip her body slightly to the left and move the uterus off the vena cava, preventing supine hypotension syndrome

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS PROCEDURE: Take the maternal blood pressure and measure FHR for baseline levels Explain that a sonogram will be done to determine the position of the fetus, a pocket of amniotic fluid, and the placenta. The abdomen will be washed with an antiseptic solution, and a local anesthesia will be given. Caution the woman that she may feel a sensation of pressure as the needle used for aspiration, a 3 in. or 4 in., 20 to 22 gauge spinal needle is introduced Do not suggest that she take a deep breath and hold it as a distraction against discomfort; this lowers the diaphragm against the uterus and shifts intrauterine contents.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS PROCEDURE: The needle is inserted into the amniotic cavity over a pool of amniotic fluid, carefully avoiding the fetus and placenta A syringe is attached and about 15ml of amniotic fluid is withdrawn. The needle is then removed, and the woman rests quietly for about 30 minutes During the procedure and for the 30 minutes afterward, observe the FHR monitor to be certain the rate remains normal, and observe the uterine contraction monitor to be sure that no contractions are occurring.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS PROCEDURE: If the woman has Rh-negative blood, Rho(D) immune globulin (RhIG; RhoGAM) may be administered after the procedure to prevent fetal isommunization. This is to ensure that maternal antibodies will not form against any placental red blood cells that might have accidentally been released during the procedure Amniocentensis can provide information in a number of areas: Color Lecithin/Sphingomyelin ratio Phospatidyl Glycerol and Desaturated Phosphatidylcholine Bilirubin determination Chromosome analysis Fetal fibronectin Inborn errors of metabolism Alpha-fetoprotein

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS COLOR Normal amniotic fluid is the color of water; late in pregnancy, it may have a slightly yellow tinge A strong yellow color suggests blood incompatibility (the yellow results from the presence of bilirubin released with the hemolysis of red blood cells) A green color suggests meconium staining, a phenomenon associated with fetal distress

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS LECITHIN/SPHINGOMYELIN RATIO Lecithin and sphingomyelin are the protein components of the lung enzyme surfactant that the alveoli begin to form at 22nd to 24th weeks of pregnancy. After amniocentesis, the L/S ratio may be determined quickly by a shake test (if bubbles appear in the amniotic fluid after shaking, the ratio is mature) or it can be sent for laboratory analysis. An L/S ratio of 2:1 is traditionally accepted as lung maturity.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS LECITHIN/SPHINGOMYELIN RATIO Infants of mothers with severe diabetes may have false mature readings of lecithin because the stress to the infant in utero tends to mature lecithin pathways easily. Infant may be born with mature lung function but be immature overall (fragile giants) and thus may not do well in postnatal life. Some laboratories interpret a ratio of 2.5:1 or 3:1 as a mature indicator in infants of diabetic mothers

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS

PHOSPHATIDYL GLYCEROL AND DESATURATED PHOSPHATIDYLCHOLINE Other compounds, in addition to L/S, that are found in surfactant Pathways for these compounds mature 35 to 36 weeks They present only with mature lung function, if they are present in the sample amniotic fluid obtained by amniocentesis, it can be predicted that respiratory distress syndrome will not occur

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS BILIRUBIN DETERMINATION Presence of bilirubin may be analyzed if a blood incompatibility is suspected. If bilirubin is going to be analyzed, the specimen must be free of blood or a false-positive reading will occur.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS CHROMOSOME ANALYSIS A few fetal skin cells are always present in amniotic fluid. These cells may be cultured for karyotyping.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS

FETAL FIBRONECTIN Fibronectin is a glycoprotein that plays a part in helping the placenta attach to the uterine deciduas. It can be found in abundant amounts to the uterine deciduas. Early in pregnancy, it can be assessed in the womans cervical mucus, but the amount then fades, after 20 weeks of pregnancy, it is no longer present. As labor approaches and cervical dilatation begins, it can be assessed again in cervical or vaginal fluid.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS FETAL FIBRONECTIN Damage to fetal membranes releases a great deal of the substance, so detection of fibronectin in the amniotic fluid or in the mothers vagina can serve as announcement that preterm labor may be beginning.

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS

INBORN ERRORS OF METABOLISM Some inherited diseases that are caused by inborn errors of metabolism can be detected by amniocentesis. For a condition to be identified, the enzyme defect must be present in the amniotic fluid as early as the time of the procedure. Illnesses that can be detected in this way are cystinosis and maple syrup urine disease (amino acid disorders)

ASSESSING FETAL WELL-BEING

AMNIOCENTESIS ALPHA-FETOPROTEIN
If the fetus has an open body defect, such an anencephaly,

myelomeningocele, or omphalocele, increased levels of AFP will be present in the amniotic fluid because of leakage of AFP into the fluid. The level will be decreased in the amniotic fluid of fetuses with chromosomal defects such as Down syndrome. Acetylcholinesterase is another compound that is obtained from amniotic fluid in high levels if a neural tube defect is present.

ASSESSING FETAL WELL-BEING

PERCUTANEOUS BLOOD SAMPLING
PUBS, also called Cordocentesis or

Funicentesis aspiration of blood from the umbilical vein for analysis. After the umbilical vein is located by sonography, a thin needle is inserted by amniocentesis technique into the uterus and is guided by ultrasound until it pierces the umbilical vein

ASSESSING FETAL WELL-BEING

PERCUTANEOUS BLOOD SAMPLING
A sample blood is then removed for blood studies, such as
Complete blood count

Direct Coombs test

Blood gases Karyotyping

To ensure that the blood obtained is fetal blood, it is submitted to KLEIHAUER-BETKE Test

ASSESSING FETAL WELL-BEING

PERCUTANEOUS BLOOD SAMPLING
If a fetus is found anemic, blood may be transfused using the same

technique Because the umbilical vein continues to ooze for a moment after the procedure, fetal blood could enter the maternal circulation, so RhIG is given to Rh-negative women to prevent sensitization. Fetus is monitored by a nonstress test before and after the procedure to be certain that uterine contractions are not present and by ultrasound to see that no bleeding is evident. PUBS carries little additional risk to the fetus or mother over amniocentesis and can yield information not available by any other means, especially about blood dyscrasias (an imbalance components of blood).

ASSESSING FETAL WELL-BEING

AMNIOSCOPY
Visual inspection of the amniotic fluid through the cervix and membranes with an amnioscope (a small

fetoscope). The main use of the technique is to detect meconium staining. It carries some risk of membrane rupture

ASSESSING FETAL WELL-BEING

FETOSCOPY Fetus is visualized by inspection through a fetoscope (an extremely narrow, hollow tube inserted by amniocentesis technique), is sometimes helpful in assessing fetal well-being. A photograph can be taken through the fetoscope to reassure parents that their infants is well and perfectly formed. The procedure may be used for the following purposes: To confirm the intactness of the spinal column To obtain biopsy samples of fetal tissue and fetal blood samples

ASSESSING FETAL WELL-BEING

FETOSCOPY
To perform elemental surgery, such as

inserting a polyethylene shunt into the fetal ventricles to relieve hydrocephalus or anteriorly into the fetal bladder to relieve a stenosed urethra. Earliest time that fetoscopy can be performed is about the 16th or 17th week.

ASSESSING FETAL WELL-BEING

FETOSCOPY PROCEDURE Mother is prepared and draped as for amniocentesis Local anesthesia is injected into the abdominal skin Fetoscope is then inserted through a minor abdominal incision If the fetus is very active, meperidine (Demerol) may be administered to the mother this drug crosses the placenta and sedates the fetus, to avoid fetal injury by the scope to allow better observation Fetoscopy carries a small risk of premature labor Amnionitis (infection of the amniotic fluid) may occur to avoid this, mother may be prescribed 10 days of antibiotic therapy after the procedure

ASSESSING FETAL WELL-BEING

BIOPHYSICAL PROFILE Combines five parameters into one assessment : Fetal activity Fetal breathing movements Fetal body movement Fetal tone Amniotic fluid volume Fetal heart and breathing record measures shortterm nervous system function Amniotic fluid volume helps measure long-term adequacy of placental function

ASSESSING FETAL WELL-BEING

BIOPHYSICAL PROFILE By this system, each item has the potential for scoring a 2, so 10 would be the highest score possible. Biophysical profile is more accurate in predicting fetal well-being than any single assessment. Because the scoring is similar to that of the Apgar score determined at birth on infants, it is popularly called FETAL APGAR It may be done as often as daily during a high-risk pregnancy.

ASSESSING FETAL WELL-BEING

BIOPHYSICAL PROFILE If the fetus score on a complete profile is 8 to 10, the fetus is considered to be doing well A score of 6 is considered suspicious A score of 4 denotes fetal jeopardy At present, some centers use only two assessments (amniotic fluid index and nonstress test), it is referred to as MODIFIED BIOPHYSICAL PROFILE, it predicts shortterm viability by nonstress test and long-term viability by the amniotic fluid index. Nurses play a large role in obtaining the information for both the modified and the full biophysical profile by obtaining either the nonstress or the sonogram reading.

BIOPHYSICAL PROFILE SCORING

ASSESSMENT FETAL BREATHING INSTRUMENT Sonogram CRITERIA FOR A SCORE OF 2 At least one episode of 30 sec of sustained fetal breathing movements within 30 min of observation At least three separate episodes of fetal limb or trunk movement w/in a 30-min observation

FETAL MOVEMENT

Sonogram

FETAL TONE

Sonogram

The fetus must extend and then flex the extremities or spine at least once in 30 min

BIOPHYSICAL PROFILE SCORING

ASSESSMENT AMNIOTIC FLUID VOLUME INSTRUMENT Sonogram CRITERIA FOR A SCORE OF 2 A pocket of amniotic fluid measuring more than 1 cm in vertical diameter must be present

FETAL HEART REACTIVITY

Nonstress Test

Two or more FHR accelerations of at least 15bpm above baseline and of 15 sec duration with fetal movements over a 20-min time period