ch. 6 from notes

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silvisaj44
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200187
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ch. 6 from notes
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2013-02-12 22:18:03
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maternity
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  1. biophysical factors
    stems from mother or fetus
  2. psychosocial factors
    maternal behaviors or lifestyle
  3. sociodemographic factors
    age, prenatal care, parity, income, married, ethnicity
  4. environmental factors
    work place hazards, home hazards
  5. screening test
    • -AFI-amniotic fluid index
    • -BPP-biophysical profile
    • -contraction stress test
    • -fetal movement count
    • -multiple marker screening
    • -non stress test
    • -ultrasound
    • -umbilical artery doppler flow
    • -vibroavoustic stimulation
  6. diagnostic tests
    • -amniocentesis
    • -chorionic villi sampling
    • -MRI
    • -percutaneous umbilical blood sampling
    • -ultrasound
  7. ultrasound
    • -intermittent high frequency sound waves
    • -transmitted by alternating current to a transducer
    • -evaluates structures/functions, etc
    • -painless, noninvasive, nonradiating
    • -transabdominal/transvaginal approaches
    • -no risks
    • -disadvantage: may miss something, limited to fetal position
  8. umbilical artery doppler flow
    • assesses placental perfusion
    • IUGR fetuses
    • no risk factors
  9. MRI
    very detailed, for brain or other complex abnormalities, no known risks
  10. amniocentesis
    • used with sonogram, when amniotic fluid is withdrawn from the uterus via a needle inserted through the maternal andomen
    • 14-20 weeks of gestation

    evaluates: chromosomal abnormalities, genetic testing, rh sensitization, fetal lung maturity, fetal maturity if early termination of pregnancy needed

    risk: perferation to fetus, infection, spontaneous abortion
  11. Chrorionic villi samplic (cvs)
    under ultrasound, aspiration of small amount of placental tissue (chorion) for chromosomal, metabolic, or dna testing at 10-12 weeks
  12. percutaneous umbilical blood sampling (pubs)
    removal of fetal blood from the umbilical cord for fetal blood sampling. tested for metabolic and hematological disorders, fetal infection, and fetal karyotyping. also for rbc and platelet transfusions.
  13. maternal assays
    • alpha-fetoprotein/a-1 fetoprotein/maternal serum alpha fetoprotein
    • -maternal blood drawn at 16-18 weeks gestation
    • -increased levels-associate with neural tube defects, anencephaly, gastroschisis, or omphalocele
    • -decreased levels-associated with trisomy 21 (down syndrome)
    • -abnormal findings indicate need for further testing
    • -amnio, sono
  14. multiple marker screen
    triple marker screening, combines 3 chemical markers -AFP, hCG, estriol-detects some trisomys and NTD's

    quad screen, adds inhibin A to the triple marker screen to increase detection of trisomy 21

    -blood drawn at 15-16 weeks
  15. tests of fetal status and fetal well being
    • -daily fetal movement count (kick counts)
    • -non stress test
    • -vibroacoustic stimulatin (vas)
    • -contraction stress test (cst)
    • -amniotic fluid index
    • -biophysical profile
  16. daily fetal movement count
    determines fetal movement by counting fetal movements in a period of time to identify potentially hypoxic fetuses

    • -2 hours=10 kicks
    • 1 hr=2 kicks
  17. non stress test
    • evaluates FHR in relation to fetal movement
    • -uses electric fetal monitoring to assess well being

    • -2 belts on womans abdomen
    • -one detects FHR
    • -one detects uterine activity

    • -reactive NST: two or more accelerations of 15 beats above baseline and lasing 15 seconds or more within 20 minutes, indicates intact CNS not affected by hypoxia, fetuses greater than 32 weeks (10x10) in 20 mins
    • -nonreactive NST: indicated need for further testing; fetus may be sleeping or sick, may use fetal acoustic stimulation test or vibroacoustic stimulation
  18. vibroacoustic stimulation
    • fetal acoustic stimulation
    • -sound

    • vibroacoustic stimulation
    • -vibration and sound

    buzz the baby to wake it up
  19. contraction stress test (cst)
    • -a way of evaluating placental respiratory function
    • -during contraction, intrauterine pressure increases
    • -blood flow to intervillous space is momentarily decreased
    • -thereby decrease in oxygen transport to fetus

    -healthy fetus tolerates this decrease in blood supply and maintains a steady heart rate

    -if placental reserve is insufficient: fetal hypoxia, depression of myocardium, decrease in FHR

    • -need uterine contractions
    • -20 minute recording of uterine activity and FHR

    -want negative results: shows 3 contractions lasting 40 or more seconds in 10 without decelerations, means placenta is working

    -positive means that baby will not being able to stand labor
  20. amniotic fluid index (AFI)
    • -based directly on fetal urine production
    • -predominate source of amniotic fluid
    • -directly dependent on renal perfusion
    • -measurement of amniotic fluid
    • -oligohydramnios or polyhydramnios
  21. oligohydramnios
    small amounts-less than 5cm
  22. polyhydramnios
    alot-24cm or more
  23. biophysical profile (BPP)
    ultrasound assessment of fetal status along with NST. evaluations of fetal status through ultrasound observation of various fetal reflex activities that are cns controlled and sensitive to fetal hypoxia.

    -decreased fetal o2=fetal response is reduced by cns

    -includes assessment of breathing, movement, gross body movement, fetal tone, amniotic fluid volume, heart rate reactivity.

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