When is Nuchal Translucent Screening done during pregnancy?
11-14 wks of prego
What is Nuchal Translucent Screening?
- US that checks the thickness of the nuchal fold
- done at 11-14 wks of prego
- thicker fold = increased risk of genetic anomalies
Reasons for an early US?
Nuchal Transulency Screening, early prego confirmation and accurate dating of pregnancy (date of delivery)
The sex of the child can be determined at how many wks?
18-20 wks
Why are late prego US usually done?
to monitor high-risk preggos
What does Quad testing screen for?
risks of down syndrome (trisomy 21)
What substances does Quad testing measure?
AFP, hCG, estriol and inhibin A
What is alpha-fetoprotein (AFP) and where is it produced?
is a protein that is produced by the fetus
What is estriol and where is it produced?
an estrogen produced by both the fetus and the placenta
What is hCG and where is it produced?
a hormone produced within the placenta
What is inhibin A and where is it produced?
a protein produced by the placenta and ovaries
When is the Quad Screen done during pregnancy?
1st (1-13 wks) or 2nd trimester (13-28 wks)
High levels of AFP suggests what about the developing fetus?
may have a neural tube defect
When in the pregnancy are fetal kick counts begun?
28-30 wks
Explain the fetal kick count.
- measures how long it takes the baby to kick 10x, want within 2
When is Amniocentesis done during pregnancy?
15-20 wks
Where are the cells for CVS taken from?
the cells are taken from the placenta
When is CVS done during pregnancy?
10-14 wks
What should a woman do if she feels < 10 movements within 2 hrs of fetal kick counting?
take a walk, drink something sweet and make sure to be in a quiet environment
When should a woman see her provider after when performing fetal kick counts?
if < 10 fetal movements within 2 hrs after taking a walk, drinking something sweet and make sure to be in a quiet environment
When during the pregnancy are non-stress tests (NST) begun?
26-28 wks, only useful during the 3 trimester
What is a normal (“Reactive”) NST?
≥ 2 heart rate accelerations periods of ≥ 15 BPM for ≥ 15 secs within a 20 min period
What to do if specified HR criteria are not met within for NST?
wait another 20 mins (making 40 mins total), to account for fetal sleep time
How long does the typical fetal sleep period last?
about 40 mins
Why should a prego woman not smoke prior to having a non-stress test?
it could cause a false positive
Contra-indications for Contractions Stess Test?
hx of preterm labor, previous classical/vertical incision c-section, placenta previa (placenta lies low, near cervix)
Drug of choice for contraction stress test?
Pitocin
Number of contractions and length wanted during a contraction stress test?
3 contractions, lasting ≥ 40 secs in 10 mins
What is a (1) positive and (2) negative contraction stress test interpretation?
1) repetitive late decelerations or drop in HR
2) no decelerations or drop in HR
Fluid amount for the below:
1) oligohydramnios
2) normal AFI
3) polyhydramnios
1) ≤ 4 cm
2) 5-19 cm
3) ≥ 20 cm
What test(s) are an alternative to a complete Biophysical Profile?
NST with AFI
Interpret the results and determine whether a complete BPPis needed:
1) Reactive NST and AFI of 3
2) Reactive NST and AFI 23
3) Reactive NST and AFI 16
- 1 & 2: perform full BPP
- 3: normal results, no BPP needed
Interpret the NST results (normal or not normal):
1) 3 periods of acceleration (20, 15, 20 BPM), (20, 25, 15 secs), within 12 minutes
2) 4 periods of acceleration (20, 15, 20 BPM), (20, 25, 15 secs), within 25 minutes
3) 2 periods of acceleration (24, 12, 22 BPM), (20, 25, 15 secs), within 10 minutes
1) normal
2) non-normal (timeframe is longer than 20 mins)
3) non-normal (12 BPM is < 15)
BPP Scoring and interpretation:
1) 8-10/10
2) 6/10
3) 4/10
4) 2/10
5) 0/10
6) <6/10
1) low risk for perinatal asphyxia
2) Probable perinatal asphyxia
3) high risk for perinatal asphyxia
4) perinatal asphyxia almost certain
5) perinatal asphyxia certain
6) plan will be to deliver if the fetus is mature
Components of the BPP include?
1) Nonstress test: reactive = 2 points, non=0
2) Fetal breathing:
- 2points: ≥20 secs of rythmic breathing ≤ 30 mins
- 0 points: other
3) Fetal Activity
- 2 points: ≥ 2 torso/limb movements
- 0 points: < 2 movements
4) Muscle tone
- 2 points: ≥ flexion and extension of limb or trunk
- 0 points: poor/none
5) Qualitative Amniotic Fluid volume
- 2 points: ≥ 1 vertical pockets with ≥ 2 cm of AF
- 0 points: < 2 cm of AF
Infections associated with Congenital Disorders in the Fetus/Neonate?
TORCH:
- Toxoplasmosis
- Other (chlamydia, syphilis, varicella)
- Rubella
- Cytomegalovirus
- Herpes Simplex
Adolescent Pregnancies (phase of adolescence)
1) early
2) mid
3) late
1) 10-13
2) 14-16
3) 17-20