Antepartum 2b

• Who needs additional testing?

  Young (<16) or old mom (>35)

  Maternal disease (HTN, preeclampsia, diabetes, & heart disease)

  Rh isoimmunization

  Suspected IUGR

  Post-dates pregnancy

  Multiple gestation
• What's the order of behaviors lost in reverse due to fetal hypoxia?

  FHR reactivity @ 28-32 weeks

  Sucking @ 12-14 weeks

  Breathing movement @11-12 weeks

  General movement @8-9 weeks

  Muscle tone detected @7-8 weeks
• Non-stress test

  Done in the third trimester

  Use of external FHR monitor to observe for FHR reactivity (or accelerations)
• Reactive test results

  An increase of 15 bpm for 15 seconds with 2 episodes in 20 minutes
• Contraction Stress Test (CST)

  Use of external FHR monitor in conjunction with uterine contractions to observe for late decelerations

  Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow

  Negative test: no FHR late decelerations with 3 contractions lasting at least 40 seconds
• What consists of biophysical profile?

  1. FHR accelerations
  2. Fetal Breathing movements
  3. Gross fetal movement
  4. Fetal tone
  5. Amniotic fluid volume/index
• Amniotic fluid volume/index

  More than 10 cm is reassuring
• Modified biophysical profile

  Combines a NST with an amniotic fluid index (AFI)

  Normal= reactive NST, and an AFI greater than 5 cm
• Doppler and Color Ultrasound Blood Flow Studies

  Uses sound waves to detect the movement of blood in vessels

  Can be initiated at 16-18 weeks

  Assess fetal-placental perfusion and blood flow to brain, heart

  measures systolic to diastolic (s/d) ratio
• Amniocentesis second trimester

  Genetic testing @15-20 weeks

  Diagnose neural tube defects & downs (16-19 weeks)
• Amniocentesis third trimester

  Test for lung maturity after 32 weeks
• Amniocentesis

  Test for intrauterine infections and hemolytic disease (maternal Rh sensitization -> fetal anemia)
• L/S Ratio, PG, PI tests

  Done to assess fetal lung maturity

  L/S ratio 2:1 indicates lung maturity (by 35-46 weeks)

  Phosphatidylglycerol (PG) and phosphatidylinositol (PI): positive results indicate fetal lung maturity
• Amniocentesis Risks

  May increase spontaneous abortions <15 weeks

  Trauma to fetus, umbilical cord, or placenta

  Bleeding

  Maternal infection

  Rh sensitization from fetal blood entering maternal circulation
• Chorionic villus sampling

  Done at 10-13 weeks

  Used for prenatal genetic diagnosis

  Slight increased risk of spontaneous abortion
• Percutaneous umbilical blood sampling

  Also called cordocentesis or PUBS

  Involves the aspiration of fetal blood from the umbilical cord near the placenta for prenatal diagnosis or therapy

  Used to detect blood disorders, acid-base imbalance, infection, or fetal genetic disease