M8

• ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT
• Nursing Responsibilities

  • Signed consent form
  • Scheduling of procedure
  • Explaining the procedure
  • Preparing the woman
  • Providing support during the procedure
  • Providing necessary follow-up care
  • Managing equipment & specimens
• Daily Fetal Movement Counting

  Method to assess fetal well-being
• Quickening

  Fetal movements felt by the mother at 18 to 20 weeks, peaking at 28 to 38 weeks
• Healthy fetus moves with consistency or at least 10 times a day
• Fetal Movement Counting (Sandovsky Method)

  1. Mom lies on left recumbent position

  2. Record the number of fetal movements in 1 hour

  3. Minimum 2 movements in 10 min or average of 10 to 12 times/hour
• If less than 10 movements per hour

  Repeat test for next hour
• If still less than 10 movements for 2 hours

  Notify MD
• Count-to-Ten (Cardiff Method/Fetal Kick Count)

  1. Mom records time interval to feel 10 movements

  2. Usually within 60 seconds

  3. Done at the same time daily

  4. Preferably after breakfast
• Fetal heart rate is between 120 to 160 bpm
• Rhythm Strip Testing


  1. Test for good baseline rate

  2. Presence of long- and short-term variability
• Semi-Fowler's position


  Position to prevent supine hypotension & for comfort
• Mother remains in a fixed position for 20 minutes during testing
• External fetal heart rate & uterine contraction monitors are attached abdominally
• Tocotransducer


  Measures contractions & fetal movement
• Ultrasound transducer


  Placed over abdominal site where FHR is distinct
• FHR is recorded for 20 minutes
• Baseline reading


  Average rate of fetal heartbeat per minute
• Short-term variability


  Small changes in rate from second to second if fetal
• Long-term variability


  Differences in heart rate over the 20-minute period
• Non-Stress Testing (NST)


  1. Measures the response of the FHR to fetal movement

  2. Woman is positioned and monitors are attached

  3. She pushes a mark button whenever she feels the fetus move
• Reactive (Normal) NST


  Accelerations of FHR by 15 beats or more lasting for 15 seconds occur after movement
• Nonreactive NST


  No accelerations with fetal movement, low short-term FHR variability
• 20 minutes without fetal movement may indicate a sleeping fetus
• Vibroacoustic stimulation applies a sharp sound of 80 decibels at a frequency of 80 Hz to wake the fetus
• Contraction Stress Testing


  1. FHR is analyzed in conjunction with contractions

  2. Achieved by nipple stimulation to release oxytocin

  3. Baseline FHR is obtained
• Types of Decelerations


  • Early deceleration
  • Late deceleration
  • Variable deceleration
• Ultrasonography is used to diagnose a pregnancy
• Purposes of Ultrasonography


  • Confirm presence, location, size of placenta & amniotic fluid
  • Establish fetal growth & rule out abnormalities
  • Establish sex
  • Establish presentation & position of fetus
  • Predict maturity via biparietal diameter measurement
  • Discover complications of pregnancy
• Ask mom to drink a full glass of water every 15 minutes beginning 90 minutes before the procedure
• Biparietal Diameter


  Determines length of fetus in cm
• Haase's Rule determines fetal length in cm
• Doppler Umbilical Velocimetry

  Measures velocity at which RBCs in the blood volume are flowing
• Placental Grading

  Helps determine vascular resistance in women with Diabetes Mellitus and Hypertension of pregnancy
• Placental Grading Scale

  • 0 = placenta 12 to 24 weeks
  • 1 = 30 to 32 weeks
  • 2 = 36 weeks
  • 3 = 38 weeks and fetal lungs are mature
• Amniotic Fluid Assessment measures the risk of cord compression
• Amniotic Fluid Index Measurement

  1. Measure vertical diameter of the largest pocket of fluid

  2. Sum of 2 measurements
• Normal AFI

  12 to 15 cm between 28 to 40 weeks
• Hydramnios

  AFI greater than 20 to 24 cm
• Oligohydramnios

  AFI less than 5 to 6 cm