Chapter 6: Antepartal Tests
What if they are less than 32 weeks?
2 accelerations 10 bpm > baseline x 10 secs
BPP (biophysical profile)
NST, `Fetal breathing, fetal movement, fetal tone, AFI 2 pts for present, 0 pts for absent 8/10 pts reassuring, 6/10 equivocal, 4/10 non reassuring, 2/10 prompts immediate delivery
What does a high AFP indicate?
NTDs (neural tube defects), anencephaly, omphalocele, & gastrochisis
What does a low AFP indicate?
trisomy 21 (downs syndrome)
how to perform kick counts
-lay down on left side -hydrate -get something to drink with sugar in it -be quiet
AFP: Alpha Fetal Protein
-maternal assays -Involves screening maternal serum for pregnancy related substances that can indicate abnormalities -abnormal findings may require diagnostic testing -false positives and false negatives
contraction stress test
-stimulates contractions in women who are not having contractions -have her rub nipples
How many kicks do you want?
10 kicks/2 hr or 4 kicks/1 hr
At how many weeks are kick counts detected?
17 weeks
A non stress test is nonreactive if FHR...?
No FHR accelerations X 40 minutes
positive contraction stress test
Late decels with 50% of contractions
Modified BPP (biophysical profile)
NST + AFI
diagnostic test
identifies a disease or a problem
Which test best provides an answer to the question of whether or not the infant has a congenital defect? A. Screening B. Diagnostic test C. Biophysical profile D. Multiple marker screening
B. Diagnostic test
equivocal contraction stress test
intermittent late or significant variable decels
AFI (amniotic fluid index)
Ultrasound measurement of amniotic pocket fluid
diagnostic test examples
Amnio (done at 2nd trimester for diagnosing fetal anomalies; only done during 3rd trimester to see fetal lung maturity), CVS (take a piece of villi from uterus), MRI (for anatomical structures), PUBS (needle through abdomen and draw blood through umbilical cord), Ultrasound
The multiple marker screenings identify: A. Neural tube defects B. Cerebral palsy C. Hemolytic diseases D. Cleft palate
A. Neural tube defects (and can detect down syndrome)
screening test examples
AFI, BPP, CST, Kick Ct, Multiple Marker Screening, Ultrasound, Nuchal Translucency (look at back of fetus' neck...if it's too thick it could mean possible abnormality, UA Dopplers (tells us about blood flow to vessels, Vibroacoustic Stim
biochemical profile: biological and chemical examination
Chorionic villus sampling: cells taken from placenta where it attaches to uterus Amniocentesis: Pocket of fluid taken uterus and fetal cells are there to test, done during 2nd trimester PUBS: blood is sampled from umbilical cord
multiple marker screening
Combines AFP with hCG and Estriol (Triple Marker) and Inhibin A (Quad Screen) to detect some trisomies and Neural Tube Defects
A non stress test is reactive if FHR...?
FHR 15 bpm > baseline X 2 in 20 minutes (you wanna see 2 accelerations in 20 minutes)
What is a screening test?
it identifies those not affected
negative contraction stress test
no significant variable or late decels in 10 min with 3 ctx > 40 secs, moderate variability