Tests during pregnancy

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When is an ultrasound most accurate?: 18-26 weeks gestation
what are some uses of the ultrasound related to the fetus?: -determine gestational age
-diagnosis of fetal growth patterns and congentital abnormalities.
-identification of multiple gestation
-maturity of fetus
-suspected fetal death
-biophysical assessment for fetal well being.
-determination of fetal presentation.
Why would you use ultrasound to determine position of the placenta?: so don't cut through in a C-section.
What fetal measurements can be assessed by ultrasound?: -biparietal diameter
-fetal length
-estimation of fetal weight
What can you tell about amniotic fluid volume with an ultrasound?: the volume: polyhydramnios or olighydramnios.
To what 2 tests is an ultrasound an adjunct to?: amniocentesis and chorionic villi sampling
What can you tell about the placenta from an ultrasound?: position
suspected abruptio placenta
Why would it be helpful to know the gestational age and uterine size?: To determine any significant differences.
When is an ultrasound useful when not pertaining to pregnancy and fetus?: vaginal bleeding of unknown etiology.
What is AFI?: amniotic fluid index
amniotic fluid index: pockets of fluid measured in 4 quadrants of uterus.
What is the normal range of AFI?: 5-20 cm
What does AFI less than 5 indicate?: Oligohydramnios
What does AFI more than 20 indicate?: Polyhydramnios
What factors may influence AFI?: Maternal hydration
high altitudes may increase the index without fetal compromise.
What should be done if borderline values are obtained?: Repeat before interventions are undertaken.
What is AFP?: Alpha-fetoprotein screening
What is the purpose of AFP?: To detect fetal abnormalities, particulary open neural tube defects and chromosomal anomalies.
When is AFP indicated?: -for women before 20 weeks gestation
-for all patients with a history of neural tube defects.
What kind of test is the AFP and when is it done?: Blood test
15-19 weeks gestation.
What influences AFP levels?: gestational age so it is crucial to know the correct gestational age.
What may high AFP levels indicate?: -neural tube deficits
-esphageal, intestinal, or renal obstruction
-abdominal wall defects
-low birth weight
-oligohydramnios
-multiple gestation
-decreased maternal weight
-underestimated gestational age.
When a pt. has a high AFP level, how many actually carry a fetus with open neural tube defects?: only 1 in 25.
What is a more accurate way to i.d. an open neural tube defect?: assess AF acetylcholinesterase levels
What might low AFP levels indicate?: -chromosomal trisomies - down syndrome
-trophoblastic disease
-fetal death
-increased maternal weight
-overestimated gestational age
Amniocentesis: transabdominal needle aspiration of 10-20 ml amniotic fluid for analysis.
What is enough amniotic fluid volume to do an amniocentisis?: 150 ml - usually 16th week
Why is an amnio done?: -to detect fetal abnormalities, particularly chromosomal and neural tube defects.
What disorders can be dx with amniocentesis?: metabolic and amino acid disorders, and mucopolysaccarides.
Can fetal age and maturity be determined?: Yes, especially pulmonary maturity.
How can fetal health be assessed using an amnio?: By detecting the presence of meconium or blood, or by measuring amniotic levels of estriol and fetal thryoid hormone.
When is amnio used to identify fetal gender?: When one or both parents carry a sex-linked disorder.
What happens with failure to place the fluid specimen from amnio in an amber or foil-covered tube?: In some cases this could cause abnormally low bilirubin levels
What can adversely effect the L/S ratio in the amnio?: Blood or meconium in the fluid.
What could lower creatinine levels from amnio?: maternal blood in the fluid
What, if found in the fluid speciman, invalidates the AFP results? Why?: Fetal blood
Even small amts. of fetal blood can double AFP concentrations.
What are several disorders not associated with pregnancy that could interfere with amnio results and raise AFP levels?: infectious mononucleois
cirrhosis
hepatic cancer
What kind of syringes can be toxic to amniotic fluid cells?: plastic disposable syringes
What should be monitored following an amniocentesis?: FHR and maternal VS every 15 minutes or at least 30 minutes.
What can be done if a pt. feels faint or nauseated or sweats profusely?: Position her on the left side to counteract uterine pressure on the vena cava.
What instructions should be given to pt. before she leaves?: Instruct her to notify the doctor immediately if she experiences abdominal pain or cramping, chills, fever, vaginal bleeding or leakage of serous vaginal fluid, or fetal hyperactivity or unusual fetal lethargy.
Why are estriol levels done?: For nutritive well being.
What results are needed to declare nutritive decline in well-being?: 3 consecutive tests that drop
PUBS: Percutaneous umbilical blood sampling - cordocentesis.
PUBS Defined: a technique used to obtain pure fetal blood from the umbilical cord while the fetus is in utero.
IUGR: any fetus that falls below the 10th percentile in ulrasonic estimation of wt.at a given gestational age.
Biophysical Profile scoring: an assessment of 5 fetal biophysical variable.
What are the 5 fetal biophysical profiles?: fetal heart rate acceleration
fetal breathing
fetal movements
fetal tones
amniotic fluid volume
What are normal scores for the 5 fetal biophysical variables?: 2
What is an abnormal score for 5 biophysical variables: 0 or 1
Recommended management for a normal infant, low risk for chronic asphyxia.: repeat testing at weekly intervals. Repeat twice weekly in diabetic patients and patients > or = 42 weeks.
What is the indication for delivery in the normal infant, low risk for chronic asphyxia.: oligohydramnios
Management for a infant with suspected chrinic asphyxia.: Repeat testing within 24 hr. Indication for delivery = oligohydramnios or persisting , or= 6.
Management for infant with suspected chronic asphyxia: > or = 36 weeks and favorable cervix. If <36 weeks and lecithin/sphingomyelin ratio <2.0, repeat test in 24 hr. Indication for delivery = repeat score </= 6 or oligohydramnios.

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