Westminster College School of Nursing

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Westminster CollegeSchool of Nursing Health
SciencesNursing 308-Spring 2009Nursing of the
Childbearing FamilyStephanie Zimmer
FNP-BCAssistant Professor

• Module II - C
• Antenatal Testing

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Antenatal Testing

• Definition-
• Reproductive technologies used to
  determine fetal well being

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Ultrasound

• High frequency soundwaves
• Non invasive Transabdominal
• Transvaginal
• Preparation-
• Full Bladder
• Does not have to be NPO

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Ultrasound

• First Trimester
• Confirm pregnancy location
• Determine multiple gestation
• Localize structures

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Ultrasound

• Second Trimester
• Date Pregnancy
• Determine Placental Function
• AFI or AFV
• Detect Anomolies
• Detect Fetal Growth Pattern

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Ultrasound

• Third Trimester
• For BPP/AFI
• Fetal Growth Patterns
• Fetal Lie and Presentation
• Guide Invasive Procedures
• Determine Source of Vaginal Bleeding

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BPP

• Biophysical Profile
• NST
• Fetal Breathing Movements
• Fetal Body Movements
• Fetal Tone
• AFV

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The Three Bs

• Warning Signs
• Bleeding
• BOW
• Baby

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NST

• Non-Stress Test
• Completed Third Trimester
• Tests FHR Reactivity
• NORMAL is REACTIVE

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NST

• Reactive NST
• 15 beats gt baseline for 15 seconds
• OR 2 in 10
• 3 in 15
• 4 in 20

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NST

• Non-Reactive NST (abnormal)
• Lacks sufficient heart rate accelerations over a
  40 minute period
• Give juice or snack to Mom
• Try Acoustic Stimulator VAS
• May indicate further TESTING CST or BPP

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CST

• Contraction Stress Test is Abnormal!
• Evaluates respiratory function of placenta
• Completed third trimester
• Needs 3 contractions (40-60 sec. dur.)
• in a ten minute period

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CST -Methods

• Nipple Stimulation
• IV Oxytocin

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AFI

• Amniotic Fluid Index
• Usually done with NST
• lt 5 cm. is NOT good

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Fetal Activity

• Kick Counts
• 10 per hour
• Intermittent movement
• in 12 hours

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CVS

• Chorionic Villus Sampling
• Obtaining cells from edge of placenta to detect
  genetic, metabolic and DNA abnormalities (TC or
  TA)
• Completed _at_ 8-12 weeks
• CANNOT detect neural tube defects

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CVS - Risks

• Maternal cell contamination
• False Positives
• Infection
• Abortion

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Fundal Height

• Abdomen Enlargement
• 20-36 weeks 1 cm. q week
• Measure from pubis

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FHR

• Doptone
• Reassuring _at_ 110-160
• Avg. 140
• Fetoscope

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AFP

• Alpha-Fetoprotein
• Protein produced in yolk sac first 6 wks of
  pregnancy produced by fetal liver
• Present in amniotic fluid and maternal serum
• May indicate neural tube defect
• BEST indicator _at_ 16 Weeks

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MSAFP

• Maternal Serum AFP quadruple check
• Tests AFP, hCG, urine estriol, inhibin A
• Indicates
• NTD
• Trisomy 21
• Trisomy 18

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Amniocentesis

• Completed at different times for different
  reasons
• Position Left Lateral Tilt
• Aspiration of Amniotic Fluid

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Amniocentesis

• Second Trimester
• Genetic testing
• AFP
• Bilirubin levels

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Amniocentesis

• Third Trimester
• Bilirubin levels
• most common for LS or PG ratios
• Evaluate lung maturity

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Amniocentesis - Risks

• Infection
• Placental Injury
• Rh sensitization
• Vaginal spotting/LOF
• Cramping

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PUBS

• Percutaneous Umbilical Blood Sampling
• Diagnostic for coagulation and blood disorders
• Obtained from cord while fetus is in utero

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Antibody Levels

• Evaluate Rh negative Moms

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Urine Tests

• 24 hour estriol levels
• Determines placental functioning

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Miscellaneous Testing

• MRI
• Doppler Flow
• Fetoscopy

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Wish You all GOOD Outcomes!!