CH16 Fetal Assessment Tests

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Contemporary

Maternal-NewbornNursing Care

Sixth Edition

Chapter 16 Assessment of

Fetal Well-Being

Patricia LadewigMarcia London

Michele Davidson



Purpose of Assessing Fetal

Movements

� Provides information about fetal well-being

Vigorous fetal movements indicates well-being Decreased fetal movements indicates possible

fetal compromise



Information Regarding Fetal

Movement� Associated with fetus¶s sleep-wake cycles

� Outside factors that elicit a fetal response

Sounds Cigarette smoke

Dr ugs

� Active fetal period last 40 minutes

� Fetus most active between 9 am and 1 pm

Possible relation to maternal hypoglycemia



Methods for Counting Fetal

Movements� Assess between 28 and 38 weeks¶ gestation

� Count one hour after meals for 20 minutes

� Same time each day



Recording Fetal Movements

� Record three times a day

� Should record 10 movements in a 3-hour

period



Fetal Indications for Ultrasounds

� Early identification of pregnancy

� Determine gestational age of fetus

� Detect multiple gestations

� Detect fetal anomalies



FIGURE 16±2 Ultrasound of fetal face.



Maternal Indications for

Ultrasounds� Shortened cervical length

� Cervical incompetence

� Vaginal bleeding



Clinical Findings Detected from

Ultrasounds� Fetal anomalies

� Fetal death

� Placenta previa

� Preterm labor



Ultrasounds Can Assist with

Invasive

Proced

ures

� Amniocentesis

� Chorionic villus sampling



Doppler Velocimetry

� Assess uteroplacental f unction

� Beginning at 16 to 18 weeks¶ gestation

�P

rocedure

Woman in su pine position

Apply warmed gel to abdomen

� Pulsed-wave Doppler device is used

� Possible clinical findings

Suspected uteroplacental insufficiency



Nonstress Test

� Assesses fetal well-being

� Procedure

Electronic fetal monitor applied to abdomen

Fetal heart rate is measured

� Possible clinical finding

Fetus with adequate oxygenation and an intact

central nervous system

Fetus at risk



FIGURE 16±5 Example of a reactive nonstress test ( NST). Accelerations of 15 bpm lasting 15

seconds with each fetal movement (FM). Top of strip shows FHR; bottom of strip shows uterine activity

tracing. Note that FHR increases (above the baseline) at least 15 beats and remains at that rate for at least

15 seconds before returning to the former baseline.



Contraction Stress Test

� Initiation of contractions

� Positive CST results

� N

egative CST results



FIGURE 16±8 Example of a positive contraction stress test (CST). Repetitive late decelerations occur

with each contraction. Note that there are no accelerations of FHR with three fetal movements (FM). The

baseline FHR is 120 bpm. Uterine contractions (bottom half of strip) occurred four times in 12 minutes.



Biophysical Profile

� Assessment of five biophysical variables

Fetal breathing movements

Fetal movements of body or limbs

Fetal tone

Amniotic fluid volume

Reactive nonstress test

� Identifies compromised fetus

� Desired BPP score



Table 16-3



Diagnostic Benefits of

Amniocentesis� Evaluates fetal health

� Detects genetic disorders

� Evaluates lung maturity



FIGURE 16±9 Amniocentesis. The woman is scanned by ultrasound to determine the placenta site and

to locate a pocket of amniotic fluid. The needle is then inserted into the uterine cavity to withdraw

amniotic fluid.



Evaluating Amniotic Fluid

� Purpose of amniotic fluid testing

Evaluates health status of fetus

� Triple test

Evaluates AFP level Evaluates hCG level

Evaluates UE3 level

Mostly used to screen

± Down syndrome (trisomy 21)

± Trisomy 18

± Neural tu be defects



Evaluation of Lung Maturity

� L/S ratio 2:1

Achieved by 35 weeks

Risk of RDS is very low



Chorionic Villus Sampling

(CVS)� Performed between 10 and 12 weeks

� Advantages

Early diagnosis

Quick results

� Disadvantages

Does not detect neural tu be defects

CH16 Fetal Assessment Tests

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