8: Assessment of Fetal Growth & Development

Quickening

first movement felt by the mother at 18 to 20 weeks and peaks at 28 to 38 weeks

Sandovsky method

method where mom lies on left recumbent position after a meal & record the no. of fetal movements in 1 hour

10

average of fetal movement per hour

Fetal Kick Count

mom records time interval it takes to feel 10 movements (usually within 60 minutes)

Cardiff method

other term for Fetal Kick Count test

120-160 bpm

normal fetal heart rate

Rhythm Strip Testing

test for good baseline rate & presence of long and short-term viability

Rhythm Strip Testing

in this fetal test, Semi-Fowler's position is done to prevent supine hypotension & for comfort-mother remains in a fairly fixed position for 20 mins

Rhythm Strip Testing

external fetal heart rate & uterine contraction monitors are attached abdominally

Rhythm Strip Testing

in this fetal test, tocotransducer over fundus-measures contractions & feel movement -ultrasound transducer over abdominal site where FHR is distinct

short-term variability

small changes in rate from second to second if fetal Parasympathetic NS receives adequate O2 & nutrients

short-term variability

aka beat-to-beat variability

long term variability

differences in heart rate over the 20-minute period

Non-stress test

measures the response of the FHR to fetal movement

Non-stress test

in this fetal test, woman is positioned & monitors are attached just like the rhythm strip test

10-20 minutes

NST is done for how many minutes?

Reactive

response with 2 accelerations of FHR (by 15 beats or more) lasting for 15 seconds, occur after movement within the chosen time period

nonreactive

no accelerations with the fetal movement, no movement, low short-term FHR variability (<6bpm) throughout the testing period

vibroacoustic stimulation

a specially-designed acoustic stimulator is applied to the mother's abdomen to produce a sharp sound (80 decibels at a frequency of 80 Hz), STARTLING & WAKENING the fetus

contraction stress testing

in this test, FHR is analyzed in conjunction with contractions (NIPPLE STIMULATION)

contraction stress testing

in this test, baseline FHR is obtained then woman rolls nipple until contraction begins-recorded by a uterine monitor

contraction stress testing

in this test, there are 3 contractions lasting for 40 sec or more in a 10-minute window

normal

result of CST with no FHR decelerations with the contractions

abnormal

result of CST with 50% or more of contractions cause late decelerations

early deceleration

begins on or after onset of contraction & ends when contractions ends; due to head compression during labor

late deceleration

begin after onset & peak of UC & ends after contraction; due to uteroplacental insufficiency

variable deceleration

u, w, or v shape, unrelated to contraction; due to cord compression

ultrasonography

test used to diagnose a pregnancy

ultrasonography

test used to confirm presence, location, size of placenta & amniotic fluid

ultrasonography

test used to establish fetal growth & r/o abnormalities, sex

ultrasonography

used to establish presentation & position of fetus

ultrasonography

predict maturity via the measurement of biparietal diameter of the headalso discovers complications of pregnancy

biparietal diameter

side-to-side measurement of the fetal head via ultrasound -also tests for femoral length

2500 g (5.5 lbs)

if biparietal diameter is 8.5 cm or greater, infant will weigh more than?

40 weeks

biparietal diameter of 8.5 cm indicates fetal age of?

34.5 cm

head circumference of a 40-week old fetus

Haase's Rule

determines length of fetus in cm

Doppler Umbilical Velocimetry

measures velocity at which RBC's in the blood volume are flowing

Doppler Umbilical Velocimetry

helps determine vascular resistance in women with Diabetes Mellitus & Hypertension of pregnancy

Doppler Umbilical Velocimetry

helps determine whether placental insufficiency occured

Placental Grading

based on the amount of Ca deposits in the base of the placenta (via UTZ)

0

placental grade (12 to 24 weeks)

1

placental grade (30 to 32 weeks)

2

placental grade (36 weeks)

3

placental grade (38 weeks & fetal lungs are mature)

amniotic fluid

a decrease in this puts the fetus at risk for compression of the umbilical cord with interference of nutrition as well as lack of room to exercise and maintain muscle tone

20 weeks

how many weeks of gestation will the vertical diameter of the largest pocket of AF on each side is measured in cm?

amniotic fluid index

sum of two measurements (dividing into 4 quadrants using linea nigra & umbilicus as the dividing lines & vertical diameter in each pocket is measured)

12-15 cm

normal AFI between 28 to 40 weeks

hydramnios

AFI is >20 to 24 cm (inability of fetus to swallow)

oligohydramnios

AFI is <5 to 6 cm (decreased AF may be due to poor perfusion & kidney failure)

Electrocardiography

may be recorded as early as 11th week of pregnancy

Magnetic Resonance Imaging

used to diagnose complications like ectopic pregnancy-no harmful effects to fetus

Maternal Serum Alpha-fetoprotein

levels begin to rise at 11 weeks gestation and then steadily increase until term

Maternal Serum Alpha-fetoprotein

there is high level in this in open spinal or abdominal defect because open defect allows more AFP to appear

Maternal Serum Alpha-fetoprotein

low in Down syndrome

Alpha-fetoprotein

a substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum

Triple Screening

analysis of 3 indicators (MSAFP, unconjugated estriol, hCG)

Triple Screening

test that requires only venipuncture of the mother

15-20 weeks

how many weeks of the pregnancy is TRIPLE SCREENING done?

Quadruple screening

test that requires INHIBIN determination

MSAFP, unconjugated estriol, hCG

indicators of Triple Screening

MSAFP, unconjugated estriol, hCG, inhibin A

indicators of Quadruple Screening

15th week

week where MSAFP is assessed