Several sites are utilized in aspiration. Can be done earlier than anmio
Triple screen: maternal serum alpha fetoprotein (MSAFP), beta hCG, uncongigated estriol Quad Screen: above plus pregnancy associated plasma A protein Need to be aware of maternal weight, gestational age, multiple gestation, race and diabetes – all these can skew results
Many studies, none to find side effects to fetus
Done with U/S
For ABO incompatibilities or hydrops, can tell amt of bilirubin in amniotic fluid to see if fetus needs transfusion
Isoimmunization(mom antibodies attack fetal RBC), parvo virus (slows production of RBC), fetal maternal hemorrhage
Graph is little blurry but shows how much blood to transfuse.
Magnetic resonance imaging Able to separate maternal and fetal tissue, clearer image Claustrophobia, size of abd and fitting in chamber
Due to organ formation
Watch language with pt – tazer, buzzer, zapper VAS programmed for this time, push button till stops Decels common Do not use if fetus compromised or has heart issues
Wiki.diagnostic fetal assessment tests 2011
Diagnostic Fetal Assessment tests Sandy Warner RNC-OB, MSN August 3, 2011 Inpatient Review Class
Prenatal Assessments and screening Chorionic Villous sampling: 10-12 wk using U/S to aspirate trophoblastic tissue Can be done either transabdominally or transvaginally Detects chromosome abnormality Risks: miscarriage, bleeding, infection & PROM
Prenatal Assessments and screening cont. Triple or Quad Screen Blood drawn between 15-20 wks Can detect Down’s syndrome, other chromosomal abnormalities and neural tube defects Values of blood tests added together to determine risk Screening tool – further testing needed for definitive diagnosis
Ultrasound Developed in WWII with submarines Diagnostic use since 1950s Definition: transmission of sound waves to investigate an object (Kline-Fath & Bitters, 2007)
Placental grading Grade 0 – smooth, dense w/o echogenic areas Grade 1 – undulations present, some echogenic areas Grade 2 – deeper and > indentations, more echogenic areas Grade 3 – dense echogenic areas w/ indentations, areas of calcification
Amniocentesis Trans-abdominal needle aspiration of 10-20 ml of amniotic fluid for lab analysis Done under ultrasound Requires sterile technique and time out
Amniocentesis Indications: Genetic R/O infection Fetal lung maturity Assess for bilirubin with hemolytic incompatibility
Amniocentesis Timing: Early – performed between 11-14 wks Significantly higher pregnancy loss Post procedure fluid loss 2nd trimester – performed between 15-20 wks Usually for genetic screening 3rd trimester Usually for fetal lung maturity (Gilbert, 4th edition, pg 93)
Cordocentesis /Fetal Blood Transfusion Blood Transfusion for anemia How much blood is given? Graph is used correlating the hematocrit of donor blood to the hematocrit of the fetus to determine donor blood volume to be given
Amnioreduction Reduces amount of amniotic fluid around fetus Procedure like amniocentesis only with tubing to suction canister or stopcock Done to relieve maternal symptoms or with twin to twin transfusion syndrome
Fetal MRI Superior soft tissue contrast test Does not use radiation Used for fetal brain, spinal deformities, lesions, masses Also can assess placental and cord malformations Also used to measure lung volume Research still continuing for PPROM pts (Kline-Fath & Bitters, 2007)
Fetal MRI Con’t Not recommended in first trimester (no documented studies on harm from heat or sound, but not recommended) Not used routinely, only after U/S not able to detect Contrast dye not recommended Informed consent (Kline-Fath & Bitters, 2007)
Vibroaccoustic Stimulation (VAS) Artificial acoustic stimulation Done after 25 wks gestation when fetus can hear After 10 minutes of baseline and no accelerations, place the artificial larynx on the maternal abdomen over the fetal head
Vibroaccoustic Stimulation Provide 5-10 sec stimulation near fetal head, wait one minute If no acceleration repeat cycle for a total of three times if non-reactive after 40 minutes, proceed with further evaluation
Vibroaccoustic Stimulation Fetuses 28 weeks or greater respond to VAS with a consistent increase in heart rate. Observed changes are greater as term is approached.
References Gilbert, E. S., (2011) 5th edition Manual of High Risk Pregnancy and Delivery. Kline-Fath, B. & Bitters, C. (2007) “Prenatal Imaging” Newborn and Infant Nursing Reviews, Vol.7, No. 4. Mattson, S. & Smith, J.E., (2011) 4th edition Core Curriculum for Maternal-Newborn Nursing. Queenan, J.T., Hobbins, J. C., & Spong, C. Y. (2005) 4th edition, Protocols for High-Risk Pregnancies
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