Assessment of Fetal G&D

Naegele’s Rule
count backward 3 calendar months from the first day

of the LMP and add 7 days.
Ex. LMP May 15 (April 15, March 15, February

15) 15 + 7 = 22.
Date of Birth: February 22

ASSESSMENT OF FETAL GROWTH
AND DEVELOPMENT
 metabolic or chromosomal
disorder
 supporting structures such as
placenta or cord do not form
normally
 environmental influences.
ASSESSMENT OF FETAL GROWTH
AND DEVELOPMENT
 Much information about the size and
health of the unborn child can be gathered
through a variety of assessment techniques.
Nursing responsibilities for assessment
procedures include:
Signed consent
Scheduling the procedure
Explaining the procedure
Preparing the woman physically and psychologically
Providing support during the procedure
Assessing both fetal and maternal responses to the
procedure
Providing any necessary follow-up care
Managing equipment and specimens
HEALTH HISTORY
Like all assessments, fetal assessment begins with
health history. Ask specifically about:
 Nutritional intake
Personal habits i.e. smoking, recreational drug use,
exercise
Any accidents or experienced intimate partner abuse
ESTIMATING FETAL GROWTH
McDonald’s Rule – a symphysis-fundal height measurement
A common method of determining during mid-pregnancy,
that a fetus is growing in the utero
Typically, the distance from the uterine fundus to the
symphysis pubis in centimetres is equal to the week of
gestation between the 20th and 31st weeks of pregnancy
McDonald’s rule becomes inaccurate during the third
trimester because fetus is growing more in weight than in
height.
Fundal height much greater than the standard suggests
multiple pregnancy, a large-for-gestational-age infant,
hydramnios or possibly even a hydatidiform mole
Fundal height, or
McDonald's Rule, is a
measure of the size of the
uterus to assess fetal growth
and development.
Determining and recording that the
fundus has reached typical milestone
measurement, such as:
Over the symphysis pubis = 12 weeks
At the umbilicus = 20 weeks
 at the xiphoid process = 38 weeks
ASSESSING FETAL WELL-BEING
Fetal Movement – fetal

movement can be felt by
mother (quickening) at 18 to
20 weeks of pregnancy and
peaks at 28 to 38 weeks.
Sandovsky method – mother lies in a left
recumbent position after a meal and record
how many fetal movements she feels in the
next hour.
Normally, fetus moves a minimum of twice
every every 10 minutes or an average of 10
to 12 times an hour
If less than 10, the mother repeats the test
for the next hour.
Cardiff method – the mother records the
interval it takes for her to feel 10 fetal
movements.
Usually this occurs within 60 minutes.

Make sure to instruct the woman that fetal
movements do vary, especially in relation to
sleep cycles of the fetus and the mother’s
activity during the observation time.
FETAL HEART RATE
FETAL HEART BEATS – 120 to 160 beats per
minute throughout pregnancy.
Fetal heart sounds can be heard and counted as
early as 10th to 11th week of pregnancy using a
Doppler technique.
Fetal heart beat of less than 90 bpm is high risk
for miscarriage at 5 to 8 weeks of pregnancy.
RHYTHM STRIP TESTING
Assessment of the fetal heart rate for
whether a good baseline rate and
long-and-short term variability are
present.
Baseline reading – refers to the average
rate of the fetal heartbeat per minute.
Short-term variability (Also called
beat-to-beat variability) denotes the
small changes in rate that occur from
second to second if the fetal
parasympathetic nervous system is
receiving adequate oxygen and
nutrients.
Long-term variability denotes the
differences in heart rate that occur
over the 20-minute time period.
PROCEDURE:
Woman is placed in a semi-Fowler’s position to
prevent the uterus from compressing the vena
cava causing supine hypotension syndrome
during the test.
External fetal heart rate and uterine contraction
monitors are attached abdominally.
Fetal heart rate is then recorded for 20 min
Average fetus moves about twice every 10
mins. and movement causes the heart rate
to increase. There will typically be two or
more instances of fetal heart acceleration
in a 20-minute rhythm strip.
NONSTRESS TESTING
Measures the response of the FHR to fetal movements.
PROCEDURE:
Position similar to rhythm strip
Woman pushes a button attached to the monitor
whenever she feels the fetus move. A dark line marks the
paper tracing at this point.
When the fetus moves, the FHR should increase about
15bpm and remain elevated for 15 seconds.
It should decrease to its average again as the fetus quiets.
NONSTRESS TESTING
If no increase in beats per minute is noticeable
in fetal movement, poor oxygen perfusion of
the fetus is suggested.
This test is done for 10 to 20 minutes.
The test is said to be reactive if two
accelerations of FHR (by 15 beats or more)
lasting for 15 seconds occur after movement
within the chosen time period.
NONSTRESS TESTING
Both rhythm strip and nonstress testing are
noninvasive procedures and cause no risk to
either mother or fetus, they can be used as
screening procedures in all pregnancies.

If a nonstress test is nonreactive, additional
fetal assessment, such as contraction stress test
or a biophysical profile test, will be scheduled.
VIBROACOUSTIC STIMULATION
A specially designed acoustic (sound) stimulator is

applied to the mother’s abdomen to produce a sharp
sound of approximately 80 decibels at a frequency of
80 Hz, startling and waking the fetus.
If a spontaneous acceleration has not occurred within
5 minutes, this could be repeated again at the end of 10
minutes if no spontaneous movement occurs.
CONTRACTION STRESS TESTING
Nipple stimulation as a source of oxytocin is
used for contraction stress testing
Gentle stimulation of the nipples releases
oxytocin in the same way as happens with
breastfeeding.
With external uterine contraction and fetal
heart rate monitors in place, the baseline FHR
is obtained.
CONTRACTION STRESS TESTING
3 contractions with a duration of 40 seconds or
longer before the test can be interpreted.
The test is negative (normal) if no FHR
decelerations are present with contractions.
It is positive (abnormal) if 50% or more of
contractions cause a late deceleration (a dip in
FHR that occurs toward the end of a
contraction and continues after the
COMPARISON OF NONSTRESS & CONTRACTION TESTS
ASSESSMENT NONSTRESS CONTRACTION
What is measured Response of FHR in Response of FHR in
relation to fetal relation to uterine
movements contractions produced by
nipple stimulation
Normal findings 2 or more accelerations of No late decelerations
FHR of 15bpm lasting 15 with contractions
sec.or more following
fetal movements in a 20-
min period
Safety considerations Woman should not lie In addition to preventing
supine to prevent supine supine hypo.. Observe
hypotension syndrome woman for 30 min
afterward to see that
contractions are quiet
and preterm labor does
not begin
ULTRASONOGRAPHY
Ultrasound is a technique that uses sound waves to show a

picture of a baby (fetus) in the uterus. Because it uses
sound waves instead of radiation, ultrasound is safer than
X-rays.
Ultrasound provides important information about the
health of the fetus and conditions in the uterus. This
information can guide a health care provider's plans for a
pregnant woman and improve the outcome of pregnancy.
ULTRASONOGRAPHY
It can be used for the following purposes:

To diagnose pregnancy as early as 6weeks of gestation
To confirm the presence, size, and location of the placenta and
amniotic fluid
To establish that a fetus is growing and has no gross anomalies, such
as hydrocephalus, anencephaly (congenital absence of all or major
part of the brain), or spinal cord, heart, kidney, and bladder defects
To establish sex if a penis is revealed
To establish the presentation and position of the fetus
To predict maturity by measurement of the biparietal diameter of the
head
ULTRASONOGRAPHY
It is also used to discover complications of pregnancy, such as

the presence of an intrauterine device, hydramnios or
oligohydramnios, ectopic pregnancy, missed miscarriage,
abdominal pregnancy, placenta previa, premature separation of
the placenta, coexisting tumors, multiple pregnancy, or genetic
abnormalities such as Down syndrome.
Fetal anomalies such as neural tube disorders, diaphragmatic
hernia, or urethral stenosis can also be diagnosed.
Fetal death can be revealed by a lack of heartbeat and
respiratory movement. After birth, a sonogram may be used to
detect a retained placenta or poor uterine involution in the
mother.
ULTRASONOGRAPHY
Intermittent sound waves of high frequency are projected

toward the uterus by a transducer placed on the abdomen
(TRANSABDOMINAL) or in the vagina
(TRANSVAGINAL). The sound frequencies that bounce
back can be displayed on an oscilloscope screen as a visual
image. The frequencies returning from tissues of various
thickness and properties present distinct appearances. A
permanent record can be made of the scan.
ULTRASONOGRAPHY
The intricacy of the image obtained depends of the type of
process used.
B-MODE SCANNING – most frequently used and produces
what people generally refer to as Sonogram. This mode allows
patterns to merge and form a picture, similar to a black and
white television picture (gray-scale imaging).
REAL-TIME MODE – involves the use of multiple waves that
allow screen picture to move, and even movement of the
extremities, such as bringing a hand to the mouth to suck a
thumb, can be seen. A parent who is in doubt that her fetus is
well or whole can be greatly reassured by viewing a real-time
sonogram.
ULTRASONOGRAPHY
PROCEDURE:
 Before an ultrasound examination, a woman needs a good
explanation of what will happen and reassurance that the
process does not involve x-rays. It is also safe for the father
of the child to remain in the room during the test.
For the sound waves to reflect best and the uterus to be
held stable, it is helpful if the mother has a full bladder at
the time of the procedure. Mother should drink a full glass
of water every 15 minutes beginning 90 minutes before the
procedure and should not void before the procedure.
ULTRASONOGRAPHY
PROCEDURE:
For the actual procedure, the mother lies on an examining table
and is draped for privacy, but with her abdomen exposed. (To
prevent supine hypotension syndrome, place a towel under her
right buttock to tip her body slightly so that the uterus will roll
away from the vena cava).
A gel is applied to her abdomen to improve the contact of the
transducer. (Be certain that the gel is at room temperature or
even slightly warmer, or it can cause uncomfortable uterine
cramping).
The transducer is then applied to her abdomen and moved
both horizontally and vertically until the uterus and its
contents are fully scanned.
ULTRASONOGRAPHY
BIPARIETAL DIAMETER
 Ultrasonography may be used to predict fetal maturity by
measuring the biparietal diameter (side to side
measurement) of the fetal head.
In 80% of pregnancies in which the biparietal diameter of
the fetal head is 8.5 cm or greater, the infant will weigh
more than 2,500 g (5.5 lb).
A biparietal diameter of 8.5 cm indicates a fetal age of 40
weeks.
ULTRASONOGRAPHY
BIPARIETAL DIAMETER
Two other measurements made by sonography are:
head circumference (34.5 cm indicates a 40-week fetus)
femoral length -- Measures the longest bone in the body
and reflects the longitudinal growth of the fetus. Its
usefulness is similar to the BPD. It increases from about 1.5
cm at 14 weeks to about 7.8 cm at term.
ULTRASONOGRAPHY
DOPPLER UMBILICAL VELOCITY
Measures the velocity (speed or rate) at which red blood
cells in the uterine and fetal vessels are traveling.
Assessment of the blood flow through uterine blood
vessels is helpful in determining the vascular resistance
present in women with diabetes or hypertension of
pregnancy and whether resultant placental insufficiency
has occurred.
Because it will limit the number of nutrients that can
reach the fetus, decreased velocity is an important
predictor of poor neonatal outcome.
ULTRASONOGRAPHY
PLACENTAL GRADING
Based particularly on the amount of calcium deposits in
the base of the placenta, placenta can be graded by
ultrasound as:
0 = a placenta 12 to 24 weeks
1 = a placenta 30 to 32 weeks
2 = 36 weeks
3 = 38 weeks
A grade 3 placenta suggests that the fetus is mature

ULTRASONOGRAPHY
AMNIOTIC FLUID VOLUME ASSESSMENT
The amount of amniotic fluid present is an important fetal
assessment, for a portion of the fluid is formed by fetal
kidney output.
If a fetus is becoming stressed in utero because the
circulatory and kidney functions are failing, urine output,
and consequently the volume of amniotic fluid also will
decrease.
A decrease in amniotic fluid volume puts the fetus at risk
for compression of the umbilical cord and consequent
interference with nutrition.
ULTRASONOGRAPHY
For gestations of less than 20 weeks, the uterus is hypothetically
divided along the linea nigra into two vertical halves. The vertical
diameter of the largest pocket of amniotic fluid present on each
side is measured in centimeters
The amniotic volume index is the sum of the two measurements
For gestations of 20 weeks or more, the uterus is divided into four
quadrants, using the linea nigra again as the vertical dividing line
and the level of umbilicus as the horizontal dividing line.
The vertical diameter of the largest pocket of fluid in each
quadrant is obtained, and the four values are then added to
produce the amniotic fluid index.
ULTRASONOGRAPHY
The average index is approximately 12 to 25 cm. between
28 and 40 weeks.
An index greater than 20 to 24 cm. indicates hydramnios
(excessive fluid, perhaps caused by inability of the fetus to
swallow);
And index less than 5 to 6 cm. indicates oligohydramnios
(decreased amniotic fluid, perhaps caused by poor
perfusion and kidney failure)
ELECTROCARDIOGRAPHY
Fetal ECGs may be recorded as early as the 11 th week of

pregnancy.
But ECG is inaccurate before the 20th week, because fetal
electrical conduction is so weak that it is easily masked by
the mother’s ECG tracing.
It is rarely used unless specific heart anomaly is suspected.

MAGNETIC RESONANCE IMAGING
MRI may be used to assess fetus.

The technique caused no harmful effects to the fetus or
mother
MRI has the potential to replace or complement
ultrasonography as a fetal assessment technique
It may be most helpful is diagnosing complications such as
ectopic pregnancy or trophoblastic disease because later in
a pregnancy, fetal movement can obscure the findings.

MATERNAL SERUM ALPHA-FETOPROTEIN
Alpha-fetoprotein (AFP) is a substance produced by the liver

that is present in amniotic fluid and maternal serum.
Traditionally assessed at the 15th week of pregnancy, between 85
to 90% of neural tube defects and 80% of Down syndrome
babies can be detected by this method.
The level is abnormally high in the maternal serum (MSAFP) if
the fetus has an open spinal or abdominal defect, because the
open defect allows more AFP to appear.
Although the reason is unclear, the level of AFP is low if the
fetus has a chromosomal defect such as Down syndrome.
MSAFP levels begin to rise at 11 weeks gestation and then
steadily increase until term.
TRIPLE SCREENING
Analysis of three indicators: MSAFP, unconjugated estriol,

hCG – may be performed in place of AFP testing alone to
yield more reliable results.
As with the measurement of MSAFP, it requires only a
simple venipuncture of the mother.

CHORIONIC VILLI SAMPLING
CVS is a biopsy and chromosomal analysis of chorionic

villi that is done at 10-12 weeks of pregnancy.
Coelocentesis – transvaginal aspiration of fluid from the
extraembryonic cavity, is an alternative method to remove
cells for fetal analysis.

AMNIOCENTESIS
From the Greek word amnion for sac and kentesis for puncture
Aspiration of amniotic fluid from the pregnant uterus for
examination
Procedure can be done at the physician’s office or in an
ambulatory clinic
Typically scheduled between the 14th and 16th weeks of
pregnancy to allow for a generous amount of amniotic fluid to
be present.
The technique can be used again near term to test for fetal
maturity.

AMNIOCENTESIS
Amniocentesis is an easy procedure, but it can be

frightening to a woman. It involves penetration of the
integrity of the amniotic sac, there is also a risk for the
fetus, although this risk is low (less than 0.5%)
It can lead to hemorrhage due to penetration of the
placenta, infection of the amniotic fluid, and puncture of
the fetus. It can lead to irritation of the uterus, causing
premature labor.

AMNIOCENTESIS
PROCEDURE:
Ask the woman to void – to reduce bladder size, thus
preventing inadvertent puncture
Place her in a supine position on the examining table and
drape her appropriately, exposing only her abdomen.
Place a folded towel under her right buttock to tip her
body slightly to the left and move the uterus off the vena
cava, preventing supine hypotension syndrome

AMNIOCENTESIS
PROCEDURE:
Take the maternal blood pressure and measure FHR for
baseline levels
Explain that a sonogram will be done to determine the position
of the fetus, a pocket of amniotic fluid, and the placenta.
The abdomen will be washed with an antiseptic solution, and a
local anesthesia will be given.
Caution the woman that she may feel a sensation of pressure as
the needle used for aspiration, a 3 in. or 4 in., 20 to 22 gauge
spinal needle is introduced
Do not suggest that she take a deep breath and hold it as a
distraction against discomfort; this lowers the diaphragm
against the uterus and shifts intrauterine contents.

AMNIOCENTESIS
PROCEDURE:
The needle is inserted into the amniotic cavity over a pool of
amniotic fluid, carefully avoiding the fetus and placenta
A syringe is attached and about 15ml of amniotic fluid is
withdrawn.
The needle is then removed, and the woman rests quietly for
about 30 minutes
During the procedure and for the 30 minutes afterward,
observe the FHR monitor to be certain the rate remains normal,
and observe the uterine contraction monitor to be sure that no
contractions are occurring.

AMNIOCENTESIS
PROCEDURE:
If the woman has Rh-negative blood, Rho(D) immune globulin
(RhIG; RhoGAM) may be administered after the procedure to
prevent fetal isommunization. This is to ensure that maternal
antibodies will not form against any placental red blood cells
that might have accidentally been released during the procedure
Amniocentensis can provide information in a number of areas:
Color
Lecithin/Sphingomyelin ratio
Phospatidyl Glycerol and Desaturated Phosphatidylcholine
Bilirubin determination
Chromosome analysis
Fetal fibronectin
Inborn errors of metabolism
Alpha-fetoprotein
AMNIOCENTESIS
COLOR – Normal amniotic fluid is the color of water;

late in pregnancy, it may have a slightly yellow tinge
A strong yellow color suggests blood incompatibility
(the yellow results from the presence of bilirubin
released with the hemolysis of red blood cells)
A green color suggests meconium staining, a
phenomenon associated with fetal distress

AMNIOCENTESIS
LECITHIN/SPHINGOMYELIN RATIO
Lecithin and sphingomyelin are the protein components of
the lung enzyme surfactant that the alveoli begin to form
at 22nd to 24th weeks of pregnancy.
After amniocentesis, the L/S ratio may be determined
quickly by a shake test – (if bubbles appear in the amniotic
fluid after shaking, the ratio is mature) or it can be sent for
laboratory analysis.
An L/S ratio of 2:1 is traditionally accepted as lung
maturity.
AMNIOCENTESIS
LECITHIN/SPHINGOMYELIN RATIO
Infants of mothers with severe diabetes may have false
mature readings of lecithin because the stress to the
infant in utero tends to mature lecithin pathways easily.
Infant may be born with mature lung function but be
immature overall (fragile giants) and thus may not do
well in postnatal life.
Some laboratories interpret a ratio of 2.5:1 or 3:1 as a
mature indicator in infants of diabetic mothers
AMNIOCENTESIS
PHOSPHATIDYL GLYCEROL AND DESATURATED

PHOSPHATIDYLCHOLINE
Other compounds, in addition to L/S, that are found
in surfactant
Pathways for these compounds mature 35 to 36 weeks
They present only with mature lung function, if they
are present in the sample amniotic fluid obtained by
amniocentesis, it can be predicted that respiratory
distress syndrome will not occur
AMNIOCENTESIS
BILIRUBIN DETERMINATION
Presence of bilirubin may be analyzed if a blood
incompatibility is suspected.
If bilirubin is going to be analyzed, the specimen must
be free of blood or a false-positive reading will occur.

AMNIOCENTESIS
CHROMOSOME ANALYSIS
A few fetal skin cells are always present in amniotic
fluid. These cells may be cultured for karyotyping.

AMNIOCENTESIS
FETAL FIBRONECTIN
Fibronectin is a glycoprotein that plays a part in helping
the placenta attach to the uterine deciduas. It can be
found in abundant amounts to the uterine deciduas.
Early in pregnancy, it can be assessed in the woman’s
cervical mucus, but the amount then fades, after 20 weeks
of pregnancy, it is no longer present.
As labor approaches and cervical dilatation begins, it can
be assessed again in cervical or vaginal fluid.

AMNIOCENTESIS
FETAL FIBRONECTIN
Damage to fetal membranes releases a great deal of
the substance, so detection of fibronectin in the
amniotic fluid or in the mother’s vagina can serve as
announcement that preterm labor may be beginning.

AMNIOCENTESIS
INBORN ERRORS OF METABOLISM

Some inherited diseases that are caused by inborn errors of
metabolism can be detected by amniocentesis.
For a condition to be identified, the enzyme defect must be
present in the amniotic fluid as early as the time of the
procedure.
Illnesses that can be detected in this way are cystinosis and
maple syrup urine disease (amino acid disorders)
AMNIOCENTESIS
ALPHA-FETOPROTEIN
If the fetus has an open body defect, such an anencephaly,

myelomeningocele, or omphalocele, increased levels of AFP will be
present in the amniotic fluid because of leakage of AFP into the fluid.
The level will be decreased in the amniotic fluid of fetuses with
chromosomal defects such as Down syndrome.
Acetylcholinesterase is another compound that is obtained from amniotic
fluid in high levels if a neural tube defect is present.
PERCUTANEOUS BLOOD SAMPLING
PUBS, also called Cordocentesis or Funicentesis – aspiration

of blood from the umbilical vein for analysis.
After the umbilical vein is located by sonography, a thin
needle is inserted by amniocentesis technique into the
uterus and is guided by ultrasound until it pierces the
umbilical vein
A sample blood is then removed for blood studies, such as

Complete blood count
Direct Coombs test
Blood gases
Karyotyping
To ensure that the blood obtained is fetal blood, it is submitted
to KLEIHAUER-BETKE Test
• If a fetus is found anemic, blood may be transfused using the same technique
Because the umbilical vein continues to ooze for a moment after the procedure,
fetal blood could enter the maternal circulation, so RhIG is given to Rh-negative
women to prevent sensitization.
Fetus is monitored by a nonstress test before and after the procedure to be certain
that uterine contractions are not present and by ultrasound to see that no
bleeding is evident.
PUBS carries little additional risk to the fetus or mother over amniocentesis and
can yield information not available by any other means, especially about blood
dyscrasias (an imbalance components of blood).

AMNIOSCOPY
Visual inspection of the amniotic fluid through the cervix

and membranes with an amnioscope (a small fetoscope).
The main use of the technique is to detect meconium
staining.
It carries some risk of membrane rupture

FETOSCOPY
Fetus is visualized by inspection through a fetoscope (an extremely
narrow, hollow tube inserted by amniocentesis technique), is sometimes
helpful in assessing fetal well-being.
A photograph can be taken through the fetoscope to reassure parents
that their infants is well and perfectly formed.
The procedure may be used for the following purposes:
To confirm the intactness of the spinal column
To obtain biopsy samples of fetal tissue and fetal blood samples

FETOSCOPY
To perform elemental surgery, such as inserting a polyethylene

shunt into the fetal ventricles to relieve hydrocephalus or
anteriorly into the fetal bladder to relieve a stenosed urethra.
Earliest time that fetoscopy can be performed is about the 16 th or
17th week.

FETOSCOPY
PROCEDURE
Mother is prepared and draped as for amniocentesis
Local anesthesia is injected into the abdominal skin
Fetoscope is then inserted through a minor abdominal incision
If the fetus is very active, meperidine (Demerol) may be administered to the mother –
this drug crosses the placenta and sedates the fetus, to avoid fetal injury by the scope to
allow better observation
Fetoscopy carries a small risk of premature labor
Amnionitis (infection of the amniotic fluid) may occur – to avoid this, mother may be
prescribed 10 days of antibiotic therapy after the procedure

BIOPHYSICAL PROFILE
Combines five parameters into one assessment :
Fetal activity
Fetal breathing movements
Fetal body movement
Fetal tone
Amniotic fluid volume
Fetal heart and breathing record measures short-term nervous system function
Amniotic fluid volume helps measure long-term adequacy of placental function

BIOPHYSICAL PROFILE
By this system, each item has the potential for scoring a 2, so 10
would be the highest score possible.
Biophysical profile is more accurate in predicting fetal well-being
than any single assessment. Because the scoring is similar to that
of the Apgar score determined at birth on infants, it is popularly
called FETAL APGAR
It may be done as often as daily during a high-risk pregnancy.

BIOPHYSICAL PROFILE
If the fetus score on a complete profile is 8 to 10, the fetus is considered to be doing
well
A score of 6 is considered suspicious
A score of 4 denotes fetal jeopardy
At present, some centers use only two assessments (amniotic fluid index and
nonstress test), it is referred to as MODIFIED BIOPHYSICAL PROFILE, it predicts
short-term viability by nonstress test and long-term viability by the amniotic fluid
index.
Nurses play a large role in obtaining the information for both the modified and the
full biophysical profile by obtaining either the nonstress or the sonogram reading.

BIOPHYSICAL PROFILE SCORING
ASSESSMENT INSTRUMENT CRITERIA FOR A
SCORE OF 2
FETAL BREATHING Sonogram At least one episode of 30
sec of sustained fetal
breathing movements
within 30 min of
observation
FETAL MOVEMENT Sonogram At least three separate
episodes of fetal limb or
trunk movement w/in a
30-min observation
FETAL TONE Sonogram The fetus must extend
and then flex the
extremities or spine at
least once in 30 min
BIOPHYSICAL PROFILE SCORING
ASSESSMENT INSTRUMENT CRITERIA FOR A
SCORE OF 2
AMNIOTIC FLUID Sonogram A pocket of amniotic
VOLUME fluid measuring more
than 1 cm in vertical
diameter must be present
FETAL HEART Nonstress Test Two or more FHR
REACTIVITY accelerations of at least
15bpm above baseline
and of 15 sec duration
with fetal movements
over a 20-min time
period

Assessment of Fetal G&D

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Assessment of Fetal G&D

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Naegele’s Rule

count backward 3 calendar months from the first day

Ex. LMP May 15 (April 15, March 15, February

Fetal Movement – fetal

Usually this occurs within 60 minutes.

A specially designed acoustic (sound) stimulator is

Ultrasound is a technique that uses sound waves to show a

It can be used for the following purposes:

It is also used to discover complications of pregnancy, such as

Intermittent sound waves of high frequency are projected

A grade 3 placenta suggests that the fetus is mature

Fetal ECGs may be recorded as early as the 11 th week of

MRI may be used to assess fetus.

Alpha-fetoprotein (AFP) is a substance produced by the liver

Analysis of three indicators: MSAFP, unconjugated estriol,

CVS is a biopsy and chromosomal analysis of chorionic

Amniocentesis is an easy procedure, but it can be

COLOR – Normal amniotic fluid is the color of water;

PHOSPHATIDYL GLYCEROL AND DESATURATED

INBORN ERRORS OF METABOLISM

If the fetus has an open body defect, such an anencephaly,

PUBS, also called Cordocentesis or Funicentesis – aspiration

A sample blood is then removed for blood studies, such as

Visual inspection of the amniotic fluid through the cervix

To perform elemental surgery, such as inserting a polyethylene

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