OB ATI: Chapter 6 - Assessment of Fetal Well Being

OB ATI: Chapter 6 - Assessment of Fetal Well Being The diagnostic procedures to be reviewed include - ultrasound (abdominal, transvaginal, Doppler) - biophysical profile - nonstress test - contraction stress test (nipple, oxytocin [Pitocin] - amniocentesis Ultrasound - a procedure lasting approximately 20 min that consists of high-frequency sound waves used to visualize internal organs and tissues by producing a real-time, three-dimensional image of the developing fetus and maternal structures (FHR, pelvic anatomy). - An ultrasound allows for early diagnosis of complications, permits earlier interventions, and thereby decreases neonatal and maternal morbidity and mortality. - There are three types of ultrasound: external abdominal, transvaginal, and Doppler. External abdominal ultrasound a safe, noninvasive, painless procedure whereby an ultrasound transducer is moved over a client's abdomen to obtain an image. An abdominal ultrasound is more useful after the first trimester when the gravid uterus is larger. Internal transvaginal ultrasound an invasive procedure in which a probe is inserted vaginally to allow for a more accurate evaluation. An advantage of this procedure is that it does not require a full bladder. ■ It is especially useful in clients who are obese and those in the first trimester to detect an ectopic pregnancy, identify abnormalities, and to establish gestational age. ■ A transvaginal ultrasound also may be used in the third trimester in conjunction with abdominal scanning to evaluate for preterm labor. Doppler ultrasound blood flow analysis a noninvasive external ultrasound method to study the maternal-fetal blood flow by measuring the velocity at which RBCs travel in the uterine and fetal vessels using a handheld ultrasound device that reflects sound waves from a moving target. - It is especially useful in fetal intrauterine growth restriction (IUGR) and poor placental perfusion, and as an adjunct in pregnancies at risk because of hypertension, diabetes mellitus, multiple fetuses, or preterm labor. Indications for the use of an ultrasound during pregnancy: Potential diagnoses for: ■ Confirming pregnancy ■ Confirming gestational age by biparietal diameter (side-to-side) measurement ■ Identifying multifetal pregnancy ■ Site of fetal implantation (uterine or ectopic) ■ Assessing fetal growth and development ■ Assessing maternal structures ■ Confirming fetal viability or death ■ Ruling out or verifying fetal abnormalities ■ Locating the site of placental attachment ■ Determining amniotic fluid volume ■ Fetal movement observation (fetal heartbeat, breathing, and activity) ■ Placental grading (evaluating placental maturation) ■ Adjunct for other procedures (e.g., amniocentesis, biophysical profile) Ultrasound: Client presentation ■ Vaginal bleeding evaluation ■ Questionable fundal height measurement in relationship to gestational weeks ■ Reports of decreased fetal movements ■ Preterm labor ■ Questionable rupture of membranes ● Nursing actions for an ultrasound Ultrasound: Preparation of client ■ Explain the procedure to the client and that it presents no known risk to her or her fetus. ■ Advise the client to drink 1 to 2 quarts of fluid prior to the ultrasound to fill the bladder, lift and stabilize the uterus, displace the bowel, and act as an echolucent to better reflect sound waves to obtain a better image of the fetus. ■ Assist the client into a supine position with a wedge placed under her right hip to displace the uterus (prevents supine hypotension). Unltrasound: Ongoing care ■ Apply an ultrasonic/transducer gel to the client's abdomen before the transducer is moved over the skin to obtain a better fetal image, ensuring that the gel is at room temperature or warmer. ■ Allow the client to empty her bladder at the termination of the procedure. ● Nursing actions for a transvaginal ultrasound Nursing actions for a transvaginal ultrasound: Preparation of client ■ Assist the client into a lithotomy position. The vaginal probe is covered with a protective device, lubricated with a water-soluble gel, and the client or examiner inserts the probe. Nursing actions for a transvaginal ultrasound: Ongoing care ■ During the procedure, the position of the probe or tilt of the table may be changed to facilitate the complete view of the pelvis. ■ Inform the client that pressure may be felt as the probe is moved. Nursing actions for a transvaginal ultrasound: Client education Fetal and maternal structures may be pointed out to the client as the ultrasound procedure is performed. ................