OB NURS 306Study Guide for Week 2 Content Summer 2021.

OB NURS 306Study Guide for Week 2 Content Summer 2021. Study Guide for Week 2 Content (Chapters 6 & 9) The next quiz will ask about the material that is on the study guide. I will expect you to know NST (accelerations, reactive/nonreactive), the definitions about the components of a fetal heart rate tracing, VEAL- CHOP (the mnemonic we used for decelerations and what causes them) since these concepts were introduced in OB CCC. FHR strips will be on the quiz. Please also take a look at the interventions for the decelerations- you should be familiar with them from CCC as well. Chapter 6 ▪ Indications for first trimester ultrasound o Fetal abnormalities o To confirm Pregnancy is intrauterine (not ectopic) o To confirm fetal cardiac activity o Number of fetuses (to detect multiple gestation (number and size of gestational sacs) o Size and correlation to EDC (determining gestational age) o PREGNANCY VERIFICATION DATING ULTRASOUND (done for every patient) ** (usually performed as a TVS- TRANSVAGINAL ULTRASOUND ▪ Best when early in the pregnancy ▪ Tell patient to empty bladder prior to ultrasound o Evaluate pelvic anatomy o Explore cause of vaginal bleeding o Detect other potential abnormalities in early pregnancy o CRL- “crown rump length” ▪ Measure from crown of head to rump for DATING! ▪ Additional info not on study guide** chapter 4!! o RH RhoGAM- mom always gets RhoGAM no matter what (+ or -) o RH+ antibody screen o If mom is negative, were going to give RhoGAM after possible trauma or possible crossing like amniocentesis. o Every woman that is RH Neg- gets RhoGAM at 28 weeks!!! **** o If RH neg, always gets RhoGAM ▪ And trauma or birth o If mom is blood B+, gets RhoGAM shot NEVER*** ▪ What does nuchal (neck) translucency screen for? o Screens for down syndrome TRISOMY 21 o **Nuchal translucency is most reliable between 11-14 weeks gestation** o This test measures nuchal folds on back of baby’s neck ▪ Anatomy UltraSound (SCREENING TEST) tells gender o When is it performed? ▪ Typically performed in 2nd trimester between 18-22 weeks (20 weeks)* gestation o What does it look for? ▪ Head ▪ Face (cleft face and palate) ▪ Kidneys ▪ Neck ▪ Spine (spinabiffida) ▪ Lower limbs ▪ Reveals the gender** • Not 100% ▪ 3D or 4D ultrasound is reserved for high risk like cleft lip etc. o Indication for UMBILICAL ARTERY DOPPLER FLOW (SCREENING TEST) ▪ Noninvasive to assess to resistance to blood flow in the placenta • If issues with blood flow, baby will have issues with IUGR (Intrauterine growth restricted) small for gestational age. Fundal height hasn’t grown. ▪ **Looks at placental perfusion through systolic/diastolic flow ▪ If looking at the flow of the placenta if you get resistance at the end you’re going to have of Reversed end diastolic flow. Bc the vessels are so constricted ▪ **know what kind of patient needs doppler flow • **When placental vascular dysfunction results in increased umbilical artery blood flow resistance, which progresses to decreased middle cerebral artery impedance followed by ultimately by abnormal flow of the DUCTUS VENOSUS.** ▪ CVS (Chorionic Villus Sampling) (between placenta and villi) (DIAGNOSTIC TEST) o This a diagnostic test o Done between 10-12 weeks to check trisomy 21 (down syndrome) o Indication (who is it offered to?) ▪ For high-risk pregnancies • AMA • Past down syndrome baby • Strong family hx o Procedure ▪ Aspiration of a small amount of placental tissue (chorion) • Catheter up the vagina to cervix and get sample • Or more commonly use ultrasound probe with one hand and taking needle through belly and aspirate. ▪ Place supine ▪ Detects chromosomal, metabolic or DNA testing. o Timing in pregnancy ▪ 10-12 weeks o Risks ▪ 7% fetal loss o Pros and cons for parents ▪ CONs 1 week for results** ▪ PROs can do this early in the pregnancy (1st trimester) • Decide whether you want to terminate pregnancy ▪ Amniocentesis (amniotic fluid testing) (DIAGNOSTIC TEST) o Indication ▪ For genetic testing (14-20 weeks) ** ▪ Fetal lung maturity (can also be done later in the pregnancy) o Procedure ▪ This is a Diagnostic test ▪ Insert needle and take sample, centrifuge, culture of fetal cells: gives us (chemical analysis, DNA analysis, Chromosomal analysis) o Timing in pregnancy ▪ Typically done 15-20 weeks** ▪ Or later in the pregnancy for fetal lung maturity o Risks ▪ Less risky, <1% ** ▪ Rh sensitization from fetal blood into maternal circulation o Pros and cons for parents ▪ PROs confirm gender of baby ▪ PROs fetal chromosomes for genetic disorders ▪ PRO can check for Amniotic fluid infection*