N3280 Screening Tests and Assessment 2025

Assessment of fetal well-being in 1st trimester - - -confirm pregnancy -confirm viability -determine gestational age -detect fetal anomalies Is transvaginal or transabdominal ultrasonography bettwe - -transvaginal has better and clearer images Transvaginal ultrasound - --detects gestational sac at 4-5 weeks -fetal heart activity at 6-7 weeks -BPD measurement and crown length at 14 weeks predicts EDB within 7-10 days transabdominal ultrasound - --fetal heart beat at 10-12 weeks -fetal weight during pregnancy screening and diagnostic tests for first trimester - --ultrasound -nuchal translucency -maternal assays -chorionic villus sampling maternal assays - --coombs' test -cell-free (DNA) screening nuchal translucency - -measure nuchal folds (accumulation of fluids) when to screen for nuchal translucency - -between 10-14 weeks positive nuchal translucency - -3mm coombs' test - --Rh incompatibility -detects other antibodies for incompatibility with maternal antigens cell-free DNA screening - --fetal Rh status -fetal gender newest screening test for noninvasive prenatal genetic diagnosis - -cell free DNA screening chorionic villus sampling - --earlier diagnosis and rapid results -removal of small tissue specimen from fetal portion of placenta (tissue reflects fetus genetic makeup) when to do chorionic villus sampling - -between 10-13 weeks where do chorionic villi originate - -zygote assessment of fetal well being in 2nd trimester - --establish or confirm dates -confirm viability -assess placental location -assess for fetal anomalies how to establish or confirm dates - --uniformity of fetal growth -allows for biometic measurements -accurately estimate gestational age screening and diagnostic tests for second trimester - --ultrasound (2D, 3D, 4D, HD) -maternal assays alpha-fetoprotein -amniocentesis -doppler flow studies -percutaneous umbilical cord sampling maternal assay quad screen time frame - -15-21 weeks what does quad screen measure for - -alpha-fetoprotein hCG unconjugated estriol inhibin A alpha-fetoprotein - -maternal serum levels are screened for neural tube defects what percent of neural tube defects and abdominal wall defects can be detected early - -80-85% when to perform amniocentesis - -15-20 weeks indications for amniocentesis - --genetic concerned -women over 35 -family history of chromosomal abnormalities what does amniocentesis detect - --genetic, metabolic, DNA abnormalities -can detect neural tube defects -fetal hemolytic disease -lung maturity (lamellar body counts, L/S ratio) amniocentesis process - --amniotic fluid obtained from needle aspiration -ultrasound guided how accurate is amniocentesis - -99% accurate amniocentesis maternal complications - --Hemorrhage -Fetomaternal hemorrhage -Infection -Labor -Abruptio placentae -Damage to intestines or bladder -Amniotic fluid embolism amniocentesis fetal complications - --deathh -hemorrhage -infection -injury from needles how to minimize fetal complications in amniocentesis - -using ultrasound to direct the procedure physical uterine assessment - --evaluate for potential health concerns -evaluate size to assist with dating mcdonald's method - --Measure distance in cm from top of symphysis pubis to top of fundus -Centimeters correlate well with weeks of gestation (22 - 34 wks) when is mcdonald's method inaccurate - -obesity, fibroids, hydramnios fetal growth restriction - -below 10th percentile etiology of fetal growth restriction - -feto-placental or maternal macrosomia - -weight 4000g what is macrosomia determined by - -US leopolds measuring fundal height doppler blood flow analysis - -use of velocity wave forms created by movement to measure blood flow and resistance from the fetal umbilical and cerebral and maternal uterine arteries ratios of doppler blood flow analysis - --absent, reversed, or ratio above 3= restriction of umbilical artery blood flow -ratio normally decreases as pregnancy advances increased peak systolic velocity= - -fetal anemia abnormal maternal uterine artery waveform - -IUGR assessment of fetal well-being in 3rd trimester - --confirm gestational age -confirm viability -assess placental location -determine fetal position screening and diagnostic testing for 3rd trimester - --ultrasound -glucose tolerance test -group B strep -biophysical profile and non-stress test -daily fetal movement count high risk newborn - - -birth trauma -infection -hemolytic disease -infants of diabetic mothers -congenital anomalies -preterm/post-term -maternal substance s neonatal sepsis patterns - --early onset or congenital -nosocomial infection- late onset TORCH - -acronym for a group of diseases that cause congenital conditions if fetus is exposed to them what does TORCH stand for - -toxoplasmosiss other (syphillis, varicella, mumps, parovirus, HIV) rubella cytomegalovirus herpes simplex who recieves rhogam - -Rh- mom and Rh + neonate blood incompatibilities - -rh incompatibility ABO incompatibility Percutaneous Umbilical Blood Sampling (PUBS) - --direct access to fetal circulation -insertion of a needle directly into a fetal umbilical vessel under ultrasound guidance what is Percutaneous Umbilical Blood Sampling (PUBS) used for - --mostly for blood sampling and transfusion -rapid karyotyping and genotyping -diagnosis of fetal infection -platelet disorders -diagnosis, treatment of isoimmunization characteristics of infants with diabeteic mothers - --macrosomia -increased risk for birth injuries -increased congenital anomalies nursing care management for infant