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 oFetal abnormalities oTo confirm Pregnancy is intrauterine (not ectopic) oTo confirm fetal cardiac activity oNumber of fetuses (to detect multiple gestation (number and size of gestational sacs) oSize and correlation to EDC (determining gestational age) oPREGNANCY 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 oEvaluate pelvic anatomy oExplore cause of vaginal bleeding oDetect other potential abnormalities in early pregnancy oCRL- “crown rump length” ▪Measure from crown of head to rump for DATING! ▪Additional info not on study guide** chapter 4!! oRH RhoGAM- mom always gets RhoGAM no matter what (+ or -) oRH+ antibody screen oIf mom is negative, were going to give RhoGAM after possible trauma or possible crossing like amniocentesis. oEvery woman that is RH Neg- gets RhoGAM at 28 weeks!!! **** oIf RH neg, always gets RhoGAM ▪And trauma or birth oIf mom is blood B+, gets RhoGAM shot NEVER*** ▪What does nuchal (neck) translucency screen for? oScreens for down syndrome TRISOMY 21 o**Nuchal translucency is most reliable between 11-14 weeks gestation** oThis test measures nuchal folds on back of baby’s neck ▪Anatomy UltraSound (SCREENING TEST) tells gender oWhen is it performed? ▪Typically performed in 2nd trimester between 18-22 weeks (20 weeks)* gestation oWhat 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. oIndication 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) oThis a diagnostic test oDone between 10-12 weeks to check trisomy 21 (down syndrome) oIndication (who is it offered to?) ▪For high-risk pregnancies •AMA •Past down syndrome baby •Strong family hx oProcedure ▪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. oTiming in pregnancy ▪10-12 weeks oRisks ▪7% fetal loss oPros 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) oIndication ▪For genetic testing (14-20 weeks) ** ▪Fetal lung maturity (can also be done later in the pregnancy) oProcedure ▪This is a Diagnostic test ▪Insert needle and take sample, centrifuge, culture of fetal cells: gives us (chemical analysis, DNA analysis, Chromosomal analysis) oTiming in pregnancy ▪Typically done 15-20 weeks** ▪Or later in the pregnancy for fetal lung maturity oRisks ▪Less risky, 1% ** ▪Rh sensitization from fetal blood into maternal circulation oPros and cons for parents ▪PROs confirm gender of baby ▪PROs fetal chromosomes for genetic disorders ▪PRO can check for Amniotic fluid infection*