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ESTIMATING FETAL GROWTH

McDonald’s Rule

 Method of determining fetal growth


by measuring the fundal height,
 The distance from the fundus to the
symphysis pubis in centimeters is
equal to the week of gestation
between 20th and 31st week of
pregnancy.
 Fundal height greater than the
standard:
 Multiple pregnancy
 Miscalculated due date
 Large-for-gestational-age infant
 Hydramnios
 Hydatidiform mole
 Fundal height less than standard
 Failure to thrive
 Miscalculated due date
 Presence of anomaly
Typical Fundal
Milestones
 12 weeks
 Over the symphysis pubis
 2o weeks
 At the level of the umbilicus
 36 weeks
 At the level of the xiphoid process
ASSESSING FETAL WEL-BEING
FETAL MOVEMENT
 QUICKENING
 18 – 20 weeks AOG
 Varies especially in relation to sleep
cycles of the fetus and mother activity
during observation time.
 SANDOVSKY METHOD
 Ask mother to lie in a left recumbent
position after a meal and record how many
fetal movements she feels over the next
hour
 Normal: movement twice every 10
minutes or an average of 10 – 12 times
an hour
 CARDIFF METHOD
 Count-to-ten method
 The mother records the time interval it
takes for her to feel ten fetal movements
 Normal: 10 fetal movements in 1 hour
FETAL HEART RATE

 Normal: 120 – 160 beats per minute


 Can be heard as early as 10th – 11th
week of pregnancy
 NONSTRESS TESTING
 Measures the response of fetal heart
rate to fetal movement
 When a fetus moves, the fetal heart rate
should increase about 15 beats per
minute and remain elevated for 15
seconds. It should decrease to its
average rate again as the fetus quiets.
 If no increase in beats per minute is
noticeable on fetal movement, poor
oxygen perfusion of the fetus is
suggested
 Results:
 Reactive: if two accelerations of fetal
heart rage lasting for 15 seconds occur
after movement
 Non-reactive: no accelerations occur
with the fetal movement
 Contraction Stress Testing
 Negative (normal): when no fetal
heart rate decelerations are present with
contractions
 Positive (abnormal): when 50% or
more of contractions cause a late
deceleration and continues after the
contraction)
Comparison between non-stress test and
Contraction Test
ASSESSMENT NONSTRESS CONTRACTION
What is measured Response of fetal Response of fetal heart
heart rate in relation rate in relation to uterine
to fetal movement contractions porduced by
nipple stimulation

Normal findings Tw0 or more No decelerations with


accelerations of fetal contractions
heart rate of 15 bpm
lasting 15 seconds or
more following fetal
movements in a 20-
min period
ASSESSMENT NONSTRESS CONTRACTION
Safety considerations Woman should not lie In addition to supine
supine to prevent hypotension sydrome,
supine hypotension observe woman for 30 min
syndrome afterward to see that
contractions are quiet and
preterm labor does not
begin
ULTRASOUND

 Response of waves against objects


 Uses:
 Diagnose pregnancy
 Confirm the presence, size, and location
of the placenta and amniotic fluid
 Establish that the fetus is growing and
has no gross defects
 Establish the presentation and position
of the fetus
 Gender determination
 Predict maturity by measurement of
biparietal diameter.
 Discover complications of pregnancy
 Detect retained placenta.
Nursing Responsibilites

 Explain procedure and give assurance


 Mother should have a full bladder
 Instruct mother to drink a full glass of water
every 15 minutes beginning an hour and a
half before the procedure
 Instruct mother not to void before the
procedure
 Place mother in supine position with
abdomen exposed
 Place a towel under the right buttocks
 Make sure that the gel used is room
temperature or warmer
ELECTROCARDIOGRAPHY

 Fetal HCG may be recorded as early


as the 11th week of pregnancy
 Used when a fetal heart anomaly is
suspected
Magnetic Resonance
Imaging(MRI)
 Has the potential to replace or
compliment ultrasound as a fetal
assessment technique
 Helpful in assessing complications
such as ectopic pregnancy or
trophoblastic disease
MATERNAL SERUM ALPHA-
FETOPROTEIN
 Alpha-fetoprotein
 A substance produced by the fetal liver that
is present in amniotic fluid and maternal
serum
 Abnormally high levels
 Indicates open spinal (neural tube defects)
or abdominal defects
 Abnormally low levels
 Indicates chromosomal defects
AMNIOCENTESIS

 Aspiration of amniotic fluid from the


pregnant uterus for examination.
 Done 12th – 13th week of pregnancy
 Amniocentesis gives information
of the following:
 Color of the amniotic fluid
 Normal: color of water; slightly yellow
late in pregnancy
 Strong yellow color: blood
incompatibility
 Green: meconium staining
 Lecithin/Sphingomyelin Ratio
 Protein components of surfactant
 Normal: 2:1
 2:5 or 3:1 in patients with diabetes
 Phosphatidyl Glycerol and
Desaturated Phosphatidylcholin
 Also found in surfactant
 Presence indicate mature lung function
 Bilirubin Determination
 Bilirubin is present if there is blood
incompatibility
 Chromosome Analysis
 Determination of chromosomal diseases
 Fetal Fibronectin
 A glycoprotein that plays a part in helping
the placenta attach to the uterine decidua
 Presence indicate damage to fetal
membranes
 Inborn Errors of Metabolism

 Alpha-fetoprotein
 Complications:
 Hemorrhage from penetration of the
placenta
 Infectionof amniotic fluid
 Puncture of the fetus
 Preparation:
 Ask woman to void
 Place patient in supine position exposing
abdomen
 Take baseline maternal bp and FHB
 Post-procedure
 Let woman rest quietly for about 30
minutes
 Assess FHB and presence of uterine
contractions
 If woman has Rh-negative blood,
Rho immuno globulin may be
administered
PERCUTANEOUS UMBILICAL BLOOD
SAMPLING

 AKA Cordocentesis or Funicentesis


 Aspiration of blood from the
umbilical vein for analysis
 Ultrasound guided procedure
 Includes:
 CBC
 Direct Coomb’s Test
 Blood gases
 Karyotyping
 Kleihauer-Betke Test
 Test to determine if sample is fetal blood
 Post-procedure RhIG may be given to
Rh negative mothers
AMNIOSCOPY

 Visual inspection of the amniotic fluid


through the cervix and membranes
with an amnioscope
 Use: detect meconium staining
FETOSCOPY

 Visualizing the fetus by inspection


through a fetoscope
 Uses:
 Confirm the intactness of spinal column
 Obtain biopsy samples of fetal tissues
and blood samples
 Perform elemental surgery
BIOPHYSICAL PROFILE

 Combination of 4 – 6 parameters into


one assessment
 Fetal breathingmovement
 Fetal movements
 Fetal tone
 Amniotic fluid volume
 Placental grading
 Fetal heart activity
 AKA fetal Apgar
 More accurate in predicting fetal
well-being than any single
assessment
 Each parameter has a potential score
of 2
 Interpretation:
 8 – 10: fetus is doing well
 4 – 6: fetus in jeopardy
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
within a 30-min observation

Fetal Tone sonogram The fetus must extend and then


flex the extremeties or spine at
least once in 3o minutes
ASSESSMENT INSTRUMENT CRITERIA FOR A SCORE OF
2
Amniotic fluid Sonogram A pocket of amniotic fluid
Volume measuring more than 1 cm in
vertical diamter must be
present

Placental Sonogram Placenta is grade 3; grading is


Grade based on structure and
amount of calcium present

Fetal heart Nonstress test Two or more fetal heart rate


reactivity accelerations of at least 15
beats/min above baseline and
of 15 sec duration occur with
fetal movement over a 20-min
time period