Prenatal Test.pdf

Chapter 15 Prenatal Diagnostic Tests Copyright © 2018 Elsevier Inc. All rights reserved. Danger Signs of Pregnancy ˜ ˜ ˜ ˜ ˜ ˜ ˜ Vaginal Bleeding Nausea and Vomiting that last over 24 hours Dizziness –sudden and extreme associated with Pelvic or uterine pain. Pre-term Labor symptoms (between 24 -36...

Chapter 15 Prenatal Diagnostic Tests Copyright © 2018 Elsevier Inc. All rights reserved. Danger Signs of Pregnancy ˜ ˜ ˜ ˜ ˜ ˜ ˜ Vaginal Bleeding Nausea and Vomiting that last over 24 hours Dizziness –sudden and extreme associated with Pelvic or uterine pain. Pre-term Labor symptoms (between 24 -36 weeks) Leaking of Fluid from the vagina Preeeclampsia symptoms( edema, rapid weight gain, headaches, visual disturbances, vomiting,epigastric pain, irritability, scanty urine output. Symptoms of a UTI (Dysruia, severe backache,fever). Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. 2 Physical Assessment completed at prenatal visit ˜ ˜ ˜ ˜ ˜ ˜ ˜ Weight Blood Pressure Urine Evaluation Edema Uterine Activity Fetal surveillance: Fundal height, fetal tones (after 12 weeks) presence of fetal activity. Laboratory Test as indicated. Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. 3 ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ The following are signs of and symptoms of preterm contraction and/or labor Uterine Cramping (menstrual like cramp) Uterine Contractions more than 4 times in an hour. Low abdominal pressure Low backache (intermittent and/or a change in character of back pain). Vaginal bleeding Increased vaginal discharge of clear, watery, pink or tan fluid. Pelvic pressure or a feeling that “something” is in the vagina. Persistent abdominal cramping with or without nausea and vomiting or diarrhea. Thigh pain that is intermittent or persistent. Urinary frequency. Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. 4 Types of Prenatal Tests ˜ ˜ ˜ ˜ ˜ ˜ Ultrasound Doppler ultrasound blood flow assessment Alpha-fetoprotein (AFP) screening Multiple marker screening Chorionic villus sampling Amniocentesis Copyright © 2018 Elsevier Inc. All rights reserved. 5 Types of Prenatal Tests (Cont.) ˜ ˜ Percutaneous umbilical blood sampling Antepartum fetal surveillance Ø Ø Ø Ø Ø ˜ Nonstress test (NST) Vibroacoustic stimulation test Contraction stress test (CST) Biophysical profile (BPP) Modified biophysical profile Maternal assessment of fetal movement Copyright © 2018 Elsevier Inc. All rights reserved. 6 Ultrasound ˜ Used to determine a variety of fetal and placental conditions Ø Ø Ø Ø Ø ˜ ˜ Presence and location of pregnancy Multifetal gestation Gestational age Viability confirmation Identifying fetal abnormalities Emotional responses Not always possible to determine fetal sex Copyright © 2018 Elsevier Inc. All rights reserved. 7 2D Sonogram Copyright © 2018 Elsevier Inc. All rights reserved. 8 3D Ultrasound Image Copyright © 2018 Elsevier Inc. All rights reserved. 9 Sonographer Provides Information Copyright © 2018 Elsevier Inc. All rights reserved. 10 Doppler Ultrasound Blood Flow Assessment ˜ Ultrasound is used to perform the test. Ø ˜ Used in pregnancies complicated by Ø Ø Ø ˜ Doppler shift Hypertension Fetal growth restriction Placental insufficiency Measures systolic to diastolic ratio Copyright © 2018 Elsevier Inc. All rights reserved. 11 Color Doppler Imaging Umbilical Vein and Two Arteries Copyright © 2018 Elsevier Inc. All rights reserved. 12 Alpha-Fetoprotein Screening ˜ AFP assessment is performed on maternal serum or amniotic fluid to identify Ø Ø ˜ ˜ ˜ Open body wall defects (neural tube defects) Chromosomal anomalies (trisomy 21) Ideally performed between 16 and 18 weeks of gestation Requires only a blood sample Must be viewed as a first step in screening Copyright © 2018 Elsevier Inc. All rights reserved. 13 Multiple Marker Screening ˜ Two other markers have been added Ø Ø ˜ ˜ Human chorionic gonadotropin (hCG) Unconjugated estriol Increases the detection of trisomy 18 and 21 If testing is positive Ø Amniocentesis is recommended. Copyright © 2018 Elsevier Inc. All rights reserved. 14 Chorionic Villus Sampling ˜ ˜ ˜ ˜ ˜ ˜ ˜ Uses transcervical or transabdominal sampling to obtain villi Can be performed much earlier than amniocentesis Provides information about numerous chromosomal defects, metabolic or DNA abnormalities Performed between 10 and 13 weeks’ gestation Fetal genetic, chromosomal, and metabolic dosorders cannot be used for diagnosis of Neural tube defects. Women who undergo CVS is offered MATERAL SERUM APHA feto protein testing at 2520 weeks gestation This procedure carries a risk of 0.5 TO 1 PERCENT HIGHER RISK OF PREGNANY LOSS CTHAN THE AMNIOCENTESIS. AND THE POSSIBLEILITY OF MINOR NAIL OR PHALANGEAL HYPOPLASA. IF PERFORMED BETWEEN 9 AND 12 WEEKS. Copyright © 2018 Elsevier Inc. All rights reserved. 15 Transcervical Chorionic Sampling Copyright © 2018 Elsevier Inc. All rights reserved. 16 Amniocentesis ˜ ˜ Aspiration of amniotic fluid from the sac for further examination Second trimester amniocentesis Ø Ø ˜ Performed between 15 and 20 weeks Chromosomal or biochemical abnormalities Third trimester amniocentesis Ø Ø Performed during the third trimester Used to determine fetal lung maturity or hemolytic disease Copyright © 2018 Elsevier Inc. All rights reserved. 17 Indications for Second Trimester Amniocentesis Copyright © 2018 Elsevier Inc. All rights reserved. 18 Amniocentesis Copyright © 2018 Elsevier Inc. All rights reserved. 19 Percutaneous Umbilical Blood Sampling ˜ ˜ ˜ Also called cordocentesis or PUBS Involves the aspiration of fetal blood from the umbilical cord near the placenta for prenatal diagnosis or therapy Used to detect blood disorders, acid–base imbalance, infection, or fetal genetic disease Copyright © 2018 Elsevier Inc. All rights reserved. 20 Percutaneous Umbilical Cord Testing Copyright © 2018 Elsevier Inc. All rights reserved. 21 Antepartum Fetal Surveillance ˜ NST Ø Ø Ø Ø ˜ NST evaluates fetal heart rate (FHR) accelerations, with or without fetal movement. FHR reactivity with accelerations is a reassuring sign. Reactivity is associated with adequate fetal oxygenation and intact neural pathways. FHR reactivity may not develop until 32 weeks in the fetus. Vibroacoustic stimulation Copyright © 2018 Elsevier Inc. All rights reserved. 22 Nonstress Test Copyright © 2018 Elsevier Inc. All rights reserved. 23 A. Accelerations B. Accelerations Are Absent Copyright © 2018 Elsevier Inc. All rights reserved. 24 Antepartum Fetal Surveillance ˜ CST Ø Ø Ø Ø Oxytocin challenge test Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow Cannot be done if stimulated uterine contractions are contraindicated Nipple stimulation or low-dose oxytocin Copyright © 2018 Elsevier Inc. All rights reserved. 25 Contraction Stress Test Copyright © 2018 Elsevier Inc. All rights reserved. 26 Biophysical Profile ˜ BPP provides information on five parameters. Ø Ø Ø Ø Ø ˜ NST Fetal breathing movements Gross fetal movements Fetal tone Amniotic fluid volume The amniotic fluid index (AFI) is a method to quantify the amount of amniotic fluid visualized by ultrasound. Copyright © 2018 Elsevier Inc. All rights reserved. 27 Effects of Hypoxemia and Fetal Acidosis Copyright © 2018 Elsevier Inc. All rights reserved. 28 Maternal Assessment of Fetal Movement ˜ ˜ ˜ Movements by the fetus are assessed by the mother. They are often called “kick counts.” Several methods for the mother to count Ø Ø At least 10 fetal movements within 12 hours 5–10 movements per hour Copyright © 2018 Elsevier Inc. All rights reserved. 29 Assessment of Patient Who Has Diagnostic Testing ˜ ˜ ˜ ˜ ˜ Gravida, para, living children, gestation Maternal health problems Current obstetric problems Prior obstetric problems History of substance abuse, including alcohol and tobacco Copyright © 2018 Elsevier Inc. All rights reserved. 30 Assessment of Patient Who Has Diagnostic Testing (Cont.) ˜ ˜ ˜ ˜ Patient understanding of test and reasons for it Patient knowledge of surveillance regimen for additional testing Patient’s emotional response to test Patient’s and partner’s expectations of test Copyright © 2018 Elsevier Inc. All rights reserved. 31 Question ˜ BPP includes information regarding all factors except __________. A. B. C. D. fetal breathing movements gross fetal movements amniotic fluid levels fetal length and gestational age Copyright © 2018 Elsevier Inc. All rights reserved. 32