Assessment of Fetal Well-Being

Assessment of Fetal Well-Being-

1. Daily Fetal Movement Counting (DFMC) –begin 27 weeks

Mom- begin after meal - breakfast

a. Cardiff  count to 10 method – one method currently available

(1)  Begin at the same time each day (usually in the morning, after breakfast) and count each fetal movement, noting how long it takes to count 10 fetal movements (FMs)

(2) Expected findings – 10 movements in 1 hour or less

3) Warning signs

                a.) more then 1 hour to reach 10 movements

                b.) less then 10 movements in 12 hours(non-reactive- fetal distress)

                c.) longer time to reach 10 FMs than on previous days

                d.) movement are becoming weaker, less vigorous

                                Movement alarm signals - < 3 FMs in 12 hours

4.) warning signs should be reported to healthcare provider immediately; often require further testing. Examples: nonstress test (NST), biographical profile (BPP)

2. Nonstress test – to determine the response of the fetal heart rate to activity

Indication – pregnancies at risk for placental insufficiency

                Postmaturity

a.)     pregnancy induced hypertension (PIH), diabetes

b.)     warning signs noted during DFMC

c.)      maternal history of smoking, inadequate nutrition

Procedure:

Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal monitor); external monitor is applied to document fetal activity; mother activates the “mark button”  on the electronic monitor when she feels fetal movement.

Attach external noninvasive fetal monitors

1. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs)
2. ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected
3. monitor until at least 2 FMs are detected in 20 minutes
• if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen
• if no FM after 1 hour further testing may be indicated, such as a CST

Result:

Noncreative

Nonstress

Not Good

                                                Reactive

                                                Responsive is

                                                Real Good

Interpretation of results

i.                     reactive result

1.       Baseline FHR between 120 and 160 beats per minute

2.       At least  two accelerations of the FHR of at least 15 beats per minute, lasting at least 15 seconds in a 10 to 20 minute period as a result of FM

3.       Good variability – normal irregularity of cardiac rhythm representing  a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system; noted as an uneven line on the rhythm strip.

4.       result indicates a healthy fetus with an intact nervous system

ii. Nonreactive result

1. Stated criteria for a reactive result are not met
2. Could be indicative of a compromised fetus.

       Requires further evaluation with another NST, biophysical profile, (BPP) or contraction stress test (CST)

9. Health teachings

        a. Nutrition – do nutritional assessment – daily food intake

High risk moms:

1. Pregnant teenagers – low compliance to heath regimen.
2. Extremes in wt – underweight, over wt – candidate for HPN, DM
3. Low socio – economic status
4. Vegetarian mom – decrease CHON – needs Vit B12 – cyanocobalamin – formation of folic acid – needed for cell DNA & RBC formation. (Decrease folic acid – spina bifida/open neural tube defect)

       How many Kcal CHO x4,CHON x4, fats x 9