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High Risk Pregnancy (Biochemical Assessment: Maternal Assays (First…

- - - - High Risk Results =
        
        increased translucency
        
        low PAPP-A
        
        high hCG
    - - *
  - - - Results combo w/ mother's age, weight, ethnicity, GA to assess probabilities of risk for genetic disorders
        
        Abnormal results warrant for furthering test for diagnosis
        
        Old school way: do 2nd triple screen and if positive -> More invasive procedure (amniocentesis)
      - High levels AFP
        
        Neural tub defect
        Common reason: inaccurate dating of pregnancy
      - Low levels AFP and Abnorm of hCG and estriol
        
        Trisomy 18 or 21 or other types of chromosome abnormalities
- - - - REACTIVE NST
        
        2 or more FHR accels at least 15 beats/min, lasting 15 seconds w/in 20 min period w/ or w/o fetal mvmts
      - NON-REACTIVE NST
        
        Lack of desirable findings in 40 minute period
        
        Technically not bad, bby could be sleeping
        Mom eating some sugar can wake up bby
  - - - Indications:
        
        IUGR,
        
        diabetes,
        
        postdates,
        
        nonreactive NST
      - Administered until 3 contractions, lasting 40-60 sec, in 10 minutes
        
        Results:
        
        NEGATIVE: no sig late or variable deceleration - getting enough oxygen
        
        POSITIVE: 50% are late deceleration to contractions
        
        Mom cannot go home; admit her, may want to give some meds to mature babies' lungs, turn off oxytocin - Clinical decisions
        
        If positive CST w/ late deceleration and minimal variability, baby got to GTFO
        
        UNSATISFACTORY: fewer than 3 contractions in 10 min or uninterpretable tracing
        
        EQUIVOCAL/SUSPICIOUS - don't really know what's up (not on test
        
        HYPERSTIMULATORY - decels occur when contractions more frequent than every 2 min or last longer than 90 seconds
        
        Baby cannot handle too many contractions
  - - - Score 2: >/= 1 episode of rhythmic breathing lasting >/= to 30 sec w/in 30 min
        Score 0: < 30 sec of breathing in 30 min
    - - Score 2: >/= to 3 discrete body or limb mvmts in 30 min (epi of active con't mvmt considered 1 mvmt
        Score 0: </= to 2 mvmts in 30 min
    - - Score 2: >/= to 1 episode of extension of a fetal extremity w/ return to flexion, or opening or closing of hand
        Score 0: No mvmts or extension/flexion
    - - Score 2: >/= to 2 accelerations >/= to 15 beats/min for >/= to 15 sec in 20-40 min
        Score 0: 0-1 accels in 20-40 min
    - - Score 2: at least 1 pocket of amniotic fluid of at least 2 cm AFI >5
        Score 0: < 1 pocket of amniotic fluid measuring < 2 cm