Portfolio II: Objective 6
A high risk pregnancy is one in which the mother or fetus experience risk of jeopardized health status. Various forms of fetal monitoring and surveillance are used to assess fetal well-being. With high risk pregnancies, there is risk of uteroplacental insufficiency, hypoxia, or death of the fetus. Throughout any pregnancy, fetal heart rate should be measured at each prenatal visit, and ultrasounds performed periodically (Kyle & Ricci, 2009).
Ultrasonography is a tool for fetal surveillance that visualizes the fetus for malformations, growth, age, activity, and well-being. Doppler flow studies are a noninvasive tool to measure the velocity of blood flow through blood vessels and detect abnormalities or fetal compromise. An Alpha-Fetoprotein test is a useful tool to help detect neural tube defects (Kyle & Ricci, 2009).
A non-stress test measures fetal heart rate patterns characteristic of normal response to fetal movements, and in turn, uteroplacental function. It is recommended twice weekly for high risk pregnancies and is noninvasive. The procedure takes 20-30 minutes to complete and a reactive test means at least 2 fetal heart rate accelerations from baseline of 15 or more beats per minute for at least 15 seconds (Kyle & Ricci, 2009).
A contraction stress test determines the fetal heart rate response under stress, "stress" being the contractions, because blood flow is slowed to the uterus and placenta during contractions. The goal is 3 contractions in 10 minutes. The biophysical profile (BPP) was developed in the 1980s and uses real time ultrasound to assess fetal breathing, movements, reflex activity, and amniotic fluid volume assessment (Devoe, 2008). The BPP also includes a non stress test, and gives an overall picture of the fetus's well being. The results of the biophysical profile can show risk of fetal death or intrauterine asphyxia (Devoe, 2008).
