28.3: Chapter 13
Unfolding Case Study
1.
Rationale: Fetal movement counts are performed daily. The normal amount of amniotic fluid is 5 to 25 cm. Nonreactive NST results are nonreassuring, and a BPP is recommended as follow-up. The fetus does not move the expected number of times, i.e., move 10 times within a 2-hour period, and the patient is required to report the test result only when the fetus does not meet the expected number of movements within the 2-hour period. Ultrasound during pregnancy is not routinely performed on a daily basis. The expected fetal weight is between the 10th and 90th percentile. NST results are expected to be reactive to demonstrate fetal well-being and are performed weekly. BPP is not indicated if NST is reactive and are most often performed weekly.
| Prenatal Test | Education Point 1 | Education Point 2 | Education Point 3 |
| Fetal movement count | ■ performed daily | □ fetus should move 10 times within 1 hour | □ requires daily reporting to the HCP |
| Ultrasound | □ performed daily | ■ amniotic fluid should measure between 5 and 25 cm | □ fetal weight should be below the 10th percentile |
| Nonstress test | □ performed monthly | □ reactive indicates need for further testing | ■ nonreactive indicates need for further testing |
| Biophysical profile | □ performed every other week | □ ordered when the NST is reactive | ■ ordered when the NST is nonreactive |
2.
Rationale: NST is noninvasive and does not require written consent before being obtained. NST can be obtained in the side-lying and semi-Fowler positions. NST is obtained using the external fetal and contraction monitor. The pregnant person is instructed to press the marker button each time the fetus moves. The FHR is expected to rise above the FHR baseline a minimum of 15 beats per minute for 15 seconds at least two times within 20 minutes to be reactive.
| Patient Statement | Effective | Ineffective |
| I will need to sign a consent for the NST every time it is obtained. | □ | ■ |
| I can lie on my side during the NST. | ■ | □ |
| The NST is obtained by using an external fetal monitor. | ■ | □ |
| Each time I feel the baby move during the NST, I will press the marker button. | ■ | □ |
| The baby’s heart rate needs to stay within the baseline for the NST to be reactive. | □ | ■ |