Editing Maternal and Newborn Nursing (section)

=== Fetal assessment ===

* '''Fundal height''': the uterus is at the symphysis pubis around 12 weeks and at the umbilicus around 20 weeks. From roughly 18 to 32 weeks, fundal height in centimeters approximates gestational age in weeks within about 2 cm. A height more than about 2 cm larger than dates suggests multiple gestation, polyhydramnios, macrosomia, or wrong dates; smaller suggests fetal growth restriction, oligohydramnios, or wrong dates.
* '''Fetal heart tones''': audible by Doppler around 10 to 12 weeks, by fetoscope around 18 to 20 weeks. Normal baseline is '''110 to 160 beats per minute'''.
* '''Quickening''': first maternal perception of movement, about 18 to 20 weeks in a first pregnancy and 14 to 16 weeks in later pregnancies.
* '''Fetal movement (kick) counts''': a widely taught method is to have the patient rest on her side after a meal and count movements; fewer than 10 distinct movements in 2 hours warrants calling the provider. Teach that a ''decrease'' in the baby's usual pattern is always reported, never watched at home.
* '''Nonstress test (NST)''': '''reactive''' is reassuring and means at least 2 accelerations in 20 minutes, each 15 beats above baseline lasting 15 seconds, in a fetus 32 weeks or more (10 beats for 10 seconds before 32 weeks). '''Nonreactive''' requires further testing, not immediate delivery.
* '''Biophysical profile (BPP)''': 2 points each for NST, fetal breathing, gross body movement, tone, and amniotic fluid volume. 8 to 10 is reassuring, 6 is equivocal, 4 or less is concerning.
* '''Contraction stress test''': '''negative''' (no late decelerations with contractions) is the ''good'' result. In this one test the confusing convention is that negative equals normal.
* '''Amniocentesis''' after about 15 weeks assesses genetic status and, less often now, fetal lung maturity (lecithin to sphingomyelin ratio of 2:1 or greater, presence of phosphatidylglycerol). Have the patient empty her bladder before a second- or third-trimester procedure, monitor the fetal heart rate afterward, and give Rho(D) immune globulin if the patient is Rh negative.