A client who is 32 weeks gestation and has gestational diabetes calls the provider’s office to report decreased fetal movement over the last several hours. The provider advises her to report to OB triage for further testing.
What test should you anticipate the provider will order?
Non-stress test.
Contraction stress test.
Biophysical profile.
Ultrasound.
The Correct Answer is A
Choice A rationale
A non-stress test (NST) is a common test used to evaluate fetal well-being, especially in cases of decreased fetal movement. It measures the fetal heart rate in response to its movements. A reactive NST, where the fetal heart rate increases with movement, indicates good oxygenation and neurological function.
Choice B rationale
A contraction stress test (CST) evaluates the fetal heart rate response to uterine contractions, which can be induced by oxytocin or nipple stimulation. It is typically used to assess placental function and fetal tolerance to labor, not for initial assessment of decreased fetal movement.
Choice C rationale
A biophysical profile (BPP) combines an NST with ultrasound to assess fetal breathing, movement, tone, and amniotic fluid volume. While comprehensive, it is more time-consuming and usually reserved for further evaluation if the NST is non-reactive.
Choice D rationale
An ultrasound can assess fetal growth, amniotic fluid volume, and anatomical structures. However, it does not provide real-time information on fetal heart rate reactivity, making it less suitable for immediate assessment of decreased fetal movement.
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Correct Answer is A
Explanation
Choice A rationale
A non-stress test (NST) is a common initial assessment for decreased fetal movement. It evaluates fetal heart rate patterns in response to fetal movements, providing information about fetal well-being and oxygenation.
Choice B rationale
A biophysical profile (BPP) is a more comprehensive assessment that includes an NST and ultrasound evaluation of fetal movements, tone, breathing, and amniotic fluid volume. It may be ordered if the NST results are non-reassuring or if there are other concerns.
Choice C rationale
An ultrasound can provide valuable information about fetal growth, amniotic fluid volume, and placental function. It may be used in conjunction with other tests but is not the first-line assessment for decreased fetal movement.
Choice D rationale
Amniocentesis is an invasive procedure used for specific indications, such as genetic testing or assessing fetal lung maturity. It is not typically used for initial assessment of decreased fetal movement.
Correct Answer is A
Explanation
Choice A rationale
The “Passenger” refers to the fetus and its position, size, and presentation. In this case, the fetus has an estimated weight of 9 lbs and is in the left occiput posterior (LOP) position. These factors can complicate labor by making it more difficult for the fetus to navigate through the birth canal, potentially leading to prolonged labor and increased risk of interventions.
Choice B rationale
The “Passage” refers to the birth canal, including the pelvis and soft tissues. While the passage is an important factor in labor, the primary concern in this scenario is the size and position of the fetus, which falls under the “Passenger” category.
Choice C rationale
The “Powers” refer to the strength and frequency of uterine contractions. Although the patient is having contractions every 3 minutes, the main concern here is the fetal size and position, which are more directly related to the "Passenger"4.
Choice D rationale
The “Psyche” refers to the psychological state of the mother, including her stress levels and emotional well-being. While important, the primary concern in this scenario is the physical factors related to the fetus, which are categorized under the "Passenger"4.