What the Heck is Antepartum Testing?

I'm really excited to talk to you guys about antepartum testing, this is kind of a crazy time. Antepartum is the period we talk about just during pregnancy. So someone's pregnant, also for some people preparing for NCLEX. Perfect welcome. Um, perfect way. Get in all the tutoring sessions that you can. Um, so anyways, we're going to talk about antepartum tonight and there's some routine testing that of everybody gets and then there's some non routine testing that just went something is a concern. They do other things. And so we're gonna kind of go through all of those and then talk about different big item pieces to remember like certain education things that you might need to remember to tell your patient. Thanks to watch for that kind of thing. And then, um, I'll answer any questions that you guys have. So I am going to share my screen real quick maybe. Okay. Can you guys see it?
Yeah,
my little notes.
Yeah.
Okay, perfect. Um, okay. So first I just in separating this into routine and non routine, I'm going to kind kinda list the things under routines first. And then we'll go through and we'll talk about them, um, in just some more detail. Okay. So routine testing. So this is just what everybody has done. So, uh, they are, the patients will get a urinalysis, a U/A, um, at every appointment and also a protein like a dipstick for protein in the urine. So this is still up for, to fix. We are looking for bacteria and we are looking for the protein obviously. Um, and that is if they are spilling protein and we're worried about the Preeclampsia, which is that um, high blood pressure that these patients, um, can get during pregnancy. So, and when they get that, they spill protein. So the reason why we're checking the U/A every time it's bacteria and that's because women can get these UTI, the urinary tract infections and they don't feel it.
Um, usually, you know, women will get that painful burning sensation, but typically sometimes the pregnant woman won't notice that. I'm scared a whole lot of other stuff going on with her body. Right? So the, if the bacteria gets there, we don't have the patient again, septic. And we also, um, this could cause her to go into preterm labor if she did have the UTI because just think about it. The body's like, Whoa, we're sick, we're trying to get rid of whatever. And um, the baby can be one of those things that tries to get rid of it and push out. Um, I once had a patient that had gone for a routine test, routine visit. How do you U/A, she, uh, had a urinary tract infection, got put on an antibiotic and decided not to take that antibiotic and she came in Septic, um, and her baby was very sick, had to go to the NICU, um, and she almost died from being septic.
So, um, we obviously want to make sure we're telling them to take the antibiotics. Okay. So that's our big routine thing. Everyone's getting. Um, another thing is the ultrasound. So this is just a you usual routine exam and what happens? So they get that first trimester one done just early to confirm a pregnancy. Um, they will also get one at 20 weeks, around 20 weeks. And that's to look at the anatomy. Um, so typically this is the one that appointment, everyone's like, oh, we get to find out if it's a girl or a boy. Right? Well, it's really looking at all the anatomy, make sure the bone link looks good, the fetal growth, all of that looks good and it's just an added benefit that they get to find out the gestation of your baby. Okay, so another one is GBS swab. So this is Group Beta Strep, um oh one type that up.
And this is done at around 36 weeks. Give or take a little bit. Um, this is just a vaginal swab and it's done on everyone to check for that GBS. Now remember every woman has group-beta strep bacteria in the vagina area or in her urine or wherever it may be. Um, it is looking at this certain amount of colonies, like how much has been colonized. So is it a large amount of bacteria? So if she is GBS positive, then she is going to need antibiotics, uh, while in labor. So everybody has GBS, but the positive just means that we're above that certain threshold. Okay. Next or other one is going to be the Glucose Challenge. So this is to see if a woman has gestational diabetes. Okay? So this is done at around 28 weeks pregnant. Um, give or take a little bit and there's two different ones.
So first you're going to have what we call the Oral Glucose Tolerance Test. OGTT. Um, this one is not fasting. Okay? So that's key. Cause a lot of times sometimes the questions, um, between this one and the three hour, that's the difference. Um, and so sometimes people can get tripped up on some questions about that. So this is not fasting. So what happens? The patient comes in, she is going to drink 50 grams of pretty much sugar, just that oral glucose and then her blood sugar will be checked at one hour, um, after drinking that. So if it is, um, a fail, so typically a number, I think it's over one 80, um, then it's a fail, but she gets one more chance. So the next test is going to be the three hour, um, Oral Glucose Test. So this three hour one, and guys don't quote me on all the numbers, so make sure you refer to your labs like at your hospital or whatever you're learning in class because different labs look at different values.
So I'm kind of giving you a standard range, but it might be off a little bit based on what you're learning in class or in your in class books and all that. Um, if you're given a question, it's usually gonna be way far off from within normal is, but I just don't want you to have these set numbers memorized in your head. Um, okay, so for this three hour one, so this is her second chance. Um, if she passes this, she doesn't have to do the three hour. So what happens with the three hour? We are fasting. So she's going to come in, she's wanting to have a fasting sugar done and we want that to be less than 95. If it is perfect, then she's going to have a one hour check and that is going to be, or what we want to see less than 180 and then we'll have a two hour check and we want that to be less than 155 and then the three hour check.
And we want that to be less than 140, so those are our numbers and she has to fail too in order to fail and equals. Okay, so two of those numbers, if she gets her first check and it's a hundred and then all of these other ones are in the right range, then she's good. We don't have to worry. But if she fails to of these and she fails and she's just considered gestational diabetic and we'll refer her to endocrinology or somebody just to monitor her blood sugars and teach her more about diet and all that kind of good stuff. Um, so those are basic routine tests that everyone's going to get. The other thing that you might be asked about are going to be kicked counts of fetal kick counts. We want a woman's going to be doing this kind of on her own throughout her, antepartum time period, um, less than 10 kicks in two hours, then she needs to call the doctor's office.So we want her to kinda check same time each day. Um, and then we're looking for, um, her to not have less than 10 kicks in two hours.
Okay. So let's talk about our non routine testing. So there's several of these. So the first one is going to be an Amniocentesis. Okay. So an Amniocentesis used to be done all the time. This is how they would tell if you had a male or a female grow and inside of you, um, so this is where they're going to stick that needle into the abdomen and they are going to get amniotic fluid from that and that amniotic fluid, it's going to tell us all the genetic information. Um, so that's how they were going to tell if it was a male or female. So this is typically done when we're concerned about a chromosomal thing, like down syndrome, whatever it may be.
Um, these and other tests I'm about to tell you, the two of them is called the Chorionic Villi Sampling, um, are very invasive. So it's really important that the mom knows her risks and the things to watch for. And we're going to talk more about that in a second. So the Chorionic Villi Sampling, also known as CVS, this is where a little needles put in tube and it takes out, it's a piece of the placenta and that placenta is going to also give that genetic information. If I could spell tiny that'd be great. Okay. So that's going to take a little bit of a piece of said I give that genetic information. So this one you can only do really when the woman is between 11 to 14 weeks pregnant. This one can be in later gestation. So let's talk about why that's important to know.
So you want to give the mom education when she leaves because this is just outpatient. She comes in and has this done typically outpatient. So we want to tell her the things to watch for, for both of them. We are going to tell them education here. So we're going to tell them to watch for signs of infection. So a temperature, things like that, right? If she starts to get a fever, chills, anything like that, leaking of fluid, we don't want her leaking any of that amniotic fluid, uh, have, she has some spotting or if she starts having contractions. So the reason why I tell you this to know with later gestation or the CVS being 11 to 14 weeks is because with the amniocentesis, we are going to tell her, let me put that here with the Amnio check is going to want to do her fetal kick counts and let us know if she feels less than 10 and two hours with the cvs because it's only done between 11 and 14 weeks.
We don't need to give her that education because she can't yet feel that fetal movement. Um, so there's no need to tell her that, but she's going to get all the other education that we would give for the amniocentesis. So think about it. You are going sticking a big needle through a lot of muscle through the abdomen, through the uterus to get in that um, amniotic sac, you could hit the baby, you could cause miscarriage. There's all kinds of things that could happen. So she needs to be aware of the risks. These are not done as much because now they have awesome blood tests that they can do to find out a lot of this information. Um, but some women still will get them, um, to confirm different things just because of their option. I have a nurse we work with, she had an amniocentesis done for her daughter that was suspected down syndrome, which was and um, super painful, this big needle and scary, but it was just kind of, she needed to know and that was the option that she had at that time. Okay. So those are the big ones for that. Let's get into what you guys have maybe learned is our NST or Non-Stress Tests versus our Contraction Stress Tests.
Okay. So this is also the non-stress has this NST. So the NST we want to see reactive. And I'm going to draw these out for you guys after I finish screen sharing so that you can see. So don't worry. Okay. So we want reactive and that's the result that we want. Basically what you're looking for is that the fetal heart rate has increased by 15 beats per minute times 15 seconds. And we want to see it do that twice. Let's see 2 in a 20 minute period. And it might be more than that. You might have to within five minutes. Perfect. And then that's a reactive NST. So basically this is happening with fetal movement and when I draw it out, it'll help our people that are visual people. So basically when you run up the steps, your heart rate increases. When the baby flips in your abdomen, a heart rate should increase.
So that's what we want to see is that heart rate jump up with movement, showing that that baby's happy, getting oxygen, all that, our Contraction Stress Test. This one is done, um, to look to see how the baby tolerates labor. This one is a very rarely done now, but they still ask questions about this sometimes. So let's make sure we know what it is. So what this says is we are going to stimulate contractions. So we are going to do, oh Mary, you said you had one many years ago. Was that an amniocentesis you're talking about? I just saw your comment.
Okay.
Oh well that's so painful and scary.
Um, yes, I can imagine. Okay, so Contraction Stress Test, Pitocin, um, or nipple stimulation. And I have a really good story in a second. I'll tell you about that. So I'm going to do pitocin or nipple stimulation with like a breast pump, um, to cause contractions because if you remember oxytocin, natural oxytocin is released in the body, um, with nipple stimulation and it will cause the contractions to happen. So we get the oxytocin going and we are watching the fetal heart rate to make sure we don't have, um, and we want to see no decelerations. Okay?
Okay.
No deceleration, that means that the baby is tolerating the labor contractions. And I'll draw that one out for you too. When we stop. The screen share. So my story for now is that we had this couple show up to a window, I'm on night shift and one of our nurses got them situated in the room and they needed to get contractions going. She did not want to have Pitocin put on yet. So, um, the labor nurse was telling her about nipple stimulation and she would go get the breast pump, but they choose saying that the dad could or he could also the male in the room, um, like pinch the nipples and cause nipple stimulation, which is a thing they can do that they want. So she kept going back into the room, checking on the patient and the patient, they were just sitting there and nothing was happening.
So she's trying to get the ball rolling. Like she's like, no, you need to do this so we can get this baby out. So she helps the dad or the male, I should say, that was in the room. Um, do this nipple stimulation few hours later. Oh. And she suddenly looked extremely awkward a few hours later and another male shows up to the window. Who was her husband and apparently the male in the room was a brother. Um, and I forgot to, I have never to mention there was a language barrier. So another good learning factors to uh, always make sure you use that language line, um, for that poor patient and her brother were in there getting some nipple stimulation.
Okay. So AFP is our last one that I was going to talk about for our non routine. So this is the Alpha FetoProtein.
Okay.
I think it's actually fetoprotein in all one word, but you get the drive AFP. So this is going to be blood that's drawn from the mom, so not from the baby. So blood drawn from the mom while she's pregnant and it's done usually between 16 to 18 ish weeks. And this is going to um, tap check for downs and Spina Bifida. And how it does it is that AFP is that protein as this you see Alpha Fetoprotein, uh, and it's released by fetal, the fetal liver. Um, and so then it's picked up in the mom's blood stream and if it's positive or like within that certain threshold and you shouldn't have to worry about with that threshold as you wanna know, if they're positive for AFP then we would be concerned with down syndrome or spina bifida happening. Okay. So I am going to, I'll give you guys a second to jot down or take screenshots or anything you need. I'll stop the screen share and I will pull up on my little board and draw out this NST action for ya and the contraction stress test. Is everybody good if I stop this screen share. Oh sorry I didn't mean to type baby probably cause I said it. Yes. Blood drawn from mom. Sorry about that. Yes the mom is still pregnant. Thank you. Good catch. I think I was saying the baby talking about not the baby as I typed it. Alright. I am going to stop the screen share. We can go back to it if we need to. Okay. All right. So let me draw for you guys this stuff on the NST first and then we'll do the contraction stress test
one.
Okay. So our NST, you are going to have the mom position leaning back. She is going to hit a button whenever she feels fetal movement. Okay. So anytime she feels a kick or turn anything, she hits a button. So down at the bottom, usually you have contractions. Well this mom's not in labor, so you might see a few little blurps like few little contractions that she has. But what you'll notice is these little black tick marks on the NST and that's any time that she felt the movement, she hits a little button. Then up at the top you're going to have the mom's heart rate and the baby's heart rate. So we have um, the babies, we'll just show them cause you don't need to worry about them. So the baby's heart rate here and we had movement, our heart rate jumped up and stayed up another bump.
So what you want to see is an increase of 15 beats per minute by 15 seconds. And we call this 15 by 15, that is going to be reactive. You can remember that because the baby is reactive to the movement, that heart rate's gone up. So it's a reactive strip and then you have 20 minutes to get this done. Okay, so 20 minutes. That's our key there our contractions tests or contraction stress test, you talk. Um, so this one is going to be where we're getting those contractions going or maybe she is just contracting. Okay? So we see her contractions at the bottom and we want to see no decelerations. So, um, I'll first show you what we want to see. We want to see good, happy, healthy baby. Then if you see that that's not good. That's the deceleration and the heart rate. So the Contraction Stress has is just making sure that the baby is tolerating the labor.
Okay.
There you go. Is that better? Can you see it?
Okay.
I don't know if you needed the other one too. Well, I'll do one at a time. So that's what our contraction Stress Test. You can see at the end, that's the debt. And then here is for the NST. So 15 by 15 reactive. The contraction stress has, I forgot to say that you have either, it can be negative or positive. What do you think we want to see? Negative or positive?
Any ideas?
Are you all googling really quick?
Um, so
yes, we want to see negative Briana, right? So negative means that we were negative for decelerations happening. So negative is good. It's so confusing and easy to flip around, but that contraction stress has, we want to see magnets. So this one would be a positive that we have at deceleration. Lucky. Yes. Now you knew what it was in [inaudible] in your brain somewhere.
Oh,
well that's what happens when you take the boards. Somehow the information comes from somewhere and you pass.
Yeah, it is. It's confusing. I honestly, because we don't really do contraction stress test anymore. When I'm explaining to people, I have to think about it to make sure it's like been negative as positive and we want to see a reactive for non-stress test. Just think the baby's reactive and then it's a negative for depth and heart rate or however you can get yourself to remember. What questions do you guys have about any part on testing or anything ob related? Anything crazy you've seen in clinical? Have questions on or in class? Anything confusing while you guys are doing that? I'm gonna, um, because I didn't pull it up. I will, um, share and take you into the NRSNG and get you guys that link.
Okay.
Can you guys see me now? I don't know if I lost you or what happened. There's the link in the antepartum lesson. Sorry. Did you guys see me go through the site or did I lose you when that happened?
I don't know what happened. Firefox was blocking something. I'm sorry, I lost you guys. I was really in that with showing you everything. Um, okay. Here's the link again, case you guys didn't see it. This'll take you right in there. I won't go back there cause I don't want to lose you guys again, but that's until you write in on NRSNG to the antepartum. Um, and it will, there's um, little mnemonics that are helpful. There's a non-stress tests and all of that. Now if anybody typed any questions, all my stuff went away when I came back. Yes. I can share the notes again. Let's hope that, um, I don't lose you. Maybe it was, I didn't like that I went to a different browser. Okay. Can you see my notes?
Okay.
So yeah, have at that takes screenshots, whatever you need to help off them. Did anybody have any other questions? Yeah. Is the tutoring session or the process of Labor repeat session? Um, yeah, I saw her one didn't have a description. It is, it's the same type of thing to go through. [inaudible] nothing. I'm different except for maybe questions that people come up with. You're welcome. What are some topics that you guys have, specific topics that you guys are interested in for? Anything OB? asked to do the communication course tutoring sessions too. So if there's anything specific that you guys would like to have a whole lesson on, let me know. Um, and I can put that in. I kind tried to guess what is confusing to people when I do the sessions. You guys some of the screen or the notes.
Okay.
Okay. Um, you haven't started OB yet. What do you recommend studying ahead of time? So I would just start kind of going through things, kind of go in order of how you probably will go through reset when you're in class. So just go into the ob course on interest in GI and start going through it. Um, some classes so you can ask anybody that's been in it before you, some of them have. Um, I know when I taught at one of the colleges we had as all in our ob content as well and STI is not covered in my ob course that we just released at live. Say, I don't know if you guys saw in genito urinary and some of them had search, there was like five, the big STIs in there. Um, so if you can find out then you can review those because those would usually probably covered in the meeting class and then just go through, it goes your menstrual cycle.
And those kinds of things too. Just I would start on the right side and just start trying to master each thing. Get a head start. Um, okay. The NST you're asked, is it always done? No, it is not. I was on, so an NST is done. If we're worried about fetal movement, if mom saying, hey, I haven't really felt the baby move. Um, if mom has gestational diabetes or a high risk pregnancy, so high risk pregnancies come because they are hypertensive, many different things. Um, so if they're in a high risk pregnancy, then they're going to have NSTs done all lot. Um, just to make sure that that baby is still in the best environment and safe to stay inside. Um, and NST will also happen once the woman goes past 40 weeks gestation because that placenta, it's an organ and it's meant to work for 40 weeks. So after 40 weeks at night start to not work as well. Um, which means the baby's not getting oxygen as well as it should and nutrients and all that good stuff. So they're done at that point just to make sure that the fetus is still tolerating that environment.
But yes, the CST is rarely done. You're welcome. I mean most all patients will, I shouldn't say most, but over half will probably end up with an NST at some point. Um, we always will do at NST. If a woman comes in and thinks she's on labor before she leaves the hospital, we have to have not, I wouldn't say an NST, um, cause the NST is looking at the fetal movement with the um, heart rate. But we will get a strip that is reactive. So that will always be done. If a woman's ever come into the hospital for preterm labor or anything, she's put on a monitor, we have to get a reactive strip before we can send her home. So reactive strip can just mean that we have a healthy happy move in heartbeat that does 15 by 15 but doesn't have to necessarily line up with movement. And this might just kind of helps guide when they're getting that NST or the fetal movement.
One of the questions. So I didn't also say with the routine testing, but my mom will get in the prenatal labs that's a routine tasks assigned to, right. So they get their prenatal labs done, which includes like their syphillis check, um, HIV, this, their regular blood type, um, that kind of thing to get a baseline. So that'll happen routine always at the beginning, once we've confirmed a pregnancy as well on the AFP, if it is found and as an indicator of Spina Bifida and if it's not found, they're in the clear. Okay. So nothing can ever be 100% in the clear, but typically, yes. If you were to get a test question, um, then I would say you're safe. If is they're asking specifically usually about the AFP, if they're saying it, then that's what you're looking for is down syndrome or most, um, or more than down syndrome is going to be the Spina Bifida. Um, they're looking for just neural tube defects, which would be like Spina Bifida. So I wouldn't say you're 100% of that clear, but for your test questions, yes. You're welcome. What other questions, guys? Anything?
Okay.
This is our first one on any part on, so I hope it was helpful. Um, I know it's a lot of information. I was trying to pick kind of the most important things that you'll see would see the most. Um, so just make sure you really understand that NST and the CST, cause those are put together a lot and then in questions and then the amniocentesis and the, um, CVS or the Chorionic Villi sampling, those are also put together a line questions as far as education and that kind of thing just because they kind of mirror each other so they can kind of use them against each other with questions. So make sure you really get those. You're welcome. All right guys. Will he don't have anything else? Um, oh good. I'm glad it was helpful. I am back sometime next week soon. Some awesome obese stuff. So I hope you guys will join me. I'm happy nursing.