However if the NST is nonreactive and the BPP shows no fetal movement

Use at least 2 scholarly sources other than your textbook to connect your response to national

guidelines and evidence-based research in support of your ideas.

Please reply with the case discussed below.

28 weeks gestation

Scenario: A 30-year old woman of 28 weeks gestation reports inability to feel her baby move for the past 2 hours.

Subjective:

• Chief of Complaint: inability to feel her baby move for the past two hours.

• PMH: Patient had previous history of fetal death. Hypertension.

• Onset: When did you start not feeling the baby move?

• Location: Does not apply

• Duration: How long has it been since the last time you felt your baby last?

• Character: Last time that you felt your baby kick, was it the usual? Was it a strong one or faint one?

• Aggravating: Did anything happen before this?

• Reliving factor: Does not apply

• Medications: No medications provided.

• Social History: 30-year-old pregnant woman

• Allergies: No allergies provided.

Objective:

• General: Patient is awake, alert and oriented to place, person, time and situation. She is anxious as she hasn’t felt her baby move in the past two hours. Baby is normally active. She doesn’t smoke and drink alcohol.

• HEENT: No information provided.

• Pulm: No information provided.

• Neuro: Primitive reflexes not present. Normal tone, activity for muscles.

• Cardiac: No information provided.

• GI/GU: No information provided.

• Integumentary: No information provided.

• Musculoskeletal: No information provided.

• Endocrine: No information provided.

• Hematologic: No information provided.

Assessment:

• Differential Diagnosis:

o A. Fetal demise

 Positives: + no fetal movement in the past two hours, (risk: hypertension, previous history of fetal demise)

 Negatives: patient doesn’t smoke or drink alcohol, no history of diabetes

Plan:

• Test:

o NST or nonstress test- evaluate fetal movement and fetal heart rate accelerations. A reactive non-stress test must have accelerations of the fetal heart of a specific size, duration, and frequency. This includes at least three fetal heart tone (FHT) accelerations which are at least 15 beats per minute above the baseline and last at least 15 seconds, all within a 20-minute window. A non-reactive non-stress test, one that does not have the three accelerations, could indicate fetal sleep or fetal compromise, and further testing should be done. (Bryant et. al., 2020)

o Biophysical profile (BPP) – ultrasound of the fetus which is assessing: fetal breathing movement, fetal movement of the body or limbs, fetal tone and amniotic fluid volume. (Bryant et. al., 2020)

• Teaching/Treatment

o Provide teaching to the patient: to hydrate like drink juice or water and lay on left side as it could help if the baby hasn’t moved.

o However if the NST is nonreactive and the BPP shows no fetal movement, the provider should provide empathy and education to the patient and communicate about the result- which could lead to ceasarean delivery due to fetal demise. (Bryant et. al., 2020)

Bryant J, Jamil RT, Thistle J. Fetal Movement. [Updated 2020 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470566/