9.2a Assessment of Risk Factors and Antepartum Testing

Question 1

Assessment of Risk Factors

Answer 1

• Biophysical
• Psychosocial
• Sociodemographic
• Environmental

Question 2

Biophysical Risk Factors

Answer 2

• Genetics - Defective genes, transmissible inherited disorders, chromosomal anomalies, large fetus size, ABO incompatibility
• Nutrition Status - Young age, 3 pregnancies in the last 2 years, tobacco/alcohol/drugs, inadequate dietary intake, inadequate or excessive weight gain, Hct <33%
• Medica/OB disorders

Question 3

Psychosocial Factors

Answer 3

• Smoking - Risks are LBW, higher mortality rates an miscarriage, increased risk of PROM.
• Caffeine - More than 200 mg of caffeine a day can increase risk of IUGR
• Alcohol - Fetal Alcohol Syndrome, learning disabilities, hyperactivity
• Drugs - Teratogens, metabolic disturbances, CNS depression, heroin, cocaine, marijuana

Question 4

Psychologic Factors

Answer 4

• Emotional distress can cause birth complications
• Risks include intrapsychic disturbances (conflicting drives), addictive lifestyles, history of child abuse or partner abuse, inadequate support systems, maternal role changing conflicts, unsafe culture/ethics/religious practices.

Question 5

Sociodemographic Factors

Answer 5

• Low income - Inadequate resources for food, prenatal care, poor health, greater prevalence of environmental influences
• Lack of prenatal care - Failure to treat early complications due to financial barriers, lack of access, unpleasant physical surroundings, lack of understanding of the need for prenatal care
• Age - May not be a risk factor in all cases but sometimes
• Adolescents - Anemia, preeclampsia, prolonged labor, contracted pelvis, cephalopelvic disproportion, low education, low income, higher divorce rates, higher parity, increased reliance on governmental support programs
• Mature Mothers - Over the age of 35, increased likelihood of chronic illness, and invasive medical management during pregnancy, HTN, preeclampsia, diabetes, prolonged labor, C-section, Placental previa/abruption, Fetus at risk of LBW, macrosomia, congenital malformations, chromosomal abnormalities

Question 6

Sociodemographic Factors (cont)

Answer 6

• Parity - Preeclampsia and dystocia more common in first birth
• Marital Status - Increased mortality in unmarried women and preeclampsia
• SDOH - Availability and access to healthcare, metropolitan areas have more prenatal visits than rural areas.
• Ethnicity - Not usually a risk factor but in US African Americans have highest rate of preterm birth

Question 7

Environmental Factors

Answer 7

• Infection
• Radiation
• Chemicals (mercury and lead)
• Drugs
• Industrial Pollutants
• Cigarette Smoke
• Stress/Diet
• Exposure to mutagenic agents at the work place increases risk of miscarriage

Question 8

Antepartum Tests Goals

Answer 8

• Identify fetus risk for injury caused by acute/chronic interruption of oxygenation so that permanent injury or death may be prevented.
• Identify appropriately oxygenated fetuses so that unnecessary interventions are avoided