antepartdum Flashcards
high-risk pregnancy
Coincidental (had disease before pregnancy) or unique to pregnancy (unique to pregnancy). visit dr every 4 weeks during 1st and 2nd, and 3rd every 2 weeks. 0-13 - 1st, 14-26 - 2nd, 27-40 3rd trimester.*****
Risk Factors
Biophysical - mostly due to diseases. multiple birth, genetic abnormalities, nutritional deficiencies.
Psychosocial - depression, smoking, caffeine, alcohol, substance abuse. crisis w/ domestic violence.
Socio-demographic - poverty, lack of nutrition, prenatal care, less than 15 years of age, parody (# of deliveries greater than 20 wks) access to health care.
Environmental - a little bit of all of them, not clean or healthy place to live, more infections. radiation, air and water polution, and 2nd hand smoke, stress.
Antepartum Testing
To detect potential fetal compromise (usually a lack of 02)
32-34 weeks until delivery - fetal fibernectincan predict when person is going to deliver
Used primarily for women at risk for disrupted fetal oxygenation
BIOPHYSICAL ASSESSMENTS
VVP - vital physical profile. Daily Fetal Movement Count (AKA Kick Count) - daily movement counts - should be performed same time every day. lay on left side, hand on stomach, and lay for an hour and count. should be around 10 kicks an hour. best time is after meals.
Ultrasound - used for many things - wellbeing - usually look at movement, heartbeat, and RR, can see baby move, can see diaphragm
Biophysical Profile (BPP) - measures health of fetus. HR, muscle tone, breathing action, and how much amniotic fluid. also a non-stress test.
ultrasound
Abdominal or transvaginal. usually abdominal. if looking for anomalies, will do transvaginal.
when is Transvaginal used? (trans is first)
Transvaginal used mainly in in the first trimester - provides greater detail and can dx IUP (intrauterine pregnancy) and establish Gestational age earlier. can tell if cervix is thin.
Levels of ultrasonography:
Standard
Levels of ultrasonography:
Standard – GA, AFI’s etc.
Limited – e.g., check for vertex presentation, fetal HR
Specialized- suspected anatomical or physiological abnormal fetus
get to know your baby’s movements
if she doesn’t feel that movement, call the provider.
Indications For Use
Fetal Heart Activity
Gestational Age
Fetal Growth
Fetal Anatomy
Fetal Genetic
Fetal Position
Disorders and Physical Anomalies
Placental Position and Function
Adjunct to other tests
Fetal Well Being
Ultrasound to Determine Gestational Age
Fetal Growth
Recommended method of dating.
Most accurate between 14-22 weeks. most common one is from last mentstural period and nagal’s rule.
Gestational Sac dimensions (8 weeks)
Crown/Rump length (7-12 weeks)
BPD (biparatal diameter - just transverse section of skull) (12 weeks) and Femur Length (12 weeks)
Serial evaluations of BPD, Limb length and abdominal circumference can determine Fetal Growth
Biparietal Diameter (BPD) to determine (gest bpg at 12)
Gestational age
After 12 weeks
fetal well being
doppler flood flow analysis (not as common), amniotic fluid (through umbelical cord), NST, biophsical profile, modified biophycial profile.
biophysical profile scoring
fetal breathing movements - 2 ,gross body movement - 2, fetal tone - 2, reactive HR - 2, qualatative amniotic fluid - 2`
missing slide
14 - prob don’t need this
biophysical profile scoring
8 - 10 normal, 4-6 suspected chronic asphysxia, 2 strong suspicion of asphysxia
Amniotic Fluid Index (AFI)
Amniotic Fluid Volume (AVI) (same thing as amniotic fluid test) - what is the normal amount?
Measures the vertical depths of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus and totaled. 5 - 25 cm is normal fluid amount.
Biochemical Assessment
Procedures to obtain specimens:
Amniocentesis - take some anmiotic fluid.
Chorionic Villus Sampling (CVS) (placenta side towards infant)
Maternal Assays - blood draws - looking for downs, etc.
Percutaneous Umbilical Blood Sampling
AMNIOCENTESIS
Genetic and chromosomal abnormalities (15- 20 weks), Fetal Lung Maturity, Rh isoimmunization status and severity of hemolytic anemia, AFP (Alpha Feto Protein) levels which indicate anatomic abnormalities
2 Ways of Measuring the Infant’s Lung Maturity
- Lecithin to sphingomyelin (L/S) ratio: a mixture of lipids, proteins, and glycoproteins that make up surfactant:
2 or more indicated fetal lung maturity and low risk of infant respiratory distress syndrome
1.5 or less is associated w/high risk
- Phosphatidylglycerol: is a glycerophospholipid found in pulmonary surfactant and an indicator o fetal lung maturity
If a patient needs to be delivered, they should be delivered
If a patient needs to be delivered, they should be delivered regardless of fetal lung maturity. If a patient doesn’t need to be delivered, then we should wait.
if the pt needs to be delivered- BMZ <34 weeks
BMZ (betamethazone) <34 weeks with imminent delivery before 7 days and have not received it BMZ in the last 14 days.
BMZ 34 to 36.6 weeks
BMZ (betamethazone) 34 to 36.6 weeks at risk of preterm birth within 7 days and have not received BMZ or prior course was > 14 days
Complications
Less than 1%. -mom
Infection
Hemorrhage
damage to bladder or intestines.
Miscarriage
PTL
leakage of AF
Rh Sensitization
Complications
Less than 1% - baby
Death
Hemorrhage
Infection
nursing care
Report leaking fluid
Abdominal pain
Bleeding
Decreased Fetal movement
Fever
Rhogham to RH- women
educate
informed consent
fetal monitoring
chorionic villus sampling (chronic for 10 weeks)
10-12 weeks. ultrasound guided.
Fetal Assessment via Electronic Fetal Monitoring
non-stress test (NST), contraction stress test (OST)
Fetal Assessment via Electronic Fetal Monitoring
To determine the the timing of childbirth for women at risk for uteroplacental insufficiency (UPI), 32-34 weeks in high-risk patients, 1-2 times a week. main thing is to ensure baby has good O2 supply.
NON-STRESS TEST
evaluate FHR during movement.
Reactive/Nonreactive
Reactive = 2 Accelerations in 20 minutes. (if they are greater than 32 weeks) (less than 32 weeks, could be 15 and 10)
Accelerations are FHR equal or greater than 15 BPM over baseline lasting 15 seconds or more.
CONTRACTION STRESS TEST (we don’t want positive contractions with the stress test!)
Endogenous or Exogenous Oxytocin, Evaluate FHT with contractions, Negative: No decelerations with 3 UC’s lasting 40-60 seconds in 10 minutes, Positive: Decelerations with 50% or more of UC’s (we don’t want a positive) (we want negative)
contractions start where?
at the top, the fundus, and then they move down.
Contraindications to contraction stress test
placenta previa (over cervix), PTL, cervical insufficiency, multiple gestations, previous C/S
slides 30-34
minimal variability
<5 bpm variation around baseline
moderate variability
6-25 bpm variation
absent variability
no detectable variation around baseline
marked variability
> 25 bpm
