Antepartum Flashcards
what groups are considered at risk
homeless
single
uninsured
no access to prenatal care
when is a preg considered high risk
when the life of the mother or fetus is jeopardized
how long is mom considered high risk for
up to 30 days after delivery
maternal complications usually resolve by when?
within 1 month after birth
when is a neonate considered high risk?
when the neonate does not meet cultural, societal, or familial norms/expectations
what are the leading causes of maternal mortality
preg induced HTN
PE
hemorrhage
what factors are r/t maternal death
younger than 20 older than 35 lack of prenatal care low edu unmarried non-white
what is the leading cause of neonate death
congenital anomaly
other causes of neonate death
short gest low birth wt SIDS resp distress effects of maternal complications
what are genetic risk factors
heritable factors that originate within the mother or fetus
name demographic risks
geo location
socio-eco status
racial disparity
occupational hazards
what are behavioral risk factors
behaviors that arise from the mother and/or family and place the fetus at incr risk
name behavioral risks
sub abuse
poor maternal nutrition
risk factors are…
inter-related and cumulative
how can mom help monitor fetal well being?
daily fetal mvmt count
indications for US
-FHR activity gest age fetal growth fetal anatomy placental position and fx adjunct to other invasive tests
how do we use the US to determine fetal well being?
amnio fluid vol
doppler blood flow analysis
biophysical profile
what is the nurses role during prenatal testing/procedures
- education
- support
what are fetal mvmts and tone
the way the baby moves
indications for MRI
-fetal structure
- placenta:
position
density
presence of gest tropho disease
- quant if amnio fluid
- maternal structures:
uterus
cervix
adnexa
pelvis
fibroids
- biochemical status of tissues and organs
-soft tissue anomalies
- metab anomalies
- fx anomalies
is the mom exposed to radiation during an MRI
no
are MRI’s and US considered invasive procedures
no
what is amniocentesis
assessment of the babys chromosomes
amniocentesis is guided via
US
when is an amnio done
on or after week 14
maternal risks a/w amniocentesis
hemorrhage infec labor abruptio placenta damage to intestines or bladder amnio fluid embolism
what % is the risk a/w amniocentesis
<1%
recommendations for mom after amniocentesis
- rest for the remainder of the day
- no bending, reaching, climbing stairs
- restrict taking care of other children- if possible
what should a mom report after an amniocentesis
dull back pain
fetal risks a/w amniocentesis
death hemorrhage infec (amniotitis) injury from needle miscarriage pre term labor amnio leakage
indications for amniocentesis
hx of genetic disorders
fetal maturity
fetal hemolytic disease
ante/intra partal meconium
what is lactophinomylin ratio
lung maturity
what is karyotyping
terminating a preg bc the baby is an undesired sex
percutaneous umbilical blood sampling is aka
cordocentesis
what is PUBS
insertion of a needle into umbilical vessel under US guidance
benefit of PUBS
direct access to fetal circulation
when can a PUBS be done
2nd and 3rd trimester only
is a PUBs done often
no- very rarely
risks a/w PUBS
infec
premature ROM
cord prolapse
what is chorionic villus sampling (CVS)
- removal of small tissue specimen from fetal portion of placenta
where does chorionic villi originate
zygote
what does chorionic villi tissue reflect?
genetic makeup of fetus
when can a CVS be done
bx 10-12 wks gest
benefits of CVS
- earlier dx
- rapid results
risks a/w CVS
miscarriage
bleeding
indication for AFP
screening:
NTD’s
abdominal wall defects
who is AFP testing recommended for
all pregnant women
how is AFP collected
maternal serum
AFP is produced by
the fetal liver
when is AFP tested?
16-18 wks gest
AFP blood tests are combined with
US results
how are the results from an AFP presented?
- a percentage risk of having a baby with down syndrome
it is possible to receive what kind of results from an AFP
false positive
what else is looked at in conjunction with AFP?
estriol and HCG
if a baby has down syndrome, describe the rship bx afp/estriol/hcg levels
- AFP and estriol will be low
- HCG will be high
what is a coombs test used for
- determine RH incompatibility and its severity
- determines other AB’s for incompatibilty w/ moms Ag’s
if mom and fetus are Rh incompatible, what will be admin to mom after birth
Rhogam
indications for electronic fetal monitoring
- assess fetal response to hypoxia and asphyxia
- fetal well being
- cxns
- cns of the baby
variability of fhr demonstrates
fetal well being
cxns
cns of the baby
what is a NST done for
fetal activity determination
how is a NST performed?
mom lays down
2 belts
mom relaxes
vibroacoustic stimulation
when is a NST indicated
- 2x per week after week 28 if mom has:
DM
HTN
previous stillborn
interpretaion of NST results
2 or more accelerations of 15 bpms lasting over 15 secs over 20 mins
demonstrates moderate variability
vibroacoutic stimulation
5-10 mins getting baseline
get a variability w/ HR
scare baby
what is the protocol if there is no activity after vibroacoustic stimulation
mom will be sent for more testing- biophysical
how long will HCP allow baby to be non-reactive before sending mom for a biophysical
40 mins
when is a contraction stress test (CST) indicated
when a baby fails NST
what are the 2 different CST’s
- nipple stim CST
- oxytocin stim CST
how is a CST performed?
- monitor for 20 mins
- get a baseline
- give 20 units
- wait a few mins
- give 10 units
- assess baby to cxns
- wait another 20 mins
- assess baby again
interpretation of CST
-if baby reacts, test is (-)
benefit of CST
- provides a warning of fetal compromise earlier than an NST
name biophysical assessment techniques
fetal mvmt counts
US
MRI
name the biochemical monitoring techniques
amnio
PUBS
CVS
maternal serum AFP
what interpretations suggest fetal well being
reactive NST
and
(-) CST
