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OB > Antepartum Assessment for High Risk Pregnancy > Flashcards

Antepartum Assessment for High Risk Pregnancy Flashcards

1
Q

Risk factors for high risk pregnancy

A 
Homeless
Single
Uninsured pregnant women without access to prenatal care
Lifestyle 
Age
History
Nutrition
*** others
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2
Q

What is high risk pregnancy?

A

High risk pregnancy: life or health of mother or fetus is jeopardized

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3
Q

How long is mother at risk for ?

A

it extends through puerperium! 30-45 days after birth

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4
Q

When do complications usually resolve for mother’s at risk?

A

within 1 month of birth.

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5
Q

What are the 3 leading causes of maternal mortality?

A

Pre- eclampsia

Pulmonary embolism

Hemorrhage

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6
Q

Factors related to maternal death ?

A

Age: <20 years or > 35 years

Lack of prenatal care

Low educational attainment

Unmarried status

Nonwhite race

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7
Q

Fetal and neonatal health problems?

A

Congenital anomaly
Heart Defect
Anencephaly
Gastroschisis

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8
Q

Causes of neonatal death include?

A

Disorders related to short gestation and low birth weight

Sudden infant death

Respiratory distress syndrome

Effects of maternal complications
** Healthy People 2020- Progress being made

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9
Q

Nursing role in antepartal assessment for risks?

A
  • Assist with History intake
  • Initial nursing assessment
  • Education
  • Support person
  • Assists physician/ provider -with procedures-
  • Performs non-stress tests (NSTs), contraction stress tests (CSTs), BPPs
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10
Q

What are the 3 antepartum assessments for risk antepartum testing?

A

Biophysical Assessment

Biochemical Assessment

Electronic Fetal Monitoring

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11
Q

When does the fetal movement test start? Why?

A

28 weeks. 22 might be too early for some to be moving and kicking around.

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12
Q

If it’s been more than 12 hours without any fetal movement is this alarming? What should you do?

A

Yes alarming.

have woman drink something cold and sugary, or eat, lie down on left side…see if baby wakes up. if not you can zap it for 3 second.

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13
Q

What do ultrasounds do?

A 
Indications:
Fetal heart rate activity
Gestational age
Fetal growth &amp; Fetal anatomy
Placental position &amp; function
Dating purposes
Assess anatomy following abnormal maternal screens
Adjunct to other invasive tests
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14
Q

What does the fluid surrounding the baby do for it?

A

Fluid allows baby to grow and helps with lung development.

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15
Q

What can an ultra sound show?

A

Fetal well being
Amniotic fluid volume
Doppler blood flow analysis (slide 16)
Biophysical profile (slide 15)

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16
Q

If the Nasal Bridge and Nuchal translucency is thick what can this mean?

A

chromosomal abnormality

Thick nb and nt: it be can connected to downs syndrome

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17
Q

What does the biophysical profile show you? (4)

A

Gonna look at breaths, fetal movements, fetal tone , amniotic fluid volume

Max points someone to get is a 10.
If 8/10 that’s still acceptable.

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18
Q

What does MRI show ? (5)

A

Fetal structure

Placenta -

Quantity of amniotic fluid

Maternal structures

Biochemical status of tissues and organs

Soft tissue, metabolic, or functional anomalies

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19
Q

Is contrast used in pregnancies?

A

noooooo

20
Q

What is fetal hemolytic disease?

A

moms blood is attacking the baby.

21
Q

What does amniocentesis show for a fetus?

A

Indications
Prenatal diagnosis of disorders (genetic/ anomalies)
Fetal maturity (L/S ratio) – DM (PG)
Fetal hemolytic disease

22
Q

Maternal complications with amniocentesis?

A

Hemorrhage
Infection, Abruption
Organ injury
Amniotic embolism

23
Q

Amniocentesis complications in Fetus/infants?

A 
Death
Hemorrhage
Infection (amnionitis)
Injury from needle
Miscarriage or preterm labor
Leakage of amniotic fluid
24
Q

What is Chorionic villus sampling ? CVS

A

Removal of portion of placenta through abdomen or intravaginally through the cervix under USG guidance for genetic studies.

25
Q

How fast do results happen with Chorionic villus sampling?

A

RAPID

10 and 13 weeks gestation

26
Q

Risks and nursing considerations for Chorionic villus sampling?

A

Risks- spotting, SAB

Nursing considerations
Rhogam if RH NEG

27
Q

What is Percutaneous umbilical blood sampling? (PUBS)
and who is it indicated for?

fetuses @ risk for isoimmune hemolytic anemia

A

Insertion of needle directly into a fetal umbilical vessel under ultrasound guidance

indication: fetuses @ risk for isoimmune hemolytic anemia

28
Q

What are the risks and nursing considerations for Percutaneous umbilical blood sampling? PUBS

A

Risks- cord laceration, PTL, infection, PPROM

Nursing considerations: FHT, Rhogam post procedure if needed

29
Q

What is the Alpha-fetoprotein test ?

A

Maternal serum levels (MSAFP) screened for neural tube defects (NTDs)- done @ 15-22 wks

30
Q

In the alpha-fetoprotein test , what does it mean when its high?

A

NTDs & abdominal wall defects (HIGH)

31
Q

In the alpha-fetoprotein test , what does it mean when its low?

A

Down syndrome (LOW)

32
Q

What is the multiple marker screen?

A

1st Tri screen (11-13.6wks)

2nd Tri- Triple & Quad (16-18wks)

33
Q

What are the nursing considerations for the multiple marker screening?

A

EDUCATION
ACCURACY OF DATING
Nuchal Translucency scan

34
Q

What does the Coombs test?

A

Detects other antibodies for incompatibility with maternal antigens

Rh incompatibility – if titer >1:8

35
Q

What does the CELL FREE DNA IN MATERNAL BLOOD MAT21/HARMONY SHOW?

A 
A new screening for noninvasive prenatal genetic diagnosis- done after 10 wks 
Fetal Rh status
Fetal gender
Works by amplifying cell free DNA
Assess for trisomy 13, 18, 21
36
Q

What is the electronic fetal monitoring test?

A

To determine if the intrauterine environment is supportive to the fetus

37
Q

What is the non stress test?

A 
Procedure- 20 minute strip
Interpretation- Reactive or Non Reactive
Causes for non reactive- sleep cycle, tobacco ( can decrease blood flow), meds, fetal distress
Vibroacoustic stimulation
Max 3 sec
38
Q

if baby is over 32 weeks 2 accelerations will be what?

A

15x15

39
Q

if baby is under 32 weeks, 2 accelerations will be what?

A

10x10

40
Q

What is the contraction stress test and when is it started?

A

Procedure
Nipple-stimulated contraction test
Oxytocin-stimulated contraction test

28 weeks

41
Q

Interpretation of contraction stress test?

A

Interpretation
=] [good]NEGATIVE= 3 UC in 10 min with no late or significant variable decelerations
=[ (bad) POSITIVE= Late decelerations with >/=50% of UC (even is less than 3 in 10 min)
EQUIVICAL/Suspicious- Late or variable decels <50% of UC
UNSATISFACTORY- No UC in 10 min window or unable to trace FHT

Can provide a warning of fetal compromise earlier than NST

42
Q

Nursing role in antepartal assessment for high risk?

A 
Education
Support person
Assists physician with procedures
Performs non-stress tests (NSTs), contraction stress tests (CSTs), BPPs
Initial assessment
43
Q

What does biophysical assessment include?

A

fetal movement counts, ultrasonography, and MRI

44
Q

What does biochemical monitoring techniques include?

A

amniocentesis, PUBS, CVS, maternal assays and maternal serum AFP

45
Q

What does reactive NSTs and negative CSTs suggest?

A

fetal well being !=]

yay

OB (6 decks)

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