Antepartum Assessment for High Risk Pregnancy Flashcards
Risk factors for high risk pregnancy
Homeless Single Uninsured pregnant women without access to prenatal care Lifestyle Age History Nutrition *** others
What is high risk pregnancy?
High risk pregnancy: life or health of mother or fetus is jeopardized
How long is mother at risk for ?
it extends through puerperium! 30-45 days after birth
When do complications usually resolve for mother’s at risk?
within 1 month of birth.
What are the 3 leading causes of maternal mortality?
Pre- eclampsia
Pulmonary embolism
Hemorrhage
Factors related to maternal death ?
Age: <20 years or > 35 years
Lack of prenatal care
Low educational attainment
Unmarried status
Nonwhite race
Fetal and neonatal health problems?
Congenital anomaly
Heart Defect
Anencephaly
Gastroschisis
Causes of neonatal death include?
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
Nursing role in antepartal assessment for risks?
- 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
What are the 3 antepartum assessments for risk antepartum testing?
Biophysical Assessment
Biochemical Assessment
Electronic Fetal Monitoring
When does the fetal movement test start? Why?
28 weeks. 22 might be too early for some to be moving and kicking around.
If it’s been more than 12 hours without any fetal movement is this alarming? What should you do?
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.
What do ultrasounds do?
Indications: Fetal heart rate activity Gestational age Fetal growth & Fetal anatomy Placental position & function Dating purposes Assess anatomy following abnormal maternal screens Adjunct to other invasive tests
What does the fluid surrounding the baby do for it?
Fluid allows baby to grow and helps with lung development.
What can an ultra sound show?
Fetal well being
Amniotic fluid volume
Doppler blood flow analysis (slide 16)
Biophysical profile (slide 15)
If the Nasal Bridge and Nuchal translucency is thick what can this mean?
chromosomal abnormality
Thick nb and nt: it be can connected to downs syndrome
What does the biophysical profile show you? (4)
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.
What does MRI show ? (5)
Fetal structure
Placenta -
Quantity of amniotic fluid
Maternal structures
Biochemical status of tissues and organs
Soft tissue, metabolic, or functional anomalies
Is contrast used in pregnancies?
noooooo
What is fetal hemolytic disease?
moms blood is attacking the baby.
What does amniocentesis show for a fetus?
Indications
Prenatal diagnosis of disorders (genetic/ anomalies)
Fetal maturity (L/S ratio) – DM (PG)
Fetal hemolytic disease
Maternal complications with amniocentesis?
Hemorrhage
Infection, Abruption
Organ injury
Amniotic embolism
Amniocentesis complications in Fetus/infants?
Death Hemorrhage Infection (amnionitis) Injury from needle Miscarriage or preterm labor Leakage of amniotic fluid
What is Chorionic villus sampling ? CVS
Removal of portion of placenta through abdomen or intravaginally through the cervix under USG guidance for genetic studies.
How fast do results happen with Chorionic villus sampling?
RAPID
10 and 13 weeks gestation
Risks and nursing considerations for Chorionic villus sampling?
Risks- spotting, SAB
Nursing considerations
Rhogam if RH NEG
What is Percutaneous umbilical blood sampling? (PUBS)
and who is it indicated for?
fetuses @ risk for isoimmune hemolytic anemia
Insertion of needle directly into a fetal umbilical vessel under ultrasound guidance
indication: fetuses @ risk for isoimmune hemolytic anemia
What are the risks and nursing considerations for Percutaneous umbilical blood sampling? PUBS
Risks- cord laceration, PTL, infection, PPROM
Nursing considerations: FHT, Rhogam post procedure if needed
What is the Alpha-fetoprotein test ?
Maternal serum levels (MSAFP) screened for neural tube defects (NTDs)- done @ 15-22 wks
In the alpha-fetoprotein test , what does it mean when its high?
NTDs & abdominal wall defects (HIGH)
In the alpha-fetoprotein test , what does it mean when its low?
Down syndrome (LOW)
What is the multiple marker screen?
1st Tri screen (11-13.6wks)
2nd Tri- Triple & Quad (16-18wks)
What are the nursing considerations for the multiple marker screening?
EDUCATION
ACCURACY OF DATING
Nuchal Translucency scan
What does the Coombs test?
Detects other antibodies for incompatibility with maternal antigens
Rh incompatibility – if titer >1:8
What does the CELL FREE DNA IN MATERNAL BLOOD MAT21/HARMONY SHOW?
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
What is the electronic fetal monitoring test?
To determine if the intrauterine environment is supportive to the fetus
What is the non stress test?
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
if baby is over 32 weeks 2 accelerations will be what?
15x15
if baby is under 32 weeks, 2 accelerations will be what?
10x10
What is the contraction stress test and when is it started?
Procedure
Nipple-stimulated contraction test
Oxytocin-stimulated contraction test
28 weeks
Interpretation of contraction stress test?
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
Nursing role in antepartal assessment for high risk?
Education Support person Assists physician with procedures Performs non-stress tests (NSTs), contraction stress tests (CSTs), BPPs Initial assessment
What does biophysical assessment include?
fetal movement counts, ultrasonography, and MRI
What does biochemical monitoring techniques include?
amniocentesis, PUBS, CVS, maternal assays and maternal serum AFP
What does reactive NSTs and negative CSTs suggest?
fetal well being !=]
yay
