assessment high risk pregnancies Flashcards
categories risk factors (4)
-existing health conditions (asthma, heart conditions)
-age (<19 yo, or >35 yo)
-lifestyle factors
-conditions of pregnancy
pregnancy complications that increase with young age (<19 yo)
-preterm labor/preterm birth
-IUGR/SGA infant
-congenital anomalies
-preeclampsia
pregnancy complications that increase with older age (>35 yo)
-diabetes (preexisting and GDM)
-HTN (chronic, gestational, preeclampsia)
-multiple gestation
-preterm birth
-LBW/SGA
-congenital anomalies
-C-section birth
-miscarriage/stillbirth
lifestyle factors that contribute to antepartum risk
-substance use
-nutrition/physical activity
-intimate partner violence
-socioeconomic and demographic factors
-teratogen exposure
conditions of pregnancy that increase antepartum risk
-preeclampsia
-diabetes (GDM)
-placenta previa/abruption
-multiple gestation
-preterm labor/birth
-obstetric history (previous complications)
when can you do cell free DNA
10+ weeks
what does cell free DNA test and what does it test for
-uses mothers blood
-tests for trisomy 13, 18, 21 and sex
*decreased reliability of test for obese moms
when can you do first trimester multiple marker test
10-13 weeks
what does first trimester multiple marker test and what does it test for
-uses mothers blood
-tests for trisomy 13, 18, 21
-sonogram for nuchal translucence
*requires accurate EGA
what is increased MSAFP associated with
neural tube defects
when can you do second tri multiple marker test (quad test)
15-22 weeks
what does quad test use and what does it test for
-mothers blood (MSAFP):
-trisomy 18, 21
-neural tube defects
-sonogram:
-major defects
when can you do amniocentesis test
14+ weeks
what indicates fetal lung maturity
LS ratio 2:1
when can you chorionic villi sampling
what does it test for
10-13 weeks
advantage compared to amnio = earlier test, faster turn around time
tests for genetic anomalies
rare fetal complication of amniocentesis
club foot (talipes equinovarus)
tests for fetal well being
-kick count
-sonogram (doppler blood flow, BPP, AFI)
-MRI
maternal indications for daily fetal kick counts (4)
-HTN in pregnancy
-diabetes in pregnancy
-previous history of 3rd tri loss
-high stress parent(s)
what amount of kick counts per hr needs follow up
<3 movements/hr
*biggest thing is trends
how many hours in a row without fetal movement needs followup (fetal alarm signal)
12 hrs
BATMaN for biophysical profile
-breathing
-amniotic fluid
-tone
-movements
-nonstress test (reactive)
what is included on modified biophysical profile
-nonstress test (reactive)
-amniotic fluid volume (>2 or index >5)
what indicates a reactive nonstress test
2+ accelerations (15bpm/min) lasting 15 secs in 20 mins
what indicates a nonreactive nonstress test
20 mins without 2+ accels lasting 15 secs (can extend test to 40 mins)
what indicates a reactive vibroacoustic stimulation
increased FHR variation and acceleration
what indicates a nonreactive vibroacoustic stimulation
no response after 3 stimulations (1 min intervals)
absolute contraindications for contraction stress test
-previous classic incision for C/S
-preterm labor
-placental previa
-vasa previa
-reduced cervical competence
-multiple gestation
-any contraindication to labor
*basically anyone who shouldn’t be having contractions or shouldn’t have a vaginal birth
what is considered a negative contraction stress test
no late decels (good outcome)
what is considered a positive contraction stress test
late decels with >50% contractions
what is considered suspicious/equivocal contraction stress test
prolonged, variable or late decels with <50% of contractions
what is considered equivocal-hyperstimulatory contraction stress test
decels occur in presence of contractions >q2min or lasting >90 secs
what is considered unsatisfactory contraction stress test
unable to obtain 3 contractions in ten min period
