Assessment of High Risk Pregnancy

Question 1

Assessment of Risk Factors

types

Answer 1

• Biophysical Risks
  > factors tht originate w/in mother or fetus & affect development or functioning of either one or both
• Psychosocial Risks
  > maternal behaviors & adverse lifestyle
• Sociodemographic Risks
  > arise from mother & her family
• Environmental Risks

Question 2

Antepartum Testing/Biophysical Assessment

goals

Answer 2

• 2 Goals:
  > identify fetuses at risk for injury caused by acute or chronic interruption of oxygen so permanent injury or death might be prevented
  > identify appropriate oxygenated fetuses so unnecessary intervention can be avoided

Question 3

Ultrasonography

biophysical assess
indications

Answer 3

• Indications for use
  > fetal heart rate activity
  > gestational age
  > fetal growth
  > fetal anatomy
  > fetal genetic disorders
  > placental position & func
  > adjunct to other invasive tests

Question 4

Ultrasonography

well-being
nurse role

Answer 4

• Fetal Well-Being
  > doppler blood flow analysis
  > amniotic fluid volume
  > biophysical profile (BPP)
• Nursing Role
  > counseling & education regarding the procedure

Question 5

Amniocentesis

biochemical

Answer 5

• Indication for Use
  > genetic concerns; women >35yrs, family hx of chromosomal abns
  > fetal maturity; L/S & S/A ratios
  > fetal hemolytic disease
• Maternal complications
• Fetal complications

Question 6

Chorionic Villus Sampling (CVS)

biochemical

Answer 6

• Earlier diagnosis & rapid results
• Performed btwn 10-13wks of gestation
• Removal of small tissue specimen from fetal portion of placenta
  > chorionic villi originate in zygote > tissue reflects genetic makeup of fetus

Question 7

Alpha-Fetoprotein (AFP)

biochemical - maternal assays

Answer 7

• Maternal serum lvls screened for neural tube defects (NTDs)
• 80-85% of open NTDs & abd wall defects can be detected early
• Recommended for all pregnant women

Question 8

Mutliple Marker Screens

biochemical - maternal assays

Answer 8

• Detects chromosomal abnormalities
• PAPP-A, B-hCG, hCG markers associated w/ incrd risk for trisomy 21 (Down’s)

Question 9

Coombs’ Test

biochemical - maternal assay

Answer 9

• Rh incompatibility
• Detects other antibodies for incompatibility w/ maternal antigens

Question 10

Cell Free DNA in Maternal Blood

biochemical - maternal assay

Answer 10

• A new screening message for noninvasive prenatal genetic diagnosis
  > fetal Rh status
  > fetal gender
  > paternally transmitted single gene disorders
• Works by amplifying cell free DNA

Question 11

Antepartal Assessment Using Electronic Fetal Monitoring

Answer 11

• Goal
  > to determine if the intrauterine envir’t is supportive to fetus
• Nonstress test (fetal activity determination)
  > procedure
  > interpretation
• Vibroacoustic stimulation

Question 12

Contraction Stress Test (CST)

antepartal assessment using electronic fetal monitoring

Answer 12

• Procedure
  > stimulate the stress the fetus experiences in the 1st stage of labor
  > nipple-stimulated contraction test
  > oxytocin-stimulated contraction test
• Interpretation
• Provides a warning of fetal compromise earlier than NST