Assessment of Risk Factors Flashcards
Prenatal Testing
NIPT
US
Multiple Marker Screening
CVS (Diagnostic)
Amniocentesis (Diagnostic test)
Maternal Risk Factors
Under age of 17 or over 34
High Parity (>5)
HTN or preeclampsia in current preg
Multiple gestation
Rh Incompatibility
H/x of dystocia or previous C-Section
Malnutrition (15% under ideal weight) or extreme obesity ( 20% over ideal weight)
Infections
Biophysical
orignates with the mother or the fetus
may affect development and functioning of both
Genetic disorder, nutritional and genetic health, medicial illness
Psychosocial
Maternal behaviors and adverse lifestyle that have a neg effect on health of mom or bby
May include emotional distress and interpersonal distrubed relations
Inadequate social support
Substance use
Diet practice
prego of young age
Sociodemographic
Arise from mother and her family
lack of prenatal care, low income, marital status , and ethnicity
Environmental
Hazards in workplace and woman’s general enviroment
May include chemicals, anesthic gases, and radiation
Biophysical Assessment
Ultrasound
Least invasive
High frequency sound waves
Early preg: Need full bladder (also 2nd trim)
* To confirm EDC, number of fetuses (16-20wk)
* To detect presence of fetal cardiac movement and rhythm and uterine adnorm
Second and Third Trimester: have them go to the bathroom
* 18 wks: Level 2: Heart, congential malformations
* Locates the placenta
* Growth scan/ serial evalulations to assess for IUGR vs Wrong Dates
* Amnoitic Fuild Volume
* Confirm viability
NOT A DIAGNOSTIC TEST (ITS A SCREENING), expensive
US for Nuchal Translucency
- Test the back of the neck for increased fluid or thickening
- PAPP-A: Maternal Serum blood is drawn assessing for a protein produced by the placenta, abnormal levels assoicated with increased risk of chromosomal abnormal
- HCG- abnormal level
When all three put together greater ability to detect if fetus is trisomy 21/18
Nursing Care: U/S
**FULL BLADDER **is important in 1st & 2nd trim ( b/c fetus is too small)
Instruct woman to drink 3 to 4 glassess of water prior to coming ultrasound
Position pillows under neck and knees to keep pressure off bladder
Position displays so women can watch (execpt if determining viablitiy)
Have bathroom available
Biophysical Assessment
BPP (Biophsyical Profile)
SCREENING
Used to assess fetal well-being
5 variables ( each worth 2 points)
* Fetal breathing movement -> 1+ lasting 30 sec
* Gross body movementof limbs or trunk
* Fetal tone -> flexed, extended
* Reactivity of FHR
* Amniotic fluid volume -> 1+ pockets measuring 2 cm
BPP SCORE
Score of 0-2 for each variable:
Reassuring = 8-10 pts
Equivocal = 6 pts
< 6 pts = DELIVERY !!!
Biochemical Assessment
NIPT
Prenatal screening for genetic abnormalities
Done at 10 wks
Trace fetal DNA in maternal blood
Screening test, not a definitive diagnosis
Can tell gender of fetus
Blood Work
Biochemical Assessment
Multiple Marker Screening
Screening offered between 16-18 wks
**HCG & Estriol **
* detect for risk of trisomy 18 & 21
Maternal serum AFP (MSAFP)
* Decrease levels= Down Syndrome
* Increase levels = Open Neural tube defects
Add placenta hormone inhibin A “quad screen”
* Increase accuracy of trisomy 21 in women < 35 yrs
Blood Work
Biochemical Assessment
Amniocentesis
DIAGNOSTIC Test
test for from amniotic fuild sample
Early in pregnancy : 14-16 wks chromonsomal evaluation
* Increase AFP may indicated NTD
* Decrease AFP may indicated Down Syndrome
Later in pregnancy : > 35wks Fetal lung maturity/ L:S ratio (assess baby readiness to breath outside the uterus)
* L:S ratio 2:1= fetal lung maturity
* Rh iso-immunization
Nursing Care: Aminocentesis
Obtain baseline vital sign and FHR
Ultrasounography guidance/ full bladder in early pregnancy **
Place pt in supine position**
Skin prep with Betadine/astepic solution
Monitor FHR for 1hr after to identify uterine cx/vaginal bleeding/ and fetal well-being
* Risk of miscarriage
* Empty bladder after decrease uterine cx
Results take 2 wk; invasive prodcure
