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OB exam 3 > Ch 26, Assessment of high risk pregnancy > Flashcards

Ch 26, Assessment of high risk pregnancy Flashcards

1
Q

The risk factors for a pregnancy are assessed by breaking them down into 4 separate categories. What are these categories?

A

-Biophysical
-Psychosocial
-Sociodemographic
-Environmental

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2
Q

In risk factor assessment, what does the category of “Biological” risk factors mean?

A

Factors that originate in the pregnant woman or fetus and affect development/functioning of the woman or baby

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3
Q

What are some examples of biological risk factors?

A

-Diabetes Mellitus (leads to Polyhydramnios)
-Maternal Hypertension (Leads to Oligohydramnios)
-IRGR (Fetal infection, Teratogenic exposure, HTN)
-AMA (chromosome abnormalities)
-

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4
Q

What are “Psychosocial” risks that affect pregnancy?

A

-Emotional distress
-Hx of depression
-d\Disturbed relationships
-Intimate partner violence
-Substance abuse
-No social support

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5
Q

What are some “Sociodemographic” risks for pregnancy?

A

-Lack of prenatal care
-Low income
-Single marital status
-Ethnic minorities

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6
Q

What are “Environmental” risk factors that affect pregnancy?

A

“Workplace hazards and toxic home environment”
-Chemicals (mercury)
-Anesthetic gases
-Radiation
-Asbestos

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7
Q

When does Antepartum testing typically begin?

A

Between 32-34 weeks of gestation, and continues regularly until birth

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8
Q

What are some common Maternal and Fetal indications for Antepartum testing?

A

-Diabetes
-HTN
-Preeclampsia
-Lupus
-Renal Disease
-Cyanotic Heart Disease
-Oligohydramnios

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9
Q

What is a DFMC and what is it used for?

A

DFMC stands for Daily Fetal Movement Count

DFMC, also called the “kick” count, is used to monitor a baby in a pregnancy with conditions that may affect fetal oxygenation (DM, HTN, etc.)

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10
Q

DFMC, also called the “(____)” count, is used to monitor a (____) in a pregnancy with conditions that may affect fetal (___________) (DM, HTN, etc.)

A

DFMC, also called the “(kick)” count, is used to monitor a (fetus) in a pregnancy with conditions that may affect fetal (oxygenation) (DM, HTN, etc.)

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11
Q

Decreased fetal activity is noted in response to what?

A

Hypoxemia

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12
Q

Several different protocols are used for counting DFMC. One method is to count (____) a day for long?

A

Several different protocols are used for counting DFMC. One method is to count (once) a day for 60 minutes

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13
Q

Another method for DFMC is for women to count ALL fetal activity in a (__) hour period each day until (__) movements are counted

A

Another method for DFMC is for women to count ALL fetal activity in a (12) hour period each day until (10) movements are counted

The 12-10 method

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14
Q

When is the fetal alarm signal sounded?

A

No fetal movements are recorded in 12 hours. EMERGENCY!!!!!!!!!!!!

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15
Q

When a woman reports decreased fetal activity, what test is usually preformed?

A

A non-stress test

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16
Q

It is important to know that fetal movement cannot be recorded during the fetal (____-____)) and movements may be reduced if the mother it taking (_______) that depress the (___)

A

It is important to know that fetal movement cannot be recorded during the fetal (sleep-cycle)) and movements may be reduced if the mother it taking (medications) that depress the (CNS)

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17
Q

What is considered the most valuable diagnostic tool in obstetrics?

A

The Ultrasound

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18
Q

Ultrasonography can be used to detect fetal genetic disorders and physical anomalies. What is the technique known as NT, and what does stand for?

A

NT stands for Nuchal Translucency, and an NT screening uses ultrasound measurements of fluid in the nape of the neck between 10 and 14 weeks to ID fetal abnormalities

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19
Q

NT stands for (_____ ___________), and an NT screening uses ultrasound measurements of (____) in the (____) of the neck between (__) and (__) weeks to ID fetal abnormalities

A

NT stands for (Nuchal Translucency), and an NT screening uses ultrasound measurements of (fluid) in the (nape) of the neck between (10) and (12) weeks to ID fetal abnormalities

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20
Q

In an NT test, a fluid collection greater than (___) is considered abnormal

A

In an NT test, a fluid collection greater than (3mm) is considered abnormal

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21
Q

An elevated NT level indicates an increased risk for isolated anomalies, such as what 3 things?

A

-Congenital heart defects
-Abdominal wall defects
-Diaphragmatic hernia

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22
Q

When combined with abnormal maternal (____) marker levels, increased NT levels indicate the possibility of (__________) abnormalities, such as (________) 13, 18, and 21

A

When combined with abnormal maternal (serum) marker levels, increased NT levels indicate the possibility of (chromosomal) abnormalities, such as (trisomies) 13, 18, and 21

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23
Q

An ultrasound is also valuable in DX relating to the location of the placenta. After 16 weeks of gestation, where should the edge of the placenta be in relation to the cervix to be considered normal?

A

The edge of the placenta needs to be AT LEAST 2cm from the cervix to be normal.

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24
Q

If the placental edge is LESS THAN 2cm from the cervix, it is considered previa. What is previa?

What should be done?

A

Previa is a low-lying placenta

Repeat ultrasound scans as the pregnancy progresses until it moves away from the cervical os. 90% of Previas resolve by the 3rd trimester

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25
Q

Why do 90% of Previas resolve by the 3rd trimester?

A

Because the placenta grows towards the fundus, where the blood supply is way better than the lower uterine segment

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26
Q

PUBS (Percutaneous Umbilical Blood Sampling) and CVS (Chorionic Villus Sampling) are two adjunct methods of DX used with an ultrasound to do what?

A

PUBS identifies the umbilical cord
(Percutaneous Umbilical Blood Sampling)

CVS identifies the Chorion Frondosum
(Chorionic Villus Sampling)

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27
Q

AFV and FBM’s are abbreviations that mean what in fetal well-being assessments?

A

AFV is Amniotic Fluid Volume

FBM is Fetal Breathing Movements

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28
Q

Which fetal assessment tool is used to analyze systolic/diastolic flow ratios and resistance to estimate blood flow to certain arteries?

A

Doppler Blood Flow Analysis

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29
Q

What are the 3 most studies vessels in the Doppler Blood Flow Analysis?
(2 fetal, 1 mother)

A

-Fetal umbilical arteries
-Middle cerebral arteries
-Maternal uterine arteries

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30
Q

Significantly increased peak systolic velocity in the (______) (______) artery predict moderate to severe fetal (____). Abnormal (______) (______) artery levels predict IUGR

A

Significantly increased peak systolic velocity in the (middle) (cerebral) artery predict moderate to severe fetal (anemia). Abnormal (maternal) (abdominal) artery levels predict IUGR

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31
Q

Determine which of these subjective measurements are examples of the AFV issues:
Oligohydramnios or Polyhydramnios

-Fundal height that is small for gestational age and easily palpable

-Fundal height that is large for gestational age and cannot be easily palpated (ballotable)

A

-Fundal height that is small for gestational age and easily palpable is indicative of Oligohydramnios

Fundal height that is large for gestational age and cannot be easily palpated (ballotable) is indicative of polyhydramnios

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32
Q

What are the FV differences and amniotic vertical pocket cm differences between Oligohydramnios and Polyhydramnios?

A

Oligohydramnios is an AFV of <300 and an amniotic pocket circumference of less than 2cm

Polyhydramnios is an AFV of 2L and an amniotic pocket circumference of greater than 8cm

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33
Q

An AFI (Amniotic Fluid Index) of what indicates Oligohydramnios?

An AFI of what indicates Polyhydramnios?

A

AFI of less than <5cm Indicates Oligo

AFI of greater than >25cm indicates Poly

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34
Q

Prelabor ruptures and IUGR is associated with which AFV issue?

GI/CNS issues, twin-to-twin transfusion syndrome and infections are associated with which AFV issue?

A

Prelabor ruptures and IUGR are associated with Oligo

GI/CNS issues, twin-to-twin transfusion syndrome, and infections are associated with Poly

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35
Q

The BPP can be considered a physical examination of the fetus. What is BPP?

A

Biophysical Profile

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36
Q

Why can BPP be considered a reliable, physical examination of the fetus’s well-being, while an AFV test only demonstrates placental function over the pregnancy?

A

The BPP takes into account FHT’s, FBM’s, Fetal tone, movement and FHR determined by a non-stress test. This put together determines CNS status

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37
Q

What is a desired BPP score?

A

8 or 10, like a good APGAR

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38
Q

When is the BPP test used?

A

Frequently in the late second trimester and early 3rd trimester

39
Q

What is a drawback of a BPP test?

A

If the fetus is in a quiet sleep state, it can take a long time to get results

40
Q

What is the nurses role in an Ultrasound and BPP?

A

To provide counseling and education about the procedure

41
Q

What is three and four-dimensional ultrasonography?

Is it covered by insurance?

A

Three and Four-Dimensional ultrasonography is when an ultrasound image is made like a professional photograph, capturing a 3-d image of a fetus

It is not covered by insurance

42
Q

Why is 3-d ultrasonography discouraged by AIUM and ACOG? (2 reasons)

A

Exposing the fetus to high-frequency sound waves without a clear medical reason should be avoided.
It’s also casual and performed without a trained medical professional and can give false reassurance that the pregnancy is fine.

43
Q

An MRI is an excellent way to view a fetus, because unlike a CT scan, (_____) (________) is not used to visualize vascular structures.

A

An MRI is an excellent way to view a fetus, because unlike a CT scan, (ionizing) (radiation) is not used to visualize vascular structures.

44
Q

In an MRI, you can evaluate fetal (_______) and overall (_____), the (_______), the (_______) of Amniotic fluid, Maternal; structures like the (_____) and (_____), and the biochemical status of tissues and organs.

A

In an MRI, you can evaluate fetal (structure) and overall (growth), the (placenta), the (quantity) of Amniotic fluid, Maternal structures like the (uterus) and (cervix), and the biochemical status of tissues and organs.

45
Q

What fetal and maternal anomalies can be detected in an MRI?

A

Metabolic, soft-tissue, and functional

46
Q

During an MRI, what position should a pregnant woman be put into?

A

Supine with one hip elevated

47
Q

During an MRI, a fetus may move and obscure details. What is the only way to deal with this issue?

What should that method of resolution be reserved for?

A

Sedate the woman to resolve the issue

Only use a sedative is the visualization of fetus detail is critical

48
Q

An MRI has what effect on the fetus?

A

Little to no effect on the fetus

49
Q

Biochemical assessments involve Procedures used to obtain needed specimens. What are these 4 procedures? amniocentesis, percutaneous umbilical blood sampling, chorionic villus sampling, and maternal sampling

A

-Amniocentesis
-Percutaneous Umbilical Blood Sampling
(PUBS)
-Chorionic Villus Sampling
(CVS)
-Maternal sampling

50
Q

An implication of biochemical assessment is that, based on test results, woman may consider having what?

A

An induced Abortion

51
Q

A Coombs test is a Biochemical assessment tool used for the testing of what?

A

A Coombs test checks for antibodies that attack your red blood cells; RH antibody test for mothers

52
Q

When is an Amniocentesis performed and what is this test for?

A

An Amniocentesis is performed usually at or after 15 weeks’ gestation (NOT BEFORE) and is for collecting amniotic fluid for testing fetal cells.

53
Q

How is an Amniocentesis conducted?

A

A needle is inserted abdominally into the uterus and amniotic fluid is absorbed into a syringe

54
Q

What test is commonly used to check for fetal lung maturity?

A

An LBC test is commonly used to test for fetal lung maturity

55
Q

When performed in the 1st trimester, a CVS is better known as a what?

A

A Placental biopsy

56
Q

When can a Chorionic Villus Sampling (CVS) be performed?

A

between 10 and 13 weeks’ gestation

57
Q

PUBS is also called what?

A

PUBS is also called Cordocentesis

58
Q

What is the purpose of PUBS?

A

PUBS is used for fetal blood sampling and transfusions

59
Q

PUBS has recently been replaced with the newer, faster, and easier method of collecting fetal blood samples by using what method?

A

A Placental biopsy, aka CVS

60
Q

What is the procedure for a PUBS?

A

PUBS involves inserting a needle directly into the umbilical cord (under ultrasound guidance)

61
Q

PUBS is most often used when fetal blood is needed in determining a (_______)

A

PUBS is most often used when fetal blood is needed in determining a (mutation)

62
Q

What are the 2 most common complications of PUBS?

A

Bleeding from the umbilical cord puncture and fetal-maternal bleeding

63
Q

What are 3 other things that a PUBS can test for in a fetus?

A

-Anemia
-Infection
-Thrombocytopenia

64
Q

Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for (___)’s during pregnancy.

A

Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for (NTD)’s during pregnancy.

65
Q

Through the use of Maternal serum alpha-fetoprotein’s (MSAFP) approximately (__)% to (__)% of open (___)’s and almost ALL cases of (___________) can be found early

A

Through the use of Maternal serum alpha-fetoprotein’s (MSAFP) approximately (85)% to (90)% of open (NTD)’s and almost ALL cases of (anencephaly) can be found early

66
Q

MSAFP screening occurs during what gestational weeks?

A

15-20 weeks, with 16-18 being best

67
Q

What should be done if there are elevated AFP levels?

A

Ultrasound

68
Q

Screening to detect fetal chromosomal abnormalities like down syndrome occurs during what trimester and gestational age?

A

1st trimester, 11-14 weeks gestation

69
Q

The 1st trimester screening for chromosomal abnormalities (Down Syndrome) involves measuring what 3 biochemical markers?

A

PAPP-A (Pregnancy Associated Plasma Protein-A)
-HCG
-ADAM 12

70
Q

cfDNA, aka cell-free DNA, is the newest screening test for Aneuploidy. What is Aneuploidy?

A

Aneuploidy is having one or more extra chromosomes in the 23 pairs each individual normally possesses

71
Q

If women test positive in a cfDNA test, what tests are they referred to for further analysis?

A

An Amniocentesis or CVS to confirm the findings

72
Q

Common aneuploids are (_______) 13, 18, and 21, each of which results in an extra (____________)

A

Common aneuploids are (trisomies) 13, 18, and 21, each of which results in an extra (chromosome)

73
Q

The accuracy of a cfDNA test relies on the proportion of what?
What is the proportional value?
When is it best to perform this test?

A

Relies on the proportion of fetal DNA to mother DNA in the maternal plasma.

It needs to be at least 4% of the mothers plasma DNA to be accurate.

Best to test by 11 to 13 weeks, when the proportion is at 10% of the maternal DNA

74
Q

Many Fetal Care Centers have a (____) who coordinates with the family to navigate appointments

A

Many Fetal Care Centers have a (nurse) who coordinates with the family to navigate appointments

75
Q

Fetal Care Centers give access to support services such as (_______) counseling, social work, (_______) services, a palliative care team, and (_____) consultation because of the complex emotional stressors they face

A

Fetal Care Centers give access to support services such as (genetic) counseling, social work, (chaplain) services, a palliative care team, and (ethics) consultation because of the complex emotional stressors they face

76
Q

The goal of third trimester testing is to determine what?

A

Whether the intrauterine environment continues to support the fetus

77
Q

What is the most widely applied technique for antepartum evaluation of the fetus?

A

The Nonstress test

78
Q

What medications and chronic condition can adversely affect the NST?

A

Meds: Opioids and Propranolol

Chronic condition: Smoking

79
Q

What is the basis for the NST?

A

The fetus produces normal FHR (Fetal Heart Rate) patterns in response to fetal movement, uterine contractions, or stimulation.

80
Q

Most fetuses who do not produce results from a NST are NOT compromised, they usually are just what?

A

In a quiet sleep state

81
Q

What is one way a physician may try to stimulate the fetus during an NST?

A

Having the mother drink orange juice to spike her blood sugar

82
Q

During a NST, what tools are used to monitor the fetus?

A

-A Doppler transductor monitors the FHR
-A Toco detects uterine contractions and fetal movements

83
Q

If 40 minutes have passed over the course of a NST, and there is still no reactive fetal activity, what should be done?

A

A CST or a BPP test should be performed

84
Q

If normal methods during a NST don’t work, what is an adjunct test used to stimulate the fetus during an NST?

A

A VAS test

85
Q

Vibroacoustic stimulation (VAS), also called FAST (Fetal Acoustic Stimulation Test) is another method of testing for the what?

A

VAS/FAST tests for the FHR

86
Q

What does a VAS test do to stimulate the fetus?

A

A VAS test uses a combo of sound and vibrations to stimulate the fetus.

87
Q

How long is a fetus monitored for a baseline before a VAS test is given?

A

10 to 20 minutes to establish a baseline

88
Q

CST stands for what?

A

Contraction Stress Test

89
Q

CST is an (_______) procedure if (_____) stimulation is required and more (____) consuming than an NST.

A

CST is an (invasive) procedure if (oxytocin) stimulation is required and more (time) consuming than an NST.

90
Q

The two methods of CST are the (______)-stimulated contraction test, and the more commonly used (_______)-stimulated contraction test

A

The two methods of CST are the (nipple)-stimulated contraction test, and the more commonly used (oxytocin)-stimulated contraction test

91
Q

What does the labeling of “high-risk” pregnancy to a woman’s psyche?

A

It can lead to an increase in a patient’s sense of vulnerability

92
Q

Labeling a pregnancy as “high-risk” can bring about several psychological conditions upon a mother, such as?

A

-Anxiety
-Low self-esteem
-Guilt
-Frustration
-Inability to function

93
Q

In many settings, a nurse must perform what 3 pregnancy assessment tests?

A

-Nonstress Tests (NST’s)
-Contraction Stress Tests (CST’s)
-Biophysical Profiles (BPP’s)

94
Q

Receiving a negative CST suggests what?

A

Fetal well-being

OB exam 3 (6 decks)

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