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Mom & Baby Exam 2 > Ch. 26 Assessment of high risk pregnancy > Flashcards

Ch. 26 Assessment of high risk pregnancy Flashcards

1
Q

What type of pregnancy is it when the life or health of the mother or the fetus is jeopardized by a disease or a disorder coincidental or unique to the pregnancy?

A

High risk pregnancy

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2
Q

What does UPI stand for?

A

Utero placental insufficiency

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3
Q

What is the gradual decline in delivery of needed substances by the placenta to the fetus which carry a serious threat to fetal growth, distress, morbidity, and mortality?

A

UPI

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4
Q

Are risk factors in high risk pregnancies interrelated and cumulative in effect?

A

Yes

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5
Q

What types of risk originate in mom, fetus, or both and affect their development or function?

A

Biophysical Risks

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6
Q

-Genetic disorders
-Medical- and obstetric- related illnesses
-Nutritional and general health
… are all possibly contributing factors to what type of risks?

A

Biophysical Risks

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7
Q

-Maternal behaviors
-Adverse lifestyles
… Are what type of risk factors that have a negative effect on the maternal or fetal health?

A

Psychosocial Risks

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8
Q

-Low income (lack of prenatal care)
-Marital status
-Ethnicity
… are examples of what types of risks?

A

Sociodemographic Risks

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9
Q

-Hazards in the workplace
-Woman’s general environment
… are examples of what types of risks?

A

Environmental Risks

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10
Q

Does a mom having a single mother status place her at higher risk?

A

Yes

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11
Q

When labeled a “high risk” pregnancy, are mom and fetus monitored carefully and may have to go through a lot of antenatal testing/referrals?

A

Yes

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12
Q

Does a “high risk” label create fear and anxiety?

A

Yes

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13
Q

Label of “high risk” is very frightening and leaves people what?

A

Vulnerable

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14
Q

What is the major outcome goal of “high risk” antepartum testing?

A

To detect fetal compromise

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15
Q

When does “high risk” antepartum monitoring begin?

A

32-34 weeks

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16
Q

-Post-term pregnancy
-Previous unexplained stilbirth
-IUGR
-Preeclampsia
-Oligohydramnios
-Decreased FM
…are all reasons for what type of testing?

A

Obstetrical

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17
Q

-Diabetes
-Chronic HTN
-Renal disease
-Thyroid disease
-Pulmonary disease
-Substance abuse
… are all reasons for what type of testing?

A

Medical

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18
Q

What does DMFC stand for?

A

Daily assessment of fetal activity

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19
Q

Daily fetal movement counts are also called what?

A

Kick counts

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20
Q

Are kick counts a simple yet valuable method for assessing fetal well being?

A

Yes

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21
Q

Counting fetal activity 2-3 times a day for 60 minutes is part of what?

A

Kick counts

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22
Q

Does fewer than 3 kicks per hour warrant further testing?

A

Yes

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23
Q

Is it normal for fetal movement to not be present during fetal sleep cycle? (about 20 minutes)

A

Yes

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24
Q

Is it alarming if there is no fetal movement in 12 hours?

A

Yes

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25
Q

Is adequate nutrition and fluids essential for fetal movement?

A

Yes (usually most active after consumed water or food)

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26
Q

When can fetal heart rate be seen on ultrasound?

A

6-7 wks

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27
Q

When can fetal heart rate be heard by doppler?

A

10-12 wks

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28
Q

Can fetal death also be confirmed by ultrasound?

A

Yes

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29
Q

Is ultrasound a safe technique in antepartum surveillance?

A

Yes

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30
Q

-Confirmed pregnancy
-Confirmed viability
-Determine gestational age
-Determine multiple gestation
-Determine cause of vaginal bleeding
-Detect maternal abnormalities (cysts, fibroids, uterine abnormalities)
… are all things that are determined when?

A

During first trimester US

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31
Q

-Establish or confirm dates
-Detect oligohydramnios or polyhydramnious
-Detect congenital anomalies
-Assess placental placement
-Detect IUGR
… are all things that are determined when?

A

During second trimester US

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32
Q

??When is the most advantageous time for a baseline US

A

14-22 wks

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33
Q

Fetal growth when allows for more accurate fetal measurements

A

1st 20 wks

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34
Q

Does a large volume of fluid allow for good visualization of the fetus?

A

Yes

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35
Q

-Pregnant women older than age 35
-Couple who already have a child with a birth defect or family hx
-Pregnant women with abnormal screening results
… are reasons for what type of testing to be done?

A

Amniocentesis (15-20 wks)

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36
Q

Can a amniocentesis determine fetal lung maturity ratio?

A

Yes (about 35 weeks)

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37
Q

What is it called when a sterile needle is inserted into the uterine cavity through the abdominal wall and fluid is removed?

A

Amniocentesis

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38
Q

-Confirm viability
-Detect macrosomia
-Determine fetal position
-Detect placental abruption or previa issues
-Biophysical profile
-Detect placental maturity
-Used for external version
-Amniocentesis
… are all things determined when?

A

Third trimester ultrasound

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39
Q

Does US measure various circumferences?

A

Yes

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40
Q

Macrocosmic fetal growth = >4000 gms are at risk for what?

A

Traumatic injury or asphyxia during birth

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41
Q

What is the most widely used technique for antenatal evaluation?

A

Non-stress Test (NST)

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42
Q

Tracing of fetal HR and observation for increase with movement is done through what?

A

NST

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43
Q

When is NST best done after?

A

26 wks (CNS development)

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44
Q

2 or more accelerations of 15 bpm, lasting 15 seconds, within 20 minutes is a sign of what?

A

NST: reactive

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45
Q

Insufficient accelerations over 20 minutes which may identify a at risk fetus is a sign of what?

A

NST: non-reactive

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46
Q

Is tracing from a NST observed for signs of fetal activity and how the fetus may respond if a contraction is present?

A

Yes

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47
Q

How long are NST?

A

20-30 minutes (unless fetus is sleepy may take longer)

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48
Q

Does a non-reactive NST require further testing?

A

Yes

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49
Q

What procedure is done to cause contractions in order to evaluate fetal reserve/response?

A

Contraction stress test (CST)

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50
Q

What test is being done when a women massages nipples for 10 min to cause release of oxytocin (which causes contractions)?

A

Nipple stime test

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51
Q

True/ false: In a healthy fetal placental unit do uterine contractions not usually cause fetal hypoxia that produce late decelerations?

A

True

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52
Q

When is contraction stress testing (CST) usually done?

A

32-34 wks not much earlier

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53
Q

True/false: The purpose of CST is to identify a fetus that was stable at rest but showed evidence of compromise when stressed?

A

Yes

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54
Q

Placing a women in semi fowlers position or side tilt to optimize perfusion is done for what type of testing?

A

Contraction stress testing (CST)

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55
Q

True/false: Is the goal of a CST to see 3 quality contractions (palpable) lasting 40-60 seconds in a 10 minute period?

A

True

56
Q

-Post-dates
-IUGR
-Non-reactive NST
-DM
-Abnormal or suspicious BPP
… are indications for what type of testing?

A

CST (contraction stress testing)

57
Q

-Pre-term labor
-Previous C/S
-Placenta problems (previa)
-Cervical incompetence
-Multiple gestation
… are all contraindications for what type of testing?

A

CST (contraction stress testing)

58
Q

Does CST evaluate uteroplacental function?

A

Yes

59
Q

Does CST identify intrauterine hypoxia?

A

Yes

60
Q

Does CST observe FHR response to contractions?

A

Yes

61
Q

Can a CST be performed on a women who is unable to deliver at time of test?

A

No

62
Q

If a CST is compromised, will FHR decrease and will late deccelorations be present?

A

Yes

63
Q

What does a negative CST show?

A

No decelerations

64
Q

What does a positive CST show?

A

Repetitive late decelerations

65
Q

What do equivocal-suspicious CST results show?

A

Prolonged decelerations

66
Q

What do equivocal-hyperstimulatory CST results show?

A

Decelerations every 2 min or lasting >90 seconds

67
Q

What do unsatisfactory CST results show?

A

Fewer than 3 contractions in 10 min and unable to obtain continuous tracing

68
Q

What do decelerations in CST mean?

A

Insufficient oxygen to fetus

69
Q

Do you want to see deceleration in CST?

A

No

70
Q

When mu equivocal-suspicious CST results be re tested?

A

Within 24 hours

71
Q

Do we want to see a negative CST and a reactive NST because they show uteroplacental perfusion is sufficient to withstand stress of contractions during labor?

A

Yes

72
Q

Is polyhydramnious associated with neural tube defects, multiple gestations, and fetal GI tract issues?

A

Yes

73
Q

Is a psychological condition to keep in mind when doing antenatal testing that women undergoing the assessment may be anxious?

A

Yes

74
Q

Does amniotic fluid index measure the largest pockets of fluid?

A

Yes

75
Q

What is the normal range for amniotic fluid index?

A

10-25cm (25 is upper range of normal)

76
Q

What is oligohydramnios?

A

Low fluid

77
Q

Is oligohydramnios associated with…

  • Fetal anomolies
  • Renal agenesis
  • IUGR
  • Fetal distress in labor
A

Yes

78
Q

Are abnormalities in amniotic fluid volume associated with fetal disorders?

A

Yes

79
Q

Does an amniotic fluid assessment measure the volume of fluids?

A

Yes

80
Q

Is polyhdramnios associated with fetal malformation?

A

Yes

81
Q

Does amniotic fluid testing help identify a compromised fetus and also a healthy fetus?

A

Yes

82
Q

How long does amniotic fluid testing take?

A

about 30 min.

83
Q

Is there a disadvantage of amniotic fluid testing when the fetus is in a quiet sleep because BPP may take a long time and it can’t be reviewed as it is real time?

A

Yes

84
Q

What does BPP stand for?

A

Biophysical Profile

85
Q

Is BPP a real time US?

A

Yes

86
Q

What noninvasive assessment is based on the following…

  • Breathing assessment
  • Body movement
  • Tone
  • Amniotic fluid volume
  • FHR reactivity
A

BPP

87
Q

Is a BPP of 8-10 with a normal AFV considered normal?

A

Yes

88
Q

Is a 2 for each category assessed in a BPP normal? and a 0 abnormal?

A

Yes

89
Q

-Amniocentesis
-Chorionic Villus Sampling
-Percutaneous Umbilical Sampling
-Maternal Assays
… are all included in what type of assessment?

A

Biochemical Assessment

90
Q

What is performed to obtain amniotic fluid which contains fetal cells?

A

Amniocentesis

91
Q

What is done to detect genetic, metabolic, and DNA abnormalities?

A

Amniocentesis

92
Q

What is being done when a needle is put through maternal abdomen to uterine cavity to withdraw amniotic fluid?

A

Amniocentesis

93
Q

Are amniocentesis’ done with US guidance?

A

Yes

94
Q

Are amniocentesis’ done after 14 wks?

A

Yes

95
Q

-Genetic disorders
-Congenital anomalies
-Assessment of pulmonary maturity
-Diagnosis of fetal hemolytic disease
… are indications for what to be done?

A

Amniocentesis

96
Q

-Hemorrhage
-Infection
-Bladder damage
-Amniotic fluid embolism
… are all what type of potential complications of an amniocentesis?

A

Maternal

97
Q

-Hemorrhage
-Infection
-Needle injury
-PTL
-death
… are all what type of potential complications of an amniocentesis?

A

Fetal

98
Q

When doing an amniocentesis, what is a protein that can indicate neural tube defects such as spina bifida ?

A

High levels of Alpha fetal protein (AFP)

99
Q

What is an example of a neural tube defect ?

A

Spina Bifida

100
Q

What test can be done as early as 10 weeks (b/c DNA is higher then) (earlier than an amniocentesis) to determine risk factors for mom and isolate DNA fragments?

A

Cell free DNA test

is a blood test

101
Q

What is a relatively new test that can be done instead of performing amniocentesis ?

A

Cell free DNA test

is a blood test

102
Q

What does PUBs stand for ?

A

Percutaneous umbilical blood sampling (PUBS)
or Cordocentesis

AKA: Fetal blood sampling

103
Q

What what test do they insert a needle directly into the fetal umbilical vessel under ultrasound guidance and obtain a blood sample to look at inherited blood disorders, karyotyping, very specific kinds of things, etc ?

A

PUBs

104
Q

What is Karyotyping ?

A

Looking at specific features of chromosomes

105
Q

True or False: PUBs are not done a lot because of the invasiveness of the procedure ?

A

True

106
Q

What test is used for fetal blood sampling and transfusions ?

A

PUBs

107
Q

With what test is there direct access to fetal circulation in the 2nd - 3rd trimester ?

A

PUBs

108
Q

Maternal Serum Alpha-Fetoprotein is a test that screens for what ?

A

Neural tube defects

109
Q

When are Maternal Serum Alpha-Fetoprotein screening tests performed ? When is it ideal ?

A

Performed between 15 and 20 weeks of gestation

16-18 weeks is ideal

110
Q

The rate of NTD is decreasing due to what ?

A

The use of folate preconceptually

111
Q

Is Maternal Serum Alpha-Fetoprotein screening recommended for all women ?

A

Yes !

112
Q

Neural tube defects are associated with what ?

A

high levels of AFP

113
Q

What is Spina Bifida ?

A

Incomplete closure of the vertebral arch

114
Q

What is Anencephaly ?

A

A baby born with an underdeveloped brain and an incomplete skull

115
Q

What is Anencephaly due to ?

A

A defect in the formation of a baby’s neural tube during development

  • baby might be stillborn or survive only a few hours to a few days after birth
116
Q

What protein is produced by the ovaries and placenta ?

A

Inhibin A

117
Q

What is a protein produced by the placenta and fetus ?

A

Estriol

118
Q

A quad marker test is done at 15-20 weeks. What is it ? and what markers does the test include ?

A
  • A blood test that detects the likelihood of fetal brain defects
  • Test includes markers of
    • HCG
    • AFP
    • Estriol
    • Inhibit A
119
Q

What test/screening is a blood test that looks for potential problems within the baby’s brain, spinal cord, and neural tissues ?

A

Quad screen (aka: Quad marker test)

120
Q

Cell-free DNA screening in maternal blood is optimally performed when ?

A

10-12 weeks of gestation

121
Q

True or False: Cell-free DNA screening is less sensitive in women who are obese ?

A

True

122
Q

What is an Example of Noninvasive prenatal testing (NIPT) ?

A

Cell-free DNA screening

123
Q

What test is a screening tool for fetal chromosome abnormalities ?

A

Quad Marker screen

124
Q

True or False: Quad Marker Screens are not a diagnostic test. They only provide probability ?

A

True

125
Q

When are Quad Marker Screens typically done ?

A

11-14 weeks

126
Q

Women with a positive Quad Marker Screen should be offered diagnostic testing such as ?

A
  • Trisomy 18

- Trisomy 21 Down syndrome

127
Q

If Quad Marker Screen test results are low, that may offer some reassurance of what ?

A

A healthy pregnancy

128
Q

If Quad Marker Screen test results are high, then what should be done ?

A

Additional testing is recommended

129
Q

Trisomy 18 & Trisomy 21 are associated with what ?

A

Low levels of AFP

130
Q

True or False: Women undergoing antenatal assessments are anxious ?

A

True !

test conducted b/c of suspected fetal compromise, deterioration of maternal condition or both

131
Q

What places provide access to support services such as genetic counseling, social workers, chaplain services, a palliative care team, and ethics consultation b/c of the complex emotional stressors women face ?

A

Fetal Care Centers

132
Q

What type of place provide diagnostic and therapeutic options as well as support services for families with fetal anomaly diagnosis’s ?

A

Fetal Care Centers

133
Q

True or False: Pregnancy, fetus, or neonate can be placed at risk by biophysical, sociodemographic, psychosocial, and environmental factors ?

A

True

134
Q

What type of assessment techniques include fetal movement counts, ultrasonography, and MRI ?

A

Biophysical assessment

135
Q

___________ monitoring techniques include amniocentesis, PUBs, CVS, and maternal serum AFP ?

A

Biochemical

136
Q

Reactive NSTs and negative CSTs suggest what ?

A

fetal well being

137
Q

True or False: Most assessment tests have some degree of risk for mother and fetus and cause anxiety for the women and family ?

A

True

Mom & Baby Exam 2 (5 decks)

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