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
2
Q
What does UPI stand for?
A
Utero placental insufficiency
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
4
Q
Are risk factors in high risk pregnancies interrelated and cumulative in effect?
A
Yes
5
Q
What types of risk originate in mom, fetus, or both and affect their development or function?
A
Biophysical Risks
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
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
8
Q
-Low income (lack of prenatal care)
-Marital status
-Ethnicity
… are examples of what types of risks?
A
Sociodemographic Risks
9
Q
-Hazards in the workplace
-Woman’s general environment
… are examples of what types of risks?
A
Environmental Risks
10
Q
Does a mom having a single mother status place her at higher risk?
A
Yes
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
12
Q
Does a “high risk” label create fear and anxiety?
A
Yes
13
Q
Label of “high risk” is very frightening and leaves people what?
A
Vulnerable
14
Q
What is the major outcome goal of “high risk” antepartum testing?
A
To detect fetal compromise
15
Q
When does “high risk” antepartum monitoring begin?
A
32-34 weeks
16
Q
-Post-term pregnancy
-Previous unexplained stilbirth
-IUGR
-Preeclampsia
-Oligohydramnios
-Decreased FM
…are all reasons for what type of testing?
A
Obstetrical
17
Q
-Diabetes
-Chronic HTN
-Renal disease
-Thyroid disease
-Pulmonary disease
-Substance abuse
… are all reasons for what type of testing?
A
Medical
18
Q
What does DMFC stand for?
A
Daily assessment of fetal activity
19
Q
Daily fetal movement counts are also called what?
A
Kick counts
20
Q
Are kick counts a simple yet valuable method for assessing fetal well being?
A
Yes
21
Q
Counting fetal activity 2-3 times a day for 60 minutes is part of what?
A
Kick counts
22
Q
Does fewer than 3 kicks per hour warrant further testing?
A
Yes
23
Q
Is it normal for fetal movement to not be present during fetal sleep cycle? (about 20 minutes)
A
Yes
24
Q
Is it alarming if there is no fetal movement in 12 hours?
A
Yes
25
Is adequate nutrition and fluids essential for fetal movement?
Yes (usually most active after consumed water or food)
26
When can fetal heart rate be seen on ultrasound?
6-7 wks
27
When can fetal heart rate be heard by doppler?
10-12 wks
28
Can fetal death also be confirmed by ultrasound?
Yes
29
Is ultrasound a safe technique in antepartum surveillance?
Yes
30
-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?
During first trimester US
31
-Establish or confirm dates
-Detect oligohydramnios or polyhydramnious
-Detect congenital anomalies
-Assess placental placement
-Detect IUGR
... are all things that are determined when?
During second trimester US
32
??When is the most advantageous time for a baseline US
14-22 wks
33
Fetal growth when allows for more accurate fetal measurements
1st 20 wks
34
Does a large volume of fluid allow for good visualization of the fetus?
Yes
35
-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?
Amniocentesis (15-20 wks)
36
Can a amniocentesis determine fetal lung maturity ratio?
Yes (about 35 weeks)
37
What is it called when a sterile needle is inserted into the uterine cavity through the abdominal wall and fluid is removed?
Amniocentesis
38
-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?
Third trimester ultrasound
39
Does US measure various circumferences?
Yes
40
Macrocosmic fetal growth = >4000 gms are at risk for what?
Traumatic injury or asphyxia during birth
41
What is the most widely used technique for antenatal evaluation?
Non-stress Test (NST)
42
Tracing of fetal HR and observation for increase with movement is done through what?
NST
43
When is NST best done after?
26 wks (CNS development)
44
2 or more accelerations of 15 bpm, lasting 15 seconds, within 20 minutes is a sign of what?
NST: reactive
45
Insufficient accelerations over 20 minutes which may identify a at risk fetus is a sign of what?
NST: non-reactive
46
Is tracing from a NST observed for signs of fetal activity and how the fetus may respond if a contraction is present?
Yes
47
How long are NST?
20-30 minutes (unless fetus is sleepy may take longer)
48
Does a non-reactive NST require further testing?
Yes
49
What procedure is done to cause contractions in order to evaluate fetal reserve/response?
Contraction stress test (CST)
50
What test is being done when a women massages nipples for 10 min to cause release of oxytocin (which causes contractions)?
Nipple stime test
51
True/ false: In a healthy fetal placental unit do uterine contractions not usually cause fetal hypoxia that produce late decelerations?
True
52
When is contraction stress testing (CST) usually done?
32-34 wks not much earlier
53
True/false: The purpose of CST is to identify a fetus that was stable at rest but showed evidence of compromise when stressed?
Yes
54
Placing a women in semi fowlers position or side tilt to optimize perfusion is done for what type of testing?
Contraction stress testing (CST)
55
True/false: Is the goal of a CST to see 3 quality contractions (palpable) lasting 40-60 seconds in a 10 minute period?
True
56
-Post-dates
-IUGR
-Non-reactive NST
-DM
-Abnormal or suspicious BPP
... are indications for what type of testing?
CST (contraction stress testing)
57
-Pre-term labor
-Previous C/S
-Placenta problems (previa)
-Cervical incompetence
-Multiple gestation
... are all contraindications for what type of testing?
CST (contraction stress testing)
58
Does CST evaluate uteroplacental function?
Yes
59
Does CST identify intrauterine hypoxia?
Yes
60
Does CST observe FHR response to contractions?
Yes
61
Can a CST be performed on a women who is unable to deliver at time of test?
No
62
If a CST is compromised, will FHR decrease and will late deccelorations be present?
Yes
63
What does a negative CST show?
No decelerations
64
What does a positive CST show?
Repetitive late decelerations
65
What do equivocal-suspicious CST results show?
Prolonged decelerations
66
What do equivocal-hyperstimulatory CST results show?
Decelerations every 2 min or lasting >90 seconds
67
What do unsatisfactory CST results show?
Fewer than 3 contractions in 10 min and unable to obtain continuous tracing
68
What do decelerations in CST mean?
Insufficient oxygen to fetus
69
Do you want to see deceleration in CST?
No
70
When mu equivocal-suspicious CST results be re tested?
Within 24 hours
71
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?
Yes
72
Is polyhydramnious associated with neural tube defects, multiple gestations, and fetal GI tract issues?
Yes
73
Is a psychological condition to keep in mind when doing antenatal testing that women undergoing the assessment may be anxious?
Yes
74
Does amniotic fluid index measure the largest pockets of fluid?
Yes
75
What is the normal range for amniotic fluid index?
10-25cm (25 is upper range of normal)
76
What is oligohydramnios?
Low fluid
77
Is oligohydramnios associated with...
- Fetal anomolies
- Renal agenesis
- IUGR
- Fetal distress in labor
Yes
78
Are abnormalities in amniotic fluid volume associated with fetal disorders?
Yes
79
Does an amniotic fluid assessment measure the volume of fluids?
Yes
80
Is polyhdramnios associated with fetal malformation?
Yes
81
Does amniotic fluid testing help identify a compromised fetus and also a healthy fetus?
Yes
82
How long does amniotic fluid testing take?
about 30 min.
83
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?
Yes
84
What does BPP stand for?
Biophysical Profile
85
Is BPP a real time US?
Yes
86
What noninvasive assessment is based on the following...
- Breathing assessment
- Body movement
- Tone
- Amniotic fluid volume
- FHR reactivity
BPP
87
Is a BPP of 8-10 with a normal AFV considered normal?
Yes
88
Is a 2 for each category assessed in a BPP normal? and a 0 abnormal?
Yes
89
-Amniocentesis
-Chorionic Villus Sampling
-Percutaneous Umbilical Sampling
-Maternal Assays
... are all included in what type of assessment?
Biochemical Assessment
90
What is performed to obtain amniotic fluid which contains fetal cells?
Amniocentesis
91
What is done to detect genetic, metabolic, and DNA abnormalities?
Amniocentesis
92
What is being done when a needle is put through maternal abdomen to uterine cavity to withdraw amniotic fluid?
Amniocentesis
93
Are amniocentesis' done with US guidance?
Yes
94
Are amniocentesis' done after 14 wks?
Yes
95
-Genetic disorders
-Congenital anomalies
-Assessment of pulmonary maturity
-Diagnosis of fetal hemolytic disease
... are indications for what to be done?
Amniocentesis
96
-Hemorrhage
-Infection
-Bladder damage
-Amniotic fluid embolism
... are all what type of potential complications of an amniocentesis?
Maternal
97
-Hemorrhage
-Infection
-Needle injury
-PTL
-death
... are all what type of potential complications of an amniocentesis?
Fetal
98
When doing an amniocentesis, what is a protein that can indicate neural tube defects such as spina bifida ?
High levels of Alpha fetal protein (AFP)
99
What is an example of a neural tube defect ?
Spina Bifida
100
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?
Cell free DNA test
| is a blood test
101
What is a relatively new test that can be done instead of performing amniocentesis ?
Cell free DNA test
| is a blood test
102
What does PUBs stand for ?
Percutaneous umbilical blood sampling (PUBS)
or Cordocentesis
AKA: Fetal blood sampling
103
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 ?
PUBs
104
What is Karyotyping ?
Looking at specific features of chromosomes
105
True or False: PUBs are not done a lot because of the invasiveness of the procedure ?
True
106
What test is used for fetal blood sampling and transfusions ?
PUBs
107
With what test is there direct access to fetal circulation in the 2nd - 3rd trimester ?
PUBs
108
Maternal Serum Alpha-Fetoprotein is a test that screens for what ?
Neural tube defects
109
When are Maternal Serum Alpha-Fetoprotein screening tests performed ? When is it ideal ?
Performed between 15 and 20 weeks of gestation
| 16-18 weeks is ideal
110
The rate of NTD is decreasing due to what ?
The use of folate preconceptually
111
Is Maternal Serum Alpha-Fetoprotein screening recommended for all women ?
Yes !
112
Neural tube defects are associated with what ?
high levels of AFP
113
What is Spina Bifida ?
Incomplete closure of the vertebral arch
114
What is Anencephaly ?
A baby born with an underdeveloped brain and an incomplete skull
115
What is Anencephaly due to ?
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
What protein is produced by the ovaries and placenta ?
Inhibin A
117
What is a protein produced by the placenta and fetus ?
Estriol
118
A quad marker test is done at 15-20 weeks. What is it ? and what markers does the test include ?
- A blood test that detects the likelihood of fetal brain defects
- Test includes markers of
- HCG
- AFP
- Estriol
- Inhibit A
119
What test/screening is a blood test that looks for potential problems within the baby's brain, spinal cord, and neural tissues ?
Quad screen (aka: Quad marker test)
120
Cell-free DNA screening in maternal blood is optimally performed when ?
10-12 weeks of gestation
121
True or False: Cell-free DNA screening is less sensitive in women who are obese ?
True
122
What is an Example of Noninvasive prenatal testing (NIPT) ?
Cell-free DNA screening
123
What test is a screening tool for fetal chromosome abnormalities ?
Quad Marker screen
124
True or False: Quad Marker Screens are not a diagnostic test. They only provide probability ?
True
125
When are Quad Marker Screens typically done ?
11-14 weeks
126
Women with a positive Quad Marker Screen should be offered diagnostic testing such as ?
- Trisomy 18
| - Trisomy 21 Down syndrome
127
If Quad Marker Screen test results are low, that may offer some reassurance of what ?
A healthy pregnancy
128
If Quad Marker Screen test results are high, then what should be done ?
Additional testing is recommended
129
Trisomy 18 & Trisomy 21 are associated with what ?
Low levels of AFP
130
True or False: Women undergoing antenatal assessments are anxious ?
True !
test conducted b/c of suspected fetal compromise, deterioration of maternal condition or both
131
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 ?
Fetal Care Centers
132
What type of place provide diagnostic and therapeutic options as well as support services for families with fetal anomaly diagnosis's ?
Fetal Care Centers
133
True or False: Pregnancy, fetus, or neonate can be placed at risk by biophysical, sociodemographic, psychosocial, and environmental factors ?
True
134
What type of assessment techniques include fetal movement counts, ultrasonography, and MRI ?
Biophysical assessment
135
___________ monitoring techniques include amniocentesis, PUBs, CVS, and maternal serum AFP ?
Biochemical
136
Reactive NSTs and negative CSTs suggest what ?
fetal well being
137
True or False: Most assessment tests have some degree of risk for mother and fetus and cause anxiety for the women and family ?
True
