ch. 26 high risk pregnancy Flashcards
assessment of risk factors: psychosocial (what, risks (3)
1) maternal behaviors and adverse lifestyles that have a negative effect on health of mother or fetus (what is home environment)
2) risks:
- emotional distress
- hx. depression or other mental health problems (BPD)
- disturbed interpersonal relationships such as intimate partner violence, substance use or misuse, inadequate social support, unsafe cultural practices
TIP:
- cortisol levels increase, catecholamines -> can lead to preterm labor
assessment of risk factors: biophysical (3)
- originates with the pregnant woman OR the fetus
- may affect development and functioning of either one or both
- genetic disorders, nutritional and general health status, and medical or obstetric related illnesses
TIP:
- stay physically fit during pregnancy
- folic acid
assessment of risk factors: sociodemographic (2)
- arise from the context in which the pregnant woman and family live
- lack of prenatal care (basic right), low income, single marital status, ethnicity (bed on floor)
assessment of risk factors: environmental (2)
- hazards in workplace and woman’s general environment
- may in environmental chemicals (eg. lead, mercury), anesthetic gases, and radiation
antepartum testing: biophysical assessment daily -> fetal movement count (DFMC) (aka, use, protocols, if abnormal, signal)
- AKA “kick counts”
- used to monitor fetus in pregnancies complicated by conditions that may affect oxygenation (assess for fetal adequate oxygenation)
- several different protocols are used for counting
- when a pregnant woman reports decreased fetal activity -> nonstress test performed
- fetal alarm signal
- when: 7th month pregnancy (28th week), 2 1/2 Ibs
kick counts (when, time, position, how, numbers, abnormal, none)
- initiated at 28 weeks (7 months)
- same time every day, preferably after a meal (babies LOVE food)
- left lateral position (vena cavae syndrome)
- mother counts for one to two hours
- 6 counts in 60min (1 hour)
- if <6 -> count 6 again in 2nd hour
- if none -> CONTACT PROVIDER
fetal movement (affects (4))
affects:
- tobacco smoke
- drugs
- alcohol
- caffeine (higher energy caffeine drinks affect fetal brain)
glucose levels UNRELATED to fetal movement
antepartum testing: biophysical assessment -> ultrasonography (considered, 2 types, indications (4))
considered by many to be the MOST valuable diagnostic tool used in obstetrics
- abdominal: transducer on woman’s abdomen, 10-13 weeks
- transvaginal: probe inserted into vagina against the cervix, 18-22 weeks
indications:
- fetal heart activity
- gestational age (growing)
- fetal growth
- fetal anatomy
transvaginal ultrasound (what, bladder, position, indication, relevant to)
- produces clearer image
- EMPTY BLADDER
- lithotomy position
- indication: better assessment of cervix (cervical tunneling: thinning of cervix)
- relevant to 1st trimester
transabdominal ultrasound (bladder, indication, water, time, hcg)
- FULL BLADDER: except for localizing placenta before amnio
- indication: vaginal bleeding with suspected previa
- 1-1.5 quarts water
- uncomfortable
- takes 20-30 minutes
- hcg >1800
antepartum testing: biophysical assessment -> ultrasonography indications (3)
1) fetal genetic disorders and physical anomalies:
- nuchal translucency (NT) screening: if >3mm nuchal folds -> down syndrome
2) placental position and function
3) adjunct to other invasive tests
- amniocentesis risks are reduced with use of ultrasound (LAST RESORT)
antepartum testing: fetal wellbeing (3)
- doppler blood flow and analysis
- amniotic fluid volume: amount?
- biophysical profile (BPP): modified biophysical profile (nonstress test + amniotic fluid index)
antepartum testing: biophysical assessment -> ultrasonography nursing role
primarily counseling and educating women about procedure (reason, benefits, risk)
antepartum testing: biophysical assessment nonmedical ultrasounds (2 types)
1) 3D/4D increasingly popular with pregnant women and their families (more expensive, real life time)
2) (ACOG) have published statements that strongly discourage this practice dut to exposure of the fetus to high frequency sound waves w/o a clear medical indication (CAN AFFECT HEARING)
- often performed by people who are NOT qualified health care professionals
antepartum testing: biophysical assessment magnetic resonance imaging (MRI) (what, evaluates (6), affect)
1) noninvasive radiologic technique
2) examiner can evaluate the following:
- fetal structure, overall growth
- placenta
- quantity of amniotic fluid
- maternal structures
- biochemical status of tissues and organs
- soft tissues, metabolic, or functional anomalies
3) MRI has little effect on the fetus
EXPENSIVE
antepartum testing: biochemical assessment biological examination/chemical determinations (5)
- amniocentesis
- percutaneous umbilical
- blood sampling
- chorionic villus sampling
- maternal sampling
maternal assays: multiple marker screens (screens for, types)
1) screening to detect fetal chromosomal abnormalities (TRISOMY 21)
2) quad test: only widely used multiple marker test in the US, to screen for fetuses with trisomy 21 and trisomy -> MSAFP, unconjugated estriol, hCG, inhibin(glycoprotein -> facilitates other 3, enhanced results)
maternal assays: maternal serum alpha-fetoprotein (MSAFP) (screens, all cases, screening recommended for, performed between)
- maternal serum levels used as screening tool for neural tube defects (NTDs) in pregnancy
- approximately 85-92% of open NTDs and almost all cases of anencephaly can be detected early
- screening recommended for all pregnant women
- MSAFP screening can be performed between 15-20 weeks of gestation (16-18 weeks ideal)