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OB Test 3 > Chapter 26 > Flashcards

Chapter 26 Flashcards

1
Q

Sociodemographic risk factors

A
  • Arise from mother and her family

- Lack of prenatal care, low income, marital status, and ethnicity

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2
Q

Environmental risk factors

A
  • Hazards in workplace and woman’s general environment

- May include chemicals, anesthetic gases, and radiation

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3
Q

Psychosocial risk factors

A
  • Maternal behaviors and adverse lifestyles that have a negative effect on health of mother or fetus
  • May include emotional distress and disturbed interpersonal relationships
  • Inadequate social support
  • Unsafe cultural practices
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4
Q

Biophysical risk factors

A

-Originates with the mother or the fetus
-May affect development and functioning of both
-Genetic disorders, nutritional and general health status, and medical or obstetric-related illnesses
(supposed to wait one year before becoming pregnant again)

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5
Q

Polyhydramnios -

A

(excessive amniotic fluid)

  • Diabetes mellitus
  • Fetal congenital anomalies
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6
Q

Intrauterine growth restriction: maternal causes

A 
Hypertensive disorders (had previously or developed)
Diabetes (had previously or developed)
Chronic renal disease
Thrombophilia
Cyanotic heart disease
Poor weight gain
Smoking, alcohol, illicit drug use
Multiple gestation
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7
Q

Intrauterine growth restriction: fetoplacental

A 
Chromosomal abnormalities
Congenital malformations
Intrauterine infection
Genetic syndromes (trisomy 13 and trisomy 18)
Abnormal placental development
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8
Q

Oligohydramnios -

A

(too little amniotic fluid)

  • Renal agenesis (Potter syndrome) - lack of one or both kidneys
  • Premature rupture of membranes - (give vent. stimulates surfactant production)
  • Prolonged pregnancy
  • Uteroplacental insufficiency
  • Maternal hypertensive disorders - plasma stays with mom and doesn’t go to baby
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9
Q

Chromosomal abnormalities

A

(enough chromosome material but in the wrong place)
Maternal age of 35 years or older
Balanced translocation (maternal or paternal)

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10
Q

reasons for prenatal testing

A

-Detect congenital anomalies
-Evaluate the condition of the fetus
Many times will not be done unless it is felt that the fetus may be in distress

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11
Q

assessment information

A
  • Gravida, para,gestation
  • Medical and OB problems
  • Client knowledge of why testing is being done and what it indicates
  • Emotional response to testing
  • Couple’s expectations of the diagnostic tests
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12
Q

Nursing Role in AntepartalAssessment for Risk

A

-Educator
-Support person - give positive reassurance never say will be 100% okay
-In many settings nurses perform:
__NSTs- nonstress tests
__CSTs- contraction stress test
__BPPs- biophysical profiles

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13
Q

Levels of ultrasonography

A
  • Abdominal

- Transvaginal - probe up vagina, recommended for obese women

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14
Q

Indications for use of ultrasonography

A

Fetal heart activity (6-7 wks)
Gestational age (14-22 wks)
Fetal growth
Fetal anatomy

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15
Q

Ultrasonography

A

-High frequency sound waves
-Able to detect: Heartbeat, fetal breathing and body movement
-Can be used in any trimester but the procedure and the reasons for its use vary for each trimester
(babies always exchange O2 and CO2 why lungs move)

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16
Q

Ultrasonography indications for use

A
  • Fetal genetic disorders and physical anomalies
  • Placental position and function
  • Adjunct to other invasive tests
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17
Q

Fetal well-being -

A
  • Doppler blood flow analysis
  • Amniotic fluid volume (low levels of amniotic fluid near term then baby most likely been stressed
  • Biophysical profile (BPP)
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18
Q

Ultrasonography advantages -

A

clear visualization, safe, noninvasive, comfortable, and results immediately

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19
Q

Ultrasonography disadvantages -

A

cost $200- $1000

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20
Q

1st trimester ultrasound -

A
  • Up to 12 weeks and can be transvaginal
  • Fetal movement and heartbeat visible from week 8
  • Gestational sac can be seen by 6th week
  • Crown-rump length will give gestational age estimation
  • Guide insertion of needle for villus sampling
  • Position of cervix, uterus and placenta
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21
Q

2nd and 3rd trimester ultrasound -

A
  • Transabdominal procedure with uterus rising out of pelvis
  • Wedge under hip to prevent hypotension
  • Urine filled bladder- drink 1-2 quarts of fluid before procedure
  • Takes 10-30 minutes
  • Confirm gestational age
  • Locate placenta and problems
  • Fetal presentation
  • Amniotic fluid volume
  • Guide needle for amino
  • Fetal anatomy
22
Q

doppler ultrasound blood flow assessment

A

-When blood flow is hit by an ultrasound wave the echoes change as the cycle goes through systole and diastole
-Used to detect intrauterine growth restriction (IUGR) which can be identified by characteristic blood flow abnormalities
(anyone that has vascular problems, already might have placental problems)

23
Q

alpha-fetoprotein screening (AFP)

A
  • The predominate protein in fetal plasma that diffuses from fetal plasma to fetal urine and excreted in amniotic fluid
  • Some will also cross the placental membrane and be absorbed into the maternal circulation
  • Can be found in maternal serum (MSAFP) and amniotic fluid (AFAFP)
  • AFP concentration increases w/ advancing gestational age and multi fetal pregs.
  • (helps to detect up to 85% of all neuro defects in early pregnancy)
  • (test 15-20 wks, do MSAFP sample first)
24
Q

low loevels AFP

A

in mother (MSAFP) associated with chromosomal anomalies (Trisomy 21 ):increased maternal weight, thinking fetus is older than it is

25
Q

elevated levels AFP

A

associated with neural tube defects- anencephaly and spinal bifida, fetal demise, multigestational,etc.

26
Q

MSAFP is done

A

between 15-20 wks; Screening test ONLY and further testing will need to be done, ultrasound and then amino (for AFAFP elevations)

27
Q

AFP advantages -

A

simple blood draw, least invasive and cheapest to screen for neural tube defect

28
Q

AFP disadvantages-

A

Screening only and more tests will be done, anxiety over test results, may not start prenatal care till after 20th week, inaccurate maternal weight ,false positive for fetal problems, not all neural tube defects will be identified

29
Q

triple marker screening

A
  • Looking at MSAFP plus HCG and Unconjugated estriol
  • Used to screen for chromosomal abnormalities
  • can be all done from mother’s blood test
  • Maternal serum drawn at 11-14 weeks
  • Positive if MSAFP and estriol are low andHCGis elevated
  • Offered additional testing (amino) if positive
30
Q

Williams Obstetrics states

A

that up to 60% of Downs syndrome identified with this testing (triple marker test)

31
Q

chorionic villus sampling

A
  • Obtain cells from the chorionic villus (fetal) and do genetic studies
  • Only for high risk of genetic anomalies due to potential for spontaneous abortion
  • Recommended for: >35 yrs., Hx. Of previous spontaneous abortion, fetal anomalies, couples who carry genetic defects or have an abnormality
  • Either transcervical or transabdominal
  • done 1st or 2nd trimester, can stimulate labor
32
Q

chorioinic villus advantages -

A

quick results & early diagnosis

33
Q

chorionic villus risks -

A

pregnancy loss, limb reduction defects, Rh sensitization is increased, first trimester AB

34
Q

Percutaneous umbilical cord sampling (PUBS)

A
  • Direct access to the fetal circulation during the second and third trimesters
  • Most widely used method for fetal blood sampling and transfusion
  • Insertion of needle directly into fetal umbilical vessel under ultrasound guidance
  • Used for diagnosis and management of RH disease, gentic studies, acid-base status of fetus
35
Q

PUBS risks

A

infection, cord hematoma, preterm labor, PROM

36
Q

aminocentesis

A
  • done for spontaneous abortions
  • 2nd and 3rd trimester
  • Draw off amniotic fluid for evaluation
37
Q

aminocentesis indications 2nd trimester -

A

> 35 Y.O., CHROSOMAL ABNORMALITY IN FAMILY, PREVIOUS CHILD WITH A DEFECT, PREGNANT AFTER >3 AB’s, ELEVATED MSAFP OR RH SENSITIZATION

38
Q

aminocentesis indications 3rd trimester -

A

: FETAL LUNG MATURITY AND RH SENSITIZATION

39
Q

aminocentesis fetal lung maturity testing -

A

L/S Ratios (lecithin to sphingomyelin)

40
Q

aminocentesis fetal hemolytic disease testing -

A

Fetal bilirubin levels with optical density testing

41
Q

amino procedure -

A

-Supine position
(asses FHR, assess for labor)
-Ultrasound to guide needle and locate a large pocket of fluid
-20mls of fluid removed w/ 3-4”, 20-21 gauge needle
-After procedure give Rhogam if indicated and assess FHR and any contractions that might develop

42
Q

fetal surveillance indications -

A 
Used to determine whether the intrauterine environment continues to be supportive of the fetus and help guide interventions
Nonstress  and stress test
Biophysical profile
Coomb’s testing
Fetal movement
Ultrasound
43
Q

non stress test -

A
  • Measurement of fetal heart rate to fetal movement
  • Noninvasive, painless, easy to do
  • Draw backs: false positive due to fetal sleep—can use vibroacoustic stimulation if needed
  • Generally done at least weekly can be done daily if needed
44
Q

reactive non stress test ** -

A

good

Need at least 2-3 accelerations ,at least 15 BPM (lasting at least 15secs.) over 20 minutes with fetal movement

45
Q

nonreactive non stress test ** -

A
  • Absence of acclerations w/ movement in 20 minutes–

- do additional testing:biophysical profile, stress test,etc.

46
Q

contraction stress test -

A
  • Used when concerned about marginal fetal oxygenation and have inadequate O2 for actual labor
  • Look at fetal heart rate in relation to uterine contractions
  • Look at 3 contractions of at least 40 seconds within a 10 minute period or double for 20 minutes
  • Nipple stimulation or low IV dose of Pitocin
47
Q

negative contraction stress test -

A

= GOOD
No decelerations (late/variable)of at least 3 contractions over a 10 minute period
good for 7 days

48
Q

positive contraction stress test -

A

=BAD
Late decelerations with 50% of contractions (even if few than 3 in 10 minutes)
further testing immediately

49
Q

biophysical profile

A
  • Assess 5 parameters of fetal well being: FHR, fetal breathing movements, gross fetal movements, fetal tone, amniotic fluid volume
  • Look at Fetal Heart Rate from non stress test
  • The rest of the parameters are identified during an ultrasound exam
50
Q

Coombs’ test -

A
  • Test for Rh incompatibility
  • Detects other antibodies that may place fetus at risk for incompatibility with maternal antigens
  • to see if mom is sensitized
  • ratio of 1-8 or higher need to evaluate fetal wellbeing
51
Q

maternal assessment of fetal movement

A

-Sometimes called “fetal kick counts”
-Woman lies on her side and uses a clock to determine how many movements are felt over an identified time
10 movements in 2 hours is reassuring
-Don’t feel movements, according to specific parameters, Notify MD

OB Test 3 (8 decks)

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