HIGH RISK CLIENTS Flashcards
a concurrent disorder, pregnancy related complication or external factor jeopardizes the health of the mother, the fetus or both
high risk pregnancy
2 groups of high risk pregnancy
- women with preexisting illness
- women who develop complications of pregnancy
Factors that originate within the mother or fetus and affect the development or functioning of either or both.
biophysical risks
Comprised of maternal behaviors and adverse lifestyles that have a negative effect on the health of the mother or fetus (both).
psychosocial risks
Factors arising from the mother and her family and place the mother and fetus at risk. (Ex: lack of prenatal care, low income, marital status, age, residence, etc)
sociodemographic risks
Risks that include hazards of the workplace and the woman’s general environment. (pesticides, lead, mercury), radiation, infections and pollutants)
environmental risks
- Assessment of the FHR for whether a good baseline rate and a degree of variability are present
- Record FHR for 20 min
rhythm strip testing
rhythm strip testing categories:
- none apparent
- extremely small fluctuations
- amplitude range 6-25 bpm
- amplitude range > 25 bpm
absent
minimal
moderate
marked
- a test in pregnancy that measures fetal heart rate in response to movement and contractions.
- done for 10-20 mins
nonstress test
nonstress test result:
2 accelerations of FHR (by 15 beats or more) lasting for 15 seconds occur after movement within the chosen time period
reactive
nonstress test result:
- No accelerations occur with the fetal movements
- No fetal movements occur or if there is low short-term fetal heart rate variability (less than 6 bpm) throughout the testing period
non reactive
- Producing a sharp sound of approximately 80 decibels at a frequency of 80 Hz, startling and waking the fetus
- done in conjunction with a nonstress test
vibroacoustic stimulation
what is the expected response in a vibroacoustic test
acceleration of FHR
- External fetal heart monitor is applied and obtain baseline FHR
- May be done if NST results are nonreassuring
- Involves nipple stimulation until uterine contraction begin
contraction stress testing
contraction stress testing result:
No fetal heart rate decelerations are present with contractions
negative / normal
contraction stress testing result:
50% or more of contractions cause a late deceleration
positive / abnormal
true or false - during nonstress test Woman should not lie supine to prevent supine hypotension syndrome
true
after the contraction stress test, how many minutes should you observe the woman after to see that contractions are quiet and preterm labor does not begin?
30 minutes
Measures the response of sound waves against solid objects
ultrasonography
used to:
- Diagnose pregnancy
- Confirm the presence, size, and location of the placenta and amount of amniotic fluid
- Establish that a fetus is growing and has no gross anomalies
- Establish sex
- Establish the presentation and position
- Predict maturity – biparietal diameter
ultrasonography
In determining the fetus’s biparietal diameter, UTZ is used. By measuring the biparietal diameter (side-to-side measurement) of the fetal head, ___ is determined.
fetal maturity
In 80% of pregnancies in which the biparietal diameter of the fetal head is 8.5 cm or greater, it can be predicted that the infant will weigh more than ___ at fetal age of 40 weeks
2500g or 5.5 lbs
Two other measurements commonly made by ultrasound to predict maturity are ___ and ___
head circumference and femoral length
Measures the velocity @ which RBC in the uterine & fetal blood vessels travel
doppler umbilical velocimetry
how to measure AFI for < 20 wks
- uterus is divided in to 2 vertical halves
- Measure the vertical diameter of the largest pocket of amniotic fluid present on each side in cm, then add
how to measure AFI for > 20 wks
- uterus is divided into 4 quadrants
- Measure the vertical diameter of the largest pocket of amniotic fluid present on each quadrant in cm, then add
ave index of AFI assessment:
- 28-40 wks
12-15 cm
AFI index:
- > 20-24 cm
- < 5-6 cm
- hydramnios
- oligohydramnios
- may be recorded as early as the 11th week of pregnancy (inaccurate before 20 weeks)
- Rarely used unless a specific heart anomaly is suspected
electrocardiography ECG
- Has the potential to replace or complement ultrasonography as a fetal assessment technique
- Most helpful in diagnosing complications such as ectopic pregnancy or trophoblastic disease
magnetic resonance imaging MRI
- Begins to rise at 11 weeks’ gestation and then steadily increase until term
MSAFP - maternal serum alpha-fetoprotein
MSFAP levels are ___ in maternal serum if the fetus has an open spinal or abdominal defect
high
MSFAP level are ___ if the fetus has a chromosomal defect
low
- Help estimate risk of down syndrome
- Screening @ 15-20 weeks of pregnancy
triple and quad screening
- a prenatal test that involves taking a tissue sample from the placenta to check for genetic abnormalities in the fetus
- done between 10-12 weeks
chorionic villus sampling
- a prenatal procedure that involves taking a small sample of amniotic fluid for testing. It’s used to check for genetic conditions, birth defects, and other abnormalities in a developing fetus.
- schedules between 14-16 wks of pregnancy
amniocentesis
- a procedure that involves taking a blood sample from the umbilical cord of a fetus
- a.k.a. cordocentesis or funicentesis
- done at 17 wks of pregnancy
PUBS Percutaneous umbilical blood sampling
Fetus is visualized through fetoscope
performed at 16-17th wk aog
The procedure is used to:
- Confirm the intactness of the spinal column
- Obtain biopsy samples of fetal tissue and fetal blood samples
- Perform elemental surgery
fetoscopy
- Visual inspection of the amniotic fluid
- Used to detect meconium staining
amnioscopy
5 parameters of the biophysical profile
- fetal heart reactivity
- fetal breathing
- fetal body movement
- fetal tone
- amniotic fluid volume
At least one episode of 30 sec of sustained fetal breathing movement within 30 min of observation
fetal breathing
At least 3 episodes of fetal limb or trunk movement within a 30 min observation
fetal movement
The fetus must extend and then flex the extremities or spine at least once in 30 min
fetal tone
A range of amniotic fluid between 5 and 25 cm must be present
amniotic fluid volume
Two or more fetal heart rate accelerations of at least 15 beats/min above baseline and of 15 sec duration occur with fetal movement over a 20 min time period
fetal heart reactivity
biophysical profile:
A result of ___ indicates that the fetus is doing well
A score of ___ is considered suspicious
A score of ___ denotes a fetus probably in jeopardy
- 8-10
- 6
- 4
Maternal assessment of fetal movement
daily fetal movement count / kick count
how to do daily kick count
- count once a day for 60 mins
- count 2-3 times daily for 2 hours
- count until 10 movements are counted within 12 hours
Fetal alarm signal
no fetal movements for 12 hours
Count fewer than ___ fetal movements within 1 hour or cessation of fetal movement for 12 hours warrants further evaluation
3
To determine blood type and Rh
blood grouping
To detect anemia; often checked several times during pregnancy
Hgb / Hct
To detect infection, anemia, or cell abnormalities
CBC
To check for possible maternal-fetal blood incompatibility
Rh factor and antibody screen
To screen for syphilis
VDRL / RPR
To determine immunity
rubella titer
To screen for tuberculosis
skin test
To screen for sickle cell trait if client is of African-American descent
hemoglobin electrophoresis
To detect presence of antigens in maternal blood
hepa b screening
To detect renal disease or infection
urinalysis
To screen for cervical neoplasia
pap smear
To detect group B streptococci and sexually transmissible diseases
cervical culture
To screen for possible gestational diabetes
maternal blood glucose / glucose challenge test
