High Risk Clients Flashcards
a disorder, complication or external factor that jeopardies the health of the mother, fetus or both
high risk pregnancy
involves at least 1 of the ff:
- woman or baby is more likely to become ill or die than usual
- complications before or after delivery are more likely to occure than usual
high risk pregnancy can be grouped into two (2):
- with preexisting or newly acquired illness.
- developed complications of pregnancy
a women with prexisting or newly acquired illness (6)
- CVD
- DM
- Substance Abuse
- HIV/AIDS
- RH Incompatibility
- Anemia
a women who developed complications of pregnancy
- hyperemesis Gravidarum
- ectopic pregnancy
- hydatidiform mole
- premature cervical dilatation
- abortion
- placenta previa
- abruptio placenta
- PROM
- PIH
- Multiple Pregnancies
- DIC (Disseminated Intravascular coagulation)
- APAS (Antiphospholipid Antibody Syndrome)
- HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) Syndrome
a risk factors that
originate within the mother or fetus and affect the development or functioning of either or both.
ex: genetic, nutritional status, med-ob disorders
biophysical risks
a risk factor that:
comprised of maternal behaviors and adverse lifestyles that have a negative effect on the health of the mother or fetus (both).
Ex: smoking, caffeine, alcohol, drugs, psych status
psychosocial risks
a risk factor that:
arises from the mother and her family and place the mother
and fetus at risk.
Ex: lack of prenatal care, low income, marital status, age, residences)
sociodemographic risks
a risk factor that:
include hazaards of the workplace and the woman’s general environment
Ex: pesticides, lead, mercury, radiation, infections and pollutatnts
environmental risks
assessment of the FHR for whether a good baseline rate and a degree of variability are present
rhythm strip testing
how long do you record FHR of rhythm strip testing?
20 min
variability categories of rhythm strip testing
_______1. None apparent
_______2. Extremely small fluctuations
_______3. Amplitude range: 6-25 bpm
_______4. Amplitude range: > 25 bpm
- Absent
- Minimal
- Moderate
- Marked
monitors fetal heart rate in response to movements to assess fetal well-being without causing stress.
non stress testing
non stress testing is done for ___-___ min
10-20 min
2 results for nonstress testing
- reactive
- nonreactive
define reactive non stress testing
- 2 accelerations of FHR (by 15 beats or more)
- lasting for 15 seconds occur after movement within chosen time period
define reactive non stress testing
- no acceleration occur with the fetal movements
- no fetal movments/if there is low short term fetal heart rate variability (less than 6 bpm) throughout period
- 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 - expected
response
acceleration of FHR
vibroacoustic stimulation
- 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
negative (normal)
interpretation of CST
no fetal heart rate decelerations are
present with contractions
positive (abnormal)
interpretation of CST
50% or more of contractions cause a
late deceleration
what is measured in (nst)
response of FHR in relation to fetal movement
normal findings for (nst)
two or more accelerations of
fetal heart rate of 15 bpm
lasting 15 secs or longer
following fetal movements in a 20-min period
safety consideration for (nst)
woman should NOT LIE supine to prevent supine hypotension syndrome
what is measured in (cst)
response of FHR in relation to uterine contractions as the nipples are stimulated.
normal findings of (cst)
no late decelerations with contractions
safety considerations of (cst)
In addition to preventing
supine hypotension syndrome, observe the woman for 30 min afterward to see that contractions are quiet and preterm labor does not begin
measures the response of
sound waves against solid
objects
ultrasonography
ultrasonography is 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
part of ultrasonography that detects how mature the baby is
biparietal diameter
biparietal diameter
fetal head:
weigh more than:
fetal age of:
fetal head: 8.5 cm greater
weigh more than: 2500 mg (5.5 lbs
fetal age of: 40 wks
device or software used in ultrasonography to measure various fetal parameters for assessing growth, estimating gestational age, and detecting abnormalities.
fetal biometry
ultrasonography that measures the velocity @ which RBC in the uterine & fetal blood vessels travel
doppler umbilical velocimetry
ultrasonography that determines the calcium deficit
placental grading
placental grading has 4 grades: 0, 1 ,2, 3.
what grade determines if the baby’s lung has matured already and ready for birth
grade 3
an ultrasonography that detects the level of amniotic fluid in baby
amniotic fluid volume assessment
measuring afi:
for gestations <20 wks divided into ??
2 vertical halves
measuring afi:
for gestations >20 wks divided into ??
4 quadrants
normal afi levels?
12-15 cm
a hydramnios afi levels
20-24 cm
a oligohydramnios afi levels
5-6 cm
fetal ECG’s may be recorded as early as )))
but inaccurate before___
11th week
20 weeks
most helpful in diagnosing complications such as ectopic pregnancy
or trophoblastic disease
magnetic resonance imaging
Begins to rise at 11 weeks’ gestation and then steadily
increase until term
Levels are abnormally high in maternal serum if the
fetus has an open spinal or abdominal defect
Levels are abnormally low if the fetus has a
chromosomal defect
MSFAP
High maternal serum indicates
open spinal/abdominal defect
abnormally low msafp indicates
chromosomal defect
blood tests performed during the second trimester of pregnancy @15-20 wks to assess the risk of certain birth defects:
mostly preventing downsyndrome diseases/chromosomal problems
triple and quad screening
triple screening measures (3) three substances in the mother’s blood:
- Estriol
- Beta-human chorionic gonadotropin
3 Alpha-fetoprotein
quad screening measures (4) four substances in the mother’s blood:
- Estriol
2 Beta-human chorionic gonadotropin - Alpha-fetoprotein
- Inhibin A
it involves collecting a small sample of cells from the chorionic villi — tiny finger-like projections of the placenta — either through the cervix (transcervical) or abdominal wall (transabdominal), guided by ultrasound.
chorionic villus sampling
transcervical is through a
cervix into uterus
transabdominal
a proble/needle in abdomen
when is chorionic villus sampling diagnosed
10-12 weeks, but maximum of 14 weeks
involves extracting amniotic fluid from the uterus using a needle to detect genetic disorders, chromosomal abnormalities, or fetal lung maturity.
amniocentesis
when is amniocentesis scheduled?
14-16 weeks
amniotic fluid is analyzed for (9)
- AFP
- Bilirubin Determination
- Chromosome Analysis
- Color
- Fetal Fibronectin
- Inborn Errors of Metabolism
- L/S (lecithin, sphingomyelin) Ratio
- Phosphatidyl Glycerol
- Disaturated Phosphatidylcholine
to collect fetal blood from the umbilical cord, used to diagnose chromosomal abnormalities, blood disorders, infections, and fetal anemia.
PUBS (percutaneous umbilical blood sampling)
minimally invasive procedure that allows direct visualization of the fetus inside the uterus using a small, fiber-optic instrument called a fetoscope.
fetoscopy
fetoscopy is oned in
16th or 17th week of AOG
- visual inspection of the amniotic fluid
- used to detect meconium staining
amnioscopy
biophysical profile have (5) parameters
- fetal heart reactivity
- fetal breathing
- etal body movement
- fetal tone
- amniotic fluid volume
check notes (how do you assess the 5 biophysical profile) ppt
biophysical profile:
8-10 indicates that the fetus is
doing well
biophysical profile:
6 indicates that the fetus is
suspicious
biophysical profile:
6 indicates that the fetus is in
jeopardy
materna lassessment of fetal movement
kick count/ daily fetal movement
how do you count for kick counting?
count once a day for 60 min
Count 2 or 3 times daily for 2 hours or until 10
movements are counted or all fetal movements in a 12
hour period each day until a minimum of 10 movements
are counted
what is considered a fetal alarm signal
if fetal movements cease for 12 hours
if < 3 fetal movements in 1 hr
if cessation of fetal movement for 12 hrs
what would you do for both?
for evaluation
To determine blood type
and Rh
Identifies possible causes of
incompatibility with the fetus that
may cause jaundice
blood grouping
To detect anemia; often
checked several times
during pregnancy
Hgb <11g/dl in the 1st and 3rd
trimesters or <10.5g/dl in the 2nd
trimester may indicate a need for
additional iron supplementation.
HGB/HCT
To detect infection,
anemia, or cell abnormalities
12,000/mm3 or more white blood cells or decreased platelets require follow up
CBC
To check for possible
maternal-fetal blood
incompatibility
If mother is Rh-negative and father is Rh-positive or
antibodies are present, additional testing and treatment are
required; if Rh (-) and
unsensitized, RhoGAM will be given at 28 weeks
RH factor and antibody screen
to screen for syphilis
Treat if results are positive;
retest at 36 weeks
VDRL and RPR (rapid plasma reagin)
to determine immunity
if titer is 1:8 or less, mother
is not immune; immunize
postpartum if not immune
rubella titer
to screen for tuberculosis
If results are positive, refer
for additional testing or
therapy
skin test
To screen for sickle cell trait
if client is of African
American descent
If mother is positive, check
partner; infant is at risk only
if both parents are positive
hemoglobin electrophoresis
to detect presence of antigens in maternal blood
If present, infants should be
given hepatitis immune
globulin and vaccine soon
after birth
hepatitis b screening
to detect renal disease of infection
Reassess if positive for more
than a trace protein (renal
damage, preeclampsia, or
normal), ketones (fasting or
dehydration), or bacteria
(infection)
urinalysis
to screen for cervical neoplasia
Treat and refer if abnormal
cells are present
papanicolaou test (pap smear)
To detect group B
streptococci and sexually
transmissible diseases
Treat and retest as necessary,
treat group B streptococci
during labor
cervical culture
to screen for possible gestational diabetes
If elevated, a 3-hour glucose
tolerance test is
recommended.
maternal blood glucose challenge test
