High Risk Pregnancy Indicators

Question 1

this test is commonly called cordocentesis, and is the most common method used for fetal blood sampling and transfusion. This procedure obtains fetal blood from the umbilical cord by passing a fine-gauge, fiber-optic scope into the amniotic sac using the amniocentesis method. the needle is advanced into the umbilical cord under ultrasound guidance, and blood is aspirated from the umbilical vein.

Answer 1

Percutaneous Umbilical Blood Sampling (PUBS)

Question 2

This test evaluates for isoimmune fetal hemolytic anemia and assess the need for a fetal blood transfusion. blood studies from the cordocentesis can consist of:

• Kleihauer-Betke test that ensures that fetal blood was obtained
• CBC count with differential
• Indirect Coomb’s test for Rh antibodies
• Karyotyping (visualization of chromosomes)
• Blood gases

Answer 2

PUBS

Question 3

this test is an assessment of a portion of the developing placenta(chorionic villi), which is aspirated through a thin sterile catheter or syringe inserted through the abdominal wall or intravaginally through the cervix under ultrasound guidance. This is a first trimester alternative to amniocentesis with one or its advantages being an earlier diagnosis of any abnormalities. Ideally performed at 10 to 13 weeks of gestation.

Answer 3

Chorionic Villus Sampling

Question 4

what two fetal abnormalities can a Chorionic Villus Sample (CVS) not detect?

Answer 4

Spina bifida and anencephaly

Question 5

A blood test that ascertains information about the likelihood of fetal birth defects. It does not diagnose the actual defect. It can be performed instead of a maternal serum AFP yielding more reliable findings. Preferred to be done at 16 to 18 weeks gestation, and put the mother at risk for giving birth to a neonate who has a genetic chromosomal abnormality.

Answer 5

Quad Marker Screening

Question 6

Low levels of AFP can indicate risk for ____ ______.

Answer 6

down syndrome

-levels higher than the expected range of hCG, inhibin A, estriol indicates a risk for down syndrome

Question 7

High levels of AFP can indicate risk for _____ ______ ______.

Answer 7

neural tube defects

Question 8

A screening tool used to detect neural tube defects. Clients who have abnormal findings should be referred for a quad marker screening, genetic counseling, ultrasound, and an amniocentesis.
-all pregnant clients get this test preferably between 16 to 18 weeks of gestation.

Answer 8

Maternal Serum Alpha - Fetoprotein

Question 9

Causes of bleeding during pregnancy ?

Answer 9

• first trimester (spontaneous abortion, ectopic pregnancy)
• second trimester (gestationl trophoblastic diesase)
• third trimester (placenta previa, abruptio placentae, vasa previa)
• preterm labor
• hydatidiform mole

Question 10

when a pregnancy is terminated before 20 weeks of gestation (the point of fetal viability) or fetal weight less than 500 g. Clinically classified as threatened, inevitable, incomplete, complete and missed

Answer 10

Spontaneous abortion

Question 11

abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tub, which can result in a tubal rupture causing a fatal hemorrhage. The second most frequent cause of bleeding in early pregnancy and a leading cause of infertility.

Answer 11

Ectopic pregnancy

Question 12

inhibits cell division and embryo enlargement, dissolving the pregnancy

Answer 12

Methotrexate

Question 13

done to salvage the fallopian tube if it is not ruptured.

Answer 13

salpingostomy

Question 14

(removal of the tube) is performed when the tube has ruptured.

Answer 14

Laparoscopic salpingectomy

Question 15

the proliiferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structure are associated with choriocarcinoma, which is a rapidly metastasizing malignancy. Two type of molar growths are idenitified by chromosomal analysis.

Answer 15

Gestational Trophoblastic disease

Question 16

characterized by:

• all genetic material is paternally derived
• the ovum has no genetic material, or the material is inactive
• contains no fetus, placenta, amniotic membranes or fluid
• there is no placenta to receive maternal blood

Answer 16

Complete Mole

Question 17

characterized by :

• genetic material is derived both maternally and paternally.
• a normal ovum is fertilized by two sperm, or one sperm in which meiosis or chromosome reduction and division did not occur
• often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood but congenital abnormalities are present

Answer 17

Partial Mole

Question 18

occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus. The abnormal implantation results in bleeding in the third trimester of pregnancy as the cervix begins to dilate and efface.
-classified into three types dependent on the degree to which the cervical os is covered by the placenta.

Answer 18

Placenta Previa

Question 19

The cervical os is completely covered by the placental attachment.

Answer 19

Complete Previa

Question 20

The cervical os is only partially covered by the placental attachment.

Answer 20

Incomplete or partial previa

Question 21

The placenta is attached in the lower uterine segment but does not reach the cervical OS

Answer 21

Marginal or low-lying

Question 22

premature separation of the placenta from the uterus, which can be a partial or complete detachment. This separation occurs after 20 weeks of gestation, which is usually in the third trimester. It has a significant maternal and fetal morbidity and mortality and is a leading cause of maternal death.
-coagulation defect, such as disseminated intravascular coagulopathy (DIC), is often associated with moderate to sever abruption.

Answer 22

Abruptio Placentae

Question 23

this corticosteroid promotes fetal lung maturation if early delivery is anticipated.

Answer 23

Betamethasone

Question 24

clinical manifestations of :

• unilateral stabbing pain and tenderness in the lower abdominal quadrant
• delayed (1 to 2 weeks), lighter than usual or irregular menses.
• scant, dark red, or brown vaginal spotting occurs 6 to 8 weeks after last normal menses (red vaginal bleeding if rupture has occurred)
• referred shoulder pain due to blood in the peritoneal cavity irritation the diaphragm or phrenic nerve after tubal rupture
• report of indications of shock such as faintness and dizziness related to the amount of bleeding in abdominal cavity.

Answer 24

clinical manifestations of an ectopic pregnancy

Question 25

clinical manifestations of :

• rapid uterine growth more than expected for the duration of the pregnancy due to overproliferation of trophoblastic cells
• bleeding is often dark brown resembling prune juice, or bright red that is either scant or profuse and continues for a few days or intermittently for a few weeks and can be accompanied by passage of vesicles.
• anemia from blood loss
• clinical findings of preeclampsia that occur prior to 24 weeks gestation

Answer 25

Clinical manifestations of Gestational Trophoblastic Disease

Question 26

clinical manifestations of :

• painless, bright red bleeding during the second or third trimester
• uterus soft, relaxed, and nontender with normal tone
• fundal height greater than usually expected for gestational age
• fetus in a breech, oblique or transverse position

Answer 26

Clinical Manifestations of Placenta Previa

Question 27

clinical manifestations of:

• sudden onset of intense localized uterine pain with dark red vaginal bleeding
• area of uterine tenderness can be localized or diffuse over uterus and boardlike
• contractions with hypertonicity
• fetal distress
• clinical findings of hypovolemic shock

Answer 27

clinical manifestations of abruptio placentae