Maternity Ch. 6 Flashcards
Assessing mom for factors that put her and baby at risk are called
- Biophysical factors
- Psychosocial factors
- Sociodemographic factors
- Environmental factors
Biophysical factors
impact the development or function of the mother or fetus
Psychosocial factors
maternal behaviors or lifestyles that have a negative effect on the mother or fetus. Examples include smoking, caffeine use, alcohol/drug use, and psychological status.
Sociodemographic factors
variables pertaining to the woman and her family that place the mother and the fetus at increased risk. Examples include access to prenatal care, age, parity, marital status, income, and ethnicity
Environmental factors
hazards in the workplace or the general environment that impact pregnancy outcomes. Various environmental substances can affect fetal development. Examples include exposure to chemicals, radiation, and pollutants
Nurses role in antepartal testing
- Assessing risk factors
- Providing information
- Emotional support
- Comfort
Goal: to decrease anxiety
Screening test
- Results are not definite
- Normal tests!!!!
- Designed to identify those are NOT affected by disease or abnormality
- Carry no risk to fetus
Diagnostic test
- provide a yes or no answer to whether a fetus is normal or abnormal and can detect many, but not all, birth abnormalities caused by defects in a gene or chromosomes
- May be done if family hx of birth defect
- Some carry risk like loss of fetus
- Reserved for high risk pregnancies’
Biophysical Assessment
Show movement, urine production, and structures, and blood flow
Biophysical Assessment test performed examples
US: Produces image of an organ or tissue (most common)
MRI: Provides a very detailed images of fetal anatomy (Brain/GI/GU/thorax)
Doppler flow: Assess resistance to blood flow in the placenta
- Risk for none
- Nursing actions: explain procedure and provide support
Ultrasound gives what vital information:
- Gestational age
- Fetal anatomy and presentation when performed in the second and third trimesters
- Number of fetuses
- Amount of amniotic fluid
- Confirm fetal cardias activity
- Confirm placental location
Biochemical Assessment examples
- Chorionic villus sampling
- Amniocentesis
- PUBS tests
Chorionic villus sampling
- How is it done?
- What does it test for?
- Risks?
aspiration of a small amount of placental tissue (chorionic villi) for chromosomal, metabolic, or DNA testing. This test is used for chromosomal analysis between 10 and 12 weeks’ gestation to detect fetal abnormalities caused by genetic disorders. Mom is supine/lithotomy, catheter is inserted to remove biopsy of placenta
It tests for metabolic disorders such as cystic fibrosis but does not test for neural tube defects (NTDs)
7% fetal loss due to bleeding, infection, and rupture of membranes
Amniocentesis
How is it done?
What does it test?
Risks?
is a diagnostic procedure in which a needle is inserted through the maternal abdominal wall into the uterine cavity to obtain amniotic fluid. US is used to take size of fetus and locate placenta, needle is inserted to sample amniotic fluid
It is commonly performed for genetic testing but can also be done for assessment of fetal lung maturity, assessment of hemolytic disease in the fetus, or intrauterine infection and therapy for polyhydramnios
Preterm labor
Percutaneous umbilical blood sample (PUBS)
- What is it?
- What does it test for?
- Can be used for?
- Risks?
is the removal of fetal blood from the umbilical cord. Needle goes into umbilical vein and guided via US
The blood is used to test for metabolic and hematological disorders, fetal infection, and fetal karyotyping.
It can also be used for fetal therapies such as red blood cell and platelet transfusions
● Complications are similar to those for amniocentesis and include cord vessel bleeding or hematomas, maternal–fetal hemorrhage, fetal bradycardia, and risk for infection.
● The overall procedure-related fetal death rate is 1.4% but varies depending on indication
When does mom get rogham shot?
20 weeks
Maternal Assays
- What is it?
- Examples?
increasingly common way to screen pregnant women for fetal birth defects or genetic anomalies
- AFP = alpha-fetoprotein
- Multiple marker
AFP = alpha fetoprotein High levels? Low levels? Abnormal findings? Risk?
● Increased levels are associated with defects such as NTDs, anencephaly, omphalocele, and gastroschisis.
● Decreased levels are associated with trisomy 21 (Down syndrome).
● Abnormal findings require additional testing such as amniocentesis, chorionic villus sampling, or ultrasonography to make a diagnosis.
The high false-positive rate (meaning the test results indicate an abnormality in a normal fetus) can result in increased anxiety for a woman and her family as they wait for the results of additional testing
Multiple Marker Screening
- Purpose
- Nursing action
Detect trisomies and NTD
● Educate the woman about the test. This is a maternal blood test that assesses for the levels of chemicals in the maternal blood to screen for certain developmental abnormalities.
● Provide emotional support for the woman and her family.
Goal of fetal testing?
The goal of fetal testing is to reduce the number of preventable stillbirths and to avoid unnecessary interventions.
Fetal movement counting
- Kick counts
- 4 movements in 1 hour is reassuring
Non stress test (NST)
- Fetal HR in response to movement
- A cells with movement
Contraction stress test (CST)
- Fetal HR in response to contractions (do not want HR to drop)
- if no spontaneous UCs, can be initiated by brushing nipples for 10 mins or with IV oxytocin
- Can not be done in those of risk of preterm labor, bleeding, or uterine rupture
Amniotic Fluid Index (AMI)
-Measures the volume of amniotic fluid with US to assess fetal well-being and placental function
