OB Exam 2 Flashcards
Appropriate timing for specific prenatal testing
First trimester ultrasound
confirms pregnancy and viability, determines gestational age, rules out ectopic pregnancy, detect multiple gestations, visualization if doing chorionic villi sampling, detect maternal abnormalities such at cysts, fibroids, etc.
Appropriate timing for specific prenatal testing
Second trimester ultrasound
establish or confirm dates, detect polyhydramnios and oligohydramnios, detect congenital anomalies, assess placenta function, visualization during amniocentesis
Appropriate timing for specific prenatal testing
Third trimester ultrasound
Detect macrosomia, detect congenital anomalies, detect IUGR, determine fetal position, detect placenta previa or abruption, visualization during amniocentesis or external version, amniotic fluid volume assessment, doppler flow studies
Nuchal translucency
between 10-14 weeks via ultrasound to check for abnormality that could indicate chromosomal disorder. Greater than 3 mm is considered abnormal
Fetal heart activity
by about 6 weeks of gestation via transvaginal ultrasound
Placental position and appearance-
18-23 weeks of gestation. Most cases of placenta previa diagnosed during second trimester resolve by term
Amniocentesis
possible after 14 weeks of pregnancy
Chorionic villi sampling
first trimester- popular technique for genetic studies – between 10-13 weeks
Percutaneous umbilical cord sampling
second and third trimesters- used for fetal blood sampling and transfusion
Coombs test
screening tool for rh compatibility.
Biophysical profile scoring-
Fetal breathing movements:
- score 2- at least one episode of breathing movements of at least 20 seconds
- score 0- absent fetal breathing movements or less than 30 seconds
Fetal movements:
- score 2- at least three trunk/ limb movements in 30 minutes
- score 0- fewer than 3 episodes of movements in 30 minutes
fetal tone:
- score 2- at least one episode of active extension with return to flexion of fetal limb or trunk
- score 0- absence of movement or slow flexion and extension
Biophysical profile scoring-
amniotic fluid index:
- score 2- deepest vertical pocket greater than 2 cm
- score 0- deepest vertical pocket less than 2 cm
nonstress test:
- score 2- reactive
- score 0- nonreactive
MSAFP/triple marker
analysis of results- performed at 16-18 weeks of gestation, measures the level of three maternal serum makers; MSAFP, hCG and unconjugated estriol.
**MSAFP alone can detect neural tube defects. Clients who have abnormal findings should be referred to further screening.
a. ) If a fetus has trisomy 21; the MSAFP and unconjugated levels are low and the hCG will be elevated.
b. ) Low values in all markers is associated with trisomy 18 in the fetus
Amniocentesis:
teaching/lung maturity- the aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client’s uterus and amniotic sav under direct ultrasound guidance. **Performed after 14 weeks of gestation.
Amniocentesis Teaching:
> explain procedure to patient and obtain informed consent, assist client to supine position and place a wedge under her right hip to display the uterus off the vena cava
> place a drape over the client exposing only her abdomen
> prepare for ultrasound to locate placenta
> cleanse client’s abdomen with an antiseptic solution prior to administration of a local anesthetic
> tell the patient that she will feel slight pressure as the needle is inserted. She should continue breathing because holding her breath will lower her diaphragm
Amniocentesis Teaching 2:
monitor vital signs , FHR and uterine contractions throughout and 30 minutes following the procedure. Client should rest for 30 minutes. Tell client to report any fever, chills, leakage of fluid, or bleeding, decreased fetal movement, vaginal bleeding or contractions. Encourage client to drink plenty of liquids and rest for 24 hours post procedure
Lung maturity
Amniotic fluid is tested to determine whether the fetal lungs are mature enough to adapt to extrauterine life. L/S ratio- 2:1 indicates lung maturity. Absence of PG is associated with respiratory distress.
Diab during preg.
ideal blood sugar during pregnancy should range between 70-110
increased risks to fetus-
> spontaneous abortion related to poor glycemic control
> infections related to increased glucose in urine
> decreased resistance because of altered carb metabolism
> hydramnios which can cause overdistention of the uterus
> premature ROM- preterm labor or hemorrhage
> ketoacidosis- untreated hyperglycemia
> hypo/hyperglycemia
Hypoglycemia
nervous, headache, weakness, irritability, hunger, blurred vision, tingling of mouth or extremities.
Hyperglycemia
polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath
Lab tests
routine UA with glycosuria
Glucola screening/1 hour glucose test
- 50 g oral glucose load followed by blood sugar check 1 hour later. Performed between 24-28 weeks gestation. Positive if BS above 130/140- 3 hour testing is done then