Pregnancy Flashcards
The Apgar Scoring System
Evaluation of the general condition of a newborn is done by adding the numerical values for each of the five different physiologic parameters (see table below)
Range of the Apgar score: from 0 to 10
[A score is given for each sign at one minute and five minutes after birth
(If there are problems with the baby, an additional score is given at 10 minutes)]
Apgar scoring totals and interventions total score
8 - 10 =normal
5 - 7 =mild depression
(the neonate may require some stimulation, i.e., gently but firmly
slapping the soles of the feet or rubbing the spine or the back oxygen may be necessary)
3 - 4 =moderate depression (the baby will need oxygen
the baby may need insertion of a feeding tube to decompress the stomach)
0 - 2 =severe depression, (requiring immediate life support)
Physiological Parameter
Activity (Muscle Tone) extend elbows, thigh, knees and baby flexes promptly extension yields slower responses; some flexion flaccid  Pulse above 100 slow; below 100 absent  Grimace (Reflex Irritability) stimulate and baby cries vigorously and moves weak cry and/or weak movement no response  Appearance (Skin Color) completely pink acrocyanosis (pink body, blue extremities) pale or cyanotic (blue)  Respiration vigorous crying or regular breathing irregular, shallow, or gasping Absent
First Trimester Assessments:
Chorionic villi sampling (CVS)
Basic ultrasound screening
Basic ultrasound screening
Performed transvaginally (a lubricated transducer probe is placed in the vagina) or abdominally (after application of a transmission gel) depending on gestation
Can be performed in the outpatient or inpatient setting in all three trimesters
A full bladder enhances visualization when abdominal ultrasound is performed
Confirms
viability
age of the pregnancy
Determines
the number of gestational sacs the size of the gestational sac
location of gestational sac
Identifies uterine abnormalities
rule out an ectopic pregnancy
locate the presence of an intrauterine contraceptive device
Indicates fetal presentation
Measurements can be taken to confirm/estimate gestational age Identifies morphologic anomalies
Chorionic villi sampling (CVS)
Typically performed between 10 and 12 weeks gestation Used to obtain a fetal karyotype
Involves obtaining a sample of chorionic villi from the placenta via a syringe/needle
Allows a woman earlier/safer timing for pregnancy termination as results are obtained quickly
Second Trimester Assessments
Quad marker screening
Amniocentesis
Ultrasonography
Quad marker screening
(also called maternal serum expanded alpha-fetoprotein [AFP] screening)
A screening test performed at 16 weeks gestation to assess risk for chromosomal anomalies and neural tube defects
Maternal blood sample is drawn and sent out for analysis
Measure blood serum levels of: maternal serum alpha fetoprotein (MSAFP), human chorionic gonadotropin (HcG), unconjugated estriol (UE), and inhibin A.
MSAFP = a protein produced by the baby’s liver
HcG = a hormone produced by the placenta
UE = a protein produced in both the placenta and the baby’s liver
inhibin A = a hormone produced in the placenta
Does not indicate absolutely that abnormalities are detected, only the further investigation is recommended
Amniocentesis
May be performed as early as 12 weeks gestation
A procedure performed to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes, development, viability and lung maturity
Performed under ultrasound guidance
Rh negative mother must receive RhoGAM® immediately after the procedure to prevent isoimmunization
Risks include:
amnionitis spontaneous abortion
preterm labor/delivery
premature rupture of membranes
Recommended for women 35 years of age or older and any pregnant woman with an abnormal quad marker screening
Frequently performed late in pregnancy to provide information about fetal lung maturity
lecithin and sphingomyelin are protein components of surfactant, a lung enzyme that is formed by the the alveoli beginning around the 22nd week
evaluation of amniotic fluid for lecithin/sphingomyelin (L/S) ratio is used to determine fetal lung maturity
a ratio of 2:1 (which typically occurs by 35 weeks gestation) is traditionally accepted as lung maturity
Third Trimester Assessments:
“Kick counts” (or counting fetal movements)
Non-stress test (NST)
Biophysical profile (BPP)
Percutaneous umbilical blood sampling
Contraction stress test (CST) - also called oxytocin challenge test (OCT)
Ultrasonography
Amniocentesis
“Kick counts” (or counting fetal movements)
Many variations have been developed, but there are two major methods
Method 1:
the woman lies on her side
she counts and records 10 distinct movements in a period of up to 2 hours
once 10 movements have been perceived, the count can be discontinued
Method 2:
the woman counts and records fetal movements for 1 hour, three times a week
the count should equal or exceed the woman’s previously established baseline
An active fetus reflects adequate oxygenation by the uteroplacental unit
If fetus is quiet, mother is encouraged to drink some juice, lie down on her left side and repeat the count of movements

If at least three movements are not noted within an hour’s time, the mother is encouraged to call her physician immediately
Non-stress test (NST)
The fetus should be at least 32-34 weeks in order for the test results to be accurate
The electronic fetal monitor is placed on the maternal abdomen for 20-30 minutes
Records fetal heart rate (FHR) fluctuations continuously
The mother is given a button to press each time she feels the baby move
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15 seconds
A reactive (good) outcome is one in which two or more such accelerations in FHR occur with associated fetal movement
Women with risk factors, e.g., diabetes, undergo frequent testing, often twice weekly
Biophysical profile (BPP)
A comprehensive fetal assessment of five variables:
fetal breathing movement
fetal movement of the body or limbs
fetal tone (extension or flexion of the limbs)
amniotic fluid volume index (AFI) visualized as pockets of fluid around the fetus
reactive non-stress test
First four components observed and measured under ultrasound; the non- stress test on an external fetal monitor
Allows for identification of a compromised fetus
a score of 0-2 points is awarded for each of the five components of the test
a score of 8-10 points with normal fluid volume is the desired result; less than that indicates need for intervention
Percutaneous umbilical blood sampling
An ultrasound-guided procedure used to obtain a sample of fetal blood drawn from the fetal umbilical cord
A needle is introduced through the maternal abdomen, much like amniocentesis, but is then introduced into the fetal umbilical cord
Risks and treatment same as for amniocentesis
Fetal blood sample provides information about chromosomal anomalies, fetal karyotyping, and blood disorders
Contraction stress test (CST)
also called oxytocin challenge test (OCT)
Evaluates the oxygen and carbon dioxide exchange within the fetoplacental unit
Allows for identification of the fetus at risk for intrauterine asphyxiation
Contraindications include: placenta abruption, placenta previa, undiagnosed third trimester bleeding, previous cesarean delivery, premature rupture of membranes (PROM), incompetent cervix, and/or multiple gestation
Procedure
performed in a labor and deliver unit under electronic fetal monitoring mother should have IV access and OR team available
to initiate contractions, IV oxytocin is administered or the client is instructed in nipple stimulation procedure
the desired result is a “negative” test which consists of three contractions of moderate intensity in a 10 minute period without evidence of late decelerations
a positive result = repetitive, persistent late decelerations with >50% of the contractions; an equivocal result = nonpersistent late decelerations
treatment of a positive CST is expeditious delivery, via cesarean section
Postpartum Assessment
Postpartum care begins immediately after childbirth.
Maternal Postpartum Assessment: BUBBLE-HE
Letter Assessment includes
B
Breasts
Inspection of nipples - everted, flat, inverted?
Breast tissue - soft, filling, firm?
Temperature and color - warm, pink, cool, red streaked
U
Uterus
Location - midline or deviated to either the right or the left side? Tone - firm, firm with massage or boggy?
B
Bladder
Last time the client emptied her bladder - spontaneous or via catheter?
Palpable or nonpalpable?
Color, odor, and amount of urine?
B
Bowels
Date and time of the last bowel movement? Presence of flatus and hunger?
Note: unless the colon was manipulated, there is no need to auscultate for bowel sounds
L
Lochia
Color, amount, presence of clots? Free flow of lochia?
E(I)
Episiotomy(Incision)
Type and other tissue trauma (lacerations, etc.)?
Assess using REEDA (R=redness, E=edema, E-ecchymosis, D=discharge, A=approximation)
L/H
Legs (Homans’ sign)
Pain, varicosities, warmth or discoloration in calves? Presence of pedal pulses?
Sensation and movement (after cesarean birth)

E
Emotions
Affect
Client-family interaction Effects of exhaustion
(B)
Bonding
Interaction with infant, e.g., “taking in” phase, with presence of finger tipping, gazing, enfolding, calling infant by name, identifying unique characteristics
- Homans’ sign (sometimes spelled as Homans sign) or the dorsiflexion sign is considered a sign of deep vein thrombosis (DVT)
- episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth
- lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue
Postpartum assessments that would require notifying the health care provider:
Maternal
Temperature greater than 100.4 F (38 C) Increased lochia, clots or foul odor Perineal pain or swelling
Calf tenderness
Appetite loss
Sleep disturbances
Continued mood swings or depression
Elimination problems (burning, frequency or urgency of urination, or persistent constipation)
Newborn
Temperature greater than 100.4 F (38 C) Poor feeding effort
Vomiting or diarrhea
Inconsolable crying
Inability to arouse; exceedingly sleepy Yellowing of the skin
No wet diaper in eight hours
