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Maternity > Psychosocial Adaption in Pregnancy, Antepartum Testing, & Fetal Monitoring > Flashcards

Psychosocial Adaption in Pregnancy, Antepartum Testing, & Fetal Monitoring Flashcards

1
Q

Factors that affect Maternal Adaptation

A

Physical
Psychological
Social

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2
Q

Prenatal Classes

A

Bradley (partner coached childbirth): goal is to have the best, safest, most rewarding birth experience

Lamaze: empowers women to make informed choices, assume responsibility for health, and trust in inner wisdom

HypnoBirthing: eliminating fear, stress-free, calm, gentle environment that resembles nature’s design.

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3
Q

Prenatal Assessment for Risk Factors

A

Biophysical factors: genetic, nutritional, medical, and obstetric issues that can originate from mother or fetus and subsequently impact mother or fetus

Psychosocial factors: maternal behaviors or lifestyles that can negatively impact the fetus
-ex) use of substances, high stress lifestyle, relationship with violence

Sociodemographic factors: variables that place the mother and fetus at increased risk
-ex) access to care, income, parity, type of housing, homelessness, not having a car, financial means to provide food

Environmental factors: hazards in the environment or workplace that impact pregnancy outcomes
-ex) oncology nurse that is around chemotherapy agents or radiation

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4
Q

Assessing Fetal Status in First Trimester

A

Viability Confirmation:

  • serum beta hCG test repeated every 48-72 as it should double regularly, present in virtually all pregnancies by 11 days
  • Progesterone: should be high in pregnancy
  • U/S: to confirm intrauterine pregnancy and take measurements for due date confirmation and first trimester screen
  • Genetic testing
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5
Q

Assessing Fetal Well-Being in Second Trimester

A

most advantageous time for basic U/S
done at 18-24wks

looks at:

  • uniformity of growth (biometric measurement, accurately estimate gestation age and growth)
  • volume of amniotic fluid offers good images
  • fetal anatomy shown in detail

*genetic testing can be ordered at this time if it was not previously done

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6
Q

Assessing Fetal Well-Being in Third Trimester

A

Testing type: U/S, NST, CST, BPP
*determined by specific condition (not done with routine pregnancies) and HCP determines what tests to do

Assessing lung maturity

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7
Q

Screening vs. Diagnostic Tests

A

Screening tests: aren’t perfect, can have false negatives and false positives

Diagnostic tests: have genetic information (tissue) that can be evaluated to confirm

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8
Q

NIPT

A

Non-Invasive Prenatal Testing (aka cell-free fetal DNA testing)

looks at fetal DNA in mom’s blood
can do 9 weeks through delivery
being offered more routinely (original for “at risk populations”)

does NOT screen for neural tube defects

if done, then should be offered AFP later in second trimester
*sensitive and specific for trisomy 18 and 21

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9
Q

First Trimester Screening

A

most accurate between 6-12wks:

  • confirm intrauterine pregnancy, viability, # embryos
  • establish gestational age (crown to rump length)
  • first trimester screening = combined u/s + serum testing w/ plasma-protein A and HcG
  • evaluates causes of vaginal bleeding
  • assessment of uterine anatomy

*may opt for this if NIPT not covered by insurance

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10
Q

Second Trimester U/S

A

for purpose of anatomic scan

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11
Q

CVS

A

Chorionic Villus Sampling

offered typically between 10-13wks (first trimester DIAGNOSIS)
needle aspiration of chorionic villi from placenta (u/s to guide and transcervical or transabdominal approach)
*invasive procedure so need to admin rhogam w/in 72 hours for Rh negative women

spontaneous abortion ~7% chance

  • cannot test for neural tube defects
  • can determine gender b/c you’ll get chromosomes
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12
Q

Amniocentesis

A

done at 14-20wks

amniotic fluid obtained through needle aspiration under u/s guidance

  • invasive procedure so admin rhogam to Rh negative women w/in 72 hours of procedure
  • can detect neural tube abnormalities and assess fetal lung maturity
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13
Q

Risks of Amniocentesis

A

spontaneous abortion: 1 in 200
transient vaginal spotting, cramping
amniotic fluid leakage
chorioamnionitis

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14
Q

Assessing Fetal Lung Maturity

A

Done by amniocentesis

looking for presence of lecithin & sphingomyelin
l/s ration > 2:1 indication fetal lung maturity (<3) 5wks

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15
Q

MSAFP Testing

A

second trimester, done between 15-22wks

aka "Quad Screen", looks at:
estriol
HcG
inhibin A
Alpha feto-protein (AFP)

low estriol and high AFP = associated with neural tube defects
high hCG and high inhibin A = associated with trisomy 21

*Screening test only, abnormalities need to have diagnostic testing

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16
Q

AFP

A

glycoprotein produced in fetal liver, GI tract, and yolk sac in early gestation.

tested between 15-22 wks

  • increased levels noted in NTD’s anencephaly, omphalocele, and gastrochisis (neural tube defects)
  • decreased levels are associated with down’s syndrome
  • if woman opted for first trimester screen for chromosomal abnormalities or NIPT, they should be offered this test.
  • abnormal findings require further evaluation
17
Q

How to measure FHR

A

mean FHR during 10 minute period
rounded to 5 bpm
excludes accelerations and decelerations
must be observed for at least 2 minutes

18
Q

Intervention for Fetal Tachycardia

A 
administer meds as ordered
ice packs
check hydration status and hydrate prn
explain procedures
position change
O2
stop pitocin
notify provider
19
Q

Intervention for Fetal Bradycardia

A 
verify maternal HR
assess maternal VS
reposition
O2
d/c pitocin
20
Q

Accelerations

A

visually apparent abrupt increase in baseline FHR

onset to peak < 30 seconds
>32 weeks = 15bpm x 15s
<32wks = 10bpm x 10s

Prolonged accelerations = 2-10min
*longer than 10 minutes indicates a new baseline

cause = stimulation of autonomic NS, specifically SNS response to fetal movement

21
Q

Early Decelerations

A

gradual decrease
nadir occurs at same time as peak of contraction

cause: vagal nerve stimulation from head compression

normally reassuring and no intervention needed

22
Q

Variable Decelerations

A

most common!

visually apparent abrupt decrease in FHR and return abruptly, varying in intensity and duration (>15bpmx15s)

can be u, w, or v shaped

cause: cord compression triggers vagal response

Intervention: change positions, cervical exam, amnioinfusion, administer O2, IV bolus, stop pitocin, administer tocolytics prn, modify pushing and notify provider

23
Q

Prolonged Decelerations

A

Decels that last between 2–10 minutes.

cause: interruption of uteroplacental perfusion (tachysystole, maternal hypotension, placental abruption) or umbilical blood flow (cord compression, cord prolapse), vagal stimulation (profound head compression, rapid fetal descent)
intervention: change positions, IV fluids, d/c pitocin, O2, perform sterile vaginal exam, tocolysis if ordered

24
Q

Late Decelerations

A

nadir occurs after peak of contraction

cause: uteroplacental insufficiency (decreased blood flow and/or oxygen transfer to fetus through the intervillous space)
intervention: change positions, d/c pitocin, administer terbutaline (if ordered), assess hydration and fluid bolus prn, administer O2, notify provider

25
Q

Assessing Intensity of Contractions

A

Palpations -
Mild: nose
Moderate: chin
Strong: forehead

Disadvantages to this method:

  • subjective differences in interpretations
  • no permanent record which can hinder interpretation by others
26
Q

Tachysystole

A

uterine hyperstimulation

> 5 contractions within 10 minutes OR
contractions within 1 minute of each other or contractions lasting 2 min or longer

cause: spontaneous or from induction meds
intervention: change position, provide hydration, administer tocolytics as ordered

27
Q

FHR Tracing Categories: Category I

A

normal

Criteria: ALL of the following
baseline HR in normal range (110-160bpm)
baseline variability is moderate
late or variable decelerations absent

28
Q

FHR Tracing Categories: Category III

A

Abnormal and require action

Criteria: ABSENT variability with any of the following
recurrent late decelerations
recurrent variable decelerations
bradycardia
sinusoidal pattern
29
Q

FHR Tracing Categories: Category II

A

anything not in I or III

indeterminate and need surveillance

30
Q

Intrauterine Resuscitation

A

intervention for Category II and III FHR patterns

Assess first:

  • cervical exam to assess for umbilical cord prolapse, rapid cervical dilation, rapid descent of fetal head
  • assess for uterine activity for uterine tachysystole
  • assess maternal vital signs, especially temp (for fever), BP for hypotension
Interventions:
change position
administer IV fluid
correct hypotension
reduce uterine activity if UCs are too frequent
alter pushing effort
amnioinfusion
support woman to decrease anxiety/pain
31
Q

NST

A

Reactive: 2 or more accelerations in 20 min

Nonreactive: insufficient accelerations after 40 min (not diagnostic of fetal compromise)

*only shows where the baby is at at that point in time, could be during the baby’s sleep cycle

32
Q

CST

A

screening test used to assess fetal well being and uteroplacental function in women with nonreactive NST

looks at spontaneous or induced contractions

Contraindications: 3rd trimester VB, previa

Negative test is good (no late or significant variable decelerations).
Positive is bad

33
Q

AFI

A

Amniotic Fluid Index

volume of amniotic fluid determined by:

  • placental perfusion
  • fetal urine output
  • fetal swallowing
34
Q

BPP

A

Biophysical Profile: an u/s assessing fetal status with an NST. Looks at fetal reflex activity controlled by CNS (sensitive to hypoxia). Takes 30min.

5 components:

  • FHR acceleration (NST)
  • Fetal breathing movements
  • Fetal gross body movements
  • Fetal Tone
  • Amniotic Fluid Volume

max score = 10 (higher score is better)

35
Q

Other methods of fetal assessment:

A

stimulation: scalp, acoustic, maternal abdominal palpation

cord blood analysis: immediately after birth

Maternity (13 decks)

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