T4: Assessment for High Risk Pregnancy Flashcards
high-risk pregnancy
when the life of the mother, fetus, or newborn are in danger, care of high-risk pregnancy requires an entire health care team.
Biophysical risks
Factors that originate within the mother or fetus and affect the development or functioning of either one or both
Psychosocial risks
Maternal behaviors and adverse lifestyle
o Negative lifestyle behavior, emotional distress, depression, domestic violence, alcohol abuse, inadequate social support
Sociodemographic risks
Arise from the mother and her family
o None or lack of prenatal care, low income, minorities, advanced maternal age (>35 years of age), teen pregnancy
Environmental factors
Hazards in workplace and in the environment
o Smoking, chemicals, radiation, illicit drugs
Daily fetal movement count (DFMC)
maternal assessment of fetal activity; the number of fetal movements within a specified time are counted; also called “kick count”
education for daily fetal movement count (DFMC)
everyday mom chooses time that is convenient for her, mom takes juice/water and stays on her side for 1 hour, BABY IS TO MOVE 5 TIMES IN THE HOUR (this is reassuring)
if the Daily fetal movement count (DFMC) is <5..
then mom can stay there for another hour and baby can “catch up”
what is considered “reassuring” for Daily fetal movement count (DFMC)
times in 1 hour or 10 times in 2 hours
what is considered the most valuable tool for antepartum/biophysical assessment
ultrasound
level 1 US
standard, basic US and it will measure fetal presentation (head, buttocks, foot, ect.), placental position, cardiac activity, fetal growth, and number of fetuses
level 2 US
limited US performs ONE specific piece of information, such as ONLY figuring out fetal presentation.
level 3 US
o more DETAILED US, MFM (maternal fetal medicine) uses this, it is VERY detailed and takes up to 2 hours, can measure Doppler blood flow, measurement of head chest and extremities, maternal uterine arteries, umbilical arterial flow, CAN BE USED TO DIAGNOSE IUGR
IUGR (intrauterine growth restriction)
fetal undergrowth from any cause
what do we do for IUGR babies
These babies do better on the outside so they often times will deliver them
a Biophysical profile (BPP) involves what two tests
an US and non-stress test
what is the purpose of a Biophysical profile (BPP)
ordered for fetal well-being
what is the max score for a Biophysical profile (BPP)
10 points (<6 means that prolong monitoring is needed)
what are the two tools used for biophysical profile (BPP)
US and fetal heart monitor
amniocentesis
needle puncture of the amniotic sac to withdraw amniotic fluid for analysis
amniotic fluids determines…
there are genetic disorder, congenital abnormalities, neural tube defects, cystic fibrosis or sickle cell disease
what should be done after an amniocentesis
MOM SHOULD STAY ON FETAL MONITOR FOR 1-2 HOURS AND A PRESSURE DRESSING SHOULD BE APPLIED
education after amniocentesis
if needle site continues to leak they need to return to hospital because there is a risk for infection
Oligohydramnios
<300mL of amniotic fluid (too little amniotic fluid)
oligohydraminos is associated with
renal anomaly because amniotic fluid is the baby urine
1 artery and 1 vein indicates
KIDNEY DEFECT
polyhydraminos
> 1500mL of amniotic fluid (too much amniotic fluid)
L/S ratio (Lecithin/Sphingomyelin) indicates
FETAL LUNG MATURITY
if the ratio is between 2.0-2.5 it indicates baby lungs ARE matured
CST/Oxytocin test
ordered for fetal well-being, low dose oxytocin or nipple stimulation is done to see if baby can handle contractions
positive CST test means
means baby CANNOT tolerate labor (because they have decelerations with contractions)
Chorionic villus sampling (CVS):
THEY TAKE SAMPLE FOR PLACENTA and test it to tell us if there are any genetic disorders
when is a Chorionic villus sampling (CVS) done
FIRST TRIMESTER (1-13 weeks, usually between 10-13 weeks)
Percutaneous umbilical blood sampling (PUBS) or cordocentesis
sample of fetal blood is taken for testing
Alpha-fetoprotein (AFP) is recommended to be performed when?
recommended to be performed 15-20 weeks gestation to be most reliable
Alpha-fetoprotein (AFP)
measures fetoprotein and tells us if there are any abdominal wall defects also screened for neural tube defects
Goal of electronic fetal monitoring
to determine if the intrauterine environment is supportive to the fetus
Vibroacoustic stimulation
used if there is minimum variability you use a “buzzer” to stimulate fetus
results of vibroacoustic stimulation
YOU WANT AN ACCELERATION WHEN STIMULATED, if there is a deceleration it tells us something is wrong with baby
Contraction stress test (CST) can be done either through
can be done either through nipple stimulation or oxytocin stimulation
