T4 - Assessment of High Risk Factors (Josh) Flashcards
What is a high risk pregnancy?
one in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to the pregnancy
What risk factors are associated w/ Polyhydramnios?
Diabetes Milletus
Congenital Fetal Anomolies
- **GI obstruction
- **twin-twin transfusion
What risk factors are associated w/ Intrauterine Growth Restriction?
HTN Diabetes Chronic Renal Disease Collagen Vascular Disease Thrombophilia Cyanotic Heart Disease Poor Weight Gain Smoking, ETOH, Drug Use High Altitude
**pretty much anything that can affect perfusion of O2 and nutrients to fetus
What risk factors are associated w/ Oligohydramnios?
Renal Agenesis (Potter Syndrome)
Premature ROM
Prolonged Preg
Uteroplacental Insufficiency
Severe IUGR
Maternal HTN
What risk factors are associated w/ Chromosomal Abnormalities?
Advanced Maternal Age
Parental Chromosomal Rearrangements
Prev. Preg. w/ Autosomal Trisomy
Abnormal U/S Findings
Fetus should be — if not asleep.
active (kicking)
How often will a high risk mother need to do a kick count?
What about a low risk?
High Risk = 2-3 times/day for 30 mins to 1 hr
Low Risk = 1-2 times/day for 30 mins to 1 hr
Within each 30min-1hr kick count time frame, how many fetal movements should be felt?
5-6
How long of an absence in fetal movement is a cause for concern?
12 hrs
***Call doc
How long to count fetal movement during each time period?
30 mins - 1 hr
***book says 1 hr, but if she gets 2-3 kicks in 30 mins, she would not need to continue counting
How many levels of U/S are there?
Three:
- Level One
- Level Two
- Level Three
What is Level One U/S checking for?
Fetal viability
Fetal presentation
Gest. Age
Placental Location
Fetal Amniotic Structures
AF vol.
What is Level Two U/S checking for?
Fetal Presentation during labor
FHT (when unable to obtain other ways)
What is Level Three U/S checking for?
anatomically or physiologically abnormal fetus
When would a Level Two U/S be called for?
a specific reason
When would a Level Three U/S be called for?
Detailed or Targeted inspection of fetus
When is the U/S more accurate?
the earlier it is taken
What are major uses for U/S during First Trimester?
Confirm Preg and Viability
Determine Gest. Age
Rule out Ectopic Preg
Detect Multips
Determine cause of Vag bleeding
Visualization during Chorionic Villis Sampling
Detect maternal abnormalities like bicornuate uterus, ovarian cysts, fibroids
What are major uses for U/S during Second Trimester?
Confirm EDC and Viability
Detect Poly- or Oligohydramnios
Detect Congenital Abnormalities
Detect IUGR
Assess Placental Location
Visualization during Amniocentesis
What are major uses for U/S during Third Trimester?
Confirm Gest. Age and Viability
Detect Macrosomia
Detect congenital abnormalities
Detect IUGR
Determine Fetal Position
Detect Placental Previa or Abruption
Visualization during Amniocentesis
Biophysical Profile
AF Vol. Assessment
Doppler Flow studies
Detect Placental Maturity
In order to perform an Abdominal U/S, what must we tell client?
bladder must be full (especially during first and third trimesters)
Sitting or reclining w/ wedge under hip
Which position would client be in to perform a Transvaginal U/S?
Lithotomy
When would the Transvaginal U/S be used?
frequently in early weeks of pregnancy and also to determine cervical length
How is gestational age and EDC determined via U/S during first trimester?
crown-rump length
How is gestational age and EDC determined via U/S during second trimester?
biparietal diameter of skull
femoral length
What Amniotic Fluid Index are we looking for?
between 10 - 25 cm
*** less than 5 cm is oligohydramnios
***more than 25 cm is polyhydramnios
What is oligohydramnios?
What is polyhydramnios?
> 25 cm of AF
***sign that baby’s kidney’s are overfunctioning
— is associated with congenital anomalies (renal) and growth restrictions
— is associated with neural tube defects, obstruction of GI tract, multips, and fetal hydrops.
Oligohydramnios ( 25 cm of AF)
How is Biophysical Profile measured and what is it measuring?
Abdominal U/S
Measures:
- Fetal Breathing Mvmts
- Gross Body Mvmt
- Fetal Tone
- Qualitative AF Vol.
- Reactive Non Stress Test (NST)
Biophysical Profile:
What fetal breathing movements are we looking for?
At least one episode of fetal breathing mvmts of at least 30 secs in a 20 min interval
***equals 2 points
Biophysical Profile:
What Gross Body Movements are we looking for?
At least three trunk/limb mvmts in 30 mins
***equals 2 points
Biophysical Profile:
What Fetal Tone are we looking for?
At least one episode o active extension w/ return to flexion of fetal limb or trunk;
Opening and closing of hand considered normal tone
***equals 2 points
Biophysical Profile:
What Amniotic Fluid Index are we looking for?
AFI > 5 cm or at least one pocket > 2 cm
***equals 2 points
Biophysical Profile:
What NST are we looking for?
Reactive
***equals 2 points
Biophysical Profile:
What scores do each of the five measures receive?
Normal = 2 points
Abnormal = 0 points
***Looking for 10:10 ratio
What Biophysical Profile scores are considered a low risk for chronic asphyxia?
8 - 10
What Biophysical Profile scores would make you suspect chronic asphyxia?
4 - 6
What Biophysical Profile scores would make you STRONGLY suspect chronic asphyxia?
0 - 2
When would an Amniocentesis be done?
after 14 wks gestation when uterus rises above symphysis pubis and fluid amounts are adequate to sample
*** take to lab in brown bag (kept out of light)
— is used as a screening tool for Neural Tube Defects.
Amniocentesis (Alpha-Fetoprotein)
How can Amniocentesis determine lung maturity?
shows L/S ratio to determine lung maturity
Why would we do an Amniocentesis in early pregnancy?
What about late pregnancy?
Early = detect chromosomal abnormalities
Late = determine fetal lung maturity (L/S ratio)
What L/S ratio indicates lung maturity?
2:1
What are some complications from Amniocentesis?
Infection
Fetal injury
AF leakage
Pregnancy loss (spontaneous abortion)
Maternal Hemorrhage
Rh Isoimmunization
AF Embolism
***1 out of every 450 babies can die
Nursing Responsibilities for Amniocentesis?
Have mom empty bladder
Monitor Fetus before procedure and at least 1 hour afterwards
Observe for Vaginal bleeding, leakage of AF, severe cramping, or fever
Mild physical discomfort (mom will be scared)
When would Chorionic Villus Sampling be performed?
10-13 wks of preg
***diagnoses chromosomal and genetic defects
What are the two ways that the Chorionic Villus sample can be taken?
Vaginally
Abdominally
Why is a Chorionic Villus Sample a good representation of baby’s genetic makeup?
cells from villi have same genetic makeup as the cells from embryo
Why has Chorionic Villus Sampling declined?
Triple and Quad Screenings have replaced it
What are the advantages of Chorionic Villus Sampling?
Can be done early (10-13 wks)
Sample gives ACTUAL genetic makeup of baby
What are the disadvantages of Chorionic Villus Sampling?
Bleeding
ROM
Intrauterine Infection
Spontaneous Abortion
Limb Anomalies (if done before 10 wks)
Which procedure gives direct access to fetal blood circulation and requires a 1-4mL blood draw from umbilical cord?
Percutaneous Umbilical Blood Sampling (PUBS)
***aka Cordocentesis
What important test requires a PUBS sample?
Kleihauer-Betke Test
***determines maternal/fetal cross contamination of blood
What is treatment for a positive Kleihauer-Betke Test?
transfuse the anemic or thrombocytopenic fetus in utero
What are complications of PUBS?
Bleeding from puncture site
Cord laceration
Thromobembolism
Preterm Labor
Premature ROM
Infection
What are nursing responsibilites regarding PUBS?
Continuous Fetal Monitoring for 1-2 hrs after procedure
Repeat U/S if bleeding or hematoma formation
Have mom do kick counts at home
Elevated levels of — are associated with open neural tube and abdominal wall defects.
Maternal Serum Alpha Fetoprotein (MSAFP)
***AFP is produced in the FETAL gestational tract & liver and increasing levels are detectable in the maternal serum from 14-34 weeks.
When would a Maternal Serum Alpha Fetoprotein screen be performed?
b/t 15-20 wks
What tests are done in Triple Screening?
Quad Screening?
Triple:
- MSAFP
- Unconjugated Esteriol
- hCG
Quad:
- MSAFP
- Unconjugated Esteriol
- hCG
- Inhibin A
Triple Screen:
What will it look like if Trisomy 18?
What will it look like if Trisomy 21?
Trisomy 18 = all will be low
Trisomy 21 =
- MSAFP will be low
- Esteriol will be low
- hCG will be high
With Quad Screen, what would happen if Inhibin A is high?
extra screening would be down for women less than 35 for Down Sydrome
Trisomy – babies are usually stillborn (or have many major problems if they live).
18
***will never meet developmental milestones
What is a Non-Stress Test (NST)?
fetal monitoring for 20-30 mins with vibroacoustic stimulation
What is a Reacgtive NST?
normal FHR baseline w/ accels
***nonreactive will require additional testing (BPP)
What type of Contraction Stress Test do you want?
negative (for bad outcomes)
***CST provides an earlier warning of fetal compromise than NST
What does a Contraction Stress Test look for?
see if baby gets stress by contractions
***aka Oxytocin Challenge Test
How is a Contraction Stress Test performed?
FHR baseline for 10-20 mins
Contractions Started
- 3 in 10 mins
Report findings
- Negative
- Positive
- Equivocal
- Suspicous
- Unsatisfactory
How are contractions started w/ Contraction Stress Test?
Nipple Stimulation
IV Pitocin
