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OB > Test 4 High Risk Factors > Flashcards

Test 4 High Risk Factors Flashcards

1
Q

What is a pregnancy in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to the pregnancy.

A

High risk pregnancy

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2
Q

What are the purposes of antenatal testing?

A
  • determine fetal well-being
  • estimate growth and weeks gestation
  • predict outcome of pregnancy
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3
Q

Ways that we can observe fetal well-being on the monitor:

A

Variability
FHR
Accels

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4
Q

Polyhydraminos

A

too much amniotic fluid…b/c baby is peeing a lot

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5
Q

Oligohydraminos

A

not enough amniotic fluid…b/c baby isn’t peeing enough

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6
Q

Smoking causes vasoconstriction. What can this cause for the fetus?

A

May not get enough nourishment from the placenta, so there could be a growth constriction

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7
Q

What 5 things does the nurse need to know about each test?

A

1) Indication for the test
2) Timing of the tests
3) How the test is done
4) Interpretation of test results
5) Nursing care with each test

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8
Q

Fetuses should be active unless _____.

A

asleep

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9
Q

How often should a high-risk mother check for fetal movements?

A

2-3 x day for 30 min to 1 hr

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10
Q

How often should a low risk mother check for fetal movements?

A

1-2 x day for 30 min to 1 hr

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11
Q

Should feel ____ fetal movements within each kick count.

A

5-6

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12
Q

We will be concerned if there is no fetal movement in ____ hrs. What test would be ordered?

A

12

Ultrasound

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13
Q

When should the mother call the doctor regarding fetal movement?

A

No movement in 12 hrs.

Consistent decrease in movement.

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14
Q

What are the 3 levels of ultrasound?

A

1) Standard (Basic or Level 1)
2) Limited (Specific Reason or Level 2)
3) Specialized (Detailed/Targeted or Level 3)

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15
Q

What does a Level 1 US check?

A
  • fetal viability
  • presentation
  • gestational age
  • placental location
  • fetal anatomic structures for malformation & amniotic fluid volume
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16
Q

What does a Level 2 US check?

A
  • fetal presentation during labor

- FHT when not able to obtain in other ways (ie obese mom)

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17
Q

What does a Level 3 US check?

A
  • anatomically or physiologically abnormal fetus (ie heart probs in utero)
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18
Q

Which US is more accurate - early or late?

A

Early

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19
Q

Bladder full or empty for:
1st Trimester
2nd Trimester
3rd Trimester

A

1st: Full bladder
2nd: Full bladder
3rd: Empty bladder

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20
Q

How can the gestational age and EDC (due date) be determined by US?

A

1st trimester: crown-rump length

2nd trimester: biparietal diameter of fetal skull

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21
Q

What are the classifications of amniotic fluid index (AFI)?

A

Oligohydraminous: 25cm

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22
Q

What is a biophysical profile (BPP) and what does it measure?

A 
An abdominal US
Measures:
- fetal breathing movements
- gross body movement
- fetal tone
- qualitative amniotic fluid volume
- reactive non stress test
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23
Q

What do we look for with fetal tone?

A

Is the fetus really moving extremities or just body.

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24
Q

What are the scores of the BPP?

A

Normal = 2
Abnormal = 0
Looking for a 10:10 ratio

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25
Q

What does an amniocentesis check for?

A

genetic abnormalities

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26
Q

How do we send the amniocentesis specimen to the lab, why?

A

In a brown paper sack, b/c it can be negatively effected by light

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27
Q

When can an amniocentesis be performed?

A

after 14 weeks b/c uterus rises above the symphysis pubis and fluid amounts are adequate for sample

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28
Q

What does the amniotic fluid show?

A
  • Lecithin/syhingomyelin (L/S ratio) or shake test –> checks for fetal lung maturity
  • Alpha-fetoprotein –> used as screening tool for neural tube defects
  • Desquamated fetal cells –> allows for genetic testing
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29
Q

Why would an amniocentesis be done in early pregnancy?

A

detect chromosomal abnormalities

30
Q

Why would an amniocentesis be done in late pregnancy?

A

most often to determine fetal lung maturity with L/S ratio to detect the amount of surfactant production in fetal lungs

31
Q

What does the L/S ratio of 2:1 indicate?

A

Lung maturity

32
Q

What is surfactant?

A

substance that reduces the surface tension of pulmonary fluids to allow gas exchange in the alveoli.

33
Q

What are potential complications of amniocentesis?

A
  • infection
  • injury to fetus
  • leakage of AF
  • pregnancy loss
  • maternal hemorrhage
  • Rh isoimmunization
  • amniotic fluid embolism
  • fetal death
34
Q

What are the nursing responsibilities for amniocentesis?

A
  • mother empty bladder
  • monitor fetus before procedure and at least 1 hr post-procedure using EFM
  • observe for vaginal bleeding, leakage of amniotic fluid, severe cramping, or fever
  • mild physical discomfort; most women fear procedure
35
Q

What does chorionic villus sampling check?

A

Diagnoses chromosomal and genetic defects

36
Q

When is a CVS checked?

A

10-13 weeks

37
Q

Where is the sample of blood and tissue taken from with a CVS?

A

edge of placenta

38
Q

Can the placenta be accessed vaginally or abdominally for CVS?

A

Both

39
Q

Cells from the villi have the same genetic make-up as the cells from the ____.

A

embryo

40
Q

Is CVS a safe or risky procedure for baby?

A

risky!

41
Q

What tests have helped decrease the need for CVS?

A

triple & quad screens

42
Q

What are the advantages of CVS?

A
  • can be done early in pregnancy, 10-13 wks

- sample gives genetic makeup data

43
Q

What are the disadvantages of CVS?

A
  • bleeding
  • rupture of amniotic membranes
  • intrauterine infection
  • spontaneous abortion
  • performed prior to 10 wks gestation, has been associated with limb anomalies
44
Q

What is a percutaneous umbilical blood sampling (PUBS)?

A

Test for genetic information, fetal infection, assessment & treatment of isoimmunized and thrombocytopenic fetus

45
Q

How is PUBS performed?

A

US guided withdrawal of blood (1-4ml) from a fetal umbilical blood vessel near its insertion into the placenta

46
Q

What does the PUBS Kleihauer-Betke test check for?

A

checks for maternal-fetal cross contamination

47
Q

What are potential complications of PUBS?

A
  • bleeding from puncture site
  • cord laceration
  • thromboembolism
  • preterm labor
  • premature ROM
  • infection
48
Q

What follow-up is needed after PUBS?

A
  • continuous fetal monitoring for 1-2 hours after procedure and repeat US for bleeding or hematoma formation
  • teach mom fetal kick counts for at home monitoring
49
Q

What does maternal serum alpha fetoprotein (MSAFP) check for?

A

neural tube and abdominal wall defects

50
Q

When is MSAFP performed?

A

between 15-20 weeks

51
Q

What test is ordered if MSAFP shows elevated levels indicative of neural tube or abdominal defects?

A

Ultrasound to rule out fetal abnormalities or multiple gestation

52
Q

Alpha-fetoprotein is produced in the fetal ____ ____ & ____.

A

gestational tract

liver

53
Q

What weeks is AFP detectable in maternal serum?

A

14-34 weeks

54
Q

What are the multiple marker screen tests?

A

triple & quad screens

55
Q

What does the triple screen test?

A
  • MSAFP
  • unconjugated esteriol
  • hCG
56
Q

What does the quad screen test?

A
  • MSAFP
  • unconjugated esteriol
  • hCG
  • Inhibin A
57
Q

Trisomy 21 is called:

A

Down’s Syndrome

58
Q

Trisomy 18 is called:

A

Edward’s Syndrome

59
Q

What does non stress test (NST) check for?

A

fetal movement ???

60
Q

How long is the fetus monitored in a NST?

A

20-30 min

61
Q

What is a REACTIVE finding of NST?

A

normal FHR baseline with fetal movement (accelerations = fetal movement)

62
Q

What is a NONREACTIVE finding of NST?

A

Additional testing needed

will require a BPP to be done

63
Q

What is vibroacoustic stimulation?

A

Sound & vibration used to elicit a fetal response

64
Q

Contraction Stress Test (CST) or Oxytocin Challenge Test (OCT)…monitor FHR for:

A

10-20 min for baseline

65
Q

CST or OCT…contractions started by:

A
  • nipple stimulation

- IV pitocin/oxytocin

66
Q

CST or OCT…we want ___ contractions in ___ min.

A

3 contractions in 10 min

67
Q

CST/OCT…findings are classified as:

A
  • negative
  • positive
  • equivocal
  • suspicious
  • unsatisfactory
68
Q

What constitutes a NEGATIVE CST/OCT?

A

NO decels

Negative means good

69
Q

What constitutes a POSITIVE CST/OCT?

A

Late decels with 50% or more contractions

Positive means bad

70
Q

What constitutes an EQUIVOCAL/SUSPICIOUS CST/OCT?

A

Late decels or prolonged variable with 50% of contractions

71
Q

What constitutes an EQUIVOCAL HYPERSTIMULATORY CST/OCT?

A

Decels with contractions every 2 min or lasting longer than 90 secs
*not enough time to reoxygenate

72
Q

What constitutes an UNSATISFACTORY CST/OCT?

A

No contraction in 10 min or unable to determine FHR

OB (12 decks)

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