UNIT 2 HIGH RISK PREGNANCY CHAPTER 10,11,12 Flashcards
What are some risk factors of HIGH Risk Pregnancy
Biophysical
Psychosocial
Demographic
Environmental
What would indicate the pregnant mother is at high risk Biohysically?
Biophysical risks include factors that originate within the mother or fetus and affect the development or functioning of either one or both. Examples include genetic disorders, nutritional and general health status, and medical or obstetric-related illnesses. Box 10.2 lists common risk factors for several pregnancy-related problems.
EXAMPLES
Poorly controlled diabetes mellitus
Fetomaternal hemorrhage
Fetal congenital anomalies (e.g., gastrointestinal obstruction, central nervous
system abnormalities)
Genetic disorders
Twin-to-twin transfusion syndrome
Genetic considerations: Genetic factors may interfere with normal fetal or neonatal development, result in congenital anomalies, or create difficulties for the mother. These factors include defective genes, transmissible inherited disorders and chromosomal anomalies, multiple gestation, large fetal size, and ABO incompatibility.
- Nutritional status: Adequate nutrition, without which fetal growth and devel- opment cannot proceed normally, is one of the most important determinants of pregnancy outcome. Conditions that influence nutritional status include the following: adolescent pregnancy; three pregnancies in the previous 2 years; tobacco, alcohol, or drug use; inadequate dietary intake because of chronic illness or food fads; history of bariatric surgery; inadequate or excessive weight gain; and hematocrit value less than 33%.
- Medical and obstetric disorders: Complications of current and past pregnancies, obstetric-related illnesses, and pregnancy losses put the woman at risk
What would indicate the pregnant mother is at high risk Psychosocially?
Psychosocial risks consist of maternal behaviors and adverse life events that have a negative effect on the health of the mother or fetus. These risks may include emotional distress, history of depression or other mental health problems, disturbed interpersonal relationships such as intimate partner violence, substance use or abuse, inadequate social support, and unsafe cultural practices.
Smoking: Risks include low birth weight infants, higher neonatal mortality rates, increased rates of miscarriage, and increased incidence of prelabor rupture of membranes. These risks are aggravated by low socioeconomic status, poor nutritional status, and concurrent use of alcohol.
- Caffeine: Birth defects in humans have not been related to caffeine con- sumption. However, pregnant women who consume more than 200 mg of caffeine daily (equivalent to about 12 ounces of coffee per day) may be at increased risk for giving birth to infants with intrauterine growth restriction (IUGR).
- Alcohol: Although the exact effects of alcohol in pregnancy have not been quantified and its mode of action is largely unexplained, it exerts adverse effects on the fetus, resulting in fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity.
- Drugs: The developing fetus may be affected adversely by drugs through several mechanisms. They can be teratogenic, cause metabolic disturbances, produce chemical effects, or cause depression or alteration of central nervous system (CNS) function. This category includes medications prescribed by a health care provider or bought over the counter, and commonly abused drugs such as heroin, cocaine, and marijuana (see Chapter 11 for more information about drug and alcohol abuse).
- Psychologic status: Childbearing triggers profound and complex physiologic, psychologic, and social changes, with evidence to suggest a relationship be- tween emotional distress and birth complications. This risk factor includes conditions such as specific intrapsychic disturbances and addictive lifestyles; a history of child abuse or intimate partner violence; inadequate support systems; family disruption or dissolution; maternal role changes or conflicts; noncompliance with cultural norms; unsafe cultural, ethnic, or religious prac- tices; and situational crises.
What would indicate the pregnant mother is at high risk Demographically?
Sociodemographic risks arise from the context in which the mother and family live. These risks may place the mother and fetus at risk. Examples include lack of prenatal care, low income, single marital status, and living as an ethnic minority within a context of structural racism (see Box 10.1).
Low income: Poverty underlies many other risk factors and leads to inade- quate financial resources for food and prenatal care, poor general health, in- creased risk for medical complications of pregnancy, and greater prevalence of adverse environmental influences.
* Lack of prenatal care: Failure to diagnose and treat complications early is a major risk factor arising from financial barriers or lack of access to care;
* Marital status: The increased mortality and morbidity rates for unmarried women, including an increased risk for preeclampsia, are often related to in- adequate prenatal care and a young childbearing age.
* Parity
The number of previous pregnancies is a risk factor associated with age and includes all first pregnancies, especially a first pregnancy at either end of the childbearing age continuum. The incidence of preeclampsia and dystocia is increased with a first birth.
* Age: Women at both ends of the childbearing age spectrum have an in- creased incidence of poor outcomes; however, age may not be a risk factor in all cases. Physiologic and psychologic risks should be evaluated.
* Adolescents: Possible pregnancy and birth complications include anemia, preeclampsia, prolonged labor, and contracted pelvis and cephalopelvic dis- proportion. Long-term social implications of early motherhood are lower edu- cational attainment, lower income, increased dependence on government support programs, higher divorce rates, and higher parity.
* Mature mothers: The risks to older mothers (over 35 years of age) are not from age alone but from other considerations such as number and spacing of previ- ous pregnancies, genetic disposition of the parents, medical history, lifestyle, nutrition, and prenatal care.
* Ethnicity: Although ethnicity by itself is not a major risk, race is associated with some poor pregnancy outcomes. In the United States, for example, African American women have rates of preterm birth that are almost twice as high as those of other racial and ethnic groups.
What would indicate the pregnant mother is at high risk Environmentally?
Various environmental substances can affect fertility and fetal development, the chance of a live birth, and the child’s subsequent mental and physical develop- ment. Environmental influences include infections, radiation, chemicals such as mercury and lead, therapeutic drugs, illicit drugs, industrial pollutants, cigarette smoke, stress, and diet. Paternal exposure to mutagenic agents in the workplace has been associated with an increased risk for miscarriage.
Toxoplasmosis results from infection with a common parasite found in cat feces and contaminated food. It can cause serious complications for pregnant women and people with weakened immune systems.
Symptoms include muscle pain, fever, and headache, all of which can last for weeks.
DO NOT USE OR DO
eating raw food
and handling cat litter
What statement would be considerate of a patients pyschosocial status (pregnant woman)?
A. Is there anything that has been causing stress at home are you using any drugs to cope?
B. Is there any genetic disorders that run in your family that might affect the baby?
A. Is there anything that has been causing stress at home are you using any drugs to cope?
Psychosocial risks consist of maternal behaviors and adverse life events that have a negative effect on the health of the mother or fetus. These risks may include emotional distress, history of depression or other mental health problems, disturbed interpersonal relationships such as intimate partner violence, substance use or abuse, inadequate social support, and unsafe cultural practices.
Label of a high-risk pregnancy may
result in:
* Increased sense of vulnerability
* Stress related to diagnoses
* Ambivalence regarding pregnancy
* Inability to accomplish tasks of
parenthood
* Fearful for well-being of mother
What is the function of the Coombs test?
Rh incompatibility; detects antibodies for incompatibility to
maternal antigens
* Cell free DNA in maternal blood
* A new screening message for noninvasive prenatal genetic
diagnosis
* Fetal Rh status; Fetal gender
* Paternally transmitted single gene disorders
* Works by amplifying cell free DNA
What does IUGR stand for? What type of pregnant patients?
Intrauterine Growth Restriction
A condition in which a baby doesn’t grow to normal weight during pregnancy.
What is Electronic Fetal Monitoring
- Goal
- to determine if intrauterine
environment supportive to fetus - Non-stress test (fetal activity
determination) REACTIVE IS GOOD - Procedure
- Interpretation 32 weeks
gestation before valid - Vibroacoustic stimulation
What does Fetal Monitoring Movement consist of ?
baby kicks
5 kicks every hour is good
Daily fetal movement count
(DFMC)
* Simple yet valuable method to
evaluate fetal wellbeing
* Several methods can be used
to count
* Once a day for 60 minutes
* 2 to 3 times daily
* 10 movements in 2-hour
period optimal
What is one of the most noninvasive as simplest ways to monitor fetal well being?
A. Daily fetal movement count
B. Non stress test
A. Daily fetal movement count
Is it important to eat before Daily fetal movement count?
Yes
No
Yes
- Eat meal or snack before
counting - Limit external stimuli
to concentrate on kicks
Would you increase external stimuli when starting the daily fetal movement count?
Yes
No
No
Indications for use of Ultrasonography?
Diagnostic ultrasonography is an important, safe technique in ante- partum fetal surveillance. It is considered by many to be the most valuable diagnostic tool used in obstetrics. It provides critical informa- tion to health care providers regarding fetal activity and gestational age, normal versus abnormal fetal growth curves, fetal and placental anatomy, fetal well-being, and visual assistance that increases the safety of invasive tests that must be performed
*Fetal heart rate activity
* Gestational age
* Fetal growth
* Fetal anatomy
* Fetal genetic disorders
* Placental position &
function
* Adjunct to invasive tests
Magnetic
resonance
imaging (MRI)
Magnetic resonance imaging (MRI) is a noninvasive radiologic technique used for obstetric and gynecologic diagnosis. Similar to computed tomography (CT), MRI provides excellent pictures of soft tissue. Unlike CT, ionizing radiation is not used. Therefore, vascular structures within the body can be visualized and evaluated without injecting an iodinated contrast medium, thus eliminating any known biologic risk. Similar to that of sonography, MRI is noninvasive and can provide images in multiple planes, but no interference occurs from skeletal, fatty, or gas-filled structures, and imaging of deep pelvic structures does not require a full bladder.
Fetal structure & growth
* Placenta (position, density, &
presence of gestational
trophoblastic disease)
* Quantity of amniotic fluid
* Maternal structures (uterus,
cervix, adnexa, and pelvis)
* Biochemical status of tissues &
organs
* Soft tissue, metabolic, or
functional anomalies
