week 3 Flashcards
what is the definition of a high-risk pregnancy?
The life or health of the mother or newborn is jeopardized by a disorder or medical factors
Age considerations: Adolescent Pregnancy
Risk
● Adolescent individuals (ages 10 to 19 years) are at increased risk for eclampsia,
puerperal endometritis, and systemic infections
● Mortality
● Perinatal complications are the leading cause of death for 15- to 19-year-old girls
globally (WHO, 2016).
● Early pregnancy or marriage causes an estimated 5% to 33% of girls (aged 15 to
24 years) to drop out of school (World Bank, 2017).
Age Pregnancy > 35 years risks
Increased risk of:
- Maternal death (even higher over 40)
- Miscarriage
- Stillbirth
- Preterm
- Low birth weight
- Perinatal mortality
- Down syndrome
Despite higher risk, overall risks are still low for women who are healthy, and free of
pre-existing disease
* Risk higher for women with pre-existing medical conditions
abuse during pregnancy increases the risk for?
placental abruption, preterm birth, low-birth-weight infants, and infections from nonconsensual sex
-prematurity, NICU, infant/maternal mortality
-maternal depression
-substance abuse
IPV Screening Tools
what is the RADAR Tool ?
Remember to ask routinely about IPV as a matter of routine patient care
Ask directly about violence with such questions as “at any time, has a partner hit, kicked
or otherwise hurt or frightened you?” interview your patient in private at all times
Document findings related to suspected intimate partner violence in the patient’s chart
Assess your patient’s safety. Is it safe to return home? Find out if any weapons are kept
in the house, if the children are in danger, and if the violence is escalating
Review options with your patient. Know about the types of referral resources in your
community (e.g., shelters, support groups , legal advocate)
types of pregnancy loses include
A: Threatened
B: Inevitable
C: Incomplete
D: Complete
E: Missed
-septic
-recurrent
threatened abortion
bleeding: slight, spotting
uterine cramping: mild
cx: close
-no explosion of products
-bed rest is ordered (not rlly info evidence based to say this works)
-repetitive transvaginal ultrasounds
and assessment of the human chorionic
gonadotropin and progesterone levels may be
done to determine if the fetus is still alive and in
the uterus
inevitable abortion
bleeding: moderate
uterine cramping: mild-severe
cx: open
-no explosion of products
-bed rest if no fever, pain, or bleeding is present
-if the membranes rupture, bleeding, and pain is present, the uterus is immediately emptied usually by dilation and curettage
incomplete abortion
bleeding is heavy and profuse
-uterine cramping is severe
-CX is open
-expulsion of products
-may require additional cervical dilation before curettage
-suction curettage may be performed
complete abortion
bleeding: slight
uterine cramping: mild
CX: close
expulsion of products
no further intervention may be needed if uterine
contractions are adequate to prevent hemorrhage
and no infection is present
-suction curettage may be performed to ensure no retained fetal or maternal tissue
missed abortions
bleeding: none, spotting
-uterine cramping none
CX: closed
no explosion of products
-If spontaneous evacuation of the uterus does not
occur within 1 month, pregnancy is terminated by
method appropriate to gestational age.
-monitor blood clotting until the uterus is empty
DIC (disseminated intravascular coagulation) and in coagulability of blood with uncontrolled hemorrhage may develop if fetal death products are still retained after the 12th weeks for longer than 5 weeks
sceptic abortion
bleeding: usually varies
uterine cramping: varies
CX: open usually
expulsion of products
Immediate termination of pregnancy by method
appropriate to duration of pregnancy. Cervical
culture and sensitivity studies done, and broad-
spectrum antibiotic therapy (e.g., ampicillin)
started.
Treatment for septic shock initiated if necessary
recurrent abortion
bleeding: varies
uterine cramping: varies
CX: open
expulsion of products
Prophylactic cerclage may be performed if
premature cervical dilation is the cause.
Tests of value include parental cytogenetic
analysis and lupus anticoagulant and
anticardiolipin antibody assays on the patient.
teaching after pregnancy loss
-Advise the patient to report any heavy, profuse, or bright red bleeding
● A scant, dark discharge may persist for 1 to 2 weeks.
● Avoid putting anything into the vagina for 2 weeks or until bleeding has stopped
(e.g., no tampons, no vaginal intercourse).
● Take antibiotics as prescribed.
● Report to health care provider elevated temperature or a foul-smelling discharge
● Advise the patient to eat foods high in iron and protein
● Acknowledge that the patient loss.
● Speak with family and seek support from friends.
● Refer the patient to support groups, clergy, or professional counseling, as
needed.
● Postponed for at least 2 months to allow their body to recover
Cervical insufficiency
Passive and painless dilation of the cervix without
contractions or labor
-can be d/y structural weakness or cervical trauma
treatment for Cervical insufficiency
- Cervical cerclage (placed at 12 to 14 weeks of gestation).
- Importance of continuous close observation and
supervision for the rest of the pregnancy. - Report signs of preterm labour, rupture of membranes,
and infection.
when should the pt visit the hospital immediately from a cervical cerclage?
Visit the hospital immediately: presence of regular strong contractions, preterm PROM, severe perineal
pressure, and an urge to push
what is the treatment of choice for cervical weakness?
Cervical cerclage
what are the indications for cerclage placement?
- poor obstetrical history (three or more previous early preterm births or second-trimester losses), a short (less than 25
mm) cervical length identified on transvaginal ultrasound, and an open cervix found on digital or speculum examination
Ectopic Pregnancy
Fertilized ovum implanted outside uterine cavity
* 95% occur in uterine (fallopian) tube
* Most located on ampullar
-basically pregnancy that occurs outside the uterus
what are the clinical manifestations of ectopic pregnancy?
Abdominal pain
* Missed menstrual period
* Abnormal vaginal bleeding (spotting)
* er rupture has occurred,
* referred shoulder pain present (diaphragmatic
irritation)***
* one-sided, or deep lower-quadrant acute abdominal pain
how to diagnose an Ectopic Pregnancy?
Ultrasonography, Serum progesterone, and β-hCG levels
what is the medical management of ectopic pregnancy?
Methotrexate: antimetabolite and folic acid antagonist that destroys rapidly dividing cells
* Surgical management (Salpingostomy or Salpingectomy)
* general pre and post)
what teaching to give with Methotrexate?
Advise the patient to do the following:
* Avoid intake of foods and vitamins
containing folic acid.
* Avoideating“gas-forming”foods.
* Avoidsunexposure.
* Avoid sexual intercourse until the β-hCG
level is undetectable.
* Keep all scheduled follow-up
appointments.
* Contact health care provider immediately
if experience severe abdominal pain, which may be a sign of impending or actual tubal rupture.
what is Hydatidiform Mole? (molar pregnancy)
A gestational trophoblastic disease (GTD) * Abnormal fertilization without a
viable fetus
-direct cause is unknown
there are two different kinds of Hydatidiform Mole. what are they?
-Complete mole: results from fertilization of egg with lost or inactivated nucleus
* Partial mole: result of two sperm fertilizing a normal ovum
hydratidiform mole clinical manifestations?
- Vaginal bleeding
- Significantly larger uterus
medical management of hydratidiform mole
Most pass spontaneously.
* Suction curettage is safe, rapid, and effective, if necessary.
* Induction of labour with oxytocin or prostaglandins is not recommended.
* Administration of Rho(D) immune globulin, if indicated
Late Pregnancy Bleeding: Placenta Previa
Placenta previa: the placenta is implanted in the lower uterine segment such that
it partially or completely covers the cervix to cause bleeding when the cervix
dilates or the lower uterine segment effaces
Complete placenta previa
internal cervical os totally
Marginal placenta previa
the edge of the placenta to the internal
cervical os
Low-lying placenta
relation between the placenta to the internal
cervical os has not been determined
clinical manifestations of placenta previa
-Bright red bleeding during 2nd or 3rd trimester
* Pain absent
* Uterine is normal
* Normal fetal HR
-fundal height is often greater than expected
what is the major maternal complicated associated with placenta previa?
-the major maternal complication associated with placenta previa is hemorrhage
-Bleeding,
-Preterm birth and
-IUGR
-Another serious complication is development of an abnormal placental
attachment
placenta previa is diagnosed through?
- transabdominal or vaginal ultrasound
what are the risk factors of placenta previa ?
-Smoking
● Multiparity
● Cocaine use
● Erythroblastosis
● Nonwhite ethnicity
● Infertility treatment
● Recurrent abortions
● Prior uterine surgery
● Advancing age (>35 years)
● Low SES
● Short interpregnancy interval
● Multiple gestation (larger surface area of the placenta)
expectant management of placenta previa
➢ Patient is less than 36 weeks of gestation
➢ Not in labor and the bleeding is minimal or has stopped,
➢ may remain in the hospital or be at home if bleeding is stable.
➢ No vaginal or rectal examinations are performed
➢ Ultrasound examinations may be done every 2 weeks
● Bleeding is assessed by checking the amount of bleeding on perineal pads
(weighing pad: 1 gram = 1 ml of blood)
-potential emergency b/c massive blood loss
-Antepartum steroids (betamethasone) may be ordered to promote fetal lung
maturity if the patient is at less than 34 weeks of gestation
placenta previa active management:
Cesarean birth (fetus is mature, excessive bleeding develops, or active labour
begins)
placenta abruption
Detachment of part or all of the placenta from its implementation site
Grades: 1 (mild), 2 (moderate), 3 (severe)
1. partial separation- concealed hemorrhage
2. partial separation - apparent hemorrhage
3. complete separation- concealed hemorrhage
placental abruption clinical presentation
Clinical presentation: vaginal bleeding, abdominal pain, uterine tenderness,
and contractions
Major cause antepartum hemorrhage
placental abruption risk factors
-Maternal hypertension/Preeclampsia
● Age
● Increasing parity
● Multiple gestations
● Polyhydramnios (excess amniotic fluid)
● Chorioamnionitis
● Preterm PROM
● Trauma (assault or motor vehicle collusion)
● Substance use e.g cocaine
● History of abruption
what is the main difference between placenta previa and placental abruption
is painless bleeding (previa) and painful bleeding (abruption)
partial separation- concealed hemorrhage- mild
minimal bleeding <500 - dark red
no shock (rare)
uterine tonicity -normal
pain- usually absent
fetal status- normal fetal heart rate pattern
DIC - rare/none
- partial separation - apparent hemorrhage
absent or moderate 1000-1500ml bleeding
-mild shock
-uterine tonicity -increase uterus fail relax between contraction
-pain is moderate to severe
-fetal heart rate is atypical
-occasional DIC
- complete separation- concealed -severe separation
-bleeding is absent heavy
>1500 dark red
-shock is common and sudden
-uterine tonicity- tetanic, persistent contraction birdlike uterus
-agonizing unremitting pain
-abnormal fetal heart rate, death can occur
-frequent DIC
placental abruption complications- maternal- and fetal
Maternal Complications:
● Hemorrhage
● Hypovolemic shock
● Hypofibrinogenemia and thrombocytopenia present in severe abruption
● Couvelaire uterus
● DIC
● Infection may occur
● Rh negative can become sensitized if the fetal blood type is Rh positive
Fetal Complication:
● IUGR, preterm birth, hypoxemia, and stillbirth
● Risks for neurological defects, cerebral palsy, and death from sudden infant
death syndrome
nursing care in placenta abruption
● Expectant management if the fetus is less than 36 weeks of gestation and not in
distress
● Patient is hospitalized and closely observed for signs of bleeding and labour.
● Fetal status monitoring with intermittent FHR monitoring and NST or BPP until
fetal maturity is achieved Continuous electronic fetal monitoring is mandatory
● Maternal vital signs should be monitored frequently for signs of declining
hemodynamic status,
● Use of corticosteroids to accelerate fetal lung maturity
● Immediate birth is indicated if condition deteriorates.
● Rh negative patient may be given Rho(D) immunoglobulin if fetal blood is Rh
positive.
● Emotional support for the patient and their family is crucial
Clotting Disorders in Pregnancy: DIC
Disseminated intravascular coagulation (DIC): Pathological form of diffuse clotting that
uses up clotting factors, causing widespread external and internal bleeding
DIC is most often triggered by the release of large amounts of tissue thromboplastin
causes of DIC
DIC is most often triggered by the release of large amounts of tissue thromboplastin
cause By:
* In the obstetrical population DIC is most often triggered by the release of large
amounts of tissue thromboplastin, which occurs in placental abruption
* placental abruption (the most common cause of severe consumptive
coagulopathy in obstetrics), Retained dead fetus syndrome
* Amniotic fluid embolus (anaphylactoid syndrome of pregnancy).
* Pre-eclampsia, HELLP syndrome
* Gram-negative or Gram-positive sepsis
clinical manifestations for DIC
-spontaneous bleeding from gums, nose
-oozing excessive bleeding from venipuncture site, intravenous access site, or site of insertion of urinary catheter
-petachiea (e.g. on arm where bp cuff was placed)
-other signs of bruising
-hematuria
-hemotypsis
-GI bleeding
-tachycardia
-diaphoresis
DIC- coagulation screening test results
-platelets -decreased
-fribriogen- decreased
-factor V (proaccelerin) decreased
-factor VII (anti hemolytic factor) decreased
-prothrombin time- prolonged
-partial prothrombin time -prolonged
-fibrin degradation products -increased
d-dimer test (specific fibrin degradation fragment) increased
-red blood smear- fragmented red blood cells
Nursing and Interprofessional care of DIC
● DIC involves correction of the underlying cause (treatment of existing severe
infection, pre-eclampsia, or eclampsia, or removal of a placental abruption or
dead fetus)
● Volume expansion, rapid replacement of blood products and clotting factors,
● Continued reassessment of laboratory parameters are the usual forms of
treatment.
● Vitamin K administration, recombinant activated factor VIIa, fibrinogen
concentration
● Protecting the patient from injury.
● Urinary output needs to be carefully monitored with an in-dwelling catheter
(goal for urine output is 30 mL/hr or greater)
● Vital signs are assessed frequently.
● Continuous electronic fetal monitoring is necessary.
● Side-lying tilt to maximize blood flow to the uterus.
● Oxygen may be administered
● Keep patient warm with a forced-air warming system (e.g., Bair Hugger),
warmed blankets and fluid warmers
● Patient and family is crucial by offering explanations about care and providing
emotional support
hypertensive disorders in pregnancy
-occurs in 7% and is the leading cause of maternal mortality
SBP of 140mm hg and DBP of 90mm hg or greater taken 2x, 15 minutes apart
-severe HTN is BP 160mm hg and diastolic 110 mm hg
1. chronic HTN occurs before 20 weeks gestation
2. gestational HTN develops after 20 wks gestation and has an absence of proteinuria
manifestations of HELLP
-N/V
-epigastric or right upper quadrant abdominal pain (possibly r/t hepatic ischemia)
Nursing Care Pre-eclampsia and HELLP
Blood pressure assessment
● Deep tendon reflexes: Biceps reflex, Patellar reflex with patient’s legs hanging
freely and test for ankle clonus.
- Decreased or absent deep tendon reflexes are an indication of magnesium
toxicity
-Fetal health surveillance (nonstress test [NST], contraction stress test [CST],
biophysical profile [BPP]), FHR, ultrasonography, fetal movement counting
● Activity restriction – NOT STRICT BEDREST
- Do not restrict but limit would help decrease BP and promote fetal growth
as well as improve amniotic fluid levels
why do we not want to promote bedrest for HELLP syndrome?
Adverse physiological outcomes related to bed rest include cardiovascular deconditioning; diuresis with accompanying fluid, electrolyte, and weight loss; muscle atrophy; and psychological stress
diet and HELLP
- High in protein and low in salt are NOT recommended to prevent pre-eclampsia
- Adequate fluid intake helps maintain optimum fluid volume and aids in renal perfusion and bowel function
Nursing Care Preeclampsia-patient teaching
Report any increase in blood pressure, protein in urine, or decreased fetal
movement.
● Monitor Blood Pressure
● Dipstick Test Clean-Catch Urine Sample to assess proteinuria
● Decreased activity (five or fewer movements in 2 hours) may indicate fetal
compromise.
● Regular appointments need to be kept so that any changes in condition of the
patient or the fetus can be detected immediately.
Nursing Care Preeclampsia and HELLP
Severe pre-eclampsia and HELLP syndrome:
Hospital care
o High-riskunit
o Invasive monitoring
o Seizureprecautions
▪ Environment
✓ Quiet
✓ Nonstimulating
✓ Lighting subdued
✓ Seizure precautions (have magnesium sulphate available
✓ Suction equipment tested and ready to use
✓ Oxygen administration equipment tested and ready to
use
✓ Call button within reach
- Magnesium sulphate
o Magnesium sulphate is the medication of choice in the prevention and treatment of convulsions caused by pre-eclampsia or eclampsia
adverse effects of magnesium sulphate
Observe for signs of toxicity (Loss of patellar reflexes, respiratory and muscular depression, oliguria, and a decreased level of consciousness
o Tissue necrosis can occur with this
-Diuresis within 24 to 48 hours is an excellent prognostic sign; it is considered evidence that perfusion of the kidneys has improved as a result of relaxation of arteriolar spasm
o Early signs of toxicity include vomiting, respiratory distress, hypotension, flushing, muscle weakness, decreased reflexes, and slurred speech
Labetalol
first choice in treating hypertension
eclampsia
usually preceded persistent headache, blurred vision, photophobia, severe epigastric or right upper quadrant abdominal pain, and fits, altered mental status.
-requires immediate care ***
eclampsia nursing considerations
-ensure an patent airway
-administer magnesium sulphate and observe for S/S of toxicity
-assess fetal status
-A rapid assessment of uterine activity, cervical status, and fetal status should be performed after a seizure.
-assessment of vital signs, reflexes, LOC, urine output (intake/output), uterine tone, lochia flow (discharge after giving birth, comprised of mucus, blood and uterine tissue)
Seizure: Immediate care during seizure
-keep airway patient: turn head to one side, and place pillow under one should or back if possible
-call for assistance
-do NOT leave the bedside
-protect pts from injury by having padded railings and a safety lock
-observe and record convulsion activity including time
After Care: of seizure
-do not leave patient unattended until they are fully alert
-observe for post convulsion coma, incontinence
-use suction as needed
-administer oxygen via face mask at 10ml/min
-administer magnesium sulphate or anticonvulsant medication as ordered
-insert in-dwelling urinary catheter and monitor hourly output
-monitor BP
-Monitor fetal and uterine status.
-Expedite laboratory work as ordered to monitor kidney function, liver function;
coagulation system, and medication levels.
-Provide hygiene and a quiet environment.
-Support patients and family and keep them informed.
-Be prepared to assist with birth as needed
Gestational Diabetes Mellitus (GDM)
Elevated glucose levels that are first recognized during pregnancy
● Patients with GDM increased risk of developing glucose intolerance later in life
● Increased incidence of adverse maternal and fetal outcomes
● In the first trimester of pregnancy, uncontrolled hyperglycemia can affect fetal
development, resulting in malformations
Risk Factors of GDM
-Being 35 years of age or older
● Being a member of a high-risk group (African, Arab, Asian, Latin-
American, indigenous or south Asian)
● Using corticosteroid medication
● Pregestational diabetes
● Obesity (BMI greater or equal to 30)
● Gestational diabetes in a previous pregnancy
● Given birth to a baby that weighed more than 4 kg
● A parent, brother, or sister with type 2 diabetes
● Polycystic ovary syndrome or acanthosis nigricans (dark patches of skin)
Interventions of GDM
Antepartum:
- Aim of therapy is good blood glucose control
- Diet- mainstay therapy
- Exercise
- Monitoring blood glucose levels
- Pharmacological therapy: insulin, glyburide, metformin
- Fetal surveillance
Postpartum:
- Women with dx with GDM- test again in 6-12 weeks postpartum, depending on doctor
what does Rh positive mean?
Rh blood group is present on the surface of erythrocytes
what does Rh negative mean?
without RH factor on erythrocytes
Isoimmunization
when about 0.1 mL of Rh positive fetal blood mixing with
maternal Rh negative
Rh incompatibility/Alloimmunization
Occurs when Rh negative woman carries an Rh positive fetus either to term or termination (miscarriage/abortion)
RBCs from fetus invade maternal circulation, stimulating production of Rh antibodies forms an anti-Rh agglutinin – is sensitized
-occurs at birth and the 1st child is usually not affected
Rh incompatibility/Alloimmunization- 2nd pregnancy
-In subsequent pregnancy – Rh antibodies cross the placenta into fetal circulation.
-Can cause severe hemolysis & therefore anemia in fetus
prevention of Rh incompatibility/Alloimmunization
Prevention
Rh [D] immune globulin (RhoGAM) to pregnant Rh-negative women who are not sensitized
-Administered at 28 weeks of pregnancy & within 72 hrs. postpartum
hyperemesis gravidarum
protracted vomiting that causes severe dehydration,
weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria
-requires hospitalizations (fetal complications (LBW, SGA, preterm)
maternal (vitamin deficiency, thiamine)
hyperemesis gravidarum treatment
-vital signs
-assess signs of dehydration
-deep urine test for ketones
-clear liquids
-small bland melas that are high in carbs but low in fat
-avoid odors/taste that trigger nausea, like a stuffy room
-emotional support from nurse/family
-IV therapy
-medication:
Pyridoxine (vitamin B6) alone or in combination with doxylamine
Dimenhydrinate or diphenhydramine, promethazine, chlorpromazine,
and prochlorperazine
∙ Metoclopramide to accelerates gastric emptying
∙ Antiemetic drugs, medications to control heartburn or reflux (antacids, histamine blockers, and proton pump inhibitors)
∙ Ondansetron if above medication are not effective
Urinary Tract infections in pregnancy
Usually caused by coliform organisms that are a normal part of the
perineal flora
- By far, the most common cause is Escherichia coli
Asymptomatic bacteriuria:
presence of bacteria with no symptoms
cystitis
- Cystitis (Bladder infection): dysuria, frequency, urgency along with lower
abdominal or suprapubic pain
Usually, white blood cells and bacteria are found in the urine
➔ Microscopic or gross hematuria may also be present
➔ Symptoms are systemic confined to the bladder
➔ 3-day antibiotic therapy – 90% effective
Pyelonephritis (renal infection):
develops most often in 2nd trimester
usually caused by the E. coli organism.
➔ The onset of pyelonephritis is often abrupt, with fever, shaking
chills, and aching in the lumbar area of the back. Anorexia and
nausea and vomiting also can be present
vaginal bleeding may indicate
First trimester miscarriage; implantation bleeding;
placenta previa; abruptio placenta; “bloody show”
Any time: STI; after intercourse
dysuria, urgency and/or frequency
UTI/STI
fever and chills may indicate
infection
intractable vomiting may indicate
Hyperemesis gravidarum
severe headaches may indicate
Preeclampsia; eclampsia
visual disturbances like spots, blurry vision- may indicate
preeclampsia
epigastric pain may indicate
preeclampsia
vaginal loss of fluid may indicate
Premature rupture of membranes
Uterine contractions, abdominal pain, pelvic
pressure, backache before 37 weeks may indicate
Preterm labour; abruptio placentae
what is the Coomb’s Test?
screening tool for Rh incompatibility
- If the maternal titre for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia
Amniocentesis
indications: genetic concerns, fetal maturity, fetal hemolytic
disease
- Obtains amniotic fluid which contains fetal cells
- Needle is inserted transabdominally into the uterus, amniotic fluid is withdrawn and tests are do
Amniocentesis indication
Prenatal diagnosis of genetic disorders or congenital anomalies
Amniocentesis complications maternal and fetal
Amniocentesis has the potential for maternal and fetal complications:
Maternal Complications
➢ Leakage of amniotic fluid
➢ hemorrhage , fetomaternal hemorrhage
➢ Infection
➢ Maternal Rh isoimmunization
➢ Placental abruption
➢ Inadvertent damage to intestines or bladder
➢ Amnioticfluidembolism
fetal complications
➢ Death
➢ Hemorrhage
➢ Infection (amnionitis)
➢ Injury from needle
Chorionic Villus Sampling (CVS)
test chromosomal abnormalities and other
genetic disorders
- Earlier diagnosis and rapid results
- Ideally performed between 10 and 13 weeks of gestation
- Removal of small tissue specimen from fetal portion of placenta
→ tissue reflects genetic makeup of fetus
Percutaneous umbilical blood sampling
- During 2nd and 3rd
- Also called cordocentesis
- Can be used for fetal blood sampling and transfusion
- Needle is inserted into fetal umbilical vessel, prefer the vein under the
ultrasound
Third Trimester Assessment for fetal well-being
-fetal movement counting -kick counts
-Patient concentrates on the movements in a reclined position (not
supine), patient should count 6 movements
-If six are not felt within 3 hours, further evaluation is required
-NST, CST, BPP, & ultrasounds can also be utilized
Nonstress test (NST)
the basis for the NST is that the normal fetus produces
characteristic heart rate patterns in response to fetal movement
▪ The pregnant patient should have an empty bladder and be seated
in a reclining chair (or in a semi-Fowler position) with a slight left
tilt, to optimize uterine perfusion and avoid supine hypotension
▪ Fetal heart rate is recorded with doppler
▪ Results are either normal, atypical or abnormal
Contraction stress test (CST)
Also known as oxytocin challenge test
-to evaluate the response of the fetus to induced contractions and identify poor placental function
-place pt in semi-flower’s position
procedure: nipple stimulated contraction test
-oxytocin stimulated contraction test
-provides a warning of fetal comprise earlier than NST
Biophysical profile (BPP)
Noninvasive dynamic assessment of a fetus that is based on the assessment of acute and chronic markers of fetal disease
▪ Observes fetal breathing movement, fetal tone
Biophysical profile (BPP)
- Assesses fetal breathing movements, fetal movements, fetal tone, and AFV
- Amniotic fluid volume (AFV)
- Abnormalities in AFV are frequently associated with fetal disorders.
- Oligohydramnios (less than 300 mL of amniotic fluid, associated with fetal renal abnormalities
- polyhydramnios (more than 2 L of amniotic fluid, associated with gastrointestinal and other malformations)
- Doppler blood flow analysis
- Systolic/diastolic flow ratios and resistance indices to estimate blood flow in various arteries
A low score on a biophysical profile might indicate that further testing is needed. In some cases, early or immediate delivery might be recommended.
Bio-physical Profile Indications
- The pregnancy has gone past 40 weeks gestation * Multiplegestationpregnancy
- Previous Stillbirth
- Polyhydramnios or Oligohydramnios
- GestationalDiabetes(GDM)
- Preeclampsia or other hypertensive disorder in pregnancy * IUGR
- Other Pregnancy Complications
