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NURS 372 > Week 3 - Complex Antenatal Care > Flashcards

Week 3 - Complex Antenatal Care Flashcards

1
Q

Major expected outcome of fetal assessment

A

detection of fetal compromise

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2
Q

When is an anatomy scan typically conducted?

A

18 - 20 weeks

sometimes able to detect abnormalities - organs, MSK

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3
Q

When can the fetal HR first be detected by Doppler?

A

8 - 10 weeks

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4
Q

Fetal Assessment components (7)

A

1) Prenatal Screening

2) CVS/Amniocentesis

3) Ultrasounds

4) SFH for monitoring growth

5) Fetal health surveillance (electronic fetal monitoring, NST)

6) Fetal movement counting

7) Biophysical profile

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5
Q

Ultrasound major uses (7)

A

1) confirm pregnancy and viability

2) determine the gestational age

3) prenatal screening: NT, fetal anatomy, congenital anomalies

4) assess level of amniotic fluid

5) detect fetal growth

6) determine fetal position

7) detect placental previa or abruption

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6
Q

T or F: Prenatal screening is diagnostic.

A

FALSE

screen results are positive, additional testing will be offered

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7
Q

T or F: All pregnant people have a chance for trisomy 21, 18 and 13, not just those of advanced age

A

TRUE

also important to consider family history

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8
Q

Non-invasive Prenatal Screening (4)

A

1) Enhanced First Trimester Screening (eFTS)

2) Second Trimester Serum Screening

3) Integrated Prenatal Screening (IPS)

4) Non-invasive Prenatal Testing (NIPT)

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9
Q

1) Enhanced First Trimester Screening (eFTS)

A

nuchal translucency
-3+ mm: genetic disorders, abnormalities
-3.5+ mm: congenital heart defects

maternal serum bio markers: 11 - 14 weeks

screen for Trisomy 18, 21, maybe 13

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10
Q

2) Second Trimester Serum Screening

A

maternal serum - screening for neural tube defects

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11
Q

3) Integrated Prenatal Screening (IPS)

A

only for + screens, carrying twins or advanced maternal age greater than 40

screen for trisomy 13, 18, 21 as well as some sex-linked chromosomal disorders

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12
Q

4) Non-invasive Prenatal Testing (NIPT)

A

screening method for prenatal genetic material using cell-free DNA

take fetal DNA that is circulating in the maternal system

anytime after 9-10 weeks until the end of the pregnancy

high detection rates for Trisomy 13, 18, 21

screens for sex chromosome disorders

maternal venipuncture and results available in about 10 days

OHIP coverage limited

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13
Q

Chorionic villi

A

in placenta

allow for attachment to uterus, o2 and co2 exchange

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14
Q

CVS/Amniocentesis

A

DIAGNOSTIC tests

if a screening test is abnormal or if high risk

CVS
-10-13 weeks
-remove piece of placenta for the chorionic villi

Amniocentesis
->15 weeks
-amniotic fluid with fetal cells
-genetic info, lung maturity, fetal hemolytic disease

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15
Q

What safety mechanism is in place with CVS/Amniocentesis?

A

ultrasound guidance

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16
Q

Amniocentesis Maternal Risks (many)

A

Hemorrhage

Fetomaternal hemorrhage

Infection

Labour

Abruptio placentae

Damage to intestines or bladder

Amniotic fluid embolism

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17
Q

Amniocentesis Fetal Risks (many)

A

Death

Hemorrhage

Infection (amnionitis)

Injury from needle

Miscarriage or preterm labor

Leakage of amniotic fluid

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18
Q

Biophysical Profile (BPP)

A

more in-depth ultrasound offered for high-risk to assess fetal wellbeing

may be frequent, ongoing

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19
Q

BPP Scoring

A

higher score=better, more normal

out of 10

if just doing ultrasound component, out of 8

0 or 2 points, no 1

always even score

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20
Q

BPP Components

A

4 ultrasound assessments

Nonstress test (NST)
-evaluates FHR & response to movement
-20 minute observation where they’re placed on external fetal monitor
-non stress because there’s no uterine activity

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21
Q

5 discrete biophysical variables

A

1) fetal movement

2) fetal tone
-want flexed, not floppy

3) fetal breathing movements
-not breathing to gain oxygen, which is obtained from the mother through the placenta
-but do practice breathing - expansion of lungs

4) amniotic fluid volume
-measure pockets of fluid

5) FHR

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22
Q

High Risk Pregnancy

A

pregnancy in which the life or health of the client or infant is jeopardized by a disorder coincident with or unique to pregnancy

not a high prevalence

early intervention to improve health outcomes

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23
Q

When does a high risk pregnancy status extend to?

A

6 weeks postpartum

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24
Q

Common causes of bleeding in EARLY pregnancy (4)

A

1) miscarriage

2) premature dilation of cervix

3) ectopic pregnancy

4) molar pregnancy

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25
Risk factors for early bleeding (3)
1) advanced client age 2) smoking exposure 3) prior preterm birth
26
Miscarriage/Spontaneous Abortion
COMMON prior to 20 weeks gestation or 500-gram fetal weight early: < 12 weeks - MOST* late: 12 - 20 weeks a lot related to chromosomal abnormalities - aneuploidy
27
Risk factors for early miscarriage
maternal endocrine imbalances (hypothyroidism, DM) immunological factors systematic disorders (lupus)
28
Risk factors for late miscarriage
advanced maternal age chronic infections premature cervical dilation abnormalities in the repro tract inadequate nutrition substance use
29
Symptoms of miscarriage
uterine bleeding cramping low back pain
30
Miscarriage tests
confirm viability or loss: B-hCG, ultrasound CBC to screen for anemia and infection
31
Types of Spontaneous Abortion (6)
1) threatened 2) inevitable 3) incomplete 4) complete 5) missed 6) recurrent
32
Threatened abortion
mild bleeding, mild cramping, cervix closed possibility that there could be a miscarriage
33
Inevitable abortion
bleeding is heavy, cervix is opening, moderate to severe cramping may have ruptured membranes - leaking may be tissue present
34
Incomplete abortion
placenta, products of conception there going to continue to bleed for a longer period of time need to pass everything - developing fetus, placenta etc. cervix open foul smell fever if hCG is still high - might still be products
35
Complete abortion
passed all products of conception cervix is closing bleeding is subsiding
36
Missed abortion
fetus died in utero no bleeding or cramping pregnancy doesn’t progress, may not even be aware sometimes may spontaneously pass or may need to be indicated by meds so uterus contracts and expels the products
37
Recurrent abortion
2 or more sequential abortions (no pregnancy in between) referral to fertility specialist to investigate why
38
Management of threatened abortion
bedrest, decreased stress levels, and supportive care wait and watch no proven effective treatment
39
Management of missed abortion
expelled or induced
40
Management of inevitable
all POC passed - no intervention retained POC - suction curettage
41
Dilation and Currettage
give meds to soften surface then use instrument or suctioning surgical management where the cervix is dilated curette inserted to remove contents commonly used in therapeutic abortions (surgical option), inevitable and incomplete miscarriages
42
Health Teaching after Miscarriage
expect vaginal bleeding or spotting to continue for several days signs to look for longer than 10 days excessive bright red clot bigger than tooney fever significant pain foul smelling discharge no tampons for 2 weeks HCP in 2-4 weeks self-harm
43
Premature Dilation of Cervix
dilation of the cervix os passive, painless without contractions caused by cervical insufficiency or incompetent cervix may result in a miscarriage or preterm birth Etiology: Hx. of cervical trauma, genetically short cervix, cervical or uterine anomalies transvaginal ultrasound to diagnose
44
Management of premature dilation of the cervix (many)
restricted activity hydration cervical cerclage to constrict the internal OS risks: PROM, preterm labour, chorioamnionitis cerclage removed between 35-37 weeks
45
Ectopic pregnancy
fertilized ovum is implanted OUTSIDE of the uterine cavity most in fallopian tube other: ovary, abdominal cavity and cervix symptoms: -abdominal pain that progresses from dull to sharp, stabbing pain -delayed menses -abnormal vaginal spotting occurring 6-8 weeks after LMP May exhibit signs of shock if rupture Diagnosis: serial B-hCG (lower), transvaginal ultrasound
46
Management of ectopic pregnancy
most will required intervention can resolve spontaneously by tubal abortion methotrexate to dissolve the tubal pregnancy follow-up until hCG undetectable monitor for severe ab pain
47
Salpingectomy
removal of the entire tube
48
Salpingostomy
incision over the pregnancy site in the tube and POC gently removed attempt to minimize scarring to preserve future fertility
49
Health teaching for ectopic pregnancy
no alcohol no vitamins or folic acid (folic acid antagonist) avoid prolonged sun exposure no analgesia stronger than Tylenol (want to notice severe pain) nothing inserted into the vagina
50
Molar pregnancy
NOT A PREGNANCY tissue that normally becomes a fetus instead becomes an abnormal growth in the uterus no placenta - risk of intrauterine bleeding sometimes associated with cancer
51
Symptoms of molar pregnancy
large SFH hCG may be really high - severe N/V vaginal discharge from brown to bright red -->anemia bleeding - purple, prune juice coloured abdominal cramping
52
What does molar pregnancy increase the risk of?
bleeding --> anemia preeclampsia with rapidly growing moles
53
Molar pregnancy types (2)
1) Complete -egg with NO genetic information, fertilized by sperm, won’t develop into fetus 2) Partial -egg fertilized by 2 sperm, but placenta developed abnormalities
54
Management of molar pregnancies
most pass spontaneously suction curettage
55
What medication should you absolutely not use with a molar pregnancy?
oxytocin or prostaglandins increased risk of embolization of trophoblastic tissue
56
Bleeding in LATE pregnancy (3)
past 20 weeks - assess immediately** 1) Placenta previa 2) Placenta abruption 3) Variations in insertion of the cord and placenta
57
Placenta previa
placenta implanted in lower uterus blocking the os TV ultrasound measurement of the distance of the placental edge from the internal os noted in mm as the uterus is expanding there can be ruptured blood vessels diagnosis: TV ultrasound
58
Complications with placenta previa are related to ____________
the amount of blood loss
59
Risk factors for placenta previa (many)
previous placenta previa previous c-section suction curettage causing possible endometrial scarring multiparity advanced maternal age (over 35) smoking higher prevalence in Black or Asian individuals
60
Placenta previa types (2)
1) Complete 2) Marginal
61
Complete placenta previa
covers the internal os totally
62
Marginal placenta previa
edge of the placenta is 2.5 cm or closer to the internal os
63
T or F: If the internal os is covered by the placenta, it will be like that the entire pregnancy.
FALSE low-lying placenta - uterus may expand through the pregnancy and expose the internal os
64
Placenta previa symptoms
bright red blood PAINLESS 2rd or 3rd trim. abdomen soft, relaxed, non-tender with normal tone presenting part of the fetus is high b/c placenta occupies lower uterine segment
65
Complications of placenta previa
hemorrhage - can be significant abnormal placenta attachment (placenta accrete, increta or percreta) IUGR, preterm birth, fetal anemia
66
What happens if the placenta is deeply embedded?
when it detaches, part of the placenta can still be there if it doesn’t fully attach: post-partum hemorrhage
67
Placenta Abruption
premature detachment of part or all of the placenta from its implantation side causes bleeding need placenta for nutrients and oxygen
68
Risk for placenta abruption (many)
HTN cocaine use blunt trauma to abdomen cigarette smoking previous abruption PPROM multiples thrombophilia (issues with coagulation)
69
How is placenta abruption classified?
based on amount of separation, amount of bleeding, and pain Class I, II, III (mild to severe)
70
Symptoms of placenta abruption
symptoms vary depending on the degree of separation dark red vaginal bleeding moderate to severe abdominal or low back pain Class II and III - uterus fails to relax between contractions and becomes hypertonic abnormal FHR or fetal death maternal hypovolemia clotting defects (DIC) maternal death
71
What is one of the leading causes of maternal death?
placenta abruption
72
Signs and symptoms of hypovolemic shock (many)
hypotension tachycardia tachypnea changes to LOC e.g. disorientation pale, cyanosis generalized weakness lethargic excessive diaphoresis hypoxia
73
Treatment for placenta abruption
antepartum steroids to promote lung development fetal surveillance Winrho if Rh- if stable, vaginal birth may be attempted C-section performed if fetal compromised, severe hemorrhage, coagulopathy, poor labour progress, increased uterine resting tone

NURS 372 (12 decks)

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