Antepartum Assessment for High Risk Pregnancy Flashcards

(45 cards)

1
Q

Risk factors for high risk pregnancy

A
Homeless
Single
Uninsured pregnant women without access to prenatal care
Lifestyle 
Age
History
Nutrition
*** others
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2
Q

What is high risk pregnancy?

A

High risk pregnancy: life or health of mother or fetus is jeopardized

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3
Q

How long is mother at risk for ?

A

it extends through puerperium! 30-45 days after birth

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4
Q

When do complications usually resolve for mother’s at risk?

A

within 1 month of birth.

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5
Q

What are the 3 leading causes of maternal mortality?

A

Pre- eclampsia

Pulmonary embolism

Hemorrhage

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6
Q

Factors related to maternal death ?

A

Age: <20 years or > 35 years

Lack of prenatal care

Low educational attainment

Unmarried status

Nonwhite race

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7
Q

Fetal and neonatal health problems?

A

Congenital anomaly
Heart Defect
Anencephaly
Gastroschisis

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8
Q

Causes of neonatal death include?

A

Disorders related to short gestation and low birth weight

Sudden infant death

Respiratory distress syndrome

Effects of maternal complications
** Healthy People 2020- Progress being made

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9
Q

Nursing role in antepartal assessment for risks?

A
  • Assist with History intake
  • Initial nursing assessment
  • Education
  • Support person
  • Assists physician/ provider -with procedures-
  • Performs non-stress tests (NSTs), contraction stress tests (CSTs), BPPs
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10
Q

What are the 3 antepartum assessments for risk antepartum testing?

A

Biophysical Assessment

Biochemical Assessment

Electronic Fetal Monitoring

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11
Q

When does the fetal movement test start? Why?

A

28 weeks. 22 might be too early for some to be moving and kicking around.

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12
Q

If it’s been more than 12 hours without any fetal movement is this alarming? What should you do?

A

Yes alarming.

have woman drink something cold and sugary, or eat, lie down on left side…see if baby wakes up. if not you can zap it for 3 second.

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13
Q

What do ultrasounds do?

A
Indications:
Fetal heart rate activity
Gestational age
Fetal growth &amp; Fetal anatomy
Placental position &amp; function
Dating purposes
Assess anatomy following abnormal maternal screens
Adjunct to other invasive tests
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14
Q

What does the fluid surrounding the baby do for it?

A

Fluid allows baby to grow and helps with lung development.

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15
Q

What can an ultra sound show?

A

Fetal well being
Amniotic fluid volume
Doppler blood flow analysis (slide 16)
Biophysical profile (slide 15)

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16
Q

If the Nasal Bridge and Nuchal translucency is thick what can this mean?

A

chromosomal abnormality

Thick nb and nt: it be can connected to downs syndrome

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17
Q

What does the biophysical profile show you? (4)

A

Gonna look at breaths, fetal movements, fetal tone , amniotic fluid volume

Max points someone to get is a 10.
If 8/10 that’s still acceptable.

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18
Q

What does MRI show ? (5)

A

Fetal structure

Placenta -

Quantity of amniotic fluid

Maternal structures

Biochemical status of tissues and organs

Soft tissue, metabolic, or functional anomalies

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19
Q

Is contrast used in pregnancies?

20
Q

What is fetal hemolytic disease?

A

moms blood is attacking the baby.

21
Q

What does amniocentesis show for a fetus?

A

Indications
Prenatal diagnosis of disorders (genetic/ anomalies)
Fetal maturity (L/S ratio) – DM (PG)
Fetal hemolytic disease

22
Q

Maternal complications with amniocentesis?

A

Hemorrhage
Infection, Abruption
Organ injury
Amniotic embolism

23
Q

Amniocentesis complications in Fetus/infants?

A
Death
Hemorrhage
Infection (amnionitis)
Injury from needle
Miscarriage or preterm labor
Leakage of amniotic fluid
24
Q

What is Chorionic villus sampling ? CVS

A

Removal of portion of placenta through abdomen or intravaginally through the cervix under USG guidance for genetic studies.

25
How fast do results happen with Chorionic villus sampling?
RAPID | 10 and 13 weeks gestation
26
Risks and nursing considerations for Chorionic villus sampling?
Risks- spotting, SAB Nursing considerations Rhogam if RH NEG
27
What is Percutaneous umbilical blood sampling? (PUBS) and who is it indicated for? fetuses @ risk for isoimmune hemolytic anemia
Insertion of needle directly into a fetal umbilical vessel under ultrasound guidance indication: fetuses @ risk for isoimmune hemolytic anemia
28
What are the risks and nursing considerations for Percutaneous umbilical blood sampling? PUBS
Risks- cord laceration, PTL, infection, PPROM Nursing considerations: FHT, Rhogam post procedure if needed
29
What is the Alpha-fetoprotein test ?
Maternal serum levels (MSAFP) screened for neural tube defects (NTDs)- done @ 15-22 wks
30
In the alpha-fetoprotein test , what does it mean when its high?
NTDs & abdominal wall defects (HIGH)
31
In the alpha-fetoprotein test , what does it mean when its low?
Down syndrome (LOW)
32
What is the multiple marker screen?
1st Tri screen (11-13.6wks) | 2nd Tri- Triple & Quad (16-18wks)
33
What are the nursing considerations for the multiple marker screening?
EDUCATION ACCURACY OF DATING Nuchal Translucency scan
34
What does the Coombs test?
Detects other antibodies for incompatibility with maternal antigens Rh incompatibility – if titer >1:8
35
What does the CELL FREE DNA IN MATERNAL BLOOD MAT21/HARMONY SHOW?
``` A new screening for noninvasive prenatal genetic diagnosis- done after 10 wks Fetal Rh status Fetal gender Works by amplifying cell free DNA Assess for trisomy 13, 18, 21 ```
36
What is the electronic fetal monitoring test?
To determine if the intrauterine environment is supportive to the fetus
37
What is the non stress test?
``` Procedure- 20 minute strip Interpretation- Reactive or Non Reactive Causes for non reactive- sleep cycle, tobacco ( can decrease blood flow), meds, fetal distress Vibroacoustic stimulation Max 3 sec ```
38
if baby is over 32 weeks 2 accelerations will be what?
15x15
39
if baby is under 32 weeks, 2 accelerations will be what?
10x10
40
What is the contraction stress test and when is it started?
Procedure Nipple-stimulated contraction test Oxytocin-stimulated contraction test 28 weeks
41
Interpretation of contraction stress test?
Interpretation =] [good]NEGATIVE= 3 UC in 10 min with no late or significant variable decelerations =[ (bad) POSITIVE= Late decelerations with >/=50% of UC (even is less than 3 in 10 min) EQUIVICAL/Suspicious- Late or variable decels <50% of UC UNSATISFACTORY- No UC in 10 min window or unable to trace FHT Can provide a warning of fetal compromise earlier than NST
42
Nursing role in antepartal assessment for high risk?
``` Education Support person Assists physician with procedures Performs non-stress tests (NSTs), contraction stress tests (CSTs), BPPs Initial assessment ```
43
What does biophysical assessment include?
fetal movement counts, ultrasonography, and MRI
44
What does biochemical monitoring techniques include?
amniocentesis, PUBS, CVS, maternal assays and maternal serum AFP
45
What does reactive NSTs and negative CSTs suggest?
fetal well being !=] yay