Flashcards in Test 4 High Risk Factors Deck (72):
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.
High risk pregnancy
What are the purposes of antenatal testing?
- determine fetal well-being
- estimate growth and weeks gestation
- predict outcome of pregnancy
Ways that we can observe fetal well-being on the monitor:
too much amniotic fluid...b/c baby is peeing a lot
not enough amniotic fluid...b/c baby isn't peeing enough
Smoking causes vasoconstriction. What can this cause for the fetus?
May not get enough nourishment from the placenta, so there could be a growth constriction
What 5 things does the nurse need to know about each test?
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
Fetuses should be active unless _____.
How often should a high-risk mother check for fetal movements?
2-3 x day for 30 min to 1 hr
How often should a low risk mother check for fetal movements?
1-2 x day for 30 min to 1 hr
Should feel ____ fetal movements within each kick count.
We will be concerned if there is no fetal movement in ____ hrs. What test would be ordered?
When should the mother call the doctor regarding fetal movement?
No movement in 12 hrs.
Consistent decrease in movement.
What are the 3 levels of ultrasound?
1) Standard (Basic or Level 1)
2) Limited (Specific Reason or Level 2)
3) Specialized (Detailed/Targeted or Level 3)
What does a Level 1 US check?
- fetal viability
- gestational age
- placental location
- fetal anatomic structures for malformation & amniotic fluid volume
What does a Level 2 US check?
- fetal presentation during labor
- FHT when not able to obtain in other ways (ie obese mom)
What does a Level 3 US check?
- anatomically or physiologically abnormal fetus (ie heart probs in utero)
Which US is more accurate - early or late?
Bladder full or empty for:
1st: Full bladder
2nd: Full bladder
3rd: Empty bladder
How can the gestational age and EDC (due date) be determined by US?
1st trimester: crown-rump length
2nd trimester: biparietal diameter of fetal skull
What are the classifications of amniotic fluid index (AFI)?
What is a biophysical profile (BPP) and what does it measure?
An abdominal US
- fetal breathing movements
- gross body movement
- fetal tone
- qualitative amniotic fluid volume
- reactive non stress test
What do we look for with fetal tone?
Is the fetus really moving extremities or just body.
What are the scores of the BPP?
Normal = 2
Abnormal = 0
Looking for a 10:10 ratio
What does an amniocentesis check for?
How do we send the amniocentesis specimen to the lab, why?
In a brown paper sack, b/c it can be negatively effected by light
When can an amniocentesis be performed?
after 14 weeks b/c uterus rises above the symphysis pubis and fluid amounts are adequate for sample
What does the amniotic fluid show?
- 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
Why would an amniocentesis be done in early pregnancy?
detect chromosomal abnormalities
Why would an amniocentesis be done in late pregnancy?
most often to determine fetal lung maturity with L/S ratio to detect the amount of surfactant production in fetal lungs
What does the L/S ratio of 2:1 indicate?
What is surfactant?
substance that reduces the surface tension of pulmonary fluids to allow gas exchange in the alveoli.
What are potential complications of amniocentesis?
- injury to fetus
- leakage of AF
- pregnancy loss
- maternal hemorrhage
- Rh isoimmunization
- amniotic fluid embolism
- fetal death
What are the nursing responsibilities for amniocentesis?
- 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
What does chorionic villus sampling check?
Diagnoses chromosomal and genetic defects
When is a CVS checked?
Where is the sample of blood and tissue taken from with a CVS?
edge of placenta
Can the placenta be accessed vaginally or abdominally for CVS?
Cells from the villi have the same genetic make-up as the cells from the ____.
Is CVS a safe or risky procedure for baby?
What tests have helped decrease the need for CVS?
triple & quad screens
What are the advantages of CVS?
- can be done early in pregnancy, 10-13 wks
- sample gives genetic makeup data
What are the disadvantages of CVS?
- rupture of amniotic membranes
- intrauterine infection
- spontaneous abortion
- performed prior to 10 wks gestation, has been associated with limb anomalies
What is a percutaneous umbilical blood sampling (PUBS)?
Test for genetic information, fetal infection, assessment & treatment of isoimmunized and thrombocytopenic fetus
How is PUBS performed?
US guided withdrawal of blood (1-4ml) from a fetal umbilical blood vessel near its insertion into the placenta
What does the PUBS Kleihauer-Betke test check for?
checks for maternal-fetal cross contamination
What are potential complications of PUBS?
- bleeding from puncture site
- cord laceration
- preterm labor
- premature ROM
What follow-up is needed after PUBS?
- 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
What does maternal serum alpha fetoprotein (MSAFP) check for?
neural tube and abdominal wall defects
When is MSAFP performed?
between 15-20 weeks
What test is ordered if MSAFP shows elevated levels indicative of neural tube or abdominal defects?
Ultrasound to rule out fetal abnormalities or multiple gestation
Alpha-fetoprotein is produced in the fetal ____ ____ & ____.
What weeks is AFP detectable in maternal serum?
What are the multiple marker screen tests?
triple & quad screens
What does the triple screen test?
- unconjugated esteriol
What does the quad screen test?
- unconjugated esteriol
- Inhibin A
Trisomy 21 is called:
Trisomy 18 is called:
What does non stress test (NST) check for?
fetal movement ???
How long is the fetus monitored in a NST?
What is a REACTIVE finding of NST?
normal FHR baseline with fetal movement (accelerations = fetal movement)
What is a NONREACTIVE finding of NST?
Additional testing needed
(will require a BPP to be done)
What is vibroacoustic stimulation?
Sound & vibration used to elicit a fetal response
Contraction Stress Test (CST) or Oxytocin Challenge Test (OCT)...monitor FHR for:
10-20 min for baseline
CST or OCT...contractions started by:
- nipple stimulation
- IV pitocin/oxytocin
CST or OCT...we want ___ contractions in ___ min.
3 contractions in 10 min
CST/OCT...findings are classified as:
What constitutes a NEGATIVE CST/OCT?
(Negative means good)
What constitutes a POSITIVE CST/OCT?
Late decels with 50% or more contractions
(Positive means bad)
What constitutes an EQUIVOCAL/SUSPICIOUS CST/OCT?
Late decels or prolonged variable with 50% of contractions
What constitutes an EQUIVOCAL HYPERSTIMULATORY CST/OCT?
Decels with contractions every 2 min or lasting longer than 90 secs
*not enough time to reoxygenate