Assessment of High-Risk Pregnancy
Define ectopic pregnancy
fertilized ovum is implanted outside the uterine cavity, usually in a fallopian tube *it is considered a medical emergency*
What could a baby who isn't moving after the fetal movement count mean?
fetal death if fetal movement is slowing down, could mean cord compression
What test are done in the biophysical profile?
fetal tone fetal movement fetal breathing amniotic fluid non stress test
During which ultrasound is the dating for a pregnancy most accurate?
first ultrasound
Why do we teach mothers to only eat fish less than three times a week?
fish, shellfish, tuna, and shark all have high amounts of mercury in them
What is crown rump length and what is it used for?
measurement of the length of the fetus from the top of the head (crown) to the bottom of the buttocks (rump). It is typically determined from ultrasound imagery and can be used to estimate gestational age
What does fetal alcohol syndrome cause?
microcephaly short palpebral fissures poor suck, cleft lip/palate mental retardation hyperactivity cardiac and joint abnormalities *effects do not reverse
What is the desired contraction stress test?
negative
What is alpha-fetoprotein used to measure?
neural tube defects
Fetal movement count teaching
once a day for 60 minutes Feel 10 movements in an hour do it 2 to 3 times daily left side-lying helps What if there aren't 10 movement? -get up and move around -drink or eat sugary things (sugar rush to baby) -if still not moving a second time, come to hospital
define previa
placenta blocks opening of uterus
Oligohydramnios is associated with
renal agenesis (Potter's syndrome) premature rupture of membranes
smoking causes what in pregnancy
spontaneous AB ectopic pregnancy (decreases cilia of the uterus) LMBW preterm labor abruption (placenta separates from uteran wall) previa (placenta block opening of uterus)
What is a nuchal translucency screen test?
uses ultrasound measurement of fluid in the nape of the fetal neck between 10-14 weeks of gestation to identify possible fetal abnormalities. A fluid collection greater than 3 mm is considered abnormal. When combined with abnormal *maternal serum marker levels,* elevated NT indicates a possible increased risk for certain chromosomal abnormalities in the fetus, including trisomies 12, 18, and 21 (Down's) *An elevated NT alone indicates an increased risk for congenital heart defects*
Do you want the biophysical profile to be high or low
high
define abruption
placenta detaches from uterine wall
What do you watch for in an infant with candidiasis?
thrush if they have white plaques in the mouth? suspect thrush
After reviewing the reports of a pregnant patient, the nurse infers that there might be a high risk for intrauterine growth restriction (IUGR). The reason for this could be that the amniotic fluid index (AFI) is what? Less than 5 cm More than 25 cm Between 5 and 10 cm Equal to or more than 10 cm
An AFI less than 5 cm indicates oligohydramnios. *Oligohydramnios is associated with intrauterine growth restriction and congenital anomalies.* An AFI of 10 cm or greater indicates that the fetus is normal. AFI values between 5 and 10 cm are considered low normal, indicating a comparatively low risk for congenital anomalies. An AFI greater than 25 cm indicates polyhydramnios. This is associated with neural tube defects and obstruction of the fetal gastrointestinal tract.
Normal amniotic fluid range
5-25 <5 oligohydramnios >25 polyhydramnios
What is the Coombs test used for?
Tests RBC antigens Hemolytic anemia Erythroblastosis fetalis, Rh factor
difference between chorionic villus sampling and amniocentesis
CVS can't measure for down's but amniocentesis can
Nursing care for amniocentesis
Establish baseline VS and FHR lay supine with hip wedge full bladder 1st trimester empty bladder 3rd trimester Monitor FHR 1 hour after procedure Notify if cramping, decreased fetal movement, bleeding or watery discharge occurs
Which technique is used to assess genetic abnormalities in a 12-week-old fetus? Amniocentesis Ultrasonography Chorionic villus sampling (CVS) Magnetic resonance imaging (MRI)
CVS is a popular technique used for genetically studying the fetus in the first trimester (11-14 weeks) of pregnancy. The advantage of CVS over other techniques is that it reveals the presence of genetic abnormalities at an early stage of pregnancy very accurately. Amniocentesis can be used for diagnosing genetic abnormalities only after 14 weeks of pregnancy; before 14 weeks, the amount of amniotic fluid available is insufficient for testing. Ultrasonography is not used to detect genetic abnormalities in the fetus. This diagnostic technique is used only for visualizing the fetus. MRI is used mostly to evaluate the fetal structure and overall growth, the placenta, and the quantity of amniotic fluid. This technique is not useful for genetic studies.
What is bacterial vaginosis?
change in ph of vagina that causes the overgrowth of bacteria occurs after heavy alcohol drinking or after eating a lot of sugar fishy odor, clear discharge Treat with Flagyl, but delay treatment until the 2nd trimester
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what tool is useful in confirming the diagnosis? Amniocentesis Doppler blood flow analysis Contraction stress test (CST) Daily fetal movement counts
Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.
While reviewing the ultrasonography images of a patient in her seventh month of pregnancy, the nurse observes an enlarged renal pelvis of the fetus. Which screening test does the nurse advise the patient to undergo? Quad screening Coombs' screening Triple marker screening Cell-free DNA screening
Enlargement of the renal pelvis may indicate Down syndrome in the fetus, and quad screening is done to determine whether the fetus has Down syndrome. In this test, the levels of placental hormone inhibin A are monitored. Low levels of inhibin A indicate Down syndrome. Coombs' test is a screening procedure to determine Rh incompatibilities. Cell-free DNA screening is done to detect certain inherited single-gene disorders. Triple marker screening is less accurate than quad screening in screening for Down syndrome.
While reviewing the ultrasonography reports of a pregnant patient, the nurse finds that there is excessive fluid collection at the nape of the neck of the fetus. Which test will the nurse recommend? Oxytocin challenge test Chorionic villus sampling Fetal acoustic stimulation test Percutaneous umbilical blood test
Excessive fluid in the nape of the neck indicates a genetic abnormality in the fetus. Genetic abnormalities can be tested further by performing chorionic villus sampling. A fetal acoustic stimulation test is done to test the fetal heart rate. Oxytocin challenge is a stress-based test for measuring fetal heart rate. Percutaneous umbilical blood sampling is the procedure done for fetal blood sampling and transfusion.
A pregnant patient who has undergone a cesarean section in her previous pregnancy needs to be checked for the fetal heart rate pattern. What test will the nurse recommend? Biophysical profile Nipple-stimulated test Oxytocin-stimulated test Fetal acoustic stimulation
Fetal acoustic stimulation is a nonstress test for monitoring the fetal heart rate pattern. It can be used in cases of previous cesarean birth because there is no stress to the fetus. A biophysical profile is done to determine the physical profile of the fetus; it cannot be used to monitor the heart rate of the fetus. An oxytocin-stimulated test is type of stress testing that is contraindicated in cases of previous cesarean birth because of the stress caused by the injected oxytocin. A nipple-stimulated test is a contraction stress test that is contraindicated in patients with previous cesarean birth. In this test, the released oxytocin may cause distress to the fetus.
The nurse is caring for an obese pregnant patient. Which test does the nurse recommend for the patient to assess the risk for intrauterine growth restriction? Daily fetal movement count Abdominal ultrasonography Computed tomography (CT) Transvaginal ultrasonography
Intrauterine growth restriction is poor growth of the fetus during pregnancy. Transvaginal ultrasonography allows early diagnosis of intrauterine growth restriction and detailed examination of the pelvic anatomic features. Thick abdominal layers in obese women may not allow adequate penetration during abdominal ultrasonography; therefore transvaginal ultrasonography is preferred in obese women. Daily fetal movement count is used to monitor the complications related to poor fetal oxygenation. CT is contraindicated in pregnant women because the ionizing radiation may cause adverse effects in the fetus.
After performing an amniocentesis, the primary health care provider asks the nurse to administer Rho(d) immunoglobulin to a pregnant patient with Rh-negative blood. A patient with Rh-negative blood should be administered Rho(d) immunoglobulin to prevent what? Infection in the fetus Pain from amniocentesis Leakage of amniotic fluid Fetomaternal hemorrhage
Fetomaternal hemorrhage may occur after amniocentesis. Administering Rho(d) immunoglobulin to a pregnant patient with Rh-negative blood is advisable to prevent fetomaternal hemorrhage. Administering Rho(d) immunoglobulin after amniocentesis will not provide pain relief. Preventing amniotic fluid leakage during amniocentesis requires expertise in the procedure; administering Rho(d) immunoglobulin does not prevent amniotic fluid leakage. Maintaining aseptic conditions while performing the procedure is helpful in preventing infection during amniocentesis; administering Rho(d) is not.
What drugs do you not give in the first trimester?
Flagyl and diflucan
Polyhydramnios is associated with
GI, and CNS abnormalities, multiple fetuses, and fetal hydrops
What type of bacterial infection is harmful only to the baby, not the momma?
Group B strep bc the bacteria are the normal flora in her stomach, she only needs antibiotics during labor to help the baby and then you can take her off of it
disease with small or large, dry, wartlike growth on vulva, vagina, cervix, or rectum
HPV human papillomavirus
The nurse is reviewing the amniocentesis reports of a patient who has completed 20 weeks of pregnancy. The reports reveal the presence of high alpha-fetoprotein (AFP) levels. What can the nurse infer from this information related to the clinical condition of the fetus? Cardiac disorder Neurologic disorder Circulatory disorder Pulmonary disorder
High AFP levels after 15 weeks of gestation indicate an open neural tube or other disorder relating to the central nervous system. AFP levels in amniotic fluid cannot test cardiac disorders. Doppler blood flow analysis can be used to assess circulatory disorders in the fetus. The lecithin-to-sphingomyelin (L/S) ratio of the amniotic fluid is a useful predictor of pulmonary disorders in the fetus.
The biophysical profile (BPP) testing report of a pregnant patient gives the following information: one episode of fetal breathing movement lasting for 30 seconds in a 30-minute observation; three limb movements of the fetus in 30 minutes; an amniotic fluid index greater than 5; a reactive nonstress test; and a BPP score of 1. The test is performed for 120 minutes. What does the nurse expect the primary health care provider to do? Repeat the test twice a week. Consider delivery of the fetus. Repeat the test in 4 to 6 hours. Extend the test time to 120 minutes.
If the BPP score is less than 2, regardless of gestational age, delivery can be performed. If the BPP score is 0 to 2 and chronic asphyxia is suspected, then testing time should be extended to 120 minutes. If the BPP score is 8 to 10 and a low risk for chronic asphyxia is suspected, then the test should be repeated at twice-weekly intervals. If the fetal pulmonary test result is negative and the BPP score is 6, then the BPP profile should be repeated in 4 to 6 hours.
What is an indicator for performing a contraction stress test? Maternal diabetes mellitus and postmaturity Adolescent pregnancy and poor prenatal care Increased fetal movement and small for gestational age History of preterm labor and intrauterine growth restriction
Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Although adolescent pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator, but history of a previous stillbirth (not preterm labor) is the other indicator.
The nurse is assessing a pregnant patient and finds that her blood pressure is 150/90 mm Hg. What procedure does the nurse recommend for this patient? Doppler blood flow analysis Nuchal translucency (NT) test Chorionic villus sampling (CVS) Percutaneous umbilical blood sampling (PUBS)
Maternal hypertension can cause serious adverse effects on the fetus. A blood pressure reading of 150/90 mm Hg indicates that the mother is hypertensive. To assess the effect of maternal hypertension on the fetus, the nurse should refer the patient for a Doppler blood flow analysis. It is a noninvasive ultrasonic technique used to study fetal blood flow. NT is a technique used to assess genetic abnormalities in the fetus. CVS is a prenatal test used to diagnose structural defects in the fetus. PUBS is used to assess the fetal circulation.
The nurse is reviewing the contraction stress test (CST) reports of a pregnant patient. The nurse expects the fetus to have meconium-stained amniotic fluid. What would be the reason for that conclusion? Positive CST results Negative CST results Suspicious CST results Unsatisfactory CST results
Meconium is normally stored in the infant's intestines until after birth, but sometimes (in cases of fetal distress and hypoxia) it is expelled into the amniotic fluid before birth. The amniotic fluid is then said to be meconium stained. Fewer than three contractions in 10 minutes or late decelerations occurring with 50% or more of contractions constitute positive CST results. Positive CST results are associated with meconium-stained amniotic fluid. Negative CST results indicate that the fetus is normal. Suspicious or unsatisfactory CST results are not associated with any other fetal conditions.
The nurse is reviewing the nuchal translucency (NT) reports of a pregnant patient. The report reveals that the fluid in the nape of the fetus is more than 3 mm. What does the nurse interpret from this finding? The fetus has cardiac disease. The fetus has growth restriction. The fetus has an organ disorder. The fetus has a genetic disorder.
NT is a type of ultrasound screening technique done to assess genetic disorders in the developing fetus. If the fluid in the nape of the fetus is more than 3 mm, it indicates that the child has a cardiac disorder. Organ disorders, growth restriction, and genetic disorders cannot be assessed using the NT screening technique only. Fetal organ disorders are identified by transvaginal ultrasound. Growth disorders can be diagnosed by normal ultrasonography. Elevated NT along with maternal serum markers indicates the presence of genetic disease.
While assessing the ultrasound scan reports of a pregnant patient, the nurse observes that the fetus is at an elevated risk for trisomy 13. What findings are likely to be associated with this risk? Select all that apply. Low amniotic fluid volume (AFV) Low maternal serum marker levels High daily fetal movement count (DFMC) Elevated levels of nuchal translucency (NT) Increased biophysical profile (BPP) of the fetus
NT screening uses ultrasound measurement of fluid in the nape of the fetal neck to identify fetal abnormalities. A low maternal serum marker level combined with elevated NT indicates a high risk for chromosomal abnormalities such as trisomy 13 in the fetus. In NT, fluid collection greater than 3 mm is considered abnormal. A low AFV is also associated with fetal disorders but not with chromosomal abnormalities. The BPP includes measurements of AFV, fetal movements, and fetal tone. Increase in BPP does not indicate chromosomal abnormalities. DFMC is measured to assess fetal well-being. High or low DFMC does not indicate chromosomal abnormalities in the fetus.
Which condition should the nurse suspect in a fetus with oligohydramnios? Potter syndrome Down syndrome Twin-twin syndrome Fetal alcohol syndrome
Oligohydramnios means that there is a low amniotic fluid volume (AFV). Oligohydramnios is known to cause Potter syndrome. Potter syndrome is the atypical physical appearance of a fetus or a neonate. Excessive alcohol intake during pregnancy may cause fetal alcohol syndrome and is not associated with oligohydramnios. Down syndrome is a genetic abnormality of the fetus and can be identified using prenatal screening tests such as triple marker screen and quad screen. Down syndrome is not associated with oligohydramnios. Twin-twin syndrome is associated mainly with polyhydramnios.
What is PUBS and what does it detect?
Percutaneous umbilical blood sampling tests for baby's hemolytic disorders rarely performed. Find placenta and gets sample of baby's blood direct access to fetal circulation to detect blood disorders insertion of needle directly into fetal umbilical vessel under ultrasound guidance
What parameter does the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? Antibody titer in the blood Alfa-fetoprotein (AFP) levels Creatinine levels in the blood Lecithin-to-sphingomyelin (L/S) ratio
Rationale The L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. Presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. The antibody titer is used to determine Rh incompatibility in the fetus.
The nurse reviews the ultrasound reports of a pregnant patient and finds that the images of fetal anatomic details are not clear. The nurse then prepares the patient for a magnetic resonance imaging (MRI) scan. What does the nurse administer to the patient before performing the MRI scan? A diuretic A sedative An analgesic An antipyretic
The MRI scan may take 20 to 60 minutes. During the scan, the patient must be perfectly still. Moreover, fetal movement during the scan will obscure the anatomic details. To avoid this problem, the patient should be administered a sedative before the MRI scan. Diuretics are administered to increase the rate of urine formation. If a diuretic is given before the MRI, frequent urination may occur. Because the patient does not complain of pain, analgesics need not be administered. Antipyretics would not helpful in decreasing the patient's activity level. They should be administered only if the patient has a fever.
Which test does the nurse recommend for the patient to help assess fetal genetic abnormalities? Fetal heart activity Fetal body movements Nuchal translucency (NT) Amniotic fluid volume (AFV)
The NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 and 14 weeks of gestation. Fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, and fetal heart activity are measured to assess fetal well-being.
The nurse finds that the nonstress test of a pregnant patient is nonreactive. Which factor in the report might have led the nurse to this finding? No qualifying accelerations in a 20-minute period Two qualifying accelerations in a 20-minute period Less than two qualifying accelerations in a 20-minute period More than two qualifying accelerations in a 20-minute period
The nonstress test is the most widely used technique for prenatal evaluation of the fetus. The results are either nonreactive or reactive. In a nonreactive test, there are less than two qualifying accelerations of the fetal heart rate in a 20-minute period. Absence of fetal heart rate accelerations during the nonstress test indicates that the fetus is sleeping. In a reactive test, there are at least two qualifying accelerations in a 20-minute time period. More than two fetal heart rate accelerations within a 20-minute time period also would be considered a reactive test.
The amniotic fluid index (AFI) of a pregnant patient is 3 cm. What clinical information related to the fetus does the nurse infer from this? Fetal hydrops Renal defects Low activity level Neural tube defect
The normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. An AFI less than 5 cm indicates oligohydramnios. This condition is associated with renal agenesis in the fetus. A high AFI indicates neural tube defects and fetal hydrops. The AFI is not directly related to fetal movement. Fetal activity can be assessed using ultrasonography.
When do you perform a non-stress test
after 28 weeks of gestation
What do we need to teach pregnant mothers about meat?
avoid undercooked meet avoid pre-packaged meats go to deli instead
