Maternal Health Chapter 10
What is the alpha-fetoprotein (AFP) test? What does it check for? Is this test widely done? Why or why not? High levels of this protein in men, non pregnant women, and children may indicate what?
-Alpha-fetoprotein (AFP) is a blood test that checks the level of AFP in a pregnant woman's blood. AFP is a substance made in the liver of an unborn baby (fetus). The amount of AFP in the blood of a pregnant woman can help see whether the baby may have such problems as spina bifida and anencephaly. An AFP test can also be done as part of a screening test to find other chromosomal problems, such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18). -In some states this test is required to screen the fetus for brain or spinal problems (aka neural tube defects). But the problem with it is that it's associated with giving both false positives and false negatives. -High levels of this Plasma protein in men, non pregnant women and children can indicate cancer. -Your results are based on your weight, so you'll be weighed before the test. -A Pts. AFP value may have to be adjusted based on the mothers age, their babies gestational age, weight, race, and whether they have diabetes.
How do we manage our pts. scheduled to undergo the CST procedure?
4. Record at least 3 cxn's in 10 mins to adequately assess the fetus well-being. 5. If your going to try to stimulate the mothers nipples to stimulate the release of oxytocin then apply warm, wet wash clothes to their nipples & roll the nipple of 1 breast for 10 mins. Begin rolling both nipple if cxn's don't begin in 10 mins. Try infusing Oxytocin (pitocin) if the nipple stimulation doesn't work. 6. IV infusion of Oxytocin can be given to stimulate cxn's 7. A negative test= no late deceleration, which = suggested fetus well-being.
What is the problem w/ nipple stimulation in CST? What is important about the bladder in Amniocentesis in early & late pregnancy & why?
A) The problem w/ nipple stimulation is that you have no control over the amount of oxytocin getting delivered to the mother, the dosage. The chance of hyperstimulation occurring or tetany (meaning cxn's over 90 secs or cxn's w/ less than 30 secs in between) increases. B) When an amniocentesis is done early in the pregnancy, the mothers bladder has to be full to help support the uterus & push the uterus upwards for easier access. When amniocentesis is done in late pregnancy, then the bladder has to be empty so it won't get punctured.
Describe what an Ultrasound is: When is it used?
A) Ultrasounds are machines that beam high frequency waves onto your abdomen, the echoes of those waves are then returned back to the machine in order to record the babies location & size. B) Ultrasonography is used in the 1st trimester to determine: *****A pts. # of pregnancies, *****Determine the presence of fetal cardiac movement & rhythm, *****Determine uterine abnormalities, *****& Determine gestational age. C) Ultrasonagraphy used in the 2nd & 3rd Trimesters to Determine: 1) Fetal viability & gestational age 2) Size data-discrepancies 3) Amniotic fluid volume 4) Placental location & maturity 5) Uterine anomalies & abnormalities 6) Results of an amniocentesis.
Describe the CVS test: Why is it used? How do we manage pts. scheduled to undergo this test? What complications can occur?
A) CVS is a Transcervical or transabdominal procedure that involves the removal of a small piece of villi between 8 & 12 wks gestation w/ the guidance of an ultrasound. This procedure can't replace amniocentesis completely b/c a sample of amniotic fluid can't be obtained for AFP or Rh dz testing. B) CVS determines genetic diagnosis early in the 1st trimester & the results are back in a week. C) Nursing Care: 1. Obtain informed consent b4 the procedure, 2. Place the pt. in a lithotomy position using stirrups, 3. Warn the pt. that they may feel this slightly sharp pain upon the catheter insertion, 4. Never give the pt. their results over the phone. D) Complications include: 5% spontaneous abortion, controversy regarding fetal anomalies (limbs).
What is the problem w/ the amniocentesis test? What does the term Karyotype describe? Who is the test done for? What does the test detect? This test is the most accurate to determine what?
A) It can take 10 days to 2 weeks to develop the cultured cell so the mom may not get her daignosis until the second trimester. The choice of having an Abortion at this time will make it more dangerous. B) Karyotype is a test used to identify/evaluate the size, shape, and # of chromosomes (it determines Down Syndrome). C) Its done 4 women who have an abnormal ultrasound -Have a family hx of certain birth defects -Have previously had a child or pregnancy with a birth defect -Will be 35 or older at the time of delivery D) Its used to detect: 1) Down syndrome, 2) Sickle cell disease 3) Cystic fibrosis 4) Muscular dystrophy 5) Tay-Sachs and similar diseases E) This is the most accurate test used to determine the babies gender.
Nursing management for our pts. continued: Are their any complications with this test? When is a Transvaginal Ultrasound performed?
A) Nursing Management Includes continued: 1. Position the display so the pt. can watch whats happening if they want. 2. Make sure a bathroom or bedpan is available immediately following the exam. B) No complications have been noted. C) A transvaginal ultrasonography is most often performed during the first trimester, when the uterus lies within the pelvis. A transabdominal procedure is more common during the second and third trimesters, when the uterus is above the pelvic brim and the contents are clearly visible.
How do we prepare our pts. for the amniocentesis Procedure? What complications can occur?
A) Obtain Baseline VS & FHR 2. Place pt. in a supine position w/ hands across chest. 3. If rx then shave the area & cleanse w/ proidone iodine (Betadine). 4. Draw the moms blood in order to compare it with their post procedure blood sample to determine if they are bleeding. 5. Explain the procedure to the pt., provide support, & don't leave their side. 6. Wash the pts. abdomen after the procedure, & help the mom empty her bladder b/c a full bladder can irritate the uterus & cause cxn's. 7. Monitor the babies Fetal Heart Rate 4 an hour after the procedure. Assess for uterine cxn's & irritability. 8. Educate the pt. to report any cxn's, change in fetal movement, or fluid leaking from the vagina. B) Complications may include: 1. A spontaneous abortion 2. Fetal injury 3. Infections
Describe a Nonstress test: Who is it recommended for? Is their a risk of doing this test?
A) A Nonstress test (aka the fetal heart rate test) is a test used to check the baby's health. During the test, the baby's heart rate is monitored to see how it responds to the baby's movements. It helps you get information regarding the babies 02 supply. B) The Nonstress test is recommended for women at increased risk of their fetus dying. This test is a noninvasive test that doesn't pose any physical risks to you or your baby. C) People who should undergo this test include: 1. A woman w/ multiple pregnancies that include complications 2. Having an underlying medical condition: i.e. type 1 diabetes, high blood pressure, a blood disorder, lupus, thyroid disease, kidney disease or heart disease 3. A pregnancy that has extended two weeks past your due date (postterm pregnancy) 4. Hx of pregnancy loss 5. A baby w/decreased fetal movements or possible fetal growth problems 6. Having too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios) 7. Rh (rhesus) sensitization — a potentially serious condition that can occur, typically during a second or subsequent pregnancy, when your blood group is Rh negative and your baby's blood group is Rh positive 8. Worrisome results from other prenatal tests
What is a BPP? How are the results interpreted? How do we prepare our pts. undergoing the BPP procedure?
A) A biophysical profile is a prenatal test used to check on the baby's well-being. The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound — an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus. During a biophysical profile, the baby's heart rate (non stress test), breathing, movements, muscle tone, & amniotic fluid level are evaluated & given a score. B) Each category is given a score between 2 & 0 points. @ points = normal. 0 = abnormal or absent response. C) Nursing Management Includes: 1. Prepare the client for the procedure 2. Educate the pt. on why the test is being done 3. Provide psychological support, especially if they will get tested throughout the pregnancy. 4. Advise the client that a low score indicates fetal compromise calls for further tests 5. A score of 8 - 10 indicates fetal well-being
Describe a Contraction Stress Test, (aka an Oxytocin Stress Test): How do we start this test? How do we know if their is something wrong w/ the baby?
A) A contraction stress test checks to see if your unborn baby (fetus) will stay healthy during the reduced 02 levels that normally occur during contractions when you are in labor. This test includes external fetal heart monitoring. Usually during a uterine cxn, the blood & 02 supply to your baby drops 4 a short time. This is not a problem for most babies. But the heart rate of some babies gets slower. This change in heart rate can be seen on the external fetal monitoring device. B) For a cxn stress test, the hormone oxytocin (Its Diluted) is given to you in a vein (intravenously, or IV) to induce labor cxn's. You may also massage your nipples. This tells your body to release oxytocin. If your baby's heart rate slows down (decelerates) in a certain pattern after a contraction instead of speeding up (accelerating), your baby may have problems with the stress of normal labor.
When is a cxn stress test needed? How do we manage our pts. scheduled to undergo this procedure?
A) A cxn stress test is usually done if you have an abnormal nonstress test or biophysical profile. The biophysical profile uses an ultrasound during a nonstress test to measure a series of physical characteristics of your baby. You may have more than one contraction stress test during your pregnancy, & some doctors may do a biophysical profile or a Doppler ultrasound test instead of a contraction stress test. B) An unhealthy fetus will develop FHR patterns that are not so reassuring of their status during uterine cxn's. Late decelerations indicate UPI. C) Nursing Management Includes: 1. Assessing the fetus for any contraindications (i.e. Prematurity, Placenta Previa, Hydramnios, Multiple Gestation, Previous uterine classical scar, & ruptured membranes (ROM) 2. Place external monitors on the pts. abdomen ( along w/ the FHR Ultrasound monitor & tocodynamometer). 3. Record a 20 min baseline strip to determine the fetus well-being (reactivity) & presence or absence of cxn's.
How do you know if the fetus is normal for a mom undergoing the Nonstress test? How do we manage our pts. who will receive this test?
A) A healthy fetus will usually respond to their own movement by speeding up their FHR by 15 beats, for at least 15 seconds after the movement. It occurs twice in 20 mins. B) A fetus that responds w/ a 15/15 acceleration is considered reactive & healthy. C) Nursing care includes: 1. Apply the fetal monitor, ultrasound, & tocodynamometer to the moms abdomen 2. Give the mom a handheld event marker, & instruct the pt. to push the button whenever she feels fetal movement/ & or its recorded as FM on the FHR strip. 3. Monitor the client for 20 -30 mins & observe for reactivity 4. If the fetus does not move, then suspect that its sleeping. Try to stimulate the fetus acoustically, physically, or have the mom move the fetus around & begin the test again.
When does APF rise? When does APF decrease? What are some possible causes for elevated levels of AFP? (6) What are some possible causes for low levels of AFP? (3)
A) AFP gradually rises in the 14th week of pregnancy, & it continues to rise up until a month or two before giving birth, then it slowly decreases. B) Elevated MSAFP may be caused by: 1. Wrong gestational age of the baby. 2. The mom is pregnant with more than 1 baby, such as twins or triplets. 3. The baby has a neural tube defect. 4. The baby's intestines or other abdominal organs are outside the body (called an abdominal wall defect or omphalocele). Surgery after birth will be needed to correct the problem. 5. The baby is dead. 6. Maternal Weight, & Maternal Diabetes. C) Low levels of AFP may be caused by: 1. Suggest Chromosomal Abnormalities or Inaccurate Gestational Age 2. Maternal weight 3. Gestational Trophoblastic Disease may also cause low AFP levels. 4. Having Down Syndrome
What is an Amniocentesis? Why is it done? When is it done? Are there any problems with this test?
A) Amniocentesis is a procedure where a fine needle is inserted into the abdomen into the uterus & a sample of amniotic fluid sample is obtained. This procedure is done under the guidance of an ultra sound. The Amniotic fluid obtained contains fetal cells, as well as AFP. B) Amniocentesis is performed to look for certain types of birth defects, such as Down syndrome - a chromosomal abnormality. But this procedure does present a small risk 4 both the mom & her baby. The prenatal test is generally offered to women who have a significant risk for genetic diseases. C) The test determines the babies well being, the babies genetic diagnosis during the 1st trimester, and there fetal lung maturity (during the last trimester) D) The test is only performed when the Pts. Uterus rises above their symphysis between 12 & 13 wks, & amniotic fluid has formed.
What does the test tell you? Nursing management for our pts. undergoing this test includes?
A) We notice that fetal heart activity is apparent as early as 6-7 weeks gestation B) The evaluation of biparietal diameter & limb length can differentiate between wrong dates & true IUGR C) BPP (biophysical profile) tells you the fetus well being 1. Assessed via fetal reathing movements, gross body movements, fetal tone, reactivity of FHR, & amniotic fluid volume. 2. A score of 2 or 0 can be obtained from each variable. Score of 10 means fetus is well on examination day. D) Nursing Management Includes: 1. Have the pt. drink 3 - 4 glasses of water before the examine, 2. Instruct the patient not to pee b/c the bladder has to be full during the exam in order for the utter to be supported for imaging. A full bladder isn't needed if the ultrasound is done transvaginally. 3. Place pillows under pts. neck, & knees to keep pressure off bladder. In the 3rd trimester place a wedge underneath their right hip to displace the uterus to the left.
