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Chapter 26 Flashcards

Assessment of High Risk Pregnancy (83 cards)

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1
Q

-OB has a very (low/high) liability
-What is the age limit to sue for a baby if something goes wrong during pregnancy or birth?

A

-HIGH
-21

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2
Q

ASSESSMENT OF RISK FACTORS
-A ____ approach to high-risk pregnancy is used now
-Who does it require the efforts of?

A

-comprehensive
-an interprofessional health care team

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3
Q

ASSESSMENT OF RISK FACTORS
-The factors associated with high-risk childbearing are grouped into broad categories based on what?

A

Threats to health & pregnancy outcomes

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4
Q

INDICATIONS FOR ANTEPARTUM TESTING
-What are 11 indicators?

A
  1. Chronic HTN or preeclampsia
  2. Suspected for confirmed fetal growth restriction
  3. Mutliple gestation
  4. Oligohydramnios
  5. Preterm rupture of membranes
  6. Late term/postterm
  7. Previous stillbirth
  8. Decreased fetal movement
  9. Systemic lupus erythematosus
  10. Renal disease
  11. Cholestasis of pregnancy
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5
Q

INDICATIONS FOR ANTEPARTUM TESTING
-What are the 4 main risk categories?

A
  1. Biophysical
  2. Psychosocial
  3. Sociodemographic
  4. Environmental
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6
Q

INDICATIONS FOR ANTEPARTUM TESTING
-What do diagnostic tests let us know?
-What is something to note about these tests?

A

-If the baby has a certain disorder
-They are more invasive & carry a higher risk of miscarriage

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7
Q

BIOPHYSICAL
-What does this originate with?
-What may it affect?
-Examples?

A

-Mother or fetus –> may be underlying things mom has
-development & functioning of both
-Genetic disorders (CF, SMA, Fragile X), nutritional/general health status, medical/obstetric-related illnesses

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8
Q

BIOPHYSICAL
-With cystic fibrosis, what would help determine the likelihood of the baby having it?

A

-Genetic counseling, family hx, testing partner

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9
Q

PSYCHOSOCIAL
-What does this consist of
-What things may affect psychosocial status?

A

-Adverse maternal behaviors/lifestyle factors (smoking, caffeine, alcohol, drugs, weight) –> have a negative effect on maternal/fetal health
-IPV, inadequate support system

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10
Q

SOCIODEMOGRAPHIC
-What does this include? (6)

A
  1. Lack of prenatal care
  2. Low income
  3. Marital status
  4. Ethnicity
  5. Age
  6. SDOH
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11
Q

ENVIRONMENTAL FACTORS
-What does this include?
-What may they possibly be exposed to?

A

-Hazards in workplace & woman’s general environment
-Chemicals, anesthetic gases, radiation

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12
Q

ENVIRONMENTAL FACTORS
-Screening for ___ & ___ is implemented into bloodwork
-What do increased levels mean?

A

-lead & mercury
-Additional protocols

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13
Q

-How are polyhydramnios & oligohydramnios identified by?
-What do we look at?

A

-Ultrasounds
-The amount of fluid around the baby

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14
Q

POLYHYDRAMNIOS
-What is this?

A

TOO much fluid

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15
Q

POLYHYDRAMNIOS
-What can it be due to? (5)

A
  1. Poorly controlled DM
  2. Fetomaternal hemorrhage
  3. Fetal congenital anomalies (GI obstruction, CNS abnormality)
  4. Genetic disorders
  5. Twin-to-twin transfusion syndrome
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16
Q

OLIGOHYDRAMNIOS
-What is this?

A

TOO little fluid

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17
Q

OLIGOHYDRAMNIOS
-What is it due to? (6)

A
  1. Renal agenesis (potter syndrome)
  2. Prelabor ROM
  3. Prolonged pregnancy
  4. IUGR
  5. Maternal HTN OR dehydration/hypovolemia
  6. Uteroplacental insufficiency
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18
Q

INDICATIONS FOR ANTEPARTUM TESTING
-What are two additional indications?

A
  1. Diabetes
  2. Cyanotic heart disease
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19
Q

DAILY FETAL MOVEMENT COUNT (DFMC)
-What is this used to monitor?

A

Fetus in pregnancies complicated by conditions that may affect oxygenation

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20
Q

DAILY FETAL MOVEMENT COUNT (DFMC)
-Usually, by _____ weeks we ask the moms to do “____ ___”
-How is this done?

A

-28+
-Kick counts
-Count once a day for 60 minutes –> you want at least 3 kicks/movement (hour) OR 10 within 2 hours

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21
Q

DAILY FETAL MOVEMENT COUNT (DFMC)
-When should mom start to worry?
-What needs to happen?

A

-Fewer than 3 kicks/hour
-Further evaluation by NST is needed –> go to hospital!!!

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22
Q

DAILY FETAL MOVEMENT COUNT (DFMC)
-Fetal movement decreases as patient reaches term gestation (T/F)

A

FALSE; it does NOT decrease

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23
Q

DAILY FETAL MOVEMENT COUNT (DFMC)
-What gestational age should you instruct the patient to start DFMC?

A

-High risk: 26 weeks
-Low risk: 28 weeks

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24
Q

ULTRASONOGRAPHY
-Baseline ultrasounds are done when?

A

At the beginning of pregnancy

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25
**ULTRASONOGRAPHY** -What are indications for use? (6)
1. Fetal heart activity 2. Gestational age 3. Fetal growth, anatomy, & positioning 4. Fetal genetic disorders & physical anomalies 5. Placental position & function 6. AF volume
26
**ULTRASONOGRAPHY** -How should fetal positioning be?
HEAD DOWN
27
**ULTRASONOGRAPHY** -What is the doppler blood flow analysis used for?
Various arteries --> umbilical cord or maternal uterine
28
**ULTRASONOGRAPHY** -This is used in adjust to other ____ tests -Example?
-invasive -Amniocentesis --> risks are reduced with use of US
29
**ULTRASONOGRAPHY** -What is the normal AF volume index? -This is the sum of the largest pocket in ____ ____
-7-24 cm -4 quadrants
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**ULTRASONOGRAPHY** -Oligohydramnios fluid volume index
<5 cm
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**ULTRASONOGRAPHY** -Polyhydramnios fluid volume index
>25 cm
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**BIOPHYSICAL PROFILE** -This is an assessment tool that health care providers use to determine what?
Fetal well-being with high-risk pregnancies
33
**BIOPHYSICAL PROFILE** -What does it consist of?
Fetal US & NST
34
**BIOPHYSICAL PROFILE** -Scoring is out of what? -Providers use this score to make important decisions regarding the ____
-10 -pregnancy
35
**BIOPHYSICAL PROFILE** -There are ___ scoring components with ___ points each -Lower score = ?
-5; 2 -greater risk for the fetus
36
**BIOPHYSICAL PROFILE** -What are the 5 components?
1. Fetal breathing 2. Fetal movemnets 3. Fetal tone 4. AF fluid index 5. Fetal HF reactivtiy (NST)
37
**BIOPHYSICAL PROFILE** -The control centers that develop later require (lower/higher) oxygen levels that those that develop earlier -Which is the first to disappear?
-HIGHER -the last to develop
38
**BIOPHYSICAL PROFILE** -What does the absence of fetal tone indicate?
Advanced asphyxia & acidosis
39
**BIOPHYSICAL PROFILE** -Fetal tone is a/n (acute/chronic) marker of what?
Chronic; fetal well-being
40
**BIOPHYSICAL PROFILE** -8-10 score?
Normal, low risk for chronic asphyxia
41
**BIOPHYSICAL PROFILE** -4-6 score?
Suspect chronic asphyxia
42
**BIOPHYSICAL PROFILE** -0-3 score?
Strongly suspect chronic asphyxia
43
**AMNIOCENTESIS** -What is this? -How is this done? -Why is it done?
-Invasive, diagnostic test for potential complications -Using a sample of amniotic fluid -To confirm congenital anomalies, genetic disorders, or fetal lung maturity
44
**AMNIOCENTESIS** -When is this done for genetic disorders? (2)
1. If parent is affect with or a carrier 2. Prior child with chromosomal abnormality
45
**AMNIOCENTESIS** -When is this done?
AFTER 14 weeks once a genetic consultation has taken place
46
**AMNIOCENTESIS** -What is the risk?
Miscarriage
47
**CHORIONIC VILLUS SAMPLING (CVS)** -What is this? -When is this done? -Benefits?
-Technique for genetic studies -In the 1st trimester (10-13 weeks) -Earlier diagnosis with rapid results
48
**CHORIONIC VILLUS SAMPLING (CVS)** -How is this done? -This can be done either _____ or _____
-Remove small tissue specimen from fetal portion of the placenta (chorionic villi --> uterine lining) -transcervical or transabdominally
49
**CHORIONIC VILLUS SAMPLING (CVS)** -Tissue reflects _______ ____-___ of fetus
genetic make-up
50
**CHORIONIC VILLUS SAMPLING (CVS)** -CVS is a relateively safe procedure BUT it has a higher risk of ______ than amniocentesis
miscarriage
51
**MATERNAL BLOOD TESTS** -What are maternal assays?
Bloodwork screening
52
**MATERNAL BLOOD TESTS** -What does the Maternal Serum Alpha-Fetoprotein (MSAFP) screen for? -Example?
-neural tube defects (NTDs) -Spina bifids --> open tube defect --> spine doesn't close
53
**MATERNAL BLOOD TESTS**: *MSAFP* -It detects ___%-___% of open NTDs & ____ ____ ____ defects early in pregnancy -Who is screening recommended for?
-80-85 -open abdominal wall -ALL pregnant women between 16-18 weeks
54
**MATERNAL BLOOD TESTS**: *Quad Test* -What is the multiple marker screens (Quad Test) used to screen for?
fetal chromosomal abnormalities
55
**MATERNAL BLOOD TESTS**: *Quad Test* -What does this measure the levels of?
-Four maternal serum markers: 1. MSAFP 2. Unconjugated estriol 3. hCG 4. Inhibin
56
**MATERNAL BLOOD TESTS**: *Quad Test* -What conditions does this screen for? (3)
1. Trisomy 21 (Down syndrome) 2. Trisomy 18 (Edwards syndrome) 3. Trisomy 13 (Patau syndrome)
57
**MATERNAL BLOOD TESTS**: *Quad Test* -When is this done?
At 11-14 weeks gestation
58
**MATERNAL BLOOD TESTS**: *Cell-free DNA* -What is this? -What is an example?
-simple blood test -Noninvasive prenatal testing (NIPT)
59
**MATERNAL BLOOD TESTS**: *Cell-free DNA* -What does the NIPT reveal?
Gender & any chromosomal issues
60
**MATERNAL BLOOD TESTS**: *Cell-free DNA* -When is this performed?
At 10-12 weeks
61
**MATERNAL BLOOD TESTS**: *Cell-free DNA* -It provides a definitive diagnosis noninvasively for what? (3)
1. Fetal Rh status 2. Fetal gender 3. Certain paternally transmitted single gene disorders (CF, Tay-Sachs, SC anemia)
62
**MATERNAL BLOOD TESTS**: *Cell-free DNA* -Women with positive results for fetal chromosonmal abnormalities are sent for what?
Amniocentesis or CVS
63
1st, 2nd, & 3rd trimester testing is directed towards what?
Screening & diagnosis of fetal anomalies
64
3rd trimester testing is used to determine if ________ environment continues to support the _____
-intrauterine -fetus
65
**FETAL STRIP** -What does this look at?
Baby's baseline, variability, & HR
66
**FETAL STRIP** -What type of NST is this?
Reactive NST
67
**ELECTRONIC FETAL MONITORING** -The goal of EFM is what?
To determine whether the intrauterine environment continues to support the fetus
68
**ELECTRONIC FETAL MONITORING**: *NST* -What are the two interpretations?
1. Reactive 2. Nonreactive (required further evaluation)
69
**ELECTRONIC FETAL MONITORING**: *NST* -Describe a reactive NST BEFORE 32 weeks gestation
2 FHR accelerations 10 beats ABOVE baseline lasting 10 seconds in a 20 minute period
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**ELECTRONIC FETAL MONITORING**: *NST* -Describe a reactive NST AFTER 32 weeks gestation
2 FHR accelerations 15 beats ABOVE baseline lasting 15 seconds in a 20 minute period
71
**ELECTRONIC FETAL MONITORING**: *VAS* -What does VAS stand for? -What is it used in conjunction with? -It uses _____ to do what?
-Vibroacoustic Stimulation -NST -sound; stimulate the baby
72
**ELECTRONIC FETAL MONITORING**: *VAS* -How is it done? -When can it be repeated? -What if there is no response?
-3 seconds over fetal head -at 1 minute intervals up to 3 times -follow up with BPP or CST
73
**ELECTRONIC FETAL MONITORING**: *CST* -What does this stand for? -Sometimes it is also called what? -What does it do?
-Contraction Stress Test -Oxytocin challenge test -Provides early warning of fetal compromise
74
**ELECTRONIC FETAL MONITORING**: *CST* -In a healthy fetoplacental unit, do uterine contractions produce late decelerations?
No
75
**ELECTRONIC FETAL MONITORING**: *CST* -How is this done?
Nipple-stimulated contraction test OR oxytocin-stimulated contraction test
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**ELECTRONIC FETAL MONITORING**: *CST* -What is the desired result?
NEGATIVE --> NO late decelerations with contractions
77
**ELECTRONIC FETAL MONITORING**: *CST* -What does a positive CST mean?
FHR decelerations are present
78
_____ NST
Reactive
79
_____ NST
Nonreactive --> NOT good; it is almost a flat line
80
**PSYCHOLOGICAL EFFECTS IN HIGH-RISK PREGNANCY** -The label of high risk often increases the patient's sense of ______
vulnerability
81
**PSYCHOLOGICAL EFFECTS IN HIGH-RISK PREGNANCY** -What may the mom's exhibit? (4)
1. Anxiety 2. Guilt 3. Frustration 4. Inability to function
82
**PSYCHOLOGICAL EFFECTS IN HIGH-RISK PREGNANCY** -It can affect what things?
Parental attachment, accomplishment of pregnancy tasks, family adaptation to pregnancy
83
**NURSE'S ROLE IN HIGH-RISK PREGNANCY** -What is your role? (3)
1. Education 2. Support 3. Counseling & anticipatory planning
OB EXAM 2
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