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29 Cards in this Set
- Front
- Back
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High Risk Pregnancy
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One in which the life or health of the mother or fetus is jeopardized
Diagnosis imposes a situational crisis on the family |
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Leading causes of maternal death
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– Hypertensive disorders, infection & hemorrhage
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Factors strongly related to maternal death
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– Age (younger than 20 years and 35 years or older)
– Lack of prenatal care – Low educational attainment – Unmarried status – Nonwhite race |
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Leading causes of neonatal death
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– Congenital anomalies, disorders related to preterm birth and LBW, SIDS, RDS, and the effects of maternal complications
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Contributing factors
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failure to respond to abnormalities of pregnancy
financial/educational/sociocultural/behavioral factors barriers to prenatal care services |
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Levels of care for perinatal services
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– Basic, specialty, or subspecialty
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Biophysical factors (Originating within the mother or fetus)
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– Genetic considerations
– Nutritional and general health status – Medical and obstetric disorders |
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Psychosocial Factors (Maternal behaviors and adverse lifestyles)
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– Smoking
– Caffeine – Alcohol – Drugs – Psychological Status |
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Psychosocial Factors
– Psychological Status |
• Emotional distress
• Disturbed interpersonal relationships • Inadequate social support |
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Sociodemographic Factors
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– Low income
– Lack of prenatal care – Age – Parity – Marital status – Residence – Ethnicity |
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Environmental Factors
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– Infections
– Radiation – Chemicals – Therapeutic or illicit drugs – Pollutants – Cigarette smoke – Stress – Diet |
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assessment First and second trimester
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– Directed primarily at the diagnosis of fetal anomalies
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assessment Third trimester
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– Determines whether the intrauterine environment continues to be supportive to the fetus
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Major expected outcome of antepartum testing
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– Detect potential fetal compromise before intrauterine asphyxia of the fetus
• So measures can be taken to prevent or minimize adverse perinatal outcomes |
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biophysical assessment
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daily fetal movement
ultrasound MRI |
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daily fetal movement
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"kick count"
concern if movements cease for more than 12 hours |
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ultrasound uses
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• Viability
• Dating/gestational age – Most accurate during first 20 weeks • Interval growth • Fetal anatomy and presentation • Placental placement and function • Uterine anatomy/abnormalities • Cervical length • Guidance with procedures |
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ultrasound to determine
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doppler blood flow analysis - HTN, IUGR, DM, multiples, PTL
amniotic fluid volume biophysical profile (CNS, hypoxia, in-utero apgar) |
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• Oligohydramnios
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renal, IUGR, fetal distress with labor
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• Polyhydramnios
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GI, NTD, multiples, hydrops
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biochemical assessments
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amniocentesis
chorionic villus sampling percutanous umbilical blood sampling maternal assays |
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Amniocentesis
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after 14th week
genetics concefns fetal pulmonary maturity fetal hemolytic disease meconium prescence |
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Chorionic Villus Sampling (CVS)
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remove tissue from fetal portion of placenta
genetic studies 10-12 weeks risk of preg. loss/limb anomalies |
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Percutaneous Umbilical Blood Sampling (PUBS) or Cordocentesis
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US guidance
fetal blood sampling - 2nd/3rd trimesters |
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why PUBS
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• Prenatal diagnosis of inherited blood disorders
• Karyotyping of malformed fetuses • Detection of fetal infection • Determination of acid-base status of fetuses with IUGR • Assessment and treatment of isoimmunization and thrombocytopenia in the fetus |
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Maternal Assays
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– Maternal Serum Alpha-Fetoprotein (MSAFP)
neural tube defect 15-22 weeks triple markers- downs indirect coombs - blood incompatabilities |
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electronic fetal monitoring
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nonstress test
contraction stress test |
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Nonstress Test (NST)
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FHR related to fetal movements
FHR accelerations with movement = reassuring reactive = normal, nonreactive = further testing |
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contraction stress test
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stimulate uterus - see how FHR tolerates contractions
FHR late decelerations = hypoxia neg = no late decls positive = late decls, need to continue monitoring, may need to deliver |
