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34 Cards in this Set
- Front
- Back
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Maternal Risk factors |
-age under 17 or over 34 -high parity (>5) -pregnancy (3 months since last delivery) -hypertension, preeclampsia in current preg -anemia, history of or hemorrhage -multiple gestations -Rh incompatibility -history of dystocia or previous operative delivery -height of 60 inches (5 ft) or less -malnutrition or extreme obesity -medical disease -infection -history of family violence, lack social support |
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Medical diseases-Risk factors during pregnancy |
diabetes hyperthyroidism hyperemesis clotting disorders ie thyrombocytopenia |
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Infection in Pregnancy (Risk factors) TORCH |
TORCH T: toxoplasmosis O: other agents R: rubella C: cytomegalovirus H: HIV -chlamydia, HPV |
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ultrasonography |
high-frequency sound waves are beamed onto the abdomen; echoes are returned to a machine that records the fetus's location and size |
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Ultrasonography (used to determine) First Semester |
-# of fetuses -presence of fetal cardiac mvmt and rhythm -uterine abnormalities -gestational age |
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Ultrasonography (used to determine) Second-Third Semester |
-fetal viability and gestational age -size-date discrepancies -amniotic fluid volume -placental location and maturity -uterine anomalies and abnormalities -results of amniocentesis |
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When is fetal heart activity apparent |
6-7 weeks gestation |
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Ultrasonography-serial evaluation of biparietal diameter and limb length |
can differentiate between wrong dates and true IUGR |
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Biophysical profile (BPP) |
-made to ascertain fetal well-being 5 variables assessed: -fetal breathing mvmts -gross body mvmts -fetal tone -reactivity of FHR -amniotic fluid volume |
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Biophysical Profile Score |
A score of 2 or 0 can be obtained for each variable. An overall score of 10 designates that the fetus is well on day of exam |
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Ultrasonography Nursing Care |
-instruct mother to drink 3-4 glasses of water and not to urinate (for 1st and 2nd trimesters when fetus is small) -position woman with pillows under neck and knees to keep pressure off bladder; late in 3rd trimester, place wedge under right hip to displace uterus to the left -position display so woman can watch -have bedpan/bathroom immediately avail. *No complications |
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Gestational Age-Sonography |
Gestational age is best determined by an EARLY sonogram rather than later one |
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Chorionic Villi Sampling |
removal of a small piece of villi during the period between 8 and 12 weeks gestation under ultrasound guidance -(cannot replace the amniocentesis completely because no sample of amniotic fluid can be obtained for AFP or Rh disease testing) |
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Chorionic Villi Sampling Findings |
-determines genetic diagnosis early in the first trimester -results are obtained in 1 week |
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Chorionic Villi Sampling Nursing Care |
-informed consent -place woman in lithotomy position using stirrups -warn of slight sharp pain upon catheter insertion -results shouldn't be given over phone |
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Complications for Chorionic Villi Sampling |
spontaneous abortion (5%) controversy regarding fetal anomalies (limb) |
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Amniocentesis |
removal of amniotic fluid sample from the uterus |
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Amniocentesis is used to determine |
-fetal genetic diagnosis (usually 1st trim) -fetal lung maturity (last trim) -fetal well-being |
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Amniocentesis Findings: genetic disorders |
-Karyotype -biochemical analysis -AFP |
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Karyotype |
determines Down syndrome (trisomy 21), other trisomies, and sex chromatin (sex linked disorders) |
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biochemical analysis |
determines more than 60 types of metabolic disorders (Tay-sachs) |
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AFP |
elevations may be associated with neutral tube defects; low levels may indicate trisomy 21 |
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Fetal lung maturity: L/S ratio |
2:1 ratio indicates fetal lung maturity unless mother is diabetic or has Rh disease or fetus is septic |
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L/S ratio and presence of PG |
most accurate determination of fetal maturity. PG is present after 35 weeks gestation |
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Best predictor of extrauterine survival |
fetal lung maturity |
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Fetal lung maturity: creatinine |
renal maturity indicator >1.8 |
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Fetal lung maturity: orange staining cells |
lipid-containing exfoliating sebaceous gland maturity >20 % stained orange means 35 weeks or more |
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Bilirubin delta optical density (OD) assessment |
should be performed in mother previously sensitized to the fetal Rh+ red blood cells (RBCs) and having antibodies to the Rh+ circulating cells -delta OD test measures the change in OD of amniotic fluid caused by staining with bilirubin. Performed at 24 weeks gestation |
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What does meconium in amniotic fluid indicate |
fetal distress |
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Nursing care for amniocentesis |
-obtain vitals and FHR -place client in supine position, hands across chest -shave area and scrub with povidone-iodine -draw maternal blood sample for comparison with postprocedure blood sample to determine maternal bleeding -stay with client, provide support -label samples |
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If bilirubin test is prescribed.. |
darken room, immediately cover tubes with aluminum foil or use opaque tubes |
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After specimen for amniocentesis is drawn |
wash abdomen, assist to empty bladder (full bladder can irritate uterus and causes contractions) -monitor FHR for 1 hr; assess for uterine contractions/irritability -instruct women to report contractions, change in fetal mvmt or fluid leaking from vagina |
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Amniocentesis Complications |
-spontaneous abortion (1%) -fetal injury -infection |
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Amniocentesis in late pregancy |
-bladder must be full if done in EARLY preg for easy access -bladder must be empty if done in LATE preg so it will not be punctured |
