Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
116 Cards in this Set
- Front
- Back
|
What is a high risk pregnancy?
|
A pregnancy in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy
|
|
|
What is a high risk status for the pregnant woman?
|
Arbitrarily extends through the puerperium (4 to 6 weeks after childbirth)
|
|
|
How long does perinatal morbidity last?
|
May continue for months or years after childbirth
(i.e. gestational diabetes) |
|
|
How long do postbirth complications last?
|
Usually resolved within 1 month of birth
(i.e. lacerations) |
|
|
What are the major causes of maternal death attributable to pregnancy?
|
1. Hypertensive disorders
2. Infection 3. Hemorrhage |
|
|
What are the major causes of maternal mortality in the U.S.?
|
1. Gestational hypertension
2. Pulmonary embolism 3. Hemorrhage |
|
|
What factors are strongly related to maternal death?
|
1. Age (<20 yrs and >35 yrs)
2. Lack of prenatal care 3. Low educational attainment 4. Unmarried status 5. Nonwhite race |
|
|
What is the leading cause of death in the neonatal period?
|
Congenital anomalies
|
|
|
What factors should be considered when determining a client's risk status?
|
1. Resources available locally to treat the condition
2. Availability of appropriate facilities for transport if needed 3. Determination of the best match for the client's needs |
|
|
What is hospitalized-based perinatal health care services?
|
A system of coordinated care, in which facilities within a geographic region are organized to provide different levels of care
|
|
|
What is basic care?
|
Routine risk-oriented prenatal care, education, and support
|
|
|
Who provides basic care?
|
1. Obstetricians
2. Family physicians 3. Certified mid-wives 4. Other advanced practice clinicians approved by local governance |
|
|
What is specialty care?
|
Fetal diagnostic testing and management of obstetric and medical complications in addition to basic care
|
|
|
Who provides specialty care?
|
Obstetricians
|
|
|
What is subspecialty care?
|
Genetic testing, advanced fetal therapies, and management of severe maternal and fetal complications in addition to specialty care
|
|
|
Who provides subspecialty care?
|
Maternal-fetal medicine specialists
|
|
|
What is the criteria for basic perinatal services?
|
1. Care of all clients admitted to the service, with an established triage system for high risk clients who should be transferred to a higher level of care
2. Ability to perform a cesarean birth within 30 minutes of decision to do so 3. Availability of blood and blood products 4. Availability of radiology, anesthesia, and laboratory services on a 24 hour basis 5. Presence of newborn and postpartum care 6. Resuscitation and stabilization of all neonates born in the hospital 7. Availability of transport or all sick neonates 8. Family visitation 9. Data collection and retrieval |
|
|
What is the criteria for specialty hospital care?
|
1. Everything for basic perinatal services
2. Care of high risk mothers and fetuses 3. Stabilization of all ill neonates before transfer 4. Care of preterm infants with birth weight of 1500 g or more |
|
|
What is the criteria for subspecialty hospital care?
|
1. Everything in specialty hospital care
2. Ability to care for women in preterm labor or those with impending births at 32 weeks of gestation or less 3. Provision of comprehensive perinatal care for women and infants of all risk categories 4. Evaluation and use of new high risk technologies and therapies 5. Data collection and retrieval |
|
|
What is the key to reducing perinatal morbidity and mortality?
|
Collaboration among providers to meet the client's needs
|
|
|
What is uteroplacental insufficiency (UPI)?
|
The gradual decline in delivery of needed substances by the placenta to the fetus
|
|
|
What risks are associated with uteroplacental insufficiency (UPI)?
|
1. Fetal growth restriction
2. Intrauterine fetal death 3. Intrapartum fetal death 4. Intrapartum fetal distress 5. Various types of neonatal morbidity |
|
|
What are some biophysical factors associated with perinatal complications?
|
1. Genetic disorders
2. Nutritional and general health status 3. Medical or obstetric-related illnesses |
|
|
What are some psychosocial factors associated with perinatal complications?
|
1. Emotional distress
2. Disturbed interpersonal relationships 3. Inadequate social support 4. Smoking, alcohol, caffeine, and drugs |
|
|
What are some sociodemographic factors associated with perinatal complications?
|
1. Lack of prenatal care
2. Low income 3. Marital status 4. Maternal age 5. Ethnicity |
|
|
What are some environmental factors associated with perinatal complications?
|
1. Hazards in the work place
2. Chemicals (i.e. lead, pesticides, mercury) 3. Radiation 4. Pollutants (i.e. smog) |
|
|
What are some pregnancy-specific problems?
|
1. Preterm labor
2. Polyhydramnios 3. IUGR 4. Oligohydramnios 5. Postterm pregnancy 6. Chromosomal abnormalities |
|
|
What factors place the postpartum woman at high risk?
|
1. Hemorrhage
2. Infection 3. Abnormal vital signs 4. Traumatic labor or birth 5. Psychosocial factors |
|
|
What factors place the neonate at high risk?
|
1. Respiratory distress
2. Asphyxia (Apgar score <6 at 5 minutes) 3. Preterm infants, dysmature infants 4. Cyanosis 5. Congenital malformations, chromosomal anomalies 6. Convulsions, sepsis, hemorrhagic diathesis, or shock 7. Meconium aspiration syndrome 8. Depressed CNS 9. Hypoglycemia 10. Hypocalcemia 11. Hyperbilirubinemia |
|
|
Which fetal assessment test has the most beneficial effects for assessing pregnancy at high risk for fetal compromise?
|
Doppler ultrasound
|
|
|
Which fetal assessment test has the least beneficial or potentially harmful effects for improving perinatal outcome?
|
1. Nipple stimulation
2. Nonselective nonstress test 3. Contraction stress test |
|
|
What is the daily fetal movement count (DFMC)?
|
"Kick counts" of the fetus inutero by the mother
|
|
|
What is the clinical value for the absolute number of fetal movements?
|
NO STANDARD ESTABLISHED YET
However, reassuring fetal movements should be 10 movements between a 2 to 12-hour period. |
|
|
What is fetal alarm signal?
|
Fetal movements CEASE entirely for 12 hours
|
|
|
When should a woman call her PCP immediately regarding fetal movements?
|
If less than 10 movements are felt within the specified time or movement is perceived to be less than the previous day
|
|
|
What is important to educate the woman about fetal movements?
|
1. Movements usually not present during fetal sleep cycle
2. Movements may be temporarily reduced if the woman is taking depressant medications, drinking alcohol, or smoking a cigarette 3. Movements do not decrease as the woman nears term 4. Obesity decreases the ability to assess fetal movements |
|
|
What is sound?
|
Wave energy that causes small particles in a medium to oscillate
|
|
|
What is the measurement of sound?
|
Frequency
|
|
|
What is the unit of frequency (sound)?
|
Hertz (= 1/second)
|
|
|
What is ultrasound?
|
Sound frequency higher than that detectable by humans (greater than 20,000 Hz)
|
|
|
What are ultrasound images?
|
A reflection of the strength of the sending beam, the strength of the returning echo, and the density of the medium
|
|
|
What types of medium can be sensed with ultrasound?
|
1. Muscle (i.e. uterus)
2. Bone 3. Tissue (i.e. placenta) 4. Fluid (i.e. amniotic fluid) 5. Blood |
|
|
What are the diagnostic uses of ultrasound?
|
1. Monitor fetal activity and gestational age
2. Assess normal vs. abnormal fetal growth curves 3. Visual assistance of the fetus 4. Fetal and placental anatomy 5. Assess fetal well-being |
|
|
What are the major uses of ultrasonography during the first trimester?
|
1. Confirm pregnancy
2. Confirm viability 3. Determine gestational age 4. Rule out ectopic pregnancy 5. Detect multiple gestation 6. Use for visualization during chorionic villus sampling 7. Detect maternal abnormalities such as bicornicate uterus, ovarian cysts, fibroids |
|
|
What are the major uses of ultrasonography during the second trimester?
|
1. Establish or confirm dates
2. Confirm viability 3. Detect polyhydramnios, oligohydramnios 4. Detect congenital anomalies 5. Detect IUGR 6. Confirm placenta placement 7. Use for visualization during amniocentesis |
|
|
What are the major uses of ultrasonography during the third trimester?
|
1. Confirm gestational age
2. Confirm viability 3. Detect macrosomia 4. Detect congenital anomalies 5. Detect IUGR 6. Determine fetal position 7. Detect placenta previa or abruptio placentae 8. Use for visualization during amniocentesis, external version 9. Biophysical profile 10. Amniotic fluid volume assessment 11. Doppler flow studies 12. Detect placental maturity |
|
|
What are the uses of a standard ultrasonography examination?
|
1. Detect fetal viability
2. Determine the presentation of the fetus 3. Assess gestational age 4. Locate the placenta 5. Examine the fetal anatomy for malformations 6. Determine amniotic fluid volume |
|
|
What are the uses of a limited ultrasonography examination?
|
1. Identify fetal presentation during labor
2. Evaluate fetal heart activity when not detected by other methods |
|
|
What is the purpose of a specialized or targeted ultrasonography examination?
|
To asses a woman who is suspected of carrying an anatomically or a physiologically abnormal fetus
|
|
|
What are the methods of fetal age estimation using ultrasonography?
|
1. Determination of gestational sac dimensions
2. Measurement of crown-rump length 3. Measurement of the biparietal diameter 4. Measurement of femur length |
|
|
What conditions require ultrasound assessment of fetal growth?
|
1. Poor maternal weight gain or pattern of weight gain
2. Previous pregnancy with IUGR 3. Chronic infections 4. Ingestion of drugs (tobacco, alcohol, OTC or street drugs) 5. Maternal DM 6. HTN 7. Multifetal pregnancy 8. Other medical or surgical complications |
|
|
What are the distinguishing characteristics of macrosomic infant of a diabetic mother?
|
1. Asymmetric growth
2. Increased fat and muscle in the abdomen and shoulders |
|
|
What anatomical structures can be identified by ultrasonography?
|
1. Head (including ventricles and blood vessels)
2. Neck 3. Spine 4. Heart 5. Stomach 6. Small bowel 7. Liver 8. Kidneys 9. Bladder 10. Limbs |
|
|
What is a fetal nuchal translucency (FNT)?
|
A prenatal screening technique that uses ultrasound measurement of fluid in the nape of the fetal neck between 10 to 14 weeks of gestation to identify potential fetal abnormalities
|
|
|
What FNT findings are considered abnormal?
|
1. Fluid collection greater than 2.5 mm is abnormal
2. Fluid collection of 3mm or greater is highly indicative of genetic disorders and/or physical anomalies |
|
|
When can ultrasonography confirm a diagnosis of placenta previa?
|
After 27 weeks of gestation, primarily because of the elongation of the lower uterine segment as pregnancy advances
|
|
|
What is of significance in postterm pregnancies?
|
Calcium deposits, because they increase as the placenta ages, which can decrease maternal blood volume and lead to fetal hypoxia
|
|
|
What is the purpose of Doppler blood flow analysis?
|
Adjunct to the management of pregnancies at risk because of HTN, IUGR, diabetes mellitus, multiple fetuses, or preterm labor
|
|
|
What is the Doppler effect?
|
The change in frequency of the reflected sound wave of a moving target relative to the transmitted wave
|
|
|
What are systolic/diastolic (S/D) ratios?
|
Velocity waveforms from umbilical and uterine arteries
|
|
|
What is the normal pattern of the S/D ratios?
|
Decreases as pregnancy advances
|
|
|
What is the normal S/D ratio of most fetuses by 30 weeks gestation?
|
3 or less
|
|
|
What is a persistent elevation of the S/D ratio associated with?
|
IUGR, which usually results from uteroplacental insufficiency (UPI)
|
|
|
What is the objective criterion of decreased amniotic fluid volume (AFV)?
|
Fluid pockets in the uterine cavity less than 2 cm in two perpendicular planes
|
|
|
What is the objective criterion of increased amniotic fluid volume (AFV)?
|
Fluid pockets in the uterine cavity greater than 8 cm in two perpendicular planes
|
|
|
What is the amniotic fluid index (AFI)?
|
Total (in cm) of all four quadrants of the uterine cavity
|
|
|
What AFI is indicative of oligohydramnios?
|
Less than 5 cm
|
|
|
What is the range of normal AFI?
|
5 to 19 cm
|
|
|
What AFI is indicative of polyhydramnios?
|
Greater than 20 cm
|
|
|
What is the biophysical profile?
|
A noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease
|
|
|
What does the biophysical profile include?
|
1. Amniotic fluid volume (AFV)
2. FBMs 3. Fetal movements 4. Fetal tone (i.e. FHR) |
|
|
What is the biophysical profile an accurate indicator of?
|
Impending fetal death
|
|
|
Can nurses perform ultrasound examinations?
|
NO
|
|
|
What is magnetic resonance imaging (MRI)?
|
A noninvasive radiologic technique that provides pictures of soft tissues used for obstetric and gynecologic diagnosis
|
|
|
What can the examiner evaluate with an MRI?
|
1. Fetal structure (i.e. CNS, thorax, abdomen) and overall growth
2. Placenta (position, density, presence of gestational trophoblastic disease) 3. Quantity of amniotic fluid 4. Maternal structures (uterus, cervix, adnexa, and pelvis) 5. Biochemical status (pH, ATP content) of tissues and organs 6. Soft-tissue, metabolic, or functional anomalies |
|
|
What is an amniocentesis?
|
An invasive procedure for obtaining amniotic fluid after 14 weeks of pregnancy
|
|
|
What are the indications for an amniocentesis?
|
1. Prenatal diagnosis of genetic disorders or congenital anomalies (i.e. NTDs)
2. Assessment of pulmonary maturity 3. Diagnosis of fetal hemolytic disease 4. Fetal sex to assess for X-linked disorders 5. Assess for meconium in the amniotic fluid |
|
|
What are the maternal complications associated with an amniocentesis?
|
1. Hemorrhage (most serious: fetomaternal hemorrhage)
2. Infection 3. Labor 4. Abruptio placentae 5. Inadvertent damage to the intestines or bladder 6. Amniotic fluid embolism |
|
|
What are the fetal complications associated with an amniocentesis?
|
1. Death
2. Hemorrhage 3. Infection (amnionitis) 4. Direct injury from the needle 5. Miscarriage or preterm labor 6. Leakage of amniotic fluid |
|
|
What is chorionic villi sampling (CVS)?
|
Retrieval of chorionic villi for genetic testing
|
|
|
What are the indications for chorionic villi sampling (CVS)?
|
Same as an amniocentesis:
1. Prenatal diagnosis of genetic disorders or congenital anomalies (i.e. NTDs) 2. Assessment of pulmonary maturity 3. Diagnosis of fetal hemolytic disease 4. Fetal sex to assess for X-linked disorders 5. Assess for meconium in the amniotic fluid |
|
|
What precaution must nurses be aware of regarding chorionic villi sampling (CVS)?
|
May need RhoGAM afterward, to prevent Rh incompatibility adverse reactions due to fetomaternal hemorrhage
|
|
|
What are the complications associated with chorionic villi sampling (CVS)?
|
1. Vaginal spotting or bleeding
2. Miscarriage 3. Rupture of membranes 4. Fetomaternal hemorrhage 5. Chorioamnionitis 6. Limb reduction 7. Infection |
|
|
What is the main protein in fetal plasma?
|
Alpha-Fetoprotein (AFP)
|
|
|
How is alpha-fetoprotein measured?
|
Measured as maternal serum alpha-fetoprotein (MSAFP) levels
|
|
|
What are the purposes of assessing maternal serum alpha-fetoprotein (MSAFP) levels?
|
1. Low levels are associated with chromosomal abnormalities (Trisomy 21 = Down syndrome)
2. Increased levels are associated with NTDs, abdominal wall defects, twins |
|
|
What is the advantage of the maternal serum alpha-fetoprotein (MSAFP) screening test?
|
Conducted as early as 16-18 weeks gestation to screen for NTDs
|
|
|
What are the disadvantages of the maternal serum alpha-fetoprotein (MSAFP) screening test?
|
1. Screening ONLY, need ultrasound follow-up if abnormal
2. False negatives |
|
|
What is a Coomb's test?
|
A screening for Rh incompatibility
|
|
|
What is the significance a Coomb's test?
|
If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia
|
|
|
What is the percutaneous umbilical sampling (PUBS)?
|
1. Method of fetal blood sampling and transfusions
2. Direct sample of fetal blood from umbilical cord (also known as cordocentesis) |
|
|
What are the indications of percutaneous umbilical sampling (PUBS)?
|
1. Prenatal diagnosis of inherited blood disorders
2. Karyotyping of malformed fetuses 3. Detection of fetal infection 4. Determination of the acid-base status of fetuses with IUGR 5. Assessment and treatment of isoimmunization and thrombocytopenia in the fetus |
|
|
What is the procedure for percutaneous umbilical sampling (PUBS)?
|
1. The umbilical cord is punctured 1 to 2 cm from its insertion into the placenta
2. 1 to 4 mL of blood is removed and tested immediately by the Kleihauer-Betke method to ensure that it is fetal in origin |
|
|
What are the complications associated with percutaneous umbilical sampling (PUBS)?
|
1. Leaking of blood from the puncture site
2. Cord laceration 3. Thromboembolism 4. Preterm labor 5. PROM 6. Infection |
|
|
What is the nursing care following a percutaneous umbilical sampling (PUBS)?
|
1. Continuous FHR monitoring for several minutes to 1 hour
2. Repeated ultrasound examination1 hour later to ensure that no further bleeding or hematoma formation has occurred |
|
|
What are the fetal biochemical markers (FBMs)?
|
1. Fetal fibrinectin (fFN)
2. Lecithin /Sphingomyelin ratio (L/S) |
|
|
What is the significance of fetal fibrinectin?
|
1. Protein found in cervical/vaginal fluid <20wk
2. If (+), may indicate PTL <14d 3. False + from bleeding, intercourse, or recent SVE |
|
|
What is the significance of lecithin/sphingomyelin ratio (L/S)?
|
1. Lipoproteins tested for fetal lung maturity
2. A 2:1 ratio is not sufficient if mom has Gestational DM 3. Phosphatidylglycerol (PG) 4. Phosphatidylinositol (PI) 5. Phospholipids that boost the properties of Lecithin |
|
|
What is the purpose of antepartum/intrapartum fetal assessments?
|
1. Determines fetal health if possible
2. Helps guide OB team interventions 3. Helps reduce perinatal morbidity/mortality |
|
|
What are the types of antepartum/intrapartum fetal assessments?
|
1. Kick count
2. NST (non-stress test) 3. BPP (biophysical profile) 4. CST (contraction stress test) |
|
|
What is the non-stress test?
|
Technique to evaluate fetal well-being through acceleration of fetal heart rate, often associated with fetal movement
Intact CNS, able to respond to stress |
|
|
What are the indications for the non-stress test?
|
1. Maternal DM
2. Chronic HTN 3. Hypertensive disorders in pregnancy 4. IUGR 5. Sickle cell disease 6. Maternal cyanotic heart disease 7. Postmaturity 8. Hx of previous stillbirth 9. Decreased fetal movements 10. Isoimmunization 11. Meconium-stained amniotic fluid at 3rd-trimester amniocentesis 12. Hyperthyroidism 13. Collagen disease 14. Older pregnant woman (>35 yrs old) 15. Chronic renal disease |
|
|
What is the procedure of the non-stress test?
|
1. Woman is seated in a reclining chair (or semi-Fowler) with a slight left or right tilt to optimize uterine perfusion and avoid supine hypotension
2. FHR recorded with Doppler transducer and a tocodynamometer is applied to detect uterine contractions or fetal movements 3. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR |
|
|
What is the interpretation of the non-stress test?
|
1. Reactive or Nonreactive tracing
2. Gestational-age dependent 3. Two or more accelerations of “10x10”, or “15x15” within a 20-min period |
|
|
"10x10" within a 20-min period
|
Accelerations of 10 BPM lasting for 10 seconds over a 20-minute period
|
|
|
"15x15" within a 20-min period
|
Accelerations of 15 BPM lasting for 15 seconds over a 20-minute period
|
|
|
What are the advantages of a non-stress test?
|
1. Noninvasive
2. Inexpensive 3. No contraindications known |
|
|
What are the disadvantages of a non-stress test?
|
High rate of false-positives due to nonreactivity as a result of fetal sleep cycles, chronic tobacco smoking, medications, and fetal immaturity
|
|
|
What is the contraction stress test?
|
Recording of the FHR as it responds to the stress of a uterine contraction
uterine blood flow (UBF) to placenta decreased during contraction |
|
|
What are the indications for the contraction stress test?
|
1. Maternal DM
2. Chronic HTN 3. Hypertensive disorders in pregnancy 4. IUGR 5. Sickle cell disease 6. Maternal cyanotic heart disease 7. Postmaturity 8. Hx of previous stillbirth 9. Decreased fetal movements 10. Isoimmunization 11. Meconium-stained amniotic fluid at 3rd-trimester amniocentesis 12. Hyperthyroidism 13. Collagen disease 14. Older pregnant woman (>35 yrs old) 15. Chronic renal disease |
|
|
What is the procedure of the contraction stress test?
|
1. Woman is in semi-Fowler position or sitting in a reclining chair with a slight left or right tilt to optimize uterine perfusion and avoid supine hypotension
2. Monitor electronically with the fetal ultrasound transducer and uterine tocodynamometer (vibroacoustic stimulation) 3. Tracing is observed for 10 to 20 minutes for baseline rate, moderate variability, and possible occurrence of spontaneous contractions |
|
|
What are the interpretations of the contraction stress test?
|
1. Negative = no late decelerations
2. Positive = persistent and consistent late decelerations 3. Equivocal-suspicious = late decelerations occurring in less than half of the uterine contractions 4. Equivocal-hyperstimulation = late decelerations occurring with excessive uterine activity or persistent increase in uterine tone 5. Unsatisfactory = inadequate uterine contraction pattern, or tracing too poor to interpret |
|
|
What are the advantages of the contraction stress test?
|
1. Provides an earlier warning of fetal compromise
2. Fewer false-positive results |
|
|
What are the disadvantages of the contraction stress test?
|
1. Many contraindications
2. Time-consuming 3. More expensive 4. Invasive |
|
|
What are the contraindications of the contraction stress test?
|
1. Rupture of membranes
2. Previous classic incision for cesarean birth 3. Preterm labor 4. Placenta previa 5. Abruptio placentae 6. Multifetal pregnancy 7. Previous preterm labor 8. Hydramnios 9. More than 36 weeks gestation 10. Incompetent cervix |
|
|
What are other critical elements to discuss with mom?
|
1. Info for chart: Why is she here to be tested? Any risk factors? EDD, ROM, any contractions? Has she felt the baby move today???
2. Prior OB history 3. What are her questions, concerns today? |
