01.+the+high risk+prenatal+client

8/3/2019 01.+the+High Risk+Prenatal+Client

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Prepared By:

NURS103 Team 2011-12


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OVERVIEW


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OVERVIEW


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TWO GROUPS OF HIGH-RISK

PRENATAL CLIENTS1. Women with preexisting or newly acquired illness such as:

- CVD, DM, Substance Abuse, HIV/AIDS, RH Incompatibility and

Anemia

2. Women who develop complications of pregnancy such as:- Hyperemesis Gravidarum - PROM

- Ectopic Pregnancy - PIH

- Hydatidiform Mole - Multiple Pregnancies

- Premature Cervical Dilatation - DIC- Abortion - APAS

- Placenta Previa - HELLP Syndrome

- Abruptio Placenta


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ASSESSMENT OF RISK FACTORS

BIOPHYSICAL risks

Factors that originate within the mother or fetus

and affect the development or functioning ofeither or both.


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PSYCHOSOCIAL risks

Comprised of maternal behaviors and adverse

lifestyles that have a negative effect on thehealth of the mother or fetus (both).


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SOCIODEMOGRAPHIC risks

Factors arising from the mother and her family

and place the mother and fetus at risk.


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ENVIRONMENTAL risks

Risks that include hazards of the workplace and

the womans general environment.


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RHYTHM STRIP TESTING

Assessment of the FHR for whether a good

baseline rate and a degree of variability are

present

Variability Categories:

Absent None apparent

Minimal Extremely small fluctuations

Moderate Amplitude range: 6-25 bpm

Marked Amplitude range: > 25 bpm


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Rhythm Strip of Fetal Heart Rate


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Measures the response of the FHR to fetal movement

NONSTRESS TESTING

RESULT INTERPRETATION

Reactive

2 accelerations of FHR (by 15 beats or

more) lasting for 15 seconds occur aftermovement within the chosen time period

Nonreactive

No accelerations occur with the fetal

movements

No fetal movements occur or if there is

low short-term fetal heart rate variability

(less than 6 bpm) throughout the testing

period


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NONSTRESS TESTING


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VIBROACOUSTIC STIMULATION

Producing a sharp sound

of approximately 80

decibels at a frequency of

80 Hz, startling andwaking the fetus

Done in conjunction with

a nonstress test


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Analysis of FHR accompanied by contractions

CONTRACTION STRESS TESTING

RESULT INTERPRETATION

Negative(Normal)

No fetal heart rate decelerations arepresent with contractions

Positive(Abnormal)

No accelerations occur with the fetal

movements

50% or more of contractions cause alate deceleration


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CONTRACTION STRESS TESTING


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COMPARISON OF THE NONSTRESS

AND CONTRACTION STRESS TESTSArea of Assessment Nonstress Test Contraction Stress Test

What is measured

Response of FHR in relation to

fetal movement

Response of FHR in relation to

uterine contractions as thenipples are stimulated

Normal findings

Two or more accelerations of

fetal heart rate of 15 bpm lasting

15 secs or longer following fetal

movements in a 20-min period

No late decelerations with

contractions

Safety considerations

Woman should not lie supine to

prevent supine hypotension

syndrome

In addition to preventing supinehypotension syndrome, observe

the woman for 30 min

afterward to see that

contractions are quiet and

preterm labor does not begin


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Used to:

Diagnose pregnancy

Confirm the presence, size, and location of the

placenta and amniotic fluid

Establish that a fetus is growing

Establish sex

Establish the presentation and position

Predict maturity

ULTRASONOGRAPHY


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ULTRASONOGRAPHY


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ULTRASONOGRAPHY


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----Ultrasonography----

BIPARIETAL DIAMETER


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DOPPLER UMBILICAL VELOCIMETRY


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PLACENTAL GRADING


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AMNIOTIC FLUID VOLUME ASSESMENT


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AMNIOTIC FLUID VOLUME ASSESMENT

Guidelines for measuring AFI:

For gestations < 20 wks., uterus is divided into 2

vertical halves

Measure the vertical diameter of the largest pocket ofamniotic fluid present on each side in cm, then add

For gestations > 20 wks., uterus is divided into 4

quadrants

Measure the vertical diameter of the largest pocket of

amniotic fluid present on each quadrant in cm, then add


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Fetal ECGs may be recorded as early as the

11th week of pregnancy

Rarely used unless a specific heart anomaly is

suspected

ELECTROCARDIOGRAPHY


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Has the potential to replace or complement

ultrasonography as a fetal assessment

technique

Most helpful in diagnosing complications such

as ectopic pregnancy or trophoblastic disease

MAGNETIC RESONANCE IMAGING


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MAGNETIC RESONANCE IMAGING


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Begins to rise at 11 weeks gestation and then

steadily increase until term

Levels are abnormally high in maternal serum

if the fetus has an open spinal or abdominal

defect

Levels are abnormally low if the fetus has a

chromosomal defect

MSAFP


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Triple Screening:

Estriol

Beta-human chorionic gonadotropin

Alpha-fetoprotein

Quad Screening:

Estriol

Beta-human chorionic gonadotropin

Alpha-fetoprotein

Inhibin A

TRIPLE AND QUAD SCREENING


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CHORIONIC VILLUS SAMPLING


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AMNIOCENTESIS


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---- Amniocentesis ----

Amniotic Fluid is Analyzed for:

AFP

Bilirubin Determination

Chromosome Analysis

Color

Fetal Fibronectin

Inborn Errors of Metabolism

L/S Ratio

Phosphatidyl Glycerol

Desaturated Phosphatidylcholine


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a.k.a. cordocentesis or funicentesis

PUBS


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The procedure is used to:

Confirm the intactness of the spinal

columnObtain biopsy samples of fetal tissue

and fetal blood samples

Perform elemental surgery

FETOSCOPY


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FETOSCOPY


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Visual inspection of the amniotic fluid

Used to detect meconium staining

AMNIOSCOPY


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BIOPHYSICAL PROFILE

A biophysical profile combines five

parameters:

fetal reactivity

fetal breathing movements

fetal body movement

fetal tone

amniotic fluid volume


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Assessment Instrument Criteria for a Score of 2

Fetal breathing Ultrasound

At least one episode of 30 sec of

sustained fetal breathing movement

within 30 min of observation

Fetal movement Ultrasound

At least 3 episodes of fetal limb or

trunk movement within a 30 minobservation

Fetal tone Ultrasound

The fetus must extend and then flex

the extremities or spine at least

once in 30 min

Amniotic fluid volume Ultrasound A range of amniotic fluid between 5

and 25 cm must be present

Fetal heart reactivity Nonstress test

Two or more fetal heart rate

accelerations of at least 15

beats/min above baseline and of 15

sec duration occur with fetal

movement over a 20 min timeeriod

BIOPHYSICAL PROFILE


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BIOPHYSICAL PROFILE

A result of 8-10 indicates that the fetus is

doing well

A score of 6 is considered suspicious

A score of 4 denotes a fetus probably in

jeopardy


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Test Purpose Significance


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Test Purpose SignificanceBlood Grouping To determine blood typeand Rh Identifies possible causes ofincompatibility with the fetus that

may cause jaundice.

Hgb / Hct To detect anemia; oftenchecked several timesduring pregnancy

Hgb


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VDRL and RPR To screen for syphilis Treat if results are positive;retest at 36 weeksRubella Titer To determine immunity If titer is 1:8 or less, motheris not immune; immunize

postpartum if not immune

Skin Test To screen for tuberculosisIf results are positive, refer

for additional testing ortherapy

HemoglobinElectrophoresis

To screen for sickle cell traitif client is of African-

American descent

If mother is positive, checkpartner; infant is at risk onlyif both parents are positive

Hepatitis BScreening To detect presence ofantigens in maternal blood

If present, infants should begiven hepatitis immune

globulin and vaccine coon

after birth



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Test Purpose SignificanceUrinalysis To detect renal disease orinfection

Reassess if positive for morethan a trace protein (renaldamage, preeclampsia, or

normal), ketones (fasting ordehydration), or bacteria

(infection)

Papanicolaou test

(Pap Smear)To screen for cervical

neoplasiaTreat and refer if abnormal

cells are present

Cervical culture To detect group Bstreptococci and sexuallytransmissible diseases

Treat and retest as necessary,

treat group B streptococci

during labor

Maternal BloodGlucose (Glucose

Challenge Test)

To screen for possiblegestational diabetes

If elevated, a 3-hour glucosetolerance test isrecommended.


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REFERENCES

Murray, S. & McKinney, E. (2006). Foundations of

maternal-newborn nursing (4th ed.). USA:

Saunders Elsevier.

Pilitteri, A. (2010), Maternal & child health

nursing: Care of the childbearing &

childrearing family (6th ed.). Philippines:Lippincott Williams & Wilkins.

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