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OVERVIEW

OVERVIEW

TWO GROUPS OF HIGH-RISK


PRENATAL CLIENTS
1. 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

ASSESSMENT OF RISK FACTORS


BIOPHYSICAL risks
Factors that originate within the mother or fetus
and affect the development or functioning of
either or both.

ASSESSMENT OF RISK FACTORS


PSYCHOSOCIAL risks
Comprised of maternal behaviors and adverse
lifestyles that have a negative effect on the
health of the mother or fetus (both).

ASSESSMENT OF RISK FACTORS


SOCIODEMOGRAPHIC risks
Factors arising from the mother and her family
and place the mother and fetus at risk.

ASSESSMENT OF RISK FACTORS


ENVIRONMENTAL risks
Risks that include hazards of the workplace and
the womans general environment.

RHYTHM STRIP TESTING


Assessment of the FHR for whether a good
baseline rate and a degree of variability are
present
Variability Categories:
Absent
Minimal
Moderate
Marked

None apparent
Extremely small fluctuations
Amplitude range: 6-25 bpm
Amplitude range: > 25 bpm

Rhythm Strip of Fetal Heart Rate

NONSTRESS TESTING
Measures the response of the FHR to fetal movement
RESULT

INTERPRETATION

Reactive

2 accelerations of FHR (by 15 beats or


more) lasting for 15 seconds occur after
movement within the chosen time period
No accelerations occur with the fetal
movements

Nonreactive

No fetal movements occur or if there is


low short-term fetal heart rate variability
(less than 6 bpm) throughout the testing
period

NONSTRESS TESTING

VIBROACOUSTIC STIMULATION
Producing a sharp sound
of approximately 80
decibels at a frequency of
80 Hz, startling and
waking the fetus
Done in conjunction with
a nonstress test

CONTRACTION STRESS TESTING


Analysis of FHR accompanied by contractions
RESULT

INTERPRETATION

Negative
(Normal)

No fetal heart rate decelerations are


present with contractions

Positive
(Abnormal)

No accelerations occur with the fetal


movements
50% or more of contractions cause a
late deceleration

CONTRACTION STRESS TESTING

COMPARISON OF THE NONSTRESS


AND CONTRACTION STRESS TESTS
Area of Assessment

Nonstress Test

Contraction Stress Test

Response of FHR in relation to Response of FHR in relation to


fetal movement
uterine contractions as the
What is measured
nipples are stimulated
Two or more accelerations of
fetal heart rate of 15 bpm lasting No late decelerations with
Normal findings
15 secs or longer following fetal contractions
movements in a 20-min period
In addition to preventing supine
Woman should not lie supine to hypotension syndrome, observe
prevent supine hypotension the woman for 30 min
Safety considerations syndrome
afterward
to
see
that
contractions are quiet and
preterm labor does not begin

ULTRASONOGRAPHY
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

ULTRASONOGRAPHY

----Ultrasonography----

BIPARIETAL DIAMETER

----Ultrasonography----

DOPPLER UMBILICAL VELOCIMETRY

----Ultrasonography----

PLACENTAL GRADING

----Ultrasonography----

AMNIOTIC FLUID VOLUME ASSESMENT

----Ultrasonography----

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 of
amniotic 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

ELECTROCARDIOGRAPHY
Fetal ECGs may be recorded as early as the
11th week of pregnancy
Rarely used unless a specific heart anomaly is
suspected

MAGNETIC RESONANCE IMAGING


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

MSAFP
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

TRIPLE AND QUAD SCREENING


Triple Screening:
Estriol
Beta-human chorionic gonadotropin
Alpha-fetoprotein

Quad Screening:
Estriol
Beta-human chorionic gonadotropin
Alpha-fetoprotein
Inhibin A

CHORIONIC VILLUS SAMPLING

AMNIOCENTESIS

---- 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

PUBS
a.k.a. cordocentesis or funicentesis

FETOSCOPY
The procedure is used to:
Confirm the intactness of the spinal
column
Obtain biopsy samples of fetal tissue
and fetal blood samples
Perform elemental surgery

FETOSCOPY

AMNIOSCOPY
Visual inspection of the amniotic fluid
Used to detect meconium staining

BIOPHYSICAL PROFILE
A biophysical
parameters:

profile

fetal reactivity
fetal breathing movements
fetal body movement
fetal tone
amniotic fluid volume

combines

five

BIOPHYSICAL PROFILE
Assessment

Instrument

Fetal breathing

Ultrasound

Fetal movement

Ultrasound

Fetal tone

Ultrasound

Amniotic fluid volume

Ultrasound

Fetal heart reactivity

Nonstress test

Criteria for a Score of 2


At least one episode of 30 sec of
sustained fetal breathing movement
within 30 min of observation
At least 3 episodes of fetal limb or
trunk movement within a 30 min
observation
The fetus must extend and then flex
the extremities or spine at least
once in 30 min
A range of amniotic fluid between 5
and 25 cm must be present
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 time
period

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

Test

Purpose

Significance

Blood Grouping

To determine blood type


and Rh

Identifies possible causes of


incompatibility with the fetus that
may cause jaundice.

Hgb / Hct

To detect anemia; often


checked several times
during pregnancy

Hgb <11g/dl in the 1st and 3rd


trimesters or <10.5g/dl in the 2nd
trimester may indicate a need for
additional iron supplementation.

CBC

To detect infection,
anemia, or cell
abnormalities

12,000/mm3 or more white blood


cells or decreased platelets
require follow up

To check for possible


maternal-fetal blood
incompatibility

If mother is Rh-negative and


father is Rh-positive or
antibodies are present, additional
testing and treatment are
required; if Rh (-) and
unsensitized, RhoGAM will be
given at 28 weeks

Rh factor and
antibody screen

Test

Purpose

Significance

VDRL and RPR

To screen for syphilis

Treat if results are positive;


retest at 36 weeks

To determine immunity

If titer is 1:8 or less, mother


is not immune; immunize
postpartum if not immune

Skin Test

To screen for tuberculosis

If results are positive, refer


for additional testing or
therapy

Hemoglobin
Electrophoresis

To screen for sickle cell trait


if client is of AfricanAmerican descent

Rubella Titer

Hepatitis B
Screening

To detect presence of
antigens in maternal blood

If mother is positive, check


partner; infant is at risk only
if both parents are positive

If present, infants should be


given hepatitis immune
globulin and vaccine coon
after birth

Test

Purpose

Significance

Urinalysis

To detect renal disease or


infection

Reassess if positive for more


than a trace protein (renal
damage, preeclampsia, or
normal), ketones (fasting or
dehydration), or bacteria
(infection)

Papanicolaou test
(Pap Smear)

To screen for cervical


neoplasia

Treat and refer if abnormal


cells are present

Cervical culture

To detect group B
streptococci and sexually
transmissible diseases

Treat and retest as necessary,


treat group B streptococci
during labor

Maternal Blood
Glucose (Glucose
Challenge Test)

To screen for possible


gestational diabetes

If elevated, a 3-hour glucose


tolerance test is
recommended.

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.