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.
