OB February 4, 2020 Menstrual Histoy
High Risk Pregnancy LNMP
Nursing care of women with complications during pregnancy Last Normal Menstrual
Period
High risk pregnancy causes Used for computing EDD
Related to the pregnancy itself using Naegele’s Rule
Occurs because the woman has a medical condition Jan-March: Add 7 days and 9
Results from environmental hazards months
Arise from maternal behavior or lifestyle April- Dec: Subtract 3
months, add 7 days and 1
Factors contributing to high risk pregnancy year
Age: < 18 yrs > 35 yrs Gynecologic & Contraceptive History
Weight: under/overweight Previous Gynecologic problems
Nutritional status Contraceptive used
Obstetrical history Hormonal conceptive
Poverty IUD
Family history Medical & Surgical History
Pre-existing medical conditions/substance abuse Presence of risk factors
Immunization
High Risk Pregnancy Chronic conditions
Socioeconomic: DM, Hypertension, Cardiac
o Ignorance problems, Thyroid problems,
o Poverty Asthma, Renal Diseases
Maternal health: Previous pelvic & back surgeries
o Chronic Pulmonary Disorder Previous infections
o PIH Hepatitis, STD, Tuberculosis, group B
o Anemia streptococcus
o Nutrient deficits Anemia
o High mortality Family History/Partner’s
Assess for diseases in the family that
Fetal health:
may increase the risk of putting the
o LBW
client in high risk condition
o Prematurity
Chronic
o Respiratory complications
Infectious
o CPD
Head to Toe assessment, including vital signs and Assisting
o Cognitive deficits the physician in Internal examination
o Death
Laboratory Exams
Danger Signs in Pregnancy Test Purpose
Sudden gush of fluid from vagina
Vaginal bleeding CBC Infection/Anemia
Abdominal pain
Persistent vomiting Urinalysis Renal Disease, Effects of
Epigastric pain Hypertension, Infection
Swelling of face and hands
Severe, persistent headache
Blurred vision or dizziness
Chills with fever > 38 degrees C
Hepa B Screening Detect antigens in
Painful urination or reduced urine output
maternal blood
Patient Assessment
Obstetric History Glucose Challenge Test Screen for GDM
o Gravidity/Parity/TPAL
o Types of previous deliveries
o Previous labor experience Oral Glucose Challenge Test
o Maternal Complications (GDM, PIH, UTI, 24-28 weeks AOG
Bleeding) Requires Fasting
o Weight of infants (previous pregnancies) Involves multiple blood extraction
o Infant complications (previous pregnancies) 100g oral glucose is given
o Other reproductive disorders
Review: Ancillary Procedures
A primigravid has had one previous pregnancy NST
Parity is the number of pregnancies terminated at 20 weeks o 90% of gross fetal body movements are
or more associated with accelerations of the FHR
Multiple pregnancy is considered 1 Gravida/Gravity o Outpatient
Multiple pregnancy is considered 1 Para/Parity
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o User friendly but must interpret strip 10-24cm: Normal value, < 9.9 cm: Low
Fetus may be in a sleep or state or affected by st
1
o
maternal medications, glucose etc. Trimester Ultrasonography
o To be reactive must meet criteria Transvaginal Sonography
o Must be at least 20 minutes in length o Visualization of uterus, gestational sac, embryo
o Must have 2 or more accelerations that meet the & pelvic structures
‘15x15’ criteria o Embryo is visible at 5-6 weeks
o Must have a normal baseline o Until 12 weeks AOG
o To stimulate a fetus that is not meeting the Purposes:
criteria: + sign of pregnancy
Change positions of the mother- LS, RS Location of pregnancy
Increase fluids Number and viability of fetus
Acoustic stimulator (VAS) AOG with measures
CST Abnormalities
o Done in the inpatient setting only Procedure:
o Has contraindications Position: Lithotomy
o May be expensive if meds/IV needed Duration: 10-15 minutes
o Monitored for 10 minutes first Equipment: trans-vaginal Probe encased in disposable
o May use nipple stimulation or oxytocin cover, lubricated
stimulation Nursing Responsibilities:
o No late decelerations: negative CST (Reactive) Secure consent
Make sure the bladder is emptied
Maternal and Fetal Assessment Teach deep breathing techniques to be used for the
Nursing responsibilities discomfort during the actual procedure
Preparing patient properly for test
Explaining reason for test
Clarifying and interpreting result in collaboration
2nd Trimester
with other health care providers
Patient support
Transabdominal Ultrasonography
Biophysical Profile Purposes
Includes 5 components: Viability of fetus
1. Fetal breathing movements Evaluate fetal anatomy
2. Gross body movements AOG
3. Fetal tone Fetal growth
4. Amniotic Fluid Index Biophysical profile
5. NST – reactive
Placental localization
Presentation
Guide in needle placement procedures
Component Definition
Chorionic Villi Sampling (CVS)
Fetal movements 3 body or limb movements
Done between 10-12 weeks AOG
Done by mother
Genetic studies
Count number of times baby
Removal of small amount of tissue from the fetal portion
moves
of the placenta
Normal: At least 10
Percutaneous Blood Sampling
movements in 1 hour
>17 weeks AOG
Abnormal: Count again. If
Withdrawal of blood from umbilicus of fetus
second hour still no
movement- call the doctor. Amniocentesis
Fetal tone One episode of active 15-18 weeks AOG
extension and flexion of the Used with direct ultrasound
limbs; opening and closing of Collects amniotic fluid
hand Less than 1% result in complications
Fetal breathing movement Episode of >= 30 seconds in o Complications include:
30 minutes. Hiccups are Fetal death, miscarriage
considered breathing activity Maternal hemorrhage
Amniotic Fluid volume Single 2cm x 2cm pocket is Infection to fetus
considered adequate Preterm labor
Non-stress test 2 accelerations > 15 beats per Leakage of amniotic fluid
minute of at least 15 seconds Maternal Quadruple Screening
duration 15-20 weeks AOG
Drawn blood from mother
AFI Alpha Fetoprotein (Fetus) , Unconjugate Estriol (Fetus +
Add the largest vertical pocket of AF in the 4 quadrants of Placenta), hCG (Placenta), inhibin A
the gravid uterus inhibin A (associated with down syndrome)
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AFP
o Genetic test
o Done with mother’s blood
o Neural tube defect
Amniotic Fluid Index
Polyhydramnios – too much amniotic fluid
Oligohydramnios – too little amniotic fluid
3rd Trimester
Doppler Umbilical Velocimetry (Third Trimester)
Study blood velocity in the fetus and placenta
Done on high risk mothers:
o IUGR- Intraunterine Growth Restri ction
o HTN- Hypertension
o DM- Diabetes Mellitus
o Multiple gestation
Gestational Conditions
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