THE HIGH RISK PRENATAL CLIENT

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.


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


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


ENVIRONMENTAL risks Risks that include hazards of the workplace and the 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 None apparent

Minimal Extremely small fluctuations

Moderate Amplitude range: 6-25 bpm

Marked Amplitude range: > 25 bpm

Rhythm Strip of Fetal Heart Rate

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 after movement 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

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

Analysis of FHR accompanied by contractions

CONTRACTION STRESS TESTING

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

What is measured Response of FHR in relation to fetal movement

Response of FHR in relation to uterine contractions as the nipples 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 supine hypotension syndrome, observe the woman for 30 min afterward to see that contractions are quiet and preterm labor does not begin

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


DOPPLER UMBILICAL VELOCIMETRY


PLACENTAL GRADING


AMNIOTIC FLUID VOLUME ASSESMENT


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

Fetal ECGs may be recorded as early as the 11th week of pregnancy

Rarely used unless a specific heart anomaly is suspected

ELECTROCARDIOGRAPHY

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

MAGNETIC RESONANCE IMAGING

Begins to rise at 11 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

Triple Screening:

Estriol

Beta-human chorionic gonadotropin

Alpha-fetoprotein

Quad Screening:

Estriol

Beta-human chorionic gonadotropin

Alpha-fetoprotein

Inhibin A

TRIPLE AND QUAD SCREENING

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

Documents

THE HIGH RISK PRENATAL CLIENT