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Maternal Age <16 or >35

Chronic maternal hypertention, preclampsia,


diabetes meliitus, or heart disease
RH alloimmunization
IUGR
Hx of unexplained stillbirth
Multiple gestation
Hx of preterm labor
Hx of cervical incompetence
Prolonged pregnancy past 42wks

Performed between 10 and 12 weeks


Identifies genetic disorders
Risks
Spontaneous abortion, infection, ROM,
bleeding, Rh alloimmunization
Nursing care
Rh immune globulin if Rh negative
Monitor for complications

Usually done between 15 and 20 weeks


for genetic diagnosis
In late pregnancy done for lung maturity 30-35
wks

Risks
Pain, contractions, rupture of membranes, fetal
injury, Rh isoimmunization, infection

Nursing care
Ultrasound- Must do first
Give Rh immune globulin if Rh negative
Monitor for complications

Assesses fetal well-being


Indications
Decreased fetal movement, post-date
pregnancy, any high-risk pregnancy
Procedure
External monitor
Avoid vena cava compression
Evaluates the acceleration of the FHR in
response to fetal activity
Reactive test
Two accelerations of at least 15 bpm lasting
at least 15 seconds in a 20-minute time
period

Evaluates the respiratory function of the


placenta

Demonstrates reaction of FHR to stress of


uterine contractions.

CST Results:
Negative- 3 good contractions of 40 or more
secs in 10 minutes, without late decelerations
Positive- repetitive late decelerations with
more than 50% on contractions
Equivocal or suspicious- nonpersistant late
decels or decels associated with
hyperstimulation

MSAFP or AFP
The test is done between 15-22 wks

Increased levels indicates:


neural tube defects or
multiple gestation

Decreased levels indicate:


Down syndrome

Performed between 11 to 13 wks

Screening test for: Trisomies 13, 18, 21; congenital


Heart disease

Advantages: Noninvasive; Detects fetus with down


syndrome

Disadvantages: False positive; not diagnostic

Measurements > 3mm =referred for amniocentesis

Comprehensive Assessment
Fetal breathing movement
Fetal movements of body or limbs
Fetal tone
Amniotic fluid volume
Reactive FHR with activity
Scoring
2=normal
0=abnormal

Review Ultrasound: screening and


diagnostic

Fetal count movements