nCM 1028

LLC1u8L
DLIINI1ICN AND SCCL CI 1nL kC8LLM
A h|gh r|sk pregnancy |s one |n wh|ch the ||fe or hea|th of the mother or
|nfant |s [eopard|zed by a d|sorder co|nc|denta| w|th or un|que to
pregnancy
Ior the mother the h|gh r|sk status arb|trar||y extends through the
puerper|um(30 days after ch||db|rth)
ostb|rth materna| comp||cat|ons usua||y are reso|ved w|th|n 1 month of
b|rth but per|nata| morb|d|ty may cont|nue for months or years
n|gh r|sk pregnancy |s a cr|t|ca| prob|em for modern med|ca| and
nurs|ng care
1he new soc|a| emphas|s on the qua||ty of ||fe and the wanted ch|d has
resu|ted |n a reduct|on of fam||y s|ze and the number of unwanted
pregnanc|es
At the same t|me techno|og|c advances have fac|||tated pregnanc|es |n
prev|ous|y |nfert||e coup|es As a consequence emphas|s |s on the
safe b|rth of norma| |nfants who can deve|op to the|r potent|a|
Sc|ent|f|c and techno|og|c advances have a||owed per|nata| hea|th care to
reach a |eve| far beyond that prev|ous|y ava||ab|e
1he d|agnos|s of h|gh r|sk |mposes a s|tuat|ona| cr|s|s on the fam||y (eg Loss
of pregnancy before the ant|c|pated date deve|opment of gestat|on
a| d|abetes me|||tus w|th |ts potent|a| comp||cat|ons or b|rth of a
neonate who does not meet cu|tura| soc|eta| or fam|||a| norms and
expectat|ons)
nIGn kISk MC1nLk regnanc|es can be des|gnated as h|gh r|sk
for any of severa| undes|rab|e outcomes
1hose cons|dered to be at r|sk for uterop|acenta|
|nsuff|c|ency carry a ser|ous threat for feta| growth
restr|ct|on |ntrauter|ne feta| death |ntrapartum
death |ntrapartum feta| d|stress and var|ous types
of neonata| morb|d|ty
When us|ng a med|ca| mode| perspect|ve a pat|ent
|s at r|sk on|y from med|ca| obstetr|c or phys|o|og|c
factors
1oday a more comprehens|ve approach to h|gh r|sk pregnancy |s used and
the factors assoc|ated w|th h|gh r|sk ch||dbear|ng are grouped |nto broad
categor|es based on threats to hea|th and pregnancy outcome
(Gu|de||nes]Gu|as box)
GUIDLLINLS ] GUIAS
nIGn kISk IAC1CkS
nIGn kISk ASSLSSMLN1 C1LN1IAL kC8LLM
Pave you had any problems wlLh Lhls
pregnancy?
Ceneral assessmenL
Pave you had blurred vlslon? reeclampsla
Pave you had severe headache? reeclampsla
Pave you had dlfflculLy of breaLhlng? Cardlac dlsease
Pave you had hearL palplLaLlons? Cardlac dlsease
Pave you been vomlLlng? Pyperemesls gravldarum
Pave you had lnfecLlons? Sexually LransmlLLed lnfecLlons/vaglnal
lnfecLlons
nIGn kISk ASSLSSMLN1 C1LN1IAL kC8LLM
Pave you had swelllngs? reeclampsla
Were all your pregnancles Lerm? reLerm labor
Pave you ever had dlabeLes? ulabeLes
Pave you ever had hlgh blood
pressure?
reeclampsla
Pave you ever had anemla? Anemla
uo you Lake drugs? rescrlpLlon
medlclnes?
SubsLance abuse
uo you drlnk alcohol? Smoke? SubsLance abuse
kLLCLAMSIA and LCLAMSIA
hyperLenslve condlLlons LhaL are lnduced by pregnancy
reec|amps|a also called gestat|ona| edemaprote|nur|ahypertens|on (GLn) ls
an acuLe Loxlc condlLlon arlslng durlng Lhe second half of Lhe gesLaLlon perlod or
ln Lhe flrsL week afLer dellvery and generally occurs ln young women durlng a flrsL
pregnancy lL ls marked by elevaLed blood pressure (hyperLenslon) proLeln ln Lhe
urlne (proLelnurla) and swelllng (edema) LhaL ls sLrlklngly noLlceable ln Lhe hands
and face
Lc|amps|a a more severe condlLlon wlLh convulslons follows preeclampsla ln
abouL 3 percenL of preeclampLlc women and poses a serlous LhreaL Lo boLh
moLher and chlld
nLk1LNSIVL DISCkDLkS
regnancy |nduced hypertens|on (In) |s the term used for hypertens|ve
d|sorders that are spec|f|ca||y assoc|ated w|th pregnancy preec|amps|a and
ec|amps|a
rev|ous|y the term toxem|a of pregnancy was used as |t was be||eved that
toxem|a was caused by tox|ns der|ved from the products of concept|on c|rcu|at|ng
|n the b|ood as a resu|t of newer theor|es th|s term |s no |onger appropr|ate
INCIDLNCL
A Cccurs |n S percent to 7 percent of a|| pregnant women
8 Seen more often |n pr|m|grav|das teenagers of |ower soc|oeconom|c c|ass
woman 3S years espec|a||y |f they are pr|m|grav|das
L1ICLCG
A Cause |s unknown
8 Var|ous theor|es and contr|but|ng factors have been |dent|f|ed but none
conc|us|ve|y
A1nCnSICLCG
A Synthes|s of prostag|and|n GL2 and prostacyc||n G12 |s decreased both
GL2 and G12 are potent vasod||ators oss|b|e decreases |n these factors
may |ead to |ncreased sens|t|v|ty to ang|otens|n II and thereby respons|b|e for
most of the pathophys|o|ogy assoc|ated w|th In
8 Arter|o|ar vasoconstr|ct|on and hypovo|em|a renog|omeru|ar |es|ons |ead to
|oss of serum prote|n eg A|bum|n and g|obu||n sod|um reabsorpt|on |s
e|evated and water |s reta|ned
C C||gur|a resu|ts from decreased g|omeru|ar f||trat|on rate and rena| b|ood f|ow
D Changes |n c|ott|ng factors decreased p|ate|et count |ncreased |ntravascu|ar
coagu|at|on and f|br|nogen depos|ts
L Centra| nervous system effects (hyperact|v|ty) headaches cerebra| edema
hyperref|ex|a and convu|s|ons
ASSLSSMLN1
A k|sk factors
1 D|abetes me|||tus
2 nypertens|on
3 kena| d|sease
4 nydat|form mo|e
S Mu|t|p|e gestat|ons
6 o|yhydramn|os
7 Age (|ess than seventeen or over th|rty f|ve)
8 r|mar||y a d|sease of the pr|m|grav|da
9 Low soc|oeconom|c status (ma|nutr|t|on |ow prote|n d|et
8 CLINICAL MANIILS1A1ICNS
MILD kLLCLAMSIA SLVLkL kLLCLAMSIA LCLAMSIA
LlevaLed 8 sysLollc
lncrease of 30 mm Pg
and 13 mm Pg
lncreased hyyperLLenslon
sysLollc aL 160 mm Pg
dlasLollc aL 110 mm Pg or
more
LlevaLed LermperaLure
(101 degrees l) may
precede convulslon (104
degrees l ls a grave slgn
roLelnurla 1 gm/24
hour (1+ proLelnurla)
roLelnurla 3 mg/24
hou (3+ Lo 4+
proLelnurla)
1onlc (13 Lo 20 sec) and
clonlc (60 sec)
convulslons
Ldema generallzed
especlally dlglLal and
perlorblLal
Ldema excesslve Coma (lasLs from few
mlnuLes Lo several hours)
MILD kLLCLAMSIA SLVLkL kLLCLAMSIA LCLAMSIA
WelghL galn 1 lb/week
ln 3
rd
LrlmesLer
LlevaLed 8un serum
creaLlnlne urlc acld
PyperLenslve crlsls or
shock
Cllgurla less Lhan 400
cc ln 24 hours
8enal shuLdown
Cerebral or vlsual
dlsLurbances
Severe headache
vomlLlng
LplgasLrlc paln (due Lo
edema of llver capsule
usually lndlcaLlve of
lmpendlng convulslons)
C CCMLICA1ICNS Materna|
1 Increased |ntraocu|ar pressure |ead|ng to ret|na| detachment
2 Syndrome ca||ed nLLL has been assoc|ated w|th severe preec|amps|a
(nemo|ys|s L|evated L|ver funct|on tests Low |ate|et count) f|nd|ngs
are assoc|ated w|th m||d DIC
3 1hrombocytopen|a
D CCMLICA1ICNS Ieta|
1 Usua||y sma|| for gestat|ona| age
2 May be born premature|y
3 Newborn may be born over sedated due to materna| med|cat|ons
4 May have hypermagnesem|a due to materna| treatment w|th MgSC4
1kLA1MLN1
A Med|ca|
1 M||d preec|amps|a 8ed rest
2 Severe preec|amps|a abso|ute bed rest sedat|ves (VALIUM)
ant|hypertens|ves (AkLSCLINL) ant|convu|sants (MgSC4) prepare
for preterm de||very v|a cesarean sect|on |f nLLL syndrome beg|ns
3 Lc|amps|a se|zure precaut|ons (v|ta| s|gns oxygen suct|on
pos|t|on|ng)
8 D|etary n|ghprote|n d|et moderate sa|t and f|u|d |ntake of s|x to
e|ght g|asses of water per day
NUkSING IN1LkVLN1ICN
Goa| (M||d preec|amps|a) to |n|t|ate preventat|ve measures
1 Instruct|on as to home care encourage bed rest prov|de d|etary |nstruct|on
and regu|ar prenata| checkups
2 1ests to eva|uate feta| status eg Ieta| movement record u|trasound NS1
estr|o| creat|n|ne |eve|s
8 Goa|s and nurs|ng |ntervent|on for the severe|y preec|ampt|c and ec|ampt|c
c||ent
Goa| kecogn|ze the ear|y s|gns of In and |ncreased 8
1 Check 8 and perform ro||over or pressor response test at weeks 2832 |n the
h|gh r|sk c||ent 1ake 8 |n |eft |atera| recumbent pos|t|on repeat 8 after
turn|ng to sup|ne pos|t|on
Nurs|ng pr|or|ty D|asto||c |ncreases of 20 mm ng or more may be pred|ct|ve
of In
2 Mon|tor ur|ne for prote|nur|a Usua||y the |ast of the tr|ad of symptoms to
appear
3 Mon|tor for nondependent patho|og|c edema eg er|orb|ta| and hands
Goa| kecogn|ze progress|on of In symptoms and m|n|m|ze or contro| the|r
seque|a
1 Inst|tute we|ght contro|s Check for sudden |ncreases of 2 |b]week or 6 |b]month
2 Increase prote|n |ntake |n the d|et Ma|nta|n norma| sod|um |ntake avo|d use of
d|uret|cs
3 Inst|tute bedrest
4 Mon|tor for om|nous s|gns of deter|orat|ng cond|t|on headache v|sua|
d|sturbances hyperref|ex|a marked|y decreased ur|ne output ep|gastr|c or r|ght
upper quadrant pa|n dyspnea vag|na| b|eed|ng (abrupt|o p|acenta) or any change
|n feta| act|v|ty
S Adm|n|ster AkLSCLINL a vasod||ator check materna| 8 u|se and Ink
Goa| prevent or contro| se|zures
1 Adm|n|ster IV MgSC4
2 nave emergency |tems read||y ava||ab|e eg C2 suct|on a|rway sedat|ves
ca|c|um g|uconate
3 Mod|fy env|ronment to ensure rest and qu|et
a L||m|nate no|se br|ght ||ghts other harsh st|mu||
b M|n|m|ze number of personne| g|v|ng care
c In|t|ate pa|nfu| and]or |ntrus|ve procedures after sedat|on
d romote comfort at bed rest
NUkSING DIAGNCSLS
know|edge Def|c|t re|ated to In |ts treatment and the |mp||cat|ons for the
unborn ch||d
Materna| In[ury n|gh k|sk re|ated to convu|s|on secondary to cerebra|
vasospasm and |ncreased b|ood pressure or edema
Ieta| In[ury n|gh k|sk re|ated to deve|opment of hemato|og|c and hepat|c
abnorma||t|es secondary to the nLLL syndrome
I|u|d Vo|ume Def|c|t Intravascu|ar re|ated to prote|n |oss and f|u|d sh|fts to
the extravascu|ar space
I|u|d Vo|ume Lxcess Ldema re|ated to sod|um and water retent|on
A|terat|on |n Nutr|t|on Less 1han 8ody kequ|rements re|ated to |ow prote|n
|ntake
Sensoryperceptua| A|terat|on V|sua| re|ated to ret|na| edema or ret|na|
detachment
nLkLMLSIS GkAVIDAkUM
1h|s d|sorder |s character|zed by pern|c|ous vom|t|ng dur|ng pregnancy
It occurs |n one out of every one thousand pregnanc|es the cause |s debatab|e
but seems to be re|ated to gonadotrop|n product|on and psycho|og|ca| factors
ASSLSSMLN1
1 k|sk factors none known
2 D|agnost|cs by symptoms
3 C||n|ca| man|festat|ons
a Severe pers|stent vom|t|ng wh|ch |eads to dehydrat|on or nutr|t|ona|
def|c|ency progresses to f|u|d e|ectro|yte |mba|ance and a|ka|os|s
from |oss of nc|
b If untreated ketoac|dos|s (from |oss of |ntest|na| [u|ces) hypovo|em|a
hypoka|em|a [aund|ce and hemorrhage
c nypothromb|nem|a and decreased ur|ne output
1kLA1MLN1
1 Med|ca| rep|acement of parenta| f|u|ds e|ectro|ytes and v|tam|ns a|ong
w|th a tranqu|||zer or an ant|emet|c
2 D|etary NC for f|rst 48 hours after cond|t|on |mproves then s|x sma||
feed|ngs a|ternated w|th ||qu|d nour|shment |n sma|| amounts every one to
two hours |f vom|t|ng reoccurs NC and IV f|u|ds restarted
NUkSING IN1LkVLN1ICN
Goa| 1o ass|st w|th the med|ca| and d|etary management
1 Accurate record|ng of vom|tus
2 Da||y we|ght checks and ma|ntenance of |ntake and output
3 Des|red ur|ne output |s 1000cc |n 24 hours usua||y
adm|n|strat|on of IV's at 3000cc |n f|rst 24 hours after
adm|ss|on to correct hypovo|em|a
4 Cra| hyg|ene measures
S NC for f|rst 48 hours then s|ow d|et progress|on
Goa| 1o detect and treat comp||cat|ons
1 In|t|a| ac|dbase |mba|ance |s a|ka|os|s from |oss of
hydroch|or|c ac|d however w|th pro|onged vom|t|ng and |oss
of a|ka||ne |ntest|na| [u|ces a ketoac|dot|c state occurs
2 rotracted hyperemes|s grav|darum may necess|tate
term|nat|on of pregnancy
NUkSING DIAGNCSIS
A|tered Nutr|t|on Less 1han 8ody kequ|rements re|ated to nausea emes|s and
subsequent |ncons|stent or |nsuff|c|ent food |ntake
I|u|d Vo|ume Def|c|t re|ated to protracted emes|s
Iear re|ated to effects of hyperemes|s on feta| we||be|ng
Categor|es of r|sk |nc|ude b|ophys|ca| psychosoc|a| soc|odemograph|c and
env|ronmenta| (G||bert narmon 2003)
8ICnSICAL kISkS |nc|ude factors that or|g|nate w|th|n the mother
or fetus and affect the deve|opment or
funct|on|ng of e|ther or both
Lxamp|e |nc|udes genet|c d|sorders nutr|t|ona|
and genera| hea|th status and med|ca| or
obstetr|c re|ated |||ness
SCnCSCCIAL kISkS compr|se materna| behav|ors and adverse
||festy|es that have a negat|ve effect on the hea|th
of the mother or fetus (or both) 1hese r|sks may
|nc|ude emot|ona| d|stress and d|sturbed
|nterpersona| re|at|onsh|ps |nadequate soc|a|
support and unsafe cu|tura| pract|ces
|e Smok|ng caffe|ne a|coho| drugs
psycho|og|c status
SCCICDLMCGkAnIC kISkS ar|se from the mother and her fam||y and p|ace
the mother and fetus at r|sk
Lxamp|es |nc|ude |ack of prenata| care |ow
|ncome mar|ta| status and ethn|c|ty
|e Low |ncome |ack of prenata| care age
ar|ty Mar|ta| status kes|dence
Lthn|c|ty
LNVIkCNMLN1AL kISkS |nc|ude hazards of the workp|ace and the
woman's genera| env|ronment 1hese r|sks may
|nc|ude nox|ous chem|ca|s rad|at|on |nfect|ons
and po||utants
k|sk factors are |nterre|ated and cumu|at|ve |n the|r effects
kLGNANC A1 kISk kLLkIS1ING CCNDI1ICNS
Ior most women pregnancy represents a norma| part of ||fe nowever for
some women pregnancy represents a s|gn|f|cant r|sk because |t |s
super|mposed on a chron|c |||ness
W|th we|| mot|vated pat|ents who act|ve|y part|c|pate |n the treatment p|an
and w|th carefu| management from a mu|t|d|sc|p||nary hea|th care team
pos|t|ve pregnancy outcomes are often poss|b|e today
rov|d|ng safe and effect|ve care for women exper|enc|ng h|gh r|sk pregnancy
and the|r fetuses |s a cha||enge
Wh||e un|que materna| and feta| needs prompted by these cond|t|ons ex|st
these women a|so exper|ence many of the same pregnancyre|ated fee||ngs
needs and concerns as the|r "norma|" counterparts
1he pr|mary ob[ect|ve of nurs|ng care must be to gu|de and support the
woman and her fam||y |n ach|ev|ng opt|ma| outcome for both the pregnant
woman and the fetus
A h|gh r|sk pregnancy |s one |n wh|ch the ||fe or we||be|ng of the mother or
|nfant |s [eopard|zed by a b|ophys|ca| or psychosoc|a| d|sorder co|nc|denta| w|th
or un|que to pregnancy
LLADING CAUSLS CI MA1LkNAL DLA1n
1 nypertens|ve d|sorders
2 Infect|on
3 nemorrhage
IAC1CkS
1 Age (younger than 20 years and 3S years or o|der)
2 Lack of prenata| care
3 Low educat|ona| atta|nment
4 Unmarr|ed status
S Nonwh|te race
IL1AL AND NLCNA1AL nLAL1n kC8LLMS
LLADING CAUSLS CI DLA1n IN 1nL NLCNA1AL LkICD
1 Congen|ta| anoma||es
2 D|sorders re|at|ng to short gestat|on and |ow b|rth we|ght (L8W)
3 kesp|ratory D|stress Syndrome (kDS)
4 Lffects of materna| comp||cat|ons
1o reduce |nfant morta||ty rates requ|res the remova| of f|nanc|a|
educat|ona| soc|ocu|tura| and |og|st|c barr|ers to care so that pregnant
women can seek and rece|ve hea|th serv|ces
ASSLSSMLN1 ICk kISk IAC1CkS
regnanc|es can be des|gnated as h|gh r|sk for any of severa| undes|rab|e
outcomes
1hose cons|dered to be at r|sk for uterop|acenta| |nsuff|c|ency carry a
ser|ous threat for
1 Ieta| growth restr|ct|on
2 Intrauter|ne feta| death
3 Intrapartum death
4 Intrapartum feta| d|stress
S And var|ous types of neonata| morb|d|ty
MLDICAL MCDLL IN 1nL ASSLSSMLN1 CI kISk IAC1CkS
1 Med|ca|
2 Cbstetr|c
3 hys|o|og|c
1oday a more comprehens|ve approach to h|gh r|sk pregnancy |s used and
the factors assoc|ated w|th h|gh r|sk ch||dbear|ng are group |nto broad
categor|es based on threats to hea|th and pregnancy outcome
CA1LGCkILS CI kISk
1 8|ophys|ca|
2 sychosoc|a|
3 Soc|odemograph|c
4 Lnv|ronmenta|
k|sk factors are |nterre|ated and cumu|at|ve |n the|r effects
AN1LAk1UM 1LS1ING ] 8ICnSICAL ASSLSSMLN1
1he ma[or expected outcome of antepartum test|ng |s the detect|on of
potent|a| feta| comprom|se
1he techn|que used w||| |dent|fy feta| comprom|se before |ntrauter|ne
asphyx|a of the fetus occurs so that the hea|th care prov|ded ccan take
measures to prevent or m|n|m|ze adverse per|nata| outcomes
No s|ng|e test can prov|de |nformat|on
Assessment tests shou|d be se|ected based on the|r effect|veness and the
resu|ts must be |nterpreted |n ||ght of the comp|ete c||n|ca| p|cture
DAIL IL1AL MCVLMLN1 CCUN1
Assessment of feta| da||y act|v|ty the the mother |s a s|mp|e and va|uab|e
method for mon|tor|ng the cond|t|on of the fetus
Da||y Ieta| Movement Count (DIMC) ] "k|ck counts" can be done at home |s
s|mp|e to understand |s non|nvas|ve and does not |nterfere w|th a da||y
rout|ne
Used to mon|tor the fetus |n pregnanc|es comp||cated by cond|t|ons that
may affect feta| oxygenat|on |e Gestat|ona| hypertent|on or chron|c
hypertens|on and d|abetes
resence of feta| movements |s genera||y a reassur|ng s|gn of feta| hea|th
NUkSING ALLk1
In assess|ng feta| movements |t |s |mportant to remember that
1 1hey are usua||y not present dur|ng the feta| s|eep cyc|e
2 1hey may be temporar||y reduced |f the woman |s tak|ng depressant
med|cat|ons
3 Dr|nk|ng a|coho|
4 Smok|ng a c|garette
Do not decrease as the woman nears term
Cbes|ty decreases the ab|||ty of the mother to assess feta| movement
UL1kASCNCGkAn
1he use of h|ghfrequency sound waves to produce a graph|c |mage of the
grow|ng fetus
u|trasonography|s becom|ng a ub|qu|tous too| |n prenata| med|c|ne
furn|sh|ng |nformat|on on the morpho|og|ca| and funct|ona| status of the
fetus
It |s common|y used to est|mate the gestat|ona| age of the fetus |dent|fy
feta| number assess growth determ|ne feta| heart act|v|ty and prov|de a
genera| survey of feta| anatomy
1he presentat|on of the fetus and p|acenta and the vo|ume of amn|ot|c
f|u|d a|so can be determ|ned us|ng u|trasound
1LS
1 A8DCMINAL UL1kASCNCGkAn usefu| after the f|rst tr|mester when
pregnant uterus becomes an abdom|na| organ
the woman |s requ|red to have a fu|| b|adder to get a better |mage of
the fetus
2 1kANSVAGINAL UL1kASCNCGkAn a probe |s |nserted |nto the vag|na
and a||ows pe|v|c anatomy to be eva|uated |n greater deta|| and a||ows
|ntrauter|ne pregnancy to be d|agnosed ear||er
we|| to|erated by most pat|ents because |t a||ev|ates the need for a
fu|| b|adder
espec|a||y usefu| |n obese pat|ents whose th|ck abdom|na| |ayers
cannot be penetrated adequate|y by an abdom|na| approach
|t |s used |n f|rst tr|mester to detect ectop|c pregnanc|es mon|tor the
deve|op|ng embryo he|p |dent|fy abnorma||t|es and he|p estab||sh
gestat|ona| age
may be used as an ad[unct to abdom|na| scann|ng to eva|uate
preterm |abor |n second and th|rd tr|mester pregnanc|es
LLVLLS CI UL1kASCNCGkAn
1 8ASIC SCkLLNING ] LIMI1LD LkAMINA1ICN used most frequent|y and
can be performed by u|trasonographers or other hea|th care
profess|ona|s |nc|ud|ng nurses who have has spec|a| tra|n|ng
2 1AkGL1LD ] CCMkLnLSIVL LkAMINA1ICNS performed |f a woman |s
suspected of carry|ng an anatom|ca||y or a phys|o|og|ca||y abnorma|
fetus It |s performed by h|gh|y tra|ned and exper|enced personne|
INDICA1ICNS
1 Abnorma| f|nd|ngs on c||n|ca| exam|nat|on espec|a||y w|th
po|yhydramn|os e|evated a|phafetoprote|n (AI) |eve|s
2 n|story of offspr|ng w|th anoma||es that can be detected by
u|trasound exam|nat|on
INDICA1ICNS ICk USL
IIkS1 1kIMLS1Lk It |s performed to obta|n |nformat|ons on
1 number s|ze and |ocat|on of gestat|ona| sacs
2 resence or absence of feta| card|ac and body movements
3 resence or absence of uter|ne abnorma||te|s (eg 8|cornuate uterus or
f|bro|ds) or adnexa| masses
4 regnancy dat|ng (|e 8y measur|ng crownrump |ength)
S resence and |ocat|on of an |ntrauter|ne contracept|ve dev|ce
SLCCND 1kIMLS1Lk ] 1nIkD 1kIMLS1Lk
1 Ieta| v|ab|||ty number pos|t|on gestat|ona| age growth pattern and
anoma||es
2 Amn|ot|c f|u|d vo|ume
3 |acenta| |ocat|on and matur|ty
4 Uter|ne f|bro|ds and anoma||es
S Adnexa| masses
6 Cerv|ca| |ength
U|trasonography can |ead to ear||er d|agnos|s a||ow|ng therapy to be
|nst|tuted ear|y |n pregnancy
It |s a very |mportant assessment too| to determ|ne and co||ect |nformat|ons
to ru|e out abnorma||t|es and r|sks thereby prevent|ng adverse effects on the
mother and fetus
It |s used to determ|ne
1 Ieta| neart Act|v|ty
2 Gestat|ona| Age
3 Ieta| Growth
4 Ieta| Anatomy
S |acenta| os|t|on and Iunct|on
6 Ad[unct to Amn|ocentes|s ercutaneous Umb|||ca| 8|ood Samp||ng and
Chor|on|c V|||us Samp||ng
7 Ieta| We||8e|ng
8 Amn|ot|c I|u|d Vo|ume
9 Dopp|er 8|ood I|ow Ana|ys|s
10 8|ophys|ca| rof||e
NUkSING kCLL
1he ma|n ro|e of nurses |s |n counse||ng and educat|ng women about the
procedure
rov|d|ng accurate |nformat|on regard|ng the procedure |s |mperat|ve to a||ay
the mother's anx|ety
Women shou|d be prov|ded amp|e opportun|ty to ask
quest|ons and be reassured that the procedure |s safe
where|n there |s no conc|us|ve ev|dence of any harmfu| effect
on humans
A|though the poss|b|||ty of un|dent|f|ed b|o|og|c effects ex|sts
the benef|ts to the woman or prudent use of d|agnost|c
u|trasonography appear to outwe|gh any poss|b|e r|sk
regnant woman hav|ng an u|trasound scan
MAGNL1IC kLSCNANCL IMAGING
threed|mens|ona| d|agnost|c |mag|ng techn|que used to v|sua||ze organs and
structures |ns|de the body w|thout the need for krays or other rad|at|on
MkI |s va|uab|e for prov|d|ng deta||ed anatom|ca| |mages and can revea| m|nute
changes that occur over t|me
It can be used to detect structura| abnorma||t|es that appear |n the course of a
d|sease as we|| as how these abnorma||t|es affect subsequent deve|opment
and how the|r progress|on corre|ates w|th menta| and emot|ona| aspects of a
d|sorder
S|nce MkI poor|y v|sua||zes bone exce||ent |mages of the |ntracran|a| and
|ntrasp|na| contents are produced
It can eva|uate
1 Ieta| structure (centra| nervous system thorax abdomen gen|tour|nary
tract and muscu|oske|eta| system
2 |acenta (pos|t|on dens|ty and presence of gestat|ona| trophob|ast|c
d|sease)
3 Amn|ot|c f|u|d quant|ty
4 Materna| structures (uterus cerv|x adnexa and pe|v|s)
S 8|ochem|ca| status (pn and adenos|ne tr|phosphate content) of t|ssues and
organs
6 Soft t|ssue metabo||c or funct|ona| ma|format|ons
LA8CkA1Ck S1UDILS CI LACLN1AL IUNC1ICN
LS1kICL DL1LkMINA1ICN
a N|nety percent of the estrogen excreted |n the ur|ne |s |n the form of estr|o|
b Lstr|o| ref|ects materna|feta|p|acenta| funt|on
c 8ecause estr|o| f|uctuates da||y more than one random test |s necessary to be
|nd|cat|ve of feta| we||be|ng
d A drop of S0 percent or more from a norma| |eve| may s|gn|fy feta| d|stress
e Ser|a| assays or tests must be performed at |east three t|mes per week to
observe a trend
f 1ypes of determ|nat|on
1 Ur|nary co||ect|on |n|t|ate at approx|mate|y 32 to 34 weeks' gestat|on
co||ect no more than once or tw|ce a week must obta|n a 24 hour ur|ne
samp|e
2 |asma (serum) estr|o| has advantage of a s|ng|e w|thdrawa| of b|ood |n
contrast to 24 hour co||ect|on of ur|ne |t has |arge|y rep|aced the ur|ne test
because they are more qu|ck|y obta|ned and more accurate
g Cr|t|ca| |eve|s
1 12 mg]m| for p|asma estr|o| and 12 mg]24 hours for ur|nary estr|o|
2 A drop of 40 from the mean of the three prev|ous h|ghest va|ues may
|nd|cate feta| d|stress
nUMAN LACLN1AL LAC1CGLN (nL)
a roduced by the p|acenta |n |ncreas|ng amounts throughout pregnancy
b Co||ected from a materna| b|ood samp|e
MA1LkNAL ASSLSSMLN1 CI IL1AL AC1IVI1
1 Da||y feta| movement response (DIMk) assessment
2 Ask woman to count the number of t|mes the fetus moves |n 30 m|nutes
three t|mes a day
3 Iour strong movements |n 30 m|nutes on three occas|ons or at |east 10
movements |n 12 hours |s cons|dered a reassur|ng s|gn
Nurs|ng r|or|ty
1he movement a|arm s|gna| (MAS) wh|ch |s a reduct|on |n feta|
movement to three or fewer movements |n 12 hours |s often assoc|ated
w|th feta| d|stress and |nd|cates |mpend|ng feta| death
NCNS1kLSS 1LS1 (NS1)
1 urpose to observe the response of feta| heart rate to the stress of
act|v|ty
2 rocedure requ|res approx|mate|y th|rty m|nutes c||ent |n sem|
Iow|er's pos|t|on externa| mon|tor |s app||ed to document feta|
act|v|ty mother act|vates the "mark button" on the e|ectron|c feta|
mon|tor when she fee|s feta| movement
If no feta| movement may gent|y rub or pa|pate abdomen to
st|mu|ate movement or may be asked to eat a ||ght mea| as
|ncreased b|ood sugar |ncreases feta| act|v|ty
3 Interpretat|on
a keact|ve acce|erat|on of at |east 2 Ink w|th feta| movements of 1S
beats per m|nute |ast|ng 1S seconds or more over 20 m|nutes repeat
test |n one week
b Nonreact|ve react|ve cr|ter|a are not met 1he acce|erat|ons are not
as much as 1S beats per m|nute or do not |ast 1S seconds and so on
needs to be further eva|uated usua||y repeat the NS1 w|th|n the same
24 hour per|od
c Unsat|sfactory un|nterpretab|e reg|strat|on of feta| heart rate or
|nadequate feta| act|v|ty reschedu|e NS1 w|th|n 24 hours
Nurs|ng r|or|ty Any appearance of any dece|erat|ons of the Ink dur|ng NS1
shou|d be |mmed|ate|y eva|uated by the phys|c|an
4 Advantages of NS1
a S|mp|e easy to perform
b Does not requ|re hosp|ta||zat|on
c nas no contra|nd|cat|ons
CCN1kAC1ICN S1kLSS 1LS1 (CS1) Ck Ck1CCIN CnALLLNGL 1LS1 (CC1) AND
1nL NILL S1IMUL1ICN CCN1kAC1ICN 1LS1 (NSCS1)
1 urpose 1o observe the response of feta| heart rate to the stress of
oxytoc|n|nduced uter|ne contract|ons means of eva|uat|ng
resp|ratory funct|on (o2 and CC2 exchange) of the p|acenta
2 Ind|cat|ons a reex|st|ng materna| med|ca| cond|t|ons d|abetes
me|||tus heart d|sease hypertens|on s|ck|e ce|| d|sease
hyperthyro|d|sm rena| d|sease
b ostmatur|ty IUGk nonreact|ve NS1 preec|amps|a
3 rocedure NSCS1
a Sem|fow|ers pos|t|on feta| mon|tor|ng |n p|ace
b N|pp|e st|mu|at|on beg|ns w|th woman brush|ng her pa|m
across one n|pp|e through her sh|rt or gown for 23 m|nutes
If contract|on start n|pp|e st|mu|at|on shou|d stop If not
contract|ons after a S m|nute rest per|od repeat process
c 1h|s process |s repeated up to 40 m|nutes have |psed or
uter|ne contract|on of at |east 40 seconds |n |ength occur at
|east 3 t|me |n 10 m|nutes
d If no contract|ons after 1S20 m|nutes then beg|n
st|mu|at|ng the other n|pp|e
e 8||atera| st|mu|at|on on|y |f un||atera| st|mu|at|on fa||s to
produce contract|ons
f Advantages takes |ess t|me to perform |ess expens|ve and
causes |ess d|scomfort because no IV |s used
3 rocedure CC1
a C||ent must be hosp|ta||zed and NC
b os|t|on |n sem|Iow|er's to avo|d sup|ne hypotens|on
c Intravenous adm|n|strat|on of oxytoc|n st|mu|ates uter|ne contract|ons
uter|ne act|v|ty and feta| heart rate are recorded by way of externa|
mon|tor|ng
d nypox|a |s ref|ected |n |ate dece|erat|on on mon|tor wh|ch |nd|cates a
d|m|n|shed feta|p|acenta| reserve
e Cxytox|n IV |s de||vered at a rate of 0S Mu per m|nute w|th the rate |ncreased
every f|fteen m|nutes unt|| contract|ons occur at the rate of three per ten
m|nutes the oxytoc|n |s d|scont|nued and the woman |s observed unt||
contract|ons stop
4 Interpretat|on CC1
a Negat|ve three contract|ons |n ten m|nutes |ast|ng forty seconds w|thout
|ate dece|erat|on |mp||es p|acenta| support |s adequate
b os|t|ve pers|stent |ate dece|erat|ons occurr|ng |n more than S0 percent
of contract|ons may |nd|cate p|acenta| reserves are
comprom|sed
c Susp|c|ous |ncons|stent |ate dece|erat|ons occurr|ng w|th |ess than ha|f of
the contract|ons repeat test |n twentyfour to fortye|ght hours
d Unsat|sfactory or |nconc|us|ve resu|ts cannot be obta|ned usua||y due to
excess|ve or |nsuff|c|ent uter|ne act|v|ty obes|ty dedema
po|yhydramn|os or excess|ve feta| act|v|ty repeat test w|th|n
twentyfour hours
Nurs|ng r|or|ty
If the CS1 |s pos|t|ve and there |s no acce|erat|on of Ink w|th
feta| movement (nonreact|ve NS1) the pos|t|ve CS1 |s an om|nous s|gn
often |nd|cat|ng a |ate s|gn of feta| hypox|a
AMNIC1IC ILUID ANALSIS
1 urpose ana|ys|s of the amn|ot|c f|u|d obta|ned by the techn|que of
amn|ocentes|s prov|des the fo||ow|ng |nformat|on
a Mon|tor|ng of khaso|mmun|zat|on process
b Determ|nat|on of feta| |ung matur|ty
c Genet|c d|agnos|s
1 Chromosoma| abnorma||t|es Down's syndrome
2 Detect|on of neurotube defects through
afetoprote|n ana|ys|s (AI)
2 rocedure
a Amn|ocentes|s |ntroduct|on of a need|e transabdom|na| through the
abdom|na| and uter|ne through the abdom|na| and uter|ne wa||s |nto
the amn|ot|c cav|ty to asp|rate f|u|d for exam|nat|on
b Sup|ne pos|t|on w|th s||ght e|evat|on of the head
c C||ent shou|d empty her b|adder
d Locat|on of the p|acenta and fetus |s scanned by u|trasound to avo|d
trauma and |n[ury
e Abdomen |s prepped |oca| anesthet|c |nf||trated subcutaneous|y need|e
|nserted and amn|ot|c f|u|d asp|rated and sent to |aboraty for ana|ys|s
3 Matur|ty stud|es
a Lec|th|n]Sp|ngomye||n rat|o (L]S) the components of phospho||p|d
prote|n substance that composes surfactant L]S rat|on of 21 or
greater |s |nd|cat|ve of suff|c|ent surfactant (occurs around th|rtyf|ve
weeks)
b Lung prof||e
1 Inc|udes L]S rat|o and percentages of |ec|th|n and
phosphad|ty| |nos|to| (I) and phosphat|dy| g|ycero| (G)
2 Add|t|ona| measurements a||ow for a more accurate p|cture
of |ung matur|ty
3 I |ncreases at th|rtyf|ve to th|rtys|x weeks and then
dec||nes
4 G appears at th|rtyf|ve weeks and |ncreases rap|d|y unt||
term