Exam 1

steps of conception

Fertilization – Fallopian Tube -> Zygote (egg + sperm) -> Replication (cleavage) = Morula (16 cells) -> Traveling to the uterus! -> Blastocyst – cavity forms in ball of cells -> Implantation! 

stages of human development

Preembryonic 

• conception to Day 14 (2 wks.) 

Embryonic 

• Day 15 to 8 wks. -> after conception 

• Organogenesis 

• All organ systems are developing 

• When teratogens have the most damaging effects 

Fetal 

• 9 wks. until the end of pregnancy

embryonic layers

• Ectoderm 

  • CNS; special senses; skin; and glands 

• Mesoderm 

  • Skeletal, urinary, circulatory, and reproductive organs 

• Endoderm 

  • Forms respiratory system, liver, pancreas, and digestive system 

teratogen exposure

• Things in the environment that can cause harm to fetuses 

• Medications 

  • Drugs 

  • Alcohol 

  • Viruses 

  • Radiation 

  • Lithium 

  • Lead 

  • Tetracycline 

• Education is important 

• Occupational exposures 

  • viruses 

amniotic fluid functions

• Maintain body temperature 

• Source of oral fluid (swallowing) and a repository for waste (urine) 

• Promotes muscle development 

• Movement through the fluid 

• Cushions against trauma 

• Weightless state – allows symmetrical development 

• Antibacterial factors in fluid 

• Facilitates normal lung development 

polyhydramnios

• Too much fluid 

• > 2,000ml or 2L 

• GI malformations 

• Cord entanglement 

• Difficulty monitoring FHR 

• labor conmplications

oligohydramnios

• Too little fluid 

• <300 ml 

• Renal abnormalities 

• Asymmetric growth and development 

• Not enough fluid to suspend fetus

umbilical cord

• This is the baby’s lifeline 

• 1 vein, 2 arteries 

  • “AVA” 

  • The vein carries the oxygenated blood 

  • The arteries carry the deoxygenated blood 

• Wharton jelly prevents compression 

• Cushions the vessels 

• Average cord is 22 inches long, 1 in wide 

• Should be centrally inserted on placenta 

placenta

• One cell layer between mom and placenta 

• Functions 

• Endocrine: Hormones provide “direction” to mother’s physiology to prioritize supply of nutrients and oxygen needed for fetal growth (Respiratory & Nutrition) 

• Metabolic: Waste remover (Excretory) 

• Circulation: Interface between mom and fetus 

placental hormones

• Human Chorionic gonadotropin (hCG) 

  • Contributes to morning sickness and nausea 

  • Pregnancy tests 

• Human Placental Lactogen (hPL) 

  • Stimulates maternal metabolism for baby nutrients 

  • Increases maternal insulin resistance -> higher blood sugar but it goes to baby 

• Progesterone 

  • Pregnancy hormone 

  • Decreases the contractility of the uterus 

• Estrogen 

  • Causes breast enlargement and tenderness 

  • Increases vascularization 

  • Nosebleeds and bleeding gums 

placental metabolic function

• High demand for glucose 

• Fetal metabolic waste products cross placental membrane for excretion by maternal kidneys 

• One cell layer separates maternal and fetal blood 

  • Breaks occasional occur in this membrane 

  • Mixing of maternal / fetal blood 

  • Problematic for Rh- mothers 

    • Blood will attack Rh+ fetus 

placental and fetal circulation

• Placental function is dependent on maternal circulation 

• Important to lay on their left side to avoid obstruction of aorta and IVC 

fetal circulation

• Blood travels through 3 shunts in fetal body 

• Shunt – alternative pathway 

• Ductus Venosus (liver bypass) 

• Connects UV to IVC 

• Liver processes nutrient rich blood 

• Enters the right atrium 

foramen ovale

• Opening between the right and left atrium to bypass right ventricle 

• Blood enters left atrium and down into the left ventricle 

• Pumps up to the ascending aorta 

deoxygenated blood

• From SVC to right atrium 

• From RA to RV and goes to the pulmonary arteries and meets resistance 

• Lungs are filled with fluid 

• Ductus Arteriosus (lung bypass) 

• Connects PA to aorta 

• Bypass pulmonary circulation and to the descending aorta 

• Back to the umbilical arteries to the placenta 

fetal respiratory system

• Respiratory 

• Surfactant – used to determine fetal lung maturity 

• Decreases the surface tension of the alveoli and expand the lung 

• L/S ratio is diagnostic marker (2:1) 

• Marker of lung maturity 

fetal neuro system

• Spinal cord develops from neural tube (ectoderm) 

• Chronic poor nutrition, hypoxia, drugs, or environmental toxins can damage CNS 

• Neural tube defects 

• Healthy development linked to folic acid 

• Spina bifida 

dizygotic pregnancy

• multiple eggs/sperms 

• 2 sacs, 2 placentas 

• fraternal 

• di-mono

  • each fetus has its own sac but share placenta

• di-di 

  • Each fetus has its own placenta and sac 

• Sometimes the placentas can be fused

monozygotic pregnancy

• fertilized ovum splits 

• identical 

• mono-di 

  • Share a placenta but have their own sac 

• mono-mono 

  • Share a sac and placenta – highest risk 

nursing implications for conception

• Complex interactions between genes and environmental factors to promote growth and development 

• First 3 months are CRITICAL for embryonic and fetal development 

• So how does this translate into nursing care & understanding 

length of pregancy

• 1^st trimester – LMP (last menstrual period) -> WK 13 

  • Beginning of fetal stage 

• 2^nd trimester – WK 14 -> WK 27 

  • Fetal growth aand development 

• 3^rd trimester – WK 28 -> WK 40 

• 4^th trimester 

  • Postpartum period 

maternal adaptations to pregnancy

• Affect ALL body systems 

• Pregnancy is a stressful state 

  • Why might this fact matter? --- How does it change your thinking about pregnancy? 

• Adaptations are unfamiliar and may cause concern or distress 

• Nurses must be aware of changes to support & educate 

• Consistent healthcare surveillance is of utmost importance 

uterine changes

• Size, shape, and position 

• Checkpoints at 12 wks. (near symphysis pubis), 20 wks. (near belly button), 38-40 (xiphoid process) wks.

lightening

• 3^rd trimester 

• Baby drops into the pelvis 

hegar sign

• Softening of the lower uterine segment 

• Can be felt internally 

• Allows uterus to put pressure on the bladder 

• 1^st trimester

Contractility - Braxton Hicks

• Practice contractions 

• Not labor 

• 3^rd trimester 

Ballottment

• 16-18 weeks

• press on abdomen and fetal movement confirmed if fetus rebounds against push

Quickening

• Fetal movement 

• 18-20 weeks 

• If pregnant before can be felt earlier 

• 2^nd trimester 

cervical changes

• Softens (Goodell sign) 

• Increased vascularization* 

• Friability – tissue is easily damaged (vaginal bleeding after exam / sex) 

• Mucous plug (operculum) forms 

• Chadwick sign – violet blue discoloration 

vaginal changes

• increased vascularity with thickening – heightened sensitivity 

• secretions increase, leukorrhea 

breast and ovarian changes

Breast

• increase in size and nodularity (including nipples) 

• colostrum production starts 2nd trimester – hPL 

• Beginning of breastmilk 

Ovary

• Enlarge at first, ovulation stops 

CV changes in pregnancy

• Physiologic anemia of pregnancy 

  • Tiredness 

  • Cold 

  • Pallor 

  • Dilution of RBCs 

  • Require iron supplements 

  • Increase in plasma -> less RBCs 

• Hypercoagulable state 

  • Produce more clotting factors 

• Increase risk of DVTs 

  • Preexisting heart disease at higher risk 

  • PVCs and PACs increase 

Respiratory Changes

• Increased oxygen consumption 

  • Increase metabolism 

• Pregnancy-related dyspnea 

  • diaphragm compression 

• Hormonal changes -> Blood vessel proliferation & congestion (leaky capillaries) of resp tract 

• nosebleeds (epistaxis); voice changes; marked inflammatory response to infection (flu/covid) 

GI changes

• Mouth 

  • Bleeding gums 

  • Excessive salivation (ptyalism) 

• GI Tract 

  • Decreased tone & motility 

    • constipation 

• Nausea and vomiting 

  • 4-6 weeks thru 1st trimester 

• PICA 

  • cravings in response to changing sense of taste 

  • Ice, clay, laundry starch 

  • (iron deficiency anemia) 

genitourinary changes

• Increased size 

• More urine 

  • Fetal waste as well 

• Increased GFR (by 50%) = decreased serum & creatinine 

  • Check medications 

• UTI Risk 

• Symptoms of Adaptations: 

  • Bladder irritability 

  • Nocturia 

    • Pee at night 

  • Frequency and urgency 

integumentary changes

all caused by hormones

melasma

• Facial discoloration 

• More pronounced in darker complexions 

linea nigra

• Fades postpartum 

• Dark line down the tummy 

striae gravidarum

Stretch marks 

angiomata

• Spider veins 

• Estrogen increases capillaries 

palmar erythema

Reddening of the palms

MS changes

• Changing posture 

• Increased lordosis 

• Waddling gait 

  • More pronounced in shorter moms 

  • Softening of ligaments 

other changes

• Leg Cramps – changes in Ca & Ph metabolism; pressure of enlarging uterus 

  • Very common 

  • Charlie horse 

  • Different from DVT 

    • Pain, swelling, redness NOT NORMAL 

• Restless Leg syndrome 

• Prone to impaired balance! 

• Alterations in sleep 

  • Belly and hormones 

• Endocrine changes 

pregnancy tests

• Serum vs. Urine 

• Detect hCG (begins at implantation and rises enough for detection by 7-8 days before expected period) 

• Home kits – accuracy depends on correct use 

• Certain foods, meds can affect results 

• First void in morning 

presumptive signs

• felt by client 

• Breast Changes 

  • Tender/enlarged 3-4wks 

• Amenorrhea 

  • 4 wks 

• Urinary Frequency 

  • 6 – 12 wks 

• Fatigue 

  • 12 wks 

• Nausea & Vomiting 

  • 4 - 14 wks 

• Quickening 

  • 16-20 wks 

probable signs

• observed by HCP 

• Goodell Sign 

  • Softening of the cervix – bc of vascularization 

  • 5 wks 

• Chadwick Sign 

  • Blueish tinge to the cervix – estrogen and increase in vascularization 

  • 6-8 wks 

• Hegar Sign 

  • Softening of the lower part of the uterus 

  • 6-12 wks 

• Positive Pregnancy Test 

  • False positives 

  • Other conditions can increase HcG 

  • 4-12 wks 

• Braxton Hicks 

  • Practice contractions 

  • 16 wks 

• Ballottement 

  • Fetus is bouncing on the cervix during internal exam 

  • 16-28 wks 

positive signs

• can only be explained by fetus 

• Visualization of embryo / fetus 

  • 5-6 wks  

  • Transvaginal ultrasound 

• Fetal Heart Tones 

  • 6+ wks 

• Fetal movement (felt by HCP) 

  • 19-22 wks 

Maternal Stages of Pregnancy

• Accept the pregnancy 

  • Initial reaction can vary 

  • Emotional lability is common 

  • Ambivalence 

• Identify with the mothering role 

  • Idea of mother comes from life experience 

  • Conflict resolution 

• Reorder relationships 

  • Tension and conflict can arise 

  • Mother and partner are influential 

  • Intimacy may be affected 

• Establish a relationship with fetus 

  • 3 phases 

    • 1 acceptance 

      • Accept the fetus 

  • Accept the parenting role 

  • Prepare for birth 

Partner adaptations

• Partner 

• + & - feelings may be present 

• intense prep & learning 

• IPV 

  • Intimate partner violence 

  • Increases in pregnancy 

  • Ask questions 

• responding to fear/concerns 

• LGBTQIA 

Adaptations of other siblings

• Response varies w/ developmental stage 

• Involvement is key 

• Prep & educate 

• Answer questions 

 

Prenatal Care models

• Traditional 

  • 1st trimester 

  • Q4 wks until 28 weeks (third trimester) 

  • Q2 wks until 36 weeks 

  • Q1 wk until delivery

• Group (Centering) 

  • Grp with similar due dates 

  • Low risk pregnancies 

  • Individual assessment + group education & discussion 

• Individualized 

  • More high risk pregnancies 

  • Follow traditional model with more or less visits as needed

Initial prenatal visit

• Prenatal Interview 

  • Goal is ID risk factors 

  • So....what types of questions will the HCP ask? 

• Physical Exam 

  • Provides a baseline (VS, height, weight) 

  • Comprehensive head to toe 

• Routine Testing 

  • Cervical, urine, blood

Prenatal Interview

• Date of LMP 

• Signs or sx 

• Test used? 

  • How did you use it

• Menstrual hx 

• Contraceptive hx 

• Past pregnancies 

• STI hx 

  • Chlamydia increases risk for ectopic pregnancies 

• Hx of mood disorders 

  • Maternal mood conditions are most commonly caused by pregnancy 

• Screening 2x pregnancy 

• Special diet? 

  • Microwave lunch meat

  • limit coffee

• Education?

• Living environment/occupation? 

  • Can be inhaling teratogens 

• Social support? 

• Stable relationships? (IPV) 

• Flu/covid/MMR/Chx pox 

• Rx & OTC drugs 

• Caffeine, etoh, tobacco, other  

  • Discontinue use 

Nagele’s Rule

• Start with the date of LMP -> subract 3 months -> add 7 days -> add 1 year 

• Assumes you have a 28 day cycle 

• Assumes it was a full period 

• Need to know when LMP is  

ultrasound

• Best way  

• Used to date baby 

• Transvaginal 

• Measure crown to rump 

GPTAL terminology

• G/P (2-digit system) 

  • Gravida: # of pregnancies (regardless of outcome)  

    • INCLUDING CURRENT PREGNANCY 

  • Parity: # of pregnancies carried past 20 weeks. 

    • DOES NOT INCLUDE CURRENT PREGNANCY 

• GTPAL (5-digit system) 

  • Gravida: # of pregnancies including this one 

  • Term: delivery between 37-42 wks 

  • Preterm: delivery between 20-36 6/7 wks 

  • Abortions: delivery before 20 wks 

  • Living: # living children (not pregnancies) 

routine testing

• CBC and Type & Screen 

  • Anemia risk 

  • Rh factor 

    • Need RhoGAM if Rh- 

• Rubella & Varicella Titers 

  • looking for immune or nonimmune status 

  • Immune is good 

  • CANNOT GIVE PREGNANT WOMEN LIVE VACCINES 

  • Receive after birth if nonimmune 

  • Can give flu, COVID, TDap 

• Hepatitis B 

  • looking for reactivity 

• STI testing 

  • RPR, VDRL, HIV (serum)  

  • Gonorrhea & chlamydia (cervical swab) 

  • Syphyllis can cause congenital defects if untreated in pregnancy 

• Pap Test 

  • cervical cancer screen 

Follow up testing

• Maternal Assessment 

  • Ask about well-being & concerns 

  • Vital signs & Weight measurement 

  • Urine (protein check) 

  • Edema 

    • Especially in third trimester -> preeclampsia 

• Fetal Assessment 

  • Movement 

  • kick counts 

  • FHTs 

    • 110-160 bpm 

    • doppler 

  • Growth - fundal height 

  • McDonald's measurement 

    • Measuring tape from pubis symphysis to the top of the fundus 

    • Correlates to how many weeks pregnant a women is 

    • Needs to lie flat on her back 

Additional Screening

• 1st Trimester 

  • Transvaginal US 

  • Nuchal translucency; dating; preg confirmation 

  • Genetic abnormalities(11-14 wks) 

• 2nd Trimester 

  • QUAD test 

  • NTD (AFP levels) 

  • Chorionic villus sampling/ Amniocentesis 

  • Noninvasive prenatal testing 

  • Gestational Diabetes 

  • Anatomy Scan / Ultrasound 

• 3rd Trimester 

  • H&H, STI 

  • GBS screen (36-38 wks) 

  • Rhogam (28 weeks & after birth maybe) 

  • PTL 

  • Edema 

Gestational Diabetes Screening

• Glucose Testing 

  • Measuring the insulin response 

• 24 to 28 weeks 

• Glucose Challenge Test 

  • 50 g glucose load, 1hr serum measurement 

  • Elevated, than further testing 

  • No need to fast 

• Glucose Tolerance Test 

  • 100 g glucose load; 3 hr serum measurement 

  • Must fast before 

  • Elevated = +dx 

important Education

• Good nutrition and food safety (listeriosis) 

  • Iron; folic acid; weight gain 

• Physical activity (P. 280) 

  • Maintain prior activity level 

• Posture & body mechanics 

  • Belly bands 

  • Kegel exercises 

• Rest & relaxation 

  • Side-lying 

    • Avoid compression of aorta and IVC 

    • Avoid Supine hypotension 

• Prenatal vitamins & Other Medications --- must check with HCP 

  • Folic acid 

• Substance use 

• Immunizations 

• Rh status 

• Personal Hygiene 

  • UTI prevention 

  • Oral health 

• Clothing 

  • Loose fitting clothing 

• Employment 

• Travel 

  • DVTs/VTEs 

• Breastfeeding preparation 

1st trimester discomfort

• Fatigue 

• Nausea & vomiting 

• Breast changes 

• Urinary frequency or incontinence 

• Mood swings 

• Vaginal discharge (leukorrhea) 

• Nasal stuffiness, bleeding gums, nose bleeds 

• Leukorrhea 

2nd trimester discomforts

• Skin changes 

• Joint, back, pelvic pain 

• Constipation, hemorrhoids 

• Supine hypotension

• Varicosities of the vulva and legs 

• Flatulence, bloating 

• Heartburn 

3rd trimester discomforts

• Return of some 1^st trimester discomforts 

• SOB and dyspnea 

• Heartburn and indigestion 

• Dependent edema 

• Braxton Hicks 

• Insomnia 

1st trimester complications

• Severe vomiting 

  • Hyperemesis gravidarum 

  • Electrolyte imbalances 

• Chills, fever 

  • Infection 

  • UTI, viral 

• Abdominal cramping/bleeding 

  • Miscarriage, ectopic pregnancy 

• Burning during urination 

  • UTI 

2nd and 3rd trimester complications

• Vaginal bleeding and cramping 

  • Preterm labor 

• Chills, fever, aches 

  • Infection 

• Back or flank pain 

  • Kidney/PTL 

• Decreased fetal movement or absent FHR 

  • Death or distress 

• Visual disturbances; facial swelling; severe headaches; muscular irritability; seizures 

  • Hypertensive conditions; preeclampsia 

• Glycosuria 

  • gestational diabetes 

birth settings

• Hospital 

  • Most supplies 

• Birth center 

  • Good for low risk 

  • May not have the same pain management supplies that a hospital does 

  • Can be sent to a hospital 

• Home birth 

  • Not suitable for high-risk pregnancies 

  • Must be attended to by a healthcare provider 

labor support

• Continuous labor support is beneficial 

  • Best approach to have positive outcomes and delivery 

  • Decreased pain medication 

  • Shorter labor 

  • Increased satisfaction 

  • Increased changes of SVD 

  • Reduced risk of C/S or assisted birth 

  • Higher APGARS 

• Doulas – trained to provide physical, emotional, and information support 

  • Cannot give clinical care 

  • Some are certified 

  • Definitely in birth centers 

Birth plans

• It’s a tool 

• Tentative!!! 

• Useful in prenatal settings to begin discussions of choices r/t labor and birth

nausea and vomiting

• Increased HcG 

• Recommend 

  • Smaller more frequent meals 

  • Plain foods 

urinary frequency

• Uterus pressing on bladder 

• Recommend 

  • Kegel exercises 

  • Do not hold it 

  • Avoid caffeine 

  • Limit fluids before bed 

Constipation

• Progesterone increase 

• Decrease GI motility 

• Sharing water 

• Recommend 

  • Laxatives 

Fatigue

• Higher stress on the body 

• Recommend 

  • Take naps 

  • Do not increase workload 

Heartburn

• Hormones allow acid reflux 

  • progesterone and estrogen

• Recommend 

  • Smaller meals 

  • Stay upright after eating 

  • Drink water between emails 

  • Avoid spicy foods 

breast tenderness

• Hormones and increase in blood flow 

  • Estrogen 

• Recommend 

  • Wearing comfortable bra 

  • Cold compress 

nosebleeds and bleeding gums

• Increase estrogen creates increase vascularization 

• Recommend 

  • Humidifier, Vaseline 

  • Watch oral hygiene 

  • Look at meds 

  • Screen for anemia 

backaches

• Lots of MS changes to the body 

• Increase pelvic tilt 

• Increase curvature of spine – lordosis 

• Loosening of ligaments 

• Recommend 

  • Rest when possible 

  • Do not increase activity 

  • Heating pads 

  • Proper body mechanics 

  • Good shoes 

varicosities

• Iliac veins become compressed 

• Increase blood volume 

• Recommend 

  • Compression socks 

  • Avoid standing long 

  • Elevation 

  • Do not cross legs 

hemorrhoids

• Estrogen increased vascularization 

• Enlarged uterus 

• constipation 

• Recommend 

  • High fiber/laxatives 

  • Fluids 

  • Warm bath 

  • Topical creams 

braxton hicks

• Body's way to pair uterine muscles to contract better for during labor 

• Recommend 

  • Warm compress 

  • Change position 

  • Move around 

  • Release bladder often

weight management pregnancy

• Depends on BMI (Pre-pregnancy) 

  • Underweight (<18) OR twin pregnancy 

    • 28-40 lbs. 

  • Normal (18.5-24.9) 

    • 25-35 lbs. 

  • Overweight (25-29.9) 

    • 15-25 lbs. 

  • Obese (≥30) 

    • 11-20 lbs. 

• First Trimester 

  • 2-4 lbs. total 

• Underweight/Normal 

  • 1 lb. / week 

• Overweight/Obese 

  • <1lb / week 

important dietary needs

• Iron 

  • Anemia is a common problem 

  • Increased blood volume does not increase RBCs 

  • Iron supplementation may be necessary 

  • Review teaching 

    • Iron can cause constipation 

• Folic Acid 

  • Included in PNV 

  • Important for neural tube defects 

• Other vitamins & minerals 

  • PNV 

food precautions

• Mercury 

  • Can impact CNS of fetus 

  • Follow guidelines for daily limits 

• Deli meats / hotdogs 

  • Reheat to steaming hot 

  • Kills listeria and other bacteria 

• Unpasteurized cheeses 

  • Avoid 

  • Same reasons as deli meat 

special nutrition considerations

• Adolescents 

  • Nutrition battle 

    • Have additional nutrient needs for themselves 

  • Additional monitoring or fetal growth 

  • Encouraged for higher calorie diets 

  • Risk for small birth weight babies 

• Vegetarian diets 

  • Monitor for susceptible deficiencies 

  • Refer to dietitian 

high risk pregnancy

• A condition threatens the health of the mother, fetus, or pregnancy 

• 1 in 4 women 

• When do you assess risk factors? 

  • First trimester interview appointment 

risk factors

• Biophysical Factors 

  • Genetics 

  • Medical conditions (Diabetes) 

  • Nutrition 

• Psychosocial Factors 

  • Substance use 

  • History of violence 

  • Cultural practices 

• Sociodemographic Factors 

  • Poverty 

  • Ethnicity 

  • Parity 

  • Single 

• Environmental Factors 

  • Radiation 

  • Pollution 

  • Pesticides 

modifiable vs nonmodifiable

• Modifiable 

  • Education 

  • Follow-up care 

  • Monitoring 

• Nonmodifiable 

  • Determine need for additional testing 

  • Consider referral to maternal fetal medicine 

antepartum testing for high risk

• Biophysical 

  • Kick counts 

  • Ultrasounds 

• Biochemical 

  • Amniocentesis 

  • Chorionic Villus Sampling 

  • Maternal Assays 

• Electronic Fetal Monitoring 

  • Nonstress test (NST) 

  • Vibroacoustic Stim 

  • Contraction stress test 

Indications for further testing

• Risk factors identified 

• Diabetes 

• Hypertension 

• Prior medical conditions (lupus, renal disease, heart disease) 

• Fetal growth problems 

• Amniotic fluid alterations 

• Previous pregnancy complications or stillbirth 

• Suspected fetal compromise (decreased movements) 

• Post term pregnancy 

daily fetal monitoring count

• **noninvasive 

• Movement is a reassuring sign of fetal health 

• Count movements for 2 hours or until 10 movements reached 

• Babies have 20-minute nap cycles 

• Establish a baseline 

• No fetal movement for 12 hours – fetal alarm signal! 

ultrasonography

• Transvaginal 

  • 1^st trimester 

  • Confirm pregnancy 

  • Check FHR 

  • Genetic testing 

    • Measure nuchal fold thickness on baby 

• Abdominal

  • Fetal scan 2^nd trimester 

  • Baby is big enough to visualize 

  • Gender reveal 

  • Anatomy scan to check development 

  • One for low risk 

  • Repeated for high risk 

biophysical profile

• Score of 8-10 is normal 

• Below 8 is suspect 

• If really low they induce labor or C-section 

amniocentesis

• Genetic testing for AMA 

• Having another baby or family member with congenital problems 

• Checking fluid for lung development 

• Can be done but risky in 1^st trimester 

• Usually done in 2^nd trimester 

• Complications 

  • Cramping 

  • Contraction like pain 

  • Potential for hemorrhage 

  • Infection 

  • Risk of miscarriage 

  • Potential of mixing of blood 

  • Give RhoGAM after procedure 

Chorionic Villius Sampling

• Sample of chorion 

• Can be done 1^st trimester 10-13 wks. 

• Relatively safe 

• Complications 

  • Cramping 

  • Bleeding 

  • Pain 

  • RH testing and RhoGAM 

noninvasive prenatal testing

• Test blood sample 

• Can identify trisomy 13, 18, and 21 

• Safer and preferred to amniocentesis and CVS 

• Can figure out gender 

• Towards end of first trimester 

maternal assays

• Alpha beta protein level  

• Drawn from blood 

• Determines risk of neural tube defects 

• Elevated = further testing 

nonstress test

• NST 

• Picture of baby in that moment 

• Top belt assesses uterine activity 

• Bottom assesses fetus 

• Looking for reactive 

• Failure = nonreactive 

vibroacoustic stim

• Vibrate mom's abdomen 

• Look for baby to twitch and react to the stimulation 

• Movement, increase in FH 

contraction stress test

• Not until patient is ok to deliver 

• Give pt oxytocin to bring contractions 

• Squeezes and stops blood flow to baby 

• Healthy fetuses should tolerate contractions with reserved oxygen 

failure of any test

Biophysical profile