NU321 (Exam 1): Assessment for Risk Factors

High Risk Pregnancy

Pregnancy with potential health risks for mother or fetus.

500,000 of the 4 million births in the US are high risk

categories of risk in pregnancy

biophysical - genetic disorders, nutritional

psychosocial - emotional distress, depression, IPV (intimate partner violence)

sociodemographic - lack prenatal care, low income, ethnic minority

environmental - workplace, chemicals

daily fetal movement count

- antepartum testing

- kick count

- done at home

- movement is reassuring, noninvasive

- at least 10 kicks in less than two hours

- less than 3 movements in 1 hour require further follow-up

ultrasounds in the 1st trimester

- confirm pregnancy

- confirm viability

- determine gestational age

- rule out ectopic pregnancy

- detect multiple gestations

- visualization during chorionic villus sampling

- detect maternal abnormalities (bicornate uterus, ovarian cysts, fibroids)

ultrasound in 2nd trimester

- establish or confirm dates

- confirm viability

- detect polyhydramnios or oligohydramnios

- detect congenital abnormalities

- detect IUGR (intrauterine growth restriction/retardation)

- confirm placental placement

- use for visualization during amniocentesis

ultrasound during the 3rd trimester

- confirm gestational age

- confirm viability

- detect macrosomia (big baby)

- detect congenital abnormalities

- detect IUGR

- determine fetal position

- detect placental previa or abruption

- visualization during amnio or version (push baby other way for better positioning)

- BPP (biophysical profile)

- AFI (amniotic fluid index)

- doppler flow studies (blood flow between placenta & fetus)

- placental maturity

abruption

placenta detaches from uterus

AFI polyhydramnios

over 25

AFI normal

10-25

AFI low normal

5-10

AFI oligohydramnios

<5

biophysical profile (BPP) components

- fetal breathing movements

- gross body movements

- fetal tone (position)

- reactive fetal heart rate (NST)

- qualitative amniotic fluid volume

biophysical profile (BPP) values

normal: 8-10

equivocal: 6

abnormal: <4

chorionic villus sampling (CVS):

when is it done?

what is done?

why is it done?

- 10-12 weeks

- tissue removed from fetal portion of placenta

- genetic screening

percutaneous umbilical blood sampling (PUBS):

what is done and why?

needle inserted into fetal umbilical vessel under US guidance

- for labs, RH, antibodies

AFP (alpha fetal protein)

screens for neural tube defects through maternal blood

- done at 16-18wks

quad screen

16-18 weeks

alpha-fetoprotein, estriol, inhibin, HcG

tests for down syndrome, trisomy 18, spina bifida, abdominal wall defects

cfDNA testing/Panorama

- early as 9 weeks

- maternal blood sample

- trisomies, sex chromosome aneuploidies, microdeletions, triploidy

if result is no fetal DNA, can be due to high BMI, early test, or process was done wrong

Coombs

screening for Rh compatibility

NST

Non-stress test assessing fetal heart rate.

CST

Contraction stress test evaluating fetal response.

Variability

Fluctuations in fetal heart rate patterns.