lecture 2 - nur 224

Who do you give screening test to?

You give screening to everybody at a specific category

EX: all pregnant woman 12 weeks

all 5 year olds 

Who do you give a diagnostic test to?

You give it to specific patients who need to have a yes/no answer on their issue

What are some things we need to consider for fetal diagnostic testing?

It is used to evaluate fetal condition or any anomalies within the patient. IT SHOULD NOT BE DONE WITHOUT INFORMED CONSENT!

What is Alpha-Fetoprotein test?

A screening test done during 16-18 weeks, where a protein made by the fetus can cross into the mom’s blood.

Low levels of MSAFP - chromosomal problems (down syndrome, trisomy 18, monosomy)

High levels of AFP (anencephaly, spina bifida) 

These are SCREENINGS. these are INCREASED RISK! NOT FACT

What is a Quad Screen?

Measures the mothers blood between 15-22 weeks of pregnancy,

• AFP (fetal protein)

• Estiriol

• hCG 

• Inhibin A

What is an ultrasound?

A diagnostic/screening test that uses high-frequency sound waves and turns that into an image

Where can an ultrasound be done for babies?

Abdominally or transvaginally (inside vagina)

What is the purpose of an ultrasound in the first trimester?

• Confirms pregnancy is real

• Verify location in pregnancy (needs to be in the uterus)

• Detect twins/triplets

• Determine gestational age (MOST ACCURATE)

• checks for genetic risk

Procedure: Usually transvaginal

What is the purpose of an ultrasound in the second/third trimester?

• Checks baby viability & anatomy

• Confirms gestational age

• Assess serial fetal growth

• Guide procedures of amniocentesis, PUBS, external vision

• Locate and evaluate the placenta

• Determine fetal position

• Evaluate amniotic fluid

Procedure:

Transabdominal

Transvaginal can be used to assess for preterm labor or cervical incompetence

What is series fetal growth?

To make sure the baby is growing within their percentile, meaning their growth is steady.

EX: 
6 weeks baby - 55% percentile

12 weeks baby - 12% percentile which means inconsistency.

What is polyhydramnios?

Excessive amniotic fluid, baby can’t swallow fluid properly.

SoB
could be kidney problem

What is oligohydraminos?

Insufficient amniotic fluid

Baby cannot move well, causing lung development problems and possible limb deformities 

What are the different times of ultra sounds?

2D, 3D, 4D, and doppler (measures blood flow)

They are all noninvasive, safe, and gives instant results!

What is a Nonstress Test? (NST)

It helps evaluate the fetal well being, has to be 24 weeks pregnant.

• Mother should void before NST, and baseline vitals

• semi-fowlers with left tilt

Equipment:

• Ultrasound transducer - records fetal heart rate

• Tocotransducer - record uterine activity

• EFM - applied to abdomen

What are the results of a NST?

Reactive: reassuring tracing meets all requirements

Nonreactive: tracing does not demonstrate the required characteristics, BUT DOES NOT ALWAYS MEAN BAD. further testing required.

What is the criteria for a reactive NST?

• Baseline heart rate: 110-160 bpm

• variability 5-15 bpm, moderate

• Accelerations

  • <32 wks: 10 bpm for 10 seconds

  • >32 wks: 15 bpm for 15 seconds

Decelerations: None

What are some advantages of a NST?

• Noninvasive for patient & fetus

• Safe

• Quick & easy to administer

• Immediate Results 

What are some disadvantages of NST?

• High false-positive rate

• Can be difficult with preterm fetus, multiple fetal pregnancy

What is a vibroacoustic stimulation?

A device that makes a buzzing sound to wake the baby up, usually used for a NST.

What is a Contraction Stress Test?

See how the baby’s heart rate reacts to contractions

What is a Negative CST test?

No late decelerations with contractions, baby is tolerating labor

What is a positive CST test?

Late decelerations presents with contractions, baby may not tolerate labor.

What is Biophysical Profile? 

Combines NST + Ultrasound to give a full picture of fetal well-being

Scoring system: 0-10

8-10 normal

4-6 concerning for fetal asphyxia

< 4 likely chronic fetal asphyxia 

What is Amniocentesis?

A diagnostic test where a needle is inserted into the amniotic sac (guided by ultrasound) to withdraw a small amount of amniotic fluid for testing

What is the purpose of amniocentesis in the 2nd trimester?

Collect fetal cells to identify chromosomal abnormalities (down syndrome, trisomy 18)

What is the purpose of the Amniocentesis in the 3rd trimester?

Test fetal lung maturity using the Lecithin/Sphingomyelin ratio

What is the purpose of Amniocentesis in both 2nd & 3rd trimester?

• Diagnose intrauterine infections

• Test for fetal hemolytic disease

  • Determine fetal bilirubin concentration 

What is the procedure relating to amniocentesis?

• Ultrasound locates fluid pocket

• Needle inserted, 1-2 mL discarded, ~20 mL collected for analysis.

Done 14 weeks of gestation until birth

What are the benefits of amniocentesis?

• Safe and familiar to OB providers

• Relatively painless and quick

• Provides definitive diagnostic results

What are the risk of amniocentesis?

• Pregnancy loss rate of less than 1^

• Higher risk with early use

• Transfer of fetal blood to maternal circulation, RH negative moms need RhoGAM (immune globulin)

What is PUBS? (Percutaneous Umbilical Blood Sampling)

Aspiration of fetal blood directly from the umbilical cord for prenatal diagnosis or intrauterine transfusion

What are the risks of PUBS?

Can cause life-threatening complications for the fetus (rare, but serious)

What is the procedure for PUBS?

High-resolution ultrasound is used to locate the fetus, placenta, umbilical cord then needle is inserted into umbilical cord near the site at which the cord meets the placenta.

What must RH-negative mothers receieve after PUBs?

RhoGAM (to prevent RH sensitization)

What is the purpose of CVS? (Chorionic Villus Sampling)

Diagnose fetal chromosomal, metabolic or DNA abnormalities

When is CVS performed?

10-13 weeks gestation

What are the approaches for CVS?

Can be done transcervicalor transabdominal

What are the advantages of CVS?

Provides earlier results than amniocentesis and is accurate

What are the risk of CVS?

Rate of pregnancy loss after CVS is similar to that of amniocentesis, report of limb reduction defects 

What are some hemorrhagic / hematologic complications of pregnancy?

• Early

  • Abortion

  • Ectopic

  • Hydatidiform Mole (molar pregnancy)

• Late

  • Placenta Previa (previa)

  • Abruptio Placentae (abruption)

• Disseminated Intravascular Coagulation (DIC)

What is the definition of abortion?

Pregnancy that ends before the 20th week

What are the types of abortion?

• Spontaneous (miscarrage)

• Medical (for maternal or fetal indications)

• Elective (personal choice)

How should nurses approach abortion care?

With respectful, nonjudgmental communication and supportive care

What is a condition of employment regarding abortion care?

Nurse must provide care regardless of personal beliefs

What is a spontaneous abortion?

A miscarrage (unplanned pregnancy loss before 20 weeks)

What are the risk factors for spontaneous abortion?

• Chromosomal abnormalities (most common)

• Maternal health factors, advanced maternal age

• Infection, malnutrition, trauma

  • Antiphospholipid syndrome

What lab test are used in suspected spontaneous abortion?

• HGB/Hct (blood loss)

• Clotting factors (risk of DIC)

• WBC (infection)

• hCG (pregnancy viability)

What diagnostic test help confirm spontaneous abortion?

• Ultrasound

• Cervical Exam

What are the four types of spontaneous abortion?

• Threatened

• Inevitable

• Incomplete

• Missed

• Complete

What is an assessment you see in a threatened spontaneous abortion?

• Vaginal bleeding before 20 weeks

• Cervix is CLOSED, membranes intact

What is nursing care you do for a threatened abortion?

• Pelvic rest, 

• track bleeding (for clotting)

• s/sx infection

• Rhogam as ordered if RH-negative

• emotional support 

What defines an inevitable abortion?

• Contractions

• cervical dilation

• ruptured membranes

What is the nursing care for an inevitable abortion?

• Monitor bleeding/infection ***

• RhoGAM as ordered

• Collect any tissue for examination

• May need to evacuate products of conception 

What defines an incomplete abortion?

Expulsion of some but not all products of conception, tissue remains in the uterus

What are the assessment findings for an incomplete abortion?

• Contractions

• Cervical dilation

• Ruptured membranes

• Delivery of some of the products of conception

What are nursing interventions for an incomplete abortion?

• Pelvic rest

• monitor bleeding/infection ****

• Rhogam as ordered

• Collect any tissue for examination

What is a missed abortion?

Fetus has died but is retained in utero, no fetal heart activity is detected

What is the main risk with a missed abortion?

Risk of DIC (disseminated intravascular coagulation) due to prolonged retention

What are nursing interventions for a missed abortion?

• pelvic rest

• monitor bleeding/clotting & infection

• give RHOgam

• emotional support

• evaluate products of conception

How many products of conception evacuated in a missed abortion?

• May occur spontaneously, or with a medical or surgical management

What is a complete abortion?

Expulsion of all products of conception without intervention (uterus empty)

What defines recurrent spontaneous abortion?

History of 3 or more miscarriages

What are possible causes of recurrent spontaneous abortion?

• Fetal chromosomal defects

• Maternal structural abnormalities 

• cervical incompetence

How is cervical incompetence managed in recurrent abortion?

Cerclage procedure (stitching cervix closed), either temporary or permanent

What is an ectopic pregnancy?

• Implantation of a fertilized egg OUTSIDE the uterus, most often in the fallopian tube

Where do most ectopic pregnancies occur?

~97% in the fallopian tube 

What increases the risk of ectopic pregnancy?

Prior infection (like PID), tubal scarring, or prior surgery.

Why is ectopic pregnancy dangerous?

Can rupture and cause life-threatening internal bleeding.

What is the classic triad of ectopic pregnancy?

Abdominal pain, vaginal bleeding, and positive pregnancy test (missed period).

Why can ectopic pregnancy cause shoulder pain?

Referred pain from diaphragmatic irritation due to internal bleeding.

What is the most reliable diagnostic test for ectopic pregnancy?

Transvaginal ultrasound.

What is the medical treatment for ectopic pregnancy?

Methotrexate (dissolves pregnancy tissue if stable, non-ruptured).

What are surgical options for ectopic pregnancy?

Salpingotomy (removes pregnancy, keeps tube) or Salpingectomy (removes tube).

What are key nursing interventions after ectopic pregnancy management?

Post-op care, administer RhoGAM if Rh-negative, provide emotional support.

What is gestational trophoblastic disease (hydatidiform mole)?

Abnormal growth of trophoblasts forming grape-like vesicles in the uterus; can be complete or partial.

What are classic signs of a molar pregnancy?

• Very high β-hCG

• Uterus larger than gestational age

• Vaginal bleeding (dark prune-colored)

• Severe hyperemesis gravidarum

• Early preeclampsia

What is the intervention for a molar pregnancy?

Suction evacuation of uterine contents (not induction with oxytocin), monitor bleeding, provide emotional support.

Why must molar pregnancy patients be followed up for 1 year?

To monitor for choriocarcinoma (rare but serious cancer).

What is placenta previa?

Placenta implants in the  lower uterus, covering part or all of the cervical oss

What are the types of placenta previa?

• Marginal (low lying, >3cm from os)

• Partial (within 3cm but not covering os)

• Total (completely covers os)

What are the classic signs of placenta previa?

Painless bright red bleeding in 2nd/3rd trimester, confirmed by ultrasound

What are nursing interventions for placenta previa?

• Avoid vaginal exams

• monitor bleeding

• plan for C-section

• anticipate preterm delivery 

What is abruptio placentae?

Premature seperation of the placenta from the uterus before birth

What are the main risk factors for abruptio placentae?

• Hypertension

• drug use

• abdominal trauma

What are the types of abruption?

• Marginal (external bleeding)

• Partial (concealed or external)

• Complete (often concealed bleeding)

What are classic signs of abruptio placentae?

• Painful bleeding

• board-like abdomen

• uterine tenderness

• abdominal contractions

• fetal distress

What is the priority management for unstable abruptio placentae?

• Position mother left lateral

• administer oxygen

• IV access

• prepare for rapid delivery

• prepare transfusion

• control the bleeding!

What is vasa previa?

Condition where umbilical cord inserts into fetal membranes instead of the placenta, leaving vessels exposed.

How is vasa previa diagnosed?

Ultrasound

Why is vasa previa dangerous?

Rupture of membranes can cause fetal vessels to tear, leading to rapid, life-threatning fetal hemorrhage

What is the preferred management of vasa previa?

Cesarean delivery ( C-section) to prevent uncontrolled rupture of membranes

What is HIV/AIDs?

A retrovirous that destroys the ability of the body to fight infection

How can HIV be transmitter to the infant?

During pregnancy or at delivery (congenital HIV infection)

What is the risk of transmission with a low viral load for HIV?

About 1% risk (whether vaginal or cesarean delivery).

What is the risk of transmission with a high viral load for HIV?

Greater than 25% risk; cesarean delivery is recommended.

What medications are used in HIV-positive pregnancy?

Antiretroviral medications are given to both parent and infant to reduce risk of transmission.

Why is breastfeeding not recommended in HIV-positive mothers (U.S.)?

Breast milk can transmit HIV, so breastfeeding is avoided to reduce infant infection risk.

What type of infections are Chlamydia and Gonorrhea?

Both are sexually transmitted bacterial infections

What are complications of untreated Chlamydia/Gonorrhea?

PID, premature rupture of membranes, premature birth, chorioamnionitis, endometritis, sepsis, newborn eye complications.

What are common symptoms of Chlamydia/Gonorrhea?

May be asymptomatic; dysuria and urinary frequency.