comprehensive quizlet unit 3

Screening test (antepartal)

Identifies at-risk pregnancies, not diagnostic. Examples: NST, BPP, CST, multiple marker screening, AFI, Doppler flow. Abnormal results → follow-up with diagnostic tests.

Diagnostic test (antepartal)

Confirms or rules out disease. Examples: Amniocentesis, CVS, PUBS, MRI, specialized ultrasound. Reserved for high-risk pregnancies.

Fetal movement (kick counts)

Begin at 28 weeks. Normal = ≥10 movements in 2 hrs OR ≥4 movements in 1 hr. Decreased movement = report → further testing (NST/BPP). Affected by fetal sleep, maternal meds, smoking.

Ultrasound in pregnancy

Transabdominal/transvaginal. Uses: gestational dating, anatomy, growth, HR, breathing. Advantages: safe, noninvasive. NTK: first-line for anomalies, IUGR, and previa diagnosis.

Amniotic Fluid Index (AFI)

Normal 5-25 cm. <5 = oligohydramnios → IUGR, distress. >25 = polyhydramnios → risk of cord prolapse, malpresentation.

Biophysical Profile (BPP)

5 variables: NST, breathing, movements, tone, AFI. Score 8-10 = normal; 6 = equivocal; ≤4 = abnormal → delivery. Modified BPP = NST + AFI only.

Nonstress Test (NST)

Reactive = ≥2 accelerations (≥15 bpm x 15 sec in 20 min; if <32 wks, ≥10x10). Nonreactive = insufficient accelerations in 40 min → further testing.

Contraction Stress Test (CST)

3 contractions/10 min required.

Negative (normal) = no late decels.

Positive = late decels with ≥50% contractions → uteroplacental insufficiency.

Contraindications: previa, abruption, preterm labor.

Multiple marker screening (AFP, triple, quad)

↑ AFP = neural tube/abdominal wall defects.

↓ AFP = Trisomy 21.

Used as screening only, follow up with diagnostic testing.

Amniocentesis

Done 15-20 wks (genetics) or later (lung maturity; L/S ratio ≥2:1). Risks: miscarriage, infection, bleeding. Nursing: light activity 24h, ↑ fluids, report bleeding/fluid leakage, Rhogam if Rh-. Accuracy ~99%.

Chorionic Villus Sampling (CVS)

10-13 wks; early genetic diagnosis. Risks: SAB, bleeding, infection. Nursing: monitor FHR, post-procedure Rhogam for Rh-, teach to report pain, bleeding, fever.

PUBS (Percutaneous Umbilical Blood Sampling)

Direct fetal blood sampling via umbilical vein. Used for anemia, genetic studies, infections. High risk → only in specialized centers.

Hyperemesis gravidarum

Severe vomiting → >5% weight loss, dehydration, ketonuria. Risks: multiples, migraines, family hx. Tx: IV fluids, antiemetics, TPN last resort. Nursing: I&O, weight, labs, psychosocial support.

Multiple gestation risks

Maternal: preE, GDM, previa, abruption, anemia, hemorrhage, C/S. Fetal: prematurity, growth restriction, malformations. Highest risk = mono-mono twins.

Gestational diabetes (GDM) screening

24-28 wks, 50g GTT → if abnormal, 3-hr OGTT. GDM A1 = diet controlled; GDM A2 = insulin controlled. Risks: macrosomia, hypoglycemia, RDS, stillbirth.

Diabetes in pregnancy nursing care

Teach glucose monitoring, diet/exercise, kick counts, S/S hypo/hyperglycemia. Monitor for polyhydramnios, macrosomia. Delivery planning individualized.

Spontaneous abortion (SAB)

<20 wks. S/S: bleeding, cramping, partial/complete expulsion.

Tx: expectant, misoprostol, D&C.

Nursing: bleeding precautions, Rhogam if indicated, emotional support.

Ectopic pregnancy

Implantation outside uterus (95% fallopian tube).

S/S: unilateral pain, bleeding, shoulder pain, syncope.

Dx: hCG + transvaginal US.

Tx: methotrexate (stable), surgery (rupture).

Placenta previa

Placenta over cervix. Painless 3rd-trimester bleeding. Soft, nontender uterus. Risks: previa hx, scarring, multiples. Tx: pelvic rest, C/S delivery, avoid vaginal exams.

Placental abruption

Premature separation of placenta. Painful bleeding, rigid uterus, abnormal FHR. Risks: HTN, trauma, cocaine. Complications: hemorrhage, DIC, fetal demise. Tx: stabilize, emergent delivery.

Gestational hypertension

HTN after 20 wks without proteinuria. Can progress to preeclampsia in 25%.

Preeclampsia

HTN + proteinuria OR end-organ dysfunction (low platelets, ↑ LFTs, renal dysfunction, neuro changes, epigastric pain). Risks: nulliparity, age >35, obesity, DM, multiples.

Eclampsia

Seizures in preeclampsia. Emergency.

Risks: stroke, cerebral edema, abruption.

Nursing: seizure precautions, Mg sulfate, airway support.

HELLP syndrome

Hemolysis, Elevated Liver enzymes, Low Platelets. Severe preE complication. Risks: abruption, DIC, maternal death. Tx: delivery.

Magnesium sulfate in pregnancy

Uses: seizure prophylaxis, fetal neuroprotection, tocolytic. Dose: 4-6g load, then 1-2g/hr. Therapeutic 4-8 mEq/L. Toxicity: ↓ DTRs, RR<12, UO<30mL/hr, SOB. Antidote: Calcium gluconate 1g IV.

Antihypertensives in pregnancy

Severe HTN → Labetalol IV, Hydralazine IV, Nifedipine PO. Goal = prevent stroke/maternal complications.

Antenatal steroids

Betamethasone (12mg IM x2) or Dexamethasone (6mg IM x4). Given 24-34 wks if preterm birth expected. Benefits: ↓ RDS, IVH, NEC, neonatal death. Optimal window = 2-7 days before delivery.

PPROM (preterm premature rupture of membranes)

ROM before 37 wks. Risks: infection, abruption, prematurity. Dx: sterile speculum, ROM+ tests, US. Tx: depends on GA; steroids, abx, Mg sulfate. Teach to monitor temp, fetal movement.

Group B Strep (GBS)

Screen 36-37 wks. Causes neonatal pneumonia, sepsis, meningitis. Tx: IV penicillin during labor (cefazolin/clindamycin if allergic).

Placenta accreta spectrum

Placenta abnormally invades uterus. Accreta = superficial, increta = myometrium, percreta = into organs. Risk: prior C/S. Tx: planned C/S hysterectomy.

Trauma in pregnancy

Leading cause of maternal death in pregnancy (MVA, IPV). Complications: abruption, hemorrhage, uterine rupture, fetal demise. Maternal stabilization takes priority.

HIV in pregnancy

Transmission in utero, delivery, breastfeeding. Tx: antiretrovirals, IV meds in labor, avoid instruments, no breastfeeding. Risks: IUGR, PTL, PPROM, neonatal infection.