high-risk pregnancy

What are the 4 main categories of high-risk pregnancy factors?

Biophysical, Psychosocial, Sociodemographic, and Environmental.

What is the definition of a Biophysical risk factor in pregnancy?

Factors originating from within the mother or fetus that affect physiological development or health.

What are 3 examples of Biophysical risk factors?

Genetics (e.g., Trisomy 21), chronic illnesses (e.g., chronic hypertension, diabetes), and obstetrical disorders (e.g., multifetal pregnancy, prior preterm birth).

How does pre-pregnancy Obesity (BMI ≥ 30) act as a Biophysical risk factor?

Increases the risk for gestational diabetes, preeclampsia, neural tube defects, cesarean delivery, and fetal demise.

What is the definition of a Psychosocial risk factor in pregnancy?

Maternal behaviors or lifestyle choices that negatively impact the health of the mother or fetus.

What are 3 examples of Psychosocial risk factors?

Substance use (alcohol/drugs), tobacco or vape use, and perinatal mental health disorders (depression/anxiety).

What is the recommended daily limit for maternal Caffeine Intake during pregnancy?

Less than 200 mg/day (excess intake can constrict blood flow and increase the risk for small-for-gestational-age infants).

What is the definition of a Sociodemographic risk factor in pregnancy?

Maternal and social characteristics that place the pregnancy at increased statistical risk for complications.

What age parameters define Adolescent Pregnancy vs. Advanced Maternal Age (AMA)?

Adolescent: Age 10 to 19 years. | Advanced Maternal Age: Age 35 years or older at delivery.

What are 3 examples of Sociodemographic risk factors besides age?

Poverty/food insecurity, lack of access to prenatal care/transportation, and racial/ethnic health disparities.

What is the definition of an Environmental risk factor in pregnancy?

Hazards in the maternal surroundings or workplace that can cause harm to the developing fetus.

What fetal damage can result from maternal Lead Exposure during pregnancy?

Preterm birth, low birth weight, damage to the fetal nervous system/kidneys, and cognitive/behavioral impairments.

What infection is associated with cat litter/feces and raw meat, and what fetal risks does it carry?

Toxoplasmosis; can cause fetal blindness, deafness, microcephaly, and severe cognitive disabilities.

What dietary food restriction is mandated during pregnancy to prevent Listeria infection?

Avoid unpasteurized milk/cheese and unheated deli meats (Listeria can cross the placenta and cause fetal demise).

Why should pregnant clients avoid Saunas and Hot Tubs in the first trimester?

Maternal hyperthermia increases the risk for fetal neural tube defects and congenital anomalies.

What is the definition and primary purpose of MSAFP (Maternal Serum Alpha-Fetoprotein)?

A maternal blood screening test that measures alpha-fetoprotein to screen for open neural tube defects (NTDs) and chromosomal anomalies.

At what Gestational Age is MSAFP screening performed?

Between 14 and 22 weeks of gestation (ideal window is 16 to 18 weeks).

How are High vs. Low MSAFP levels interpreted?

High MSAFP: Indicates neural tube defects (spina bifida, anencephaly) or abdominal wall defects. | Low MSAFP: Indicates Down syndrome (Trisomy 21).

What is the definition and primary purpose of Nuchal Translucency (NT) Testing?

An ultrasound measurement of fluid collection at the posterior nape of the fetal neck to screen for chromosomal anomalies and fetal cardiac defects.

At what Gestational Age is Nuchal Translucency (NT) testing performed?

First trimester, between 11 and 13 weeks of gestation.

What NT measurement threshold indicates an increased risk for fetal abnormalities?

An NT fluid measurement greater than 3 mm indicates an increased risk for fetal cardiac disease and genetic defects.

What is the definition and procedure of Chorionic Villus Sampling (CVS)?

An ultrasound-guided aspiration biopsy of chorionic villi from the placenta (transcervical or transabdominal) for early genetic karyotyping.

At what Gestational Age is Chorionic Villus Sampling (CVS) performed?

First trimester, between 10 and 13 weeks of gestation.

What is a major diagnostic limitation of Chorionic Villus Sampling (CVS) compared to amniocentesis?

CVS CANNOT detect neural tube defects (such as spina bifida or anencephaly).

What is the definition and procedure of Amniocentesis?

Ultrasound-guided transabdominal needle aspiration of amniotic fluid to collect fetal cells for genetic, metabolic, and DNA analysis.

At what Gestational Age is Amniocentesis typically performed for genetic testing?

Second trimester, typically between 15 and 20 weeks of gestation.

What medication MUST be administered post-procedure to an Rh-negative client undergoing CVS or Amniocentesis?

Rho(D) Immune Globulin (RhIG / RhoGAM) to prevent Rh isoimmunization.

What is the primary purpose and patient prep for an External Abdominal Ultrasound?

Noninvasive visualization of the fetus and placenta; requires a full bladder in early pregnancy to lift the uterus out of the pelvis.

What is the primary purpose and patient prep for a Transvaginal Ultrasound?

Vaginal probe insertion used in the 1st trimester for early GA confirmation, cervical evaluation, or ectopic pregnancy; does NOT require a full bladder.

What is the primary purpose of Doppler Ultrasound Velocimetry?

Measures the velocity of red blood cells to assess maternal-fetal blood flow through the uterine and umbilical vessels (used in IUGR and hypertension).

At what gestational age is a routine Fetal Anatomy Scan performed via ultrasound?

Second trimester, between 18 and 20 weeks of gestation.

What is the definition and primary purpose of a Nonstress Test (NST)?

A noninvasive 3rd-trimester assessment that measures fetal heart rate (FHR) accelerations in response to fetal movement to evaluate autonomic nervous system integrity.

What are the Reactive NST criteria for a fetus ≥ 32 weeks of gestation?

At least 2 FHR accelerations rising at least 15 bpm above baseline and lasting at least 15 seconds within a 20-minute period (15x15 rule).

What are the Reactive NST criteria for a fetus < 32 weeks of gestation?

At least 2 FHR accelerations rising at least 10 bpm above baseline and lasting at least 10 seconds within a 20-minute period (10x10 rule).

What defines a Nonreactive NST?

Failure to produce the required FHR accelerations over a 40-minute monitoring period.

What technique can be used during an NST to wake a sleeping fetus?

Vibroacoustic Stimulation (VAS), applying sound and vibration to the maternal abdomen.

What is a Biophysical Profile (BPP) and what two modalities are used?

A comprehensive assessment of fetal well-being combining a Nonstress Test (NST) with a real-time Ultrasound scan over 30 minutes.

What are the 5 components evaluated in a Biophysical Profile (BPP)?

1. Fetal Breathing Movements | 2. Gross Body Movements | 3. Fetal Tone | 4. Reactive FHR (NST) | 5. Amniotic Fluid Volume.

How is each component scored in a BPP, and what is the maximum score?

Each component receives 0 points (abnormal) or 2 points (normal); total score ranges from 0 to 10 points.

How is a BPP Score of 8 to 10 interpreted?

Normal / Acceptable; indicates reassuring fetal well-being and low risk of chronic fetal asphyxia.

How is a BPP Score of 6 interpreted?

Equivocal / Suspicious; requires close monitoring and repeat testing within 24 hours.

How is a BPP Score of 0 to 4 interpreted?

Abnormal; strongly indicates fetal hypoxia and asphyxia, requiring immediate evaluation and potential delivery.

What is the definition and primary purpose of a Contraction Stress Test (CST)?

Evaluates FHR response to induced uterine contractions to assess uteroplacental function and identify intrauterine hypoxia.

What two methods are used to induce contractions during a CST?

Nipple stimulation or IV Oxytocin (Pitocin) infusion.

What contraction frequency must be achieved for a CST to be valid?

At least 3 contractions lasting 40–60 seconds within a 10-minute window.

What defines a Negative CST and what is its clinical significance?

No late decelerations or significant variable decelerations during 3 contractions in 10 minutes (Normal / Reassuring finding).

What defines a Positive CST and what is its clinical significance?

Late decelerations occur with 50% or more of contractions (Abnormal / Nonreassuring finding indicating uteroplacental insufficiency; requires hospital admission/delivery).