NURS 2866 - Assessment of High-Risk Pregnancy

What are biophysical risk factors for high-risk pregnancy?

Genetic disorders (e.g., Rh incompatibility), nutritional status, alcohol and drug use, medications, pregnancy-related disorders like gestational diabetes and preeclampsia.

What are psychosocial risk factors in pregnancy?

Smoking, caffeine, alcohol and drug abuse.

What are sociodemographic risk factors in pregnancy?

Low income, lack of support/resources, age (very young or advanced maternal age), and marital status.

What are environmental risk factors in pregnancy?

Exposure to chemicals, toxins, radiation, occupational hazards, high stress levels, and paternal exposures.

What are the goals of antepartum testing?

Identify fetuses at risk from interrupted oxygenation and identify healthy, oxygenated fetuses to avoid unnecessary interventions.

What are indications for antepartum testing?

Diabetes, hypertension, intrauterine growth restriction (IUGR), oligohydramnios, and post-term gestation.

What is a Daily Fetal Movement Count?

A noninvasive, simple method where the mother counts fetal movements, aiming for 10 movements in 2 hours.

When should a mother notify her provider during fetal movement counts?

If fewer than 3 movements are felt in 1 hour.

What are the two types of ultrasound used in pregnancy?

Abdominal (after first trimester, full bladder needed) and transvaginal (early pregnancy, no full bladder).

What are ultrasound indications in the 1st trimester?

Confirm pregnancy and viability; determine gestational age using crown-rump length.

What are ultrasound indications in the 2nd trimester?

Confirm dates, assess fetal anatomy, fluid, and placenta; guide amniocentesis.

What are ultrasound indications in the 3rd trimester?

Confirm gestational age, assess fetal well-being and position, monitor placenta.

What are signs of polyhydramnios on ultrasound?

Excessive amniotic fluid, possibly from GI or CNS anomalies.

What does oligohydramnios suggest?

Too little amniotic fluid, associated with renal anomalies or PROM.

What does a Biophysical Profile (BPP) assess?

Amniotic fluid volume, fetal movement, tone, breathing, and a nonstress test.

When is amniocentesis typically performed?

After 14 weeks.

What are the uses of amniocentesis?

Detect genetic disorders, neural tube defects, assess fetal lung maturity.

What are potential complications of amniocentesis?

Hemorrhage, placental abruption, injury to bladder/bowel, fluid embolism, and fetal risks like infection or needle injury.

When is chorionic villus sampling (CVS) performed?

Between 10–13 weeks.

What is CVS used for?

Early genetic testing from placental tissue samples.

What is alpha-fetoprotein (AFP) and what does it indicate?

A protein from fetal GI/liver; elevated levels may suggest neural tube defects.

When is AFP typically measured?

Between 14–34 weeks.

What does a multiple marker screen test for?

Chromosomal abnormalities, including Down syndrome (Trisomy 21).

When is the best time for multiple marker screening?

Between 11–14 weeks.

What does the Coombs test screen for?

Rh incompatibility.

What are indications for electronic fetal monitoring in pregnancy?

Diabetes, preeclampsia, post-term pregnancy, or other high-risk conditions.

What does a nonstress test (NST) evaluate?

Fetal heart rate response to movement.

What defines a reactive NST?

At least 2 accelerations in 20 minutes, each lasting ≥15 seconds and increasing ≥15 bpm.

What is a nonreactive NST?

Fewer than 2 accelerations in 20 minutes; further testing may be required.

How can you stimulate fetal movement during an NST?

Give juice, cold water, or use vibroacoustic stimulation.

What is vibroacoustic stimulation?

A buzzing device on the abdomen that stimulates fetal movement.

What does a contraction stress test (CST) assess?

Fetal heart rate response to uterine contractions.

How are CST contractions induced?

With oxytocin (IV) or nipple stimulation.

What does a negative CST result mean?

No late decelerations — a normal finding.

What does a positive CST result mean?

Late decelerations with ≥50% of contractions — may indicate the need for delivery.

What are CST contraindications?

Preterm labor, placenta previa, multiple gestations, or a previous C-section.

What are the nursing roles during antepartum testing?

Educating, guiding, counseling, assessing, planning, and preparing patients for tests and procedures.