NURS 2866 - Chapter 10 - Assessment of High-Risk Pregnancy

What defines a high-risk pregnancy and what are the four main categories of risk factors?

A high-risk pregnancy is one with increased risk to the mother, fetus, or both, and risk factors are categorized as biophysical, psychosocial, sociodemographic, and environmental.

What are biophysical factors that contribute to a high-risk pregnancy?

Genetic conditions (e.g., blood incompatibility), nutritional status, alcohol and drug use, medications, and obstetric disorders such as gestational diabetes and preeclampsia.

How do psychosocial factors increase the risk of pregnancy complications?

Smoking increases risk of low birth weight and miscarriage, caffeine increases risk for intrauterine growth restriction (IUGR), and alcohol/drug use negatively impacts fetal development.

What sociodemographic factors contribute to high-risk pregnancy and why?

Low income (limited resources), lack of prenatal care, age, marital status, and environmental exposure risks all contribute to increased complications.

What environmental factors can affect pregnancy outcomes?

Exposure to chemicals and stress, including paternal exposure, can affect fertility and fetal development.

What are the two primary goals of antepartum testing?

To identify fetuses at risk for injury due to decreased oxygenation and to identify well-oxygenated fetuses to avoid unnecessary interventions.

What are common indications for antepartum testing?

Diabetes, hypertension, fetal growth restriction, oligohydramnios (low amniotic fluid), and post-term pregnancy.

What is a biophysical assessment and what is its purpose?

A comprehensive evaluation of fetal well-being using methods such as kick counts, ultrasound, and biophysical profile.

What are daily fetal movement counts and why are they important?

A noninvasive, inexpensive method where the mother tracks fetal movement to assess fetal well-being.

How many movements does a fetus make per hour and how many does the mother typically perceive?

About 30 movements per hour, with the mother perceiving approximately 70–80%.

What are the accepted methods for performing fetal kick counts?

Counting movements for 1 hour or counting until 10 movements occur within 2 hours (2–3 times per day).

When should a patient report decreased fetal movement?

If fewer than 3 movements are felt in 1 hour.

What are the main purposes of ultrasound in pregnancy?

To assess fetal activity, determine gestational age, detect abnormal growth, evaluate placenta and anatomy, and guide invasive procedures like amniocentesis.

What is the difference between abdominal and transvaginal ultrasound?

Abdominal ultrasound is used after the first trimester and requires a full bladder, while transvaginal ultrasound is used early in pregnancy and does not require a full bladder.

What is the purpose of ultrasound in the first trimester?

To confirm pregnancy, determine gestational age, and measure crown-to-rump length.

What is the purpose of ultrasound in the second trimester?

To confirm dates, assess amniotic fluid, evaluate placenta location, and assist with amniocentesis.

What is the purpose of ultrasound in the third trimester?

To confirm gestational age, determine fetal position, evaluate placenta, and assist with invasive testing.

What is polyhydramnios and what conditions may it indicate?

Excess amniotic fluid, which may indicate gastrointestinal or central nervous system anomalies.

What is oligohydramnios and what conditions may it indicate?

Decreased amniotic fluid, which may indicate renal abnormalities or premature rupture of membranes (PROM).

What is a biophysical profile (BPP) and what does it assess?

A test assessing fetal well-being using amniotic fluid volume, fetal movement, fetal tone, fetal breathing movements, and fetal heart rate via NST.

What is the purpose of the Coombs test in pregnancy?

To detect Rh incompatibility between mother and fetus.

What is alpha-fetoprotein (AFP) and what does an elevated level indicate?

A protein produced by the fetal liver and GI tract; elevated levels may indicate neural tube defects.

When is AFP testing performed?

Between 14–31 weeks of gestation.

What is multiple marker screening and what does it detect?

A blood test that detects chromosomal abnormalities such as trisomy 21 (Down syndrome), performed between 11–14 weeks.

What is amniocentesis and how is it performed?

A procedure where a needle is inserted into the uterus using ultrasound guidance to withdraw amniotic fluid containing fetal cells.

When can amniocentesis be performed?

After 14 weeks of gestation.

What are the indications for amniocentesis?

Genetic disorder diagnosis, congenital anomalies, neural tube defects, and assessment of fetal lung maturity.

What maternal complications can occur with amniocentesis?

Hemorrhage, placental abruption, injury to bowel or bladder, and amniotic fluid embolism.

What fetal complications can occur with amniocentesis?

Hemorrhage, infection, and direct injury from the needle.

What is chorionic villus sampling (CVS) and when is it performed?

A genetic test that samples placental tissue, performed between 10–13 weeks of gestation.

What is the focus of fetal assessment in the first and second trimesters versus the third trimester?

First and second trimesters focus on detecting fetal anomalies, while the third trimester focuses on fetal oxygenation and well-being.

What is a nonstress test (NST) and what does it evaluate?

A test that evaluates fetal heart rate response to movement.

How is a nonstress test performed?

The mother is placed in semi-Fowler’s position and monitored for 20–30 minutes.

What defines a reactive (normal) nonstress test?

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

What defines a nonreactive NST and what does it require?

Lack of sufficient accelerations; requires further testing.

What interventions can be used to stimulate a nonreactive NST?

Giving juice or fluids and using vibroacoustic stimulation.

What is a contraction stress test (CST) and what is its purpose?

A test that evaluates fetal tolerance to contractions.

How are contractions induced during a CST?

Using Pitocin or nipple stimulation.

What is the goal contraction pattern for a CST?

Three contractions within 10 minutes.

What is a negative CST and what does it indicate?

No late decelerations; indicates adequate fetal oxygenation.

What is a positive CST and what does it indicate?

Presence of late decelerations; indicates fetal distress and need for delivery.

What are contraindications for performing a contraction stress test?

Preterm pregnancy, placenta previa, multiple gestation, previous C-section, or any condition where labor is unsafe.

What is the nurse’s role in antepartum testing?

Education, preparation, emotional support, counseling, and planning interventions based on results.

What should nurses educate patients about regarding antepartum testing?

The purpose, procedure, risks, and possibility of false positives or false negatives.

What preparations may be required before antepartum testing?

Instructions such as having a full bladder for ultrasound.

What support should nurses provide if test results are abnormal?

Emotional support, counseling, and resources.

What is the nurse’s role in planning care after antepartum testing?

Preparing for interventions and follow-up based on results.

What are the key overall takeaways for high-risk pregnancy assessment?

Risk factors fall into four categories; antepartum testing evaluates fetal oxygenation; NST is a screening tool; CST evaluates stress response; ultrasound and BPP provide full assessment; and the nurse plays a critical role in education and support.