Chapter 6: Antepartal Tests (Davis Advantage for Maternal-Newborn Nursing: Critical Components of Nursing Care: 4th Edition)

At Risk Pregnancy vs High Risk Pregnancy

At Risk: Higher chance of experiencing problems

High Risk: Something is already happening to the mother (diagnosis has already been made)

Indications for Antepartal Testing: Maternal Conditions

Renal Disease

Cardiac Disease

Lupus

Hyperthyroidism

Antiphospholipid Syndrome

Hemoglobinopathies

Insulin-treated Diabetes Mellitus

Indications for Antepartal Testing: Pregnancy-Related Conditions

Gestational Hypertension

Preeclampsia

Gestational Diabetes

Fetal Growth Restriction

Hydramnios, oligohydramnios, and polyhydramnios

Post-Term Pregnancy

Factors to assess: Biophysical

Originate from mother or fetus, impact development or function of mother or fetus

Factors to assess: Psychosocial

Maternal behaviors or lifestyles that have a negative effect on mother or fetus

Factors to assess: Socioeconomic

Variables pertaining to the woman / family that place mother / fetus at risk, access to care, age, parity, income, etc.

Factors to assess: Environmental

Hazards in the workplace or general environment

Nurses' Role in Antepartal Tests

Teach

Provide support

Assist

Conduct certain tests

Monitor maternal and fetal response

Examples of Screening Tests

Identify those not affected

AFI, BPP, Contraction Stress Test, Kick Count, Multiple Marker Screening, NST, Ultrasonography, Nuchal Translucency, Umbilical artery doppler flow, Vibroacoustic stimulation

Examples of Diagnostic Tests

Identify a disease or problem

Amniocentesis, Chorionic villi sampling, MRI, Percutaneous umbilical blood sampling, Ultrasound

Basis of Genetic Tests

Detect health problems that could affect the woman, fetus, or newborn

Provide with information to allow a fully informed decision about pregnancy management

Anyone over the age of 35 qualifies

Biophysical Assessment: Ultrasound findings

Gestational Sac, Age, Fetal growth and anatomy, Presentation, Placenta location and abnormalities, Fetal Activity, #, Viability, Amniotic Fluid, and provides Visual assistance for procedures

Biophysical Assessment: MRI Findings

Visualizes fetal or maternal abnormalities when screening tests can't tell

Very rarely used and only used in the case that nothing else works

Biophysical Assessment: Doppler Flow Findings

Placental perfusion, IUGR, Reversed end-diastolic flow in severe cases of IUGR:

Peripheral resistance increases then diastolic flow decreases and systolic increases

Biochemical Tests: CVS (Chorionic Villus Sampling)

Aspiration of small amount of placental tissue for chromosomal, metabolic, or DNA testing.

Can either be done vaginally or abdominally

Biochemical Tests: Amniocentesis

Aspiration of amniotic fluid through the abdomen, genetic testing usually, but can be used for lung maturity

Biochemical Tests: Percutaneous umbilical cord blood sampling

Fetal blood from cord, after 18 weeks.

Can be used to detect metabolic and hematological disorders, fetal infection and can be used for fetal karyotyping.

Risks of Antepartal Testing:

Contamination of mother's cells (For biochemical tests)

CVS: 1/455 fetal loss & 10% have bleeding

Amniocentesis: .1-.3% loss rate, bleeding or leaking in 1-2% of cases

PUBS: 1.4% fetal death, cord vessel bleeding or hematomas, maternal fetal hemorrhage, bradycardia, infection

Maternal Assays: Cell free DNA Screening

Screens for common fetal aneuploidies

Analysis for cell-free DNA fragments in the maternal circulation starts around 9 to 10 weeks of pregnancy

Identify fetal sex

Maternal blood, potential for false positive / negative, not equivalent to diagnostic

Maternal Assays: Alpha-Fetoprotein

High and Low Levels Tested

Abnormal findings, false positives / negatives

Glycoprotein produced in liver GI tract and yolk sac

Increased: neural tube defects, anencephaly, omphalocele, gastroschisis

Decreased: trisomy 21, abnormal needs further testing

Maternal Assays: Multiple Marker Screening

To look for trisomy and neural tube defects

Antenatal Fetal Surveillance: Fetal movement counting:

Baseline is 10 'fetal movements' in 2 hours

Antenatal Fetal Surveillance: Nonstress Test

Baseline is 2 accels in 20 minutes.

If there is not 2 accels in 20 minutes, wait 40 minutes. Watch for deccels

Antenatal Fetal Surveillance: Contraction stress test

Monitor fetus NST while contracting

Antenatal Fetal Surveillance: Amniotic fluid index

U/S measurement of AF in four quadrants of uterine cavity

Under 5 is oligo, over 24 is poly

Antenatal Fetal Surveillance: Biophysical Profile

Measures NST+ breathing, movement, tone, AFI, breathing for 30 seconds, three or more movement, extension and flexion, a pocket of fluid measuring at least 2 cm

Grading for biophysical profile

Increments of 2

10/10 no concerns for the baby

8/10 is reassuring

6/10 is equivocal (further testing)

4/10 is Non reassuring (possible delivery)

2/10 is immediate delivery

0/10 is bad

Nursing actions for Antepartal Testing

Skill and knowledge, interpret test results, BPP scores & know when to intervene

Contact the physician when you're getting test results

Patient teaching, support, resources, follow-up

Ethical responsibilities