OB Exam 2

What Prenatal Risk Factor originates within the mother and fetus?

Biophysical

What Prenatal Risk Factor originates from maternal behaviors/adverse lifestyle?

psychological

What Prenatal Risk Factor originates from mother/family characteristics?

sociodemographic

What Prenatal Risk factor originates from exposure to hazards?

enviornmental

What are the 5 Fetal Wellbeing Prenatal Assessments?

fetal kick counts, non stress test, biophysical profile, contraction stress test, ultrasound

Fetal Kick Counts begin at…

28 weeks

Fetal Kick Counts (mother counts fetal movements daily)

• count number of movements in _____ ______

• time it takes to feel _____ _______________

1 hour, 10 movements

Less than ______ fetal movements in ____ hours warrants investigation.

10, 2

Non-Stress Test

• A normotoxic fetus with CNS functioning will produce ______ patterns in response to fetal _____________

FHR, movement

A non-stress test is performed after _____ ________.

28 weeks

What do we want to see in a Non-Stress Test?

• ____________ variability

• ______________

moderate, accelerations

Non-Stress Test should have EFM x____ ______

2 mins

Reactive Non-Stress Test

• ____ accelerations

• >32 weeks = ____ bpm x ____ seconds

2, 15, 15

Non-Reactive Non-Stress Test

• didn’t meet criteria in _____ mins

• further testing is warranted

40

Biophysical Profile (BPP) is a non-invasive real-time _____________ assessment

ultrasound

Biophysical Profile is performed after ______ weeks post…

• ____-_________ Non-stress test

• OR

• routine testing w/ _______ _________

28, non reactive, risk factors

A Biophysical Profile takes ______-______ mins

30, 120

A Biophysical Profile score is based on…(5)

breathing, movements, tone, NST, amniotic fluid

What does a BPP score of 8-10 mean?

normal

What does a BPP score of 4-6 mean?

suspected chronic asphyxia

What does a BPP score of 0-2 mean?

chronic asphyxia

How do you manage a BPP score of 8-10?

repeat BPP as indicated

How do you manage a BPP of 4-6?

• consider __________ if > _____ weeks

• OR

• repeat in ____-____ hrs

delivery 36, 4,6

How do you manage a BPP of 0-2?

deliver regardless of age

Contraction Stress Test (CST) determines ______ response to _______________ after _____ weeks (resp. functioning)

FHR, contractions, 34

Contraction Stress Test is ___________ and time-consuming

invasive

Contraction Stress Test is __________ stimulated.

oxytocin

During Contraction Stress Test evaluate FHR for ________/____________ decels with _____ _______________ within _____ mins.

late, variable, 3 contractions, 10

A Contraction Stress Test (CST) with contractions and no decels is…

negative

A Contraction Stress Test (CST) with 50% contractions and late decels is…

positive

A Contraction Stress Test (CST) with intermittent decels is…

equivocal

Contraction Stress Tests (CST) are contraindicated in

• those who want to deliver ____________

• pregnancies high risk for ____-________ ________

vaginally, pre term labor

CST is contraindicated for…

• placenta _________

• previous/classified ___/___

• ________ gestation

• ________

previa, c,s mult, PPROM

Ultrasound is done either _________________ or __________________.

Abdominally, transvaginally

1st Trimester Ultrasound

• confirms pregnancy

• confirms _________

• determines _________ ______________

viability, uterine abnormalities

2nd Trimester Ultrasound

• confirms _____ ______

• anatomy scan at ____ weeks

• Detects ___________

• measures ________

• determines ___________ location

due date, 20, anomalies, growth, placental

3rd trimester Ultrasound

• fetal ______

• placental _____________

• fetal presenting ______

• ___________ ________ studies performed

• determines placental location

growth, functioning, part, doppler flow

Disorders can be…(3)

chromosomal, single gene, or complex

Chromosomal Disorders include…

• ________ ____, ____, and +____

trisomy 13, 18, 21

Single Genes include…

• _______ ____

• ________ ________

• _____________ disease

sickle cell, cystic fibrosis, huntington’s

Complex Disorders include…

• ________

• ________ ________

• ________

diabetes, spina bifida, cancer

Down Syndrome

• extra chromosome @ # ____

• higher incidence in ______

• _____ yr old life expectancy

21, AMA, 47

Conditions associated with Down Syndrome

• _____ infections

• _____ disease

• __________ ______

• obstructive __________ ________

• congenital _________ ________

ear, eye, hearing loss, sleep apnea, heart defects

Physical Characteristic of Down Syndrome

• _________ eyes w/upward slant

• _______/_______ ____ ears

• ______ nasal bridge

• palmar crease

• tongue protrusion

almond, small, low set, flat

Dominant Autosomal Inheritance Disorders

• ____________’s disease

• ________ syndrome

huntington, marfain

Dominant Autosomal Inheritance Disorders only require ______ abnormal gene

• if one parent passess down disease, offspring has ____% chance of inheritance

1, 50

Recessive Autosomal Inheritance Disorders

• ________ ______ anemia

• _________ __________

• ______-_____’s disease

sickle cell, cystic fibrosis, tay sach

Recessive Autosomal Inheritance Disorders

• _____ genes must be abnormal to have disorder

• one gene = __________

• If both parents are carriers, offspring has ____% chance of inheritance

both, carrier, 25

maternal plasma contains small fragments of fetal _____ _______ _______

cell free DNA

Cell Free DNA (cfDNA) is tested at ____-____ weeks

10, 12

Cell Free DNA (cfDNA) testing screens for…(3)

trisomy 13, 18, and 21

If the Cell Free DNA (cfDNA) screen is positive

• additional testing is recommended unless pregnancy is ________-________

multi fetal

Fetal test measuring nape fluid via ultrasound

fetal nuchal monitoring

When is Fetal Nuchal Translucency test usually done?

10-14 weeks

>3mm of Nuchal Fluid indicates…(2)

DS and heart problems

What would be considered an abnormal Nuchal Fluid amount?

>3mm

if Fetal Nuchal Translucency test comes back abnormal consider _______, ____, or _________________.

MSAFP, CVS, amniocentesis

What does a prenatal Quad Test screen for? (2)

neural tube defects and DS

Prenatal Quad Screen has 4 components…

• _____

• _____

• _______ ___

• _______

AFP, hCG, inhibin A, Estriol

Testing for ______ alone (usually included in quad screen) is recommended for ALL pregnant clients

AFP

When should a prenatal Quad Screen be performed?

16-18 weeks

Quad Screen Results indicating Down Syndrome

• AFP _____

• hCG_____

• Inhibin A _____

• Estriol _____

dec, inc, inc, dec

Quad Screen Result indicating NTD

• _____ ______

inc AFP

Chorionic Villous Sampling (CVS) is used to determine…

fetal genetic abnormalities

Chorionic Villous Sampling (CVS)

• Invasive and Risky

• removes small ______ specimen from ______ portion of the _________

tissue, fetal, placenta

Chorionic Villous Sampling (CVS) can be done either _______________ or ____. w/_______________ _____________.

transvaginal, abd, ultrasound guidance

When does one receive Chronic Villous Sampling?

10-13 weeks

5 risks of Chorionic Villous Sampling (CVS)

• _________

• fetal ______ anomaly

• ____ _______________

• ______________

• ___________

miscarriage, limb, Rh incompatibility, hemorrhage, infection

When is Chorionic Villous Sampling (CVS) indicated?

• maternal age > ____ by due date

• abnormal _______

• risk of ____-________ genetic disease

• previous ______________ ______________

• previously effected child pf family history of genetic disease, chromosome abnormalities, or metabolic disorder

35, cfDNA, sex, linked, abnormal ultrasound

An Amniocentesis determines…(2)

fetal lung maturity and genetic concerns

Genetic Amniocentesis is indicated at ____-____ weeks

14-18

Amniocentesis is a needle inserted via ____________ into the _____. _______.

ultrasound, abd, wall

_______ ________ is the surfactant needed to expand the alveoli at birth

L/S ratio

Lung Maturity Amniocentesis is indicated at…

third trimester

6 potential risks of Amniocentesis

• __________

• damage to _______

• ___-_____ _______

• ____ _______________

• amniotic _____ ________

• infection

miscarriage, organs, pre term labor, Rh Sensitization, fluid leakage

Nursing Considerations for Prenatal Testing

1) ____________ families at risk

2) provide ___________ and ___________

3) administer, assist, and ____________ findings

4) develop a _____ ____ ______

5) provide emotional _________

determine, resources, education, interpret, plan of care, support

If you are <35 yrs old, Infertility is no pregnancy after ___ ______ of ________ unprotected sex.

1 year, regular

If you are >35 years old Infertility is no pregnancy after ___ _______

6 months

Female Infertility can be __________ or ____________

primary, secondary

4 risk factors of Female Infertility

• __________/__________ factors

• _______/___________ factors

• _________ factors

• ___________/_________ factors

hormonal, ovulatory, tubal, peritoneal, uterine, vaginal, cervical

Testing for female infertility (least to most invasive)

• ____________ testing

• _________ ____________

• ______________

• ____________________

hormonal, pelvic ultrasound, hysteroscopy, hysterosalpingography

4 Risk Factors of Male Infertility

• ___________ __________

• ____________ factors

• _______ ___________

• __________

hormonal disorders, testicular, sperm transport, idiopathic

3 Tests for Male Infertility (least to most invasive)

• _______ __________

• __________ _______

• ___________ ______

semen analysis, physical exam, hormone test

6 Treatments for Infertility…

non-medical therapy, medical therapy, assisted repro technology, Surrogacy, adoption, life w/o children

Medical Therapy for Infertility

• _________

• ___________

• ______________, _______________, _____ ______________

clomid, metformin, progesterone, gonadotrophins, FSH supplements

What are 2 examples of Assisted Reproductive Therapy (ART) for Infertility?

IVF, IUI

Infertility Considerations

• pre-implantation _______ ________(PGD)

• _________ _________

• selective reduction

• ______

• _____/____-_____ pregnancy

• _______ issues

• pressure for IVF success obscures __________ issues

genetic diagnosis, embryo storage, cost, Mult, high risk, legal, ethical

Endometriosis is an _____________ response leading to…

• ________ pain

• _______________

• painful _______________

inflammation, pelvic, dysmenorrhea, intercourse

Endometriosis is when _________________ or tissue lining uterus cavity is found where it shouldn’t be.

endometrium

Pt’s with Endometriosis may develop ______ ________ and __________

scar tissue, infertility

Endometriosis Treatment

• _______ during menstruation

• ______ _________ for medically induced _____________

• ______________

• oral _____________

• _______ ____ ______________ (TAH)

NSAIDS, GnRH agonists, menopause, laparoscopy, contraceptives, total, abd., hysterectomy

Nursing Considerations for Endometriosis

• emotional/psychological support

• accurate _______

• anticipatory ____________

info, guidance

Induction

• labor has not started _____________

• ___________ are initiated __________

spontaneously, contractions, artificially

Augmentation

• labor HAS started spontaneously

• contraction _________ is ____________

progress, inadequate

Elective Induction cannot be performed before ____ _______.

39 weeks

Artificial Rupture of membrane (AROM) is also called…

amniotomy

Bishop Score assesses…

cervical Readiness

A bishop score of ___ or ______ indicates a favorable cervix.

8, more

What are 3 medications for Induction/Augmentation?

Misoprostol (cytotec), Dinoprostone (Cervidil) and Pitocin (oxytocin)

Misoprostol (Cytotec)

• _______ cervix

• contraindicated for ______!!

ripens, VBAC