Week 9: Screening Tests And Assessments & The High Risk Newborn

Subsequential Prenatal Assessment

VS

Weight

UA

Glucose screening

Isoimmunization

Fundal Height

Fetal evaluation

Assessment of Fetal Well Being in 1st Trimester

Confirm pregnancy

Confirm viability

Determine gestational age

Detect fetal anomalies

U/S in early pregnancy

Transvaginal

U/S in later pregnancy (10-12wks +)

Transabdominal

When is fetal HR detectable

10-12 weeks

Nuchal translucency

Measurement of nuchal folds, screen between 10-14 weeks

Tests risk for Down Syndrome

Screening/Diagnostics Prenatally

Pap smear

CBC

HIV

Rubella titer

Blood type, Rh, antibody screening

Hep B screen

STI screening

UA

Renal function

Varicella immunity (chickenpox)

Purified protein derivative of tuberculin (PPD)

Vaccines (Flu, COVID)

When is RHOGAM given

When any mom is RH- in case baby is RH+

Given around 28 weeks and within 72 hours of birth if baby is RH+

indirect Coombs' Test

Beginning of pregnancy & at 28 weeks

Looks for Rh antibodies in mom's serum

Direct Coombs' Test

Taken from baby's umbilical cord

Tests for maternal antibodies that have crossed placenta

ABO incompatibility

Occurs when mother has type O blood and fetus has type A, B or AB

Manifestations:

- Mild anemia

- Jaundice within the first 24hrs after birth

- Rarely causes severe issues (unlike Rh incompatibility)

Attack on baby's RBCs d/t ABO incompatibility to RH incompatibility

Jaundice within the 24 hours after birth

Cell-free DNA screening

Newest screening test for noninvasive prenatal genetic dx

Screens for chromosomal abnormality

As early as 9-10 weeks

Highly accurate

Chorionic Villus Sampling (CVS)

Small specimen removed intravaginally from portion of placenta

Early dx and rapid response

Screenign & Daignoistics in 2nd trimester

U/S

Maternal Assays Alpha-fetoprotein

Amniocentesis

Doppler flow studies

Percutaneous Umbilicul Cord Sampling

Quad screen

Tests for 4 different hormones

Tested at 15-21 weeks

Alpha-fetoprotein (AFP)

Screens for neural tube defects in serum

Recommended for all pregnancy women

Amniocentesis in 15-20 weeks

Diagnostic test (chromosomal issue, neural tube defects, etc.)

Amniocentesis in late pregnancy

Tests for fetal lung maturity

McDonald's Method

Measures distance in cm from top of symphysis pubis to top of fundus

Centimeter correlate well with weeks of gestation (22-34 weeks)

Fetal Growth Restriction (FGR)

Below 10th percentile

Macrosomia

Weight > 4000g (8lbs-13oz)

Determined by US, Leopold's maneuver, measuring fundal height

Doppler Blood Flow Analysis

Measures blood flow throuhg umbilicul and cerebrial arteries

Percutaneous Umbilical Blood Sampling (PUBS)

Insertion of needle directly into a fetal umbilical vessel under U/S guidance

Mostly used for blood sampling & transfusion

Screening & diagnostic testing in 3rd trimester

U/S

Glucose challenge test

Group B Strep

Biophysical profile & non-stress test

Daily movement count

Normal kick count

10 movements in 2 hours

Group B strep

Normal flora in GU track

Can cause sepsis, pneumonia, and/or other issues in baby

Big cause of neonatal sepsis

Group B Strep

Signs of neonatal sepsis

Non-responsiveness

Failure to hold temp

TORCH

Acronym for diseases that cause congenital conditions if a fetus is exposed to them:

Toxoplasmosis

Other (Syphilis, Varicella)

Rubella

Cytomegalovirus

Herpes Simplex

What can cause toxoplasmosis

Cat litter

Dirt

Infants of DM mothers

Macrosomia (incr risk for injury)

Hypoglycemia

Incr risk for congenital anomalies

Gastroschisis

Intestines protrude through a small opening in the abdomen

Omphalocele

Abdominal organs develop outside the body in a pouch

Spina Bifida Myelomeningocele

Incomplete closure of spine & spinal column - neural tissue exposed

What prevents neural tube defects

consumption of folic acid

Unique preterm infant characteristics

Immaturity of most organ systems

Lanugo

Translucent skin

Large head

Late preterm infant higher risks

Thermoregulation

Hypoglycemia

Hyperbilirubinemia

Sepsis

Respiratory function

Post-term infant higher risks

Placental dysfunction

Dry skin

Increase in fetal and neonatal mortality

Increase risk for birth injuries

Fetal Alcohol Spectrum Disorder

Why education is so important!!

Small head

Flat face

Epicanthal folds

Small eye openings

Underdeveloped jaw

Low nasal bridge

Tobacco in pregnancy

Infertility

Spontaneous abortion

Low-birth weight

IUGR

previa

PROM

SIDS

baby cannot even be held person with smoke on clothes

Marijuana in pregancy

Low birth weight

Developmental and mental concerns

People think incorrectly that because it is legal it is safe

Neonatal opiate withdrawal syndrome (NOWS)

group of symptoms/conditions

s/s typical 1-3 days after birth

occurs after mom takes opiates, benzos, barbs, and certain SSRIs

Eat, Sleep, Console

Eating: Baby eats on time

Sleep: At least one undisturbed hour

Consoling: Baby soothed within 10 mins of crying

Non-pharm interventions for neonatal abstinence syndrome

Environmental control

Feeding practices

Support mother-infant dyad

Other interventions