16 November 2009 High Risk Pregnancy NCM 102 HIGH RISK PREGNANCY

HIGH RISK PREGNANCY

complication which jeopardizes the health of mother, fetus, or both RISK ASSESSMENT TOOL: 1970 by Hobel, CJ (ACOG) degree of risk 5 categories: h OB history (GTPALM) h Medical history risk factor hypertension epilepsy infection h Family history risk factor DM cardio diseases h Physical risk factor incompetent cervix uterus abnormalities small pelvis h Current pregnancy risk factor gestational DM transverse presentation amniotic fluid (polyhydramios, oligohydramios) FETAL BEING fetal movements are directly proportional to sleepwake cycle 9pm 1am in response to maternal hypoglycemia

DIAGNOSTIC PROCEDURES
ULTRASOUND use frequency sound wave to visualize structure in the body non-invasive procedure 2 types: h transabdominal make sure that bladder is full 1-2 quarts of water 90 minutes before ultrasound, drink water every 15 minutes h transvaginal internal visualization predictor for pre-term birth pregnancy empty bladder dorsal recumbent ALPHA-FETOPROTEIN TESTING (AFP) level of protein in amniotic fluid checked during first trimester results and interpretation: h level chromosome abnormalities Spina Bifida (opening in spine) Amencephaly (open skull) Gastrochisis (open abdominal cavity) they will live upon delivery but will not live too long

levels gestational trophoblastic disease or hydatidiform mole (H mole) related to ectopic pregnancy nursing responsibility: h informed consent h possible complications CHRONIC VILLI SAMPLING obtaining small parts in the developing placenta at 10-12 weeks of gestation to analyze fetal cells results after 24-48 hours after procedure downside: cannot determine spina bifida, amencephaly, gastrochisis RH negative = RhoGam h sees baby as an enemy/foreign body h Rh (D) immunoglobulin to familiarize baby by the body spontaneous abortion may occur after procedure AMNIOCENTESIS insertion of thin needle to abdominal and uterine wall to obtain amniotic fluid which contains fetal cells during early pregnancy, it can detect Tay Sach s disease (with help of AFP) during late pregnancy, it can identify severity of maternal and fetal incompatibility, fetal lung maturity (surfactant) done during 15th 17th week of gestation (ideally) if there s presence of genetic disorders, it can be done 11th 14th week disadvantage: prone to spontaneous abortion nursing responsibilities: h informed consent h full bladder h supine with draping and aseptic technique NON-STRESS TEST measures fetal heart rate to fetal movement evaluation with an electronic fetal monitor of the fetal heart for accelerations of at least 15 bpm lasting 15 seconds in a 10-20 minute period results: h Non reactive = not stressed = not good h Reactive = responsive = real good 2 accelerations; 15 bpm, 15 secs, 20 minutes used to identify fetal compromise in condition associated with poor placental function such as DM, hypertension and post-term gestation adequate acceleration of FHR are reassuring that the placenta is functioning properly and fetus is well oxygenated 30th 32nd week of gestation CONTRACTION TEST calculating the respiratory function of the placenta it identifies the fetus at risk for intrauterine asphyxia by observing the response of the FHR to the stress of uterine contractions (spontaneous/induced) interpretations h positive repetitive persistent late deceleration h negative shows 3 contractions of good quality lasting 40/more seconds
h

1 //carengreyes

h suspicious/equivocal

nonpersistent late decelerations/decelerations associated with hyperstimulation

coagulation defect

i W  p COGNITIVE DISORDERS

COGNITIVE DISORDERS
h 2

i W  p COGNITIVE DISORDERS

COGNITIVE DISORDERS
h 2

i W  p

2 //carengreyes