OB February 4, 2020  Menstrual Histoy

High Risk Pregnancy  LNMP

Nursing care of women with complications during pregnancy  Last Normal Menstrual
Period
High risk pregnancy causes  Used for computing EDD
 Related to the pregnancy itself using Naegele’s Rule
 Occurs because the woman has a medical condition  Jan-March: Add 7 days and 9
 Results from environmental hazards months
 Arise from maternal behavior or lifestyle  April- Dec: Subtract 3
months, add 7 days and 1
Factors contributing to high risk pregnancy year
 Age: < 18 yrs > 35 yrs  Gynecologic & Contraceptive History
 Weight: under/overweight  Previous Gynecologic problems
 Nutritional status  Contraceptive used
 Obstetrical history  Hormonal conceptive
 Poverty  IUD
 Family history  Medical & Surgical History
 Pre-existing medical conditions/substance abuse  Presence of risk factors
 Immunization
High Risk Pregnancy  Chronic conditions
 Socioeconomic:  DM, Hypertension, Cardiac
o Ignorance problems, Thyroid problems,
o Poverty Asthma, Renal Diseases
 Maternal health:  Previous pelvic & back surgeries
o Chronic Pulmonary Disorder  Previous infections
o PIH  Hepatitis, STD, Tuberculosis, group B
o Anemia streptococcus
o Nutrient deficits  Anemia
o High mortality  Family History/Partner’s
 Assess for diseases in the family that
 Fetal health:
may increase the risk of putting the
o LBW
client in high risk condition
o Prematurity
 Chronic
o Respiratory complications
 Infectious
o CPD
 Head to Toe assessment, including vital signs and Assisting
o Cognitive deficits the physician in Internal examination
o Death
Laboratory Exams
Danger Signs in Pregnancy Test Purpose
 Sudden gush of fluid from vagina
 Vaginal bleeding CBC Infection/Anemia
 Abdominal pain
 Persistent vomiting Urinalysis Renal Disease, Effects of
 Epigastric pain Hypertension, Infection
 Swelling of face and hands
 Severe, persistent headache
 Blurred vision or dizziness
 Chills with fever > 38 degrees C
Hepa B Screening Detect antigens in
 Painful urination or reduced urine output
maternal blood
Patient Assessment
 Obstetric History Glucose Challenge Test Screen for GDM
o Gravidity/Parity/TPAL
o Types of previous deliveries
o Previous labor experience Oral Glucose Challenge Test
o Maternal Complications (GDM, PIH, UTI,  24-28 weeks AOG
Bleeding)  Requires Fasting
o Weight of infants (previous pregnancies)  Involves multiple blood extraction
o Infant complications (previous pregnancies)  100g oral glucose is given
o Other reproductive disorders
Review: Ancillary Procedures
 A primigravid has had one previous pregnancy  NST
 Parity is the number of pregnancies terminated at 20 weeks o 90% of gross fetal body movements are
or more associated with accelerations of the FHR
 Multiple pregnancy is considered 1 Gravida/Gravity o Outpatient
 Multiple pregnancy is considered 1 Para/Parity
Alliah Claire Carnice Baguio
 o User friendly but must interpret strip  10-24cm: Normal value, < 9.9 cm: Low
Fetus may be in a sleep or state or affected by st
1
o
maternal medications, glucose etc. Trimester Ultrasonography
o To be reactive must meet criteria Transvaginal Sonography
o Must be at least 20 minutes in length o Visualization of uterus, gestational sac, embryo
o Must have 2 or more accelerations that meet the & pelvic structures
‘15x15’ criteria o Embryo is visible at 5-6 weeks
o Must have a normal baseline o Until 12 weeks AOG
o To stimulate a fetus that is not meeting the Purposes:
criteria:  + sign of pregnancy
 Change positions of the mother- LS, RS  Location of pregnancy
 Increase fluids  Number and viability of fetus
 Acoustic stimulator (VAS)  AOG with measures
 CST  Abnormalities
o Done in the inpatient setting only Procedure:
o Has contraindications  Position: Lithotomy
o May be expensive if meds/IV needed  Duration: 10-15 minutes
o Monitored for 10 minutes first  Equipment: trans-vaginal Probe encased in disposable
o May use nipple stimulation or oxytocin cover, lubricated
stimulation Nursing Responsibilities:
o No late decelerations: negative CST (Reactive)  Secure consent
 Make sure the bladder is emptied
Maternal and Fetal Assessment  Teach deep breathing techniques to be used for the
 Nursing responsibilities discomfort during the actual procedure
 Preparing patient properly for test
 Explaining reason for test
 Clarifying and interpreting result in collaboration

2nd Trimester
with other health care providers
 Patient support
Transabdominal Ultrasonography
Biophysical Profile Purposes
 Includes 5 components:  Viability of fetus
1. Fetal breathing movements  Evaluate fetal anatomy
2. Gross body movements  AOG
3. Fetal tone  Fetal growth
4. Amniotic Fluid Index  Biophysical profile
5. NST – reactive
 Placental localization
 Presentation
 Guide in needle placement procedures
Component Definition
Chorionic Villi Sampling (CVS)
Fetal movements 3 body or limb movements
 Done between 10-12 weeks AOG
 Done by mother
 Genetic studies
 Count number of times baby
 Removal of small amount of tissue from the fetal portion
moves
of the placenta
 Normal: At least 10
Percutaneous Blood Sampling
movements in 1 hour
 >17 weeks AOG
 Abnormal: Count again. If
 Withdrawal of blood from umbilicus of fetus
second hour still no
movement- call the doctor. Amniocentesis
Fetal tone One episode of active  15-18 weeks AOG
extension and flexion of the  Used with direct ultrasound
limbs; opening and closing of  Collects amniotic fluid
hand  Less than 1% result in complications
Fetal breathing movement Episode of >= 30 seconds in o Complications include:
30 minutes. Hiccups are  Fetal death, miscarriage
considered breathing activity  Maternal hemorrhage
Amniotic Fluid volume Single 2cm x 2cm pocket is  Infection to fetus
considered adequate  Preterm labor
Non-stress test 2 accelerations > 15 beats per  Leakage of amniotic fluid
minute of at least 15 seconds Maternal Quadruple Screening
duration  15-20 weeks AOG
 Drawn blood from mother
AFI  Alpha Fetoprotein (Fetus) , Unconjugate Estriol (Fetus +
 Add the largest vertical pocket of AF in the 4 quadrants of Placenta), hCG (Placenta), inhibin A
the gravid uterus  inhibin A (associated with down syndrome)
Alliah Claire Carnice Baguio
  AFP
o Genetic test
o Done with mother’s blood
o Neural tube defect
Amniotic Fluid Index
 Polyhydramnios – too much amniotic fluid
 Oligohydramnios – too little amniotic fluid

3rd Trimester
Doppler Umbilical Velocimetry (Third Trimester)
 Study blood velocity in the fetus and placenta
 Done on high risk mothers:
o IUGR- Intraunterine Growth Restri ction
o HTN- Hypertension
o DM- Diabetes Mellitus
o Multiple gestation

Gestational Conditions

Alliah Claire Carnice Baguio