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Antepartum Risk Assessment:
- Provider needs to educate and reassure mother
- History (health, reproductive)
- Physical Exam
- Dx Studies
- Labs (Blood type, H&H, STD's, Rubella, Glucose, Urine)
- BP
- PAP
- STD tests
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Classification of Risk Factors
- Biophysical - preexisting
- Sociodemographic - issues with access to care
- Psychosocial - not every woman WANTS to be pregnant
- Environmental - exposure to harmful
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Biophysical Risk Factors:
- Genetic/Chromosomal
- Multiple Gestation
- Large Baby
- Pre-existing conditions
- Preeclampsia or GDM
- ABO incompatibility
- Incompetent cervix
- Placental Abnormalities
- Over/Under nutrition
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Psychosocial Factors
- Smoking
- Caffeine
- ETOH
- Drugs
- Situational Crisis
- Violence
- Unsafe Cultural Practices
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Sociodemographic Factors
- Poverty
- Lack of Prenatal Care
- Age (<15 or >35)
- Parity (1st or >5) (risk of hemorrhage)
- Marital Status (unmarried)
- Access to Care
- Ethnicity (increased for non-white)
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Environmental Exposures to what puts mom/baby at risk:
- Radiation
- Pesticides
- Infections
- Drugs
- Pollutants
- Second Hand Smoke
- Stress
- Maternal Hyperthermia (ie: if mom gets flu)
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Antenatal/Perinatal Screening and Dx Test:
- Preconception
- -Carrier Testing
- -Karyotyping
- Ultrasound
- CVS (chorionic villi sampling)
- Amniotic Fluid
- PUBS
- EFM (external fetal monitoring)
- BPP
- MSAFP
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Use of high frequency sound waves (non invasive) to scan the maternal abdomen for abnormalities of uterine and fetal structures
Ultrasonography
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Why is Ultrasonography used
- To confirm pregnancy and cardiac pulsation
- To determine gestational age
- To assess fetal well-being
- To guide invasive intrauterine procedures
- (women who need to confirm pregnancy, fetal heart pulsation, detect growth, multiple gestations, placenta position, verify dates, concerned about fetal well-being)
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Types of Ultrasounds
- Abdominal- full bladder
- Transvaginal- empty bladder
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Nursing Care related to Ultrasound
- Drink water for abdominal (full bladder)
- Urinate for transvaginal
- Gel or Mineral Oil on abdomen
- Put pillows behind their back
- Lithotomy for transvaginal
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Biopsy of cells to detect chromosomal, metabolic, or DNA disorders (10-12 weeks gestation)
Chorionic Villi Sampling
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What type of women undergo Chorionic Villi Sampling?
At risk for Down's syndrome or other genetic or inherited diseases
35 or older
Had an ultrasound suggesting that the fetus may have birth defect
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Nursing Care related to Chorionic Villi Sampling (CVS)
- Position varies (abdomen or cervical)
- Asepsis (CHECK for STD's FIRST!!!)
- Give Rhogam if mom is Rh negative
- Monitor FHT
- Explain to watch for fever, cramping, bleeding
- No strenuous activity for 48 hours
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Multiple Marker includes what 4 key things:
AFP (alpha-fetoprotein) -- spinabifida if elevated
hCG
Estriol
Inhibin A (accuracy for those under 35)
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Who should have Multiple Marker done and When is it normally performed?
- All pregnant women should be offered triple screen...
- >35
- Family Hx of Birth Defects
- Used any harmful medications/drugs
- Diabetes and Use Insulin
- Viral Infection during pregnancy
- Exposed to high levels of radiation
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16-18 weeks
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Multiple Marker (MSAFP) results are based on:
Gestational Age
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If MSAFP are LOW:
Risk for Trisomy or Down Syndrome
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If MSAFP are HIGH
Risk for Neural Tube Defects
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hCG is HIGH on a Multiple Marker test with :
- Trisomy 21
- (inversely related to Estriol which is LOW)
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Serum Estriol is LOW on multiple marker:
- Trisomy 21
- (inversly r/t hCG which is HIGH)
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Typically, MSAFP tests are done when?
14-16 weeks
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