OB NURS 306 Chapter 3 Genetics, Conception, Fetal Development, and Reproductive Technology, Chapter 4 Physiological Aspects of Antepartum Care Chapter 12 Postpartum Physiological Assessments and Nursing Care (Chap 1 to 18) Deeply elab

Chapter 3 Genetics, Conception, Fetal Development, and Reproductive Technology o  30,000 genes in the human genome (organism’s complete set of DNA)  46 chromosomes; 22 homologous pairs of chromosomes and one pair of sex chromosomes  recessive genetic disorders  sickle cell anemia, cystic fibrosis, thalassemia, Tay-Sachs disease  carrier testing  identify individuals who carry one copy of a gene mutation that, when present in two copies causes a genetic disorder; used when there is a family history of genetic disorder  preimplantation testing/preimplantation genetic diagnosis  used to detect genetic changes in embryos that are created using assisted reproductive techniques  prenatal testing  early detection of genetic disorders  risks for conceiving child with genetic disorder  maternal age older than 35, man/woman who has genetic disorder; family history of genetic disorder, history of previous pregnancy resulting in a genetic disorder or newborn  sickle cell anemia o most common of African ancestry o sickle-cell hemoglobin forms rigid crystals that distort and disrupt RBCs; oxygen-carrying capacity of blood is diminished  cystic fibrosis o most common genetic disease of European ancestry o production of thick mucus clogs in bronchial tree and pancreatic ducts o most severe effects are chronic respiratory infections and pulmonary failure  Tay-Sach disease o Most common among Jewish ancestry o Degeneration of neurons and nervous system results in death by the 2 years old  PKU o Lack of enzyme to metabolize the amino acid phenylalanine  leads to severe mental and physical retardation  Huntington’s Disease o Uncontrollable muscle contractions between 30-50 years followed by memory loss and personality o No treatment that can delay mental deterioration  Hemophilia (X-linked) o Lack of factor 8 o Can be controlled with factor 8 from donated blood  Duchenne’s Musclular Dystrophy o Replacement of muscle by adipose or scare tissue with progressive loss of muscle function; often fatal before age 20 due to involvement of cardiac muscle  teratogens  any drugs, viruses, infections, or other exposures that can cause embryonic/fetal developmental abnormality  degree or types of malformation vary on length of exposure, amount of exposure, and when it occurs during human development  exposure after 13 weeks may cause fetal growth restriction or reduction of organ size  toxoplasma is a protozoan parasite found in cat feces and uncooked/rare beef and lamb o can cause fetal demise, mental retardation, blindness when fetus is exposed  rubella  increased risk for heart defects, deafness and/or blindness, mental retardation, fetal demise  cytomegalovirus  increased risk for hydrocephaly, microcephaly, cerebral calcification, mental retardation, hearing loss  herpes varicella/chicken pox  increased risk for hypoplasia of hands and feet, blindness/cataracts, mental retardation  syphilis  increased risk for skin, bone and/or teeth defects, fetal demise  cocaine  increased risk for heart, limbs, face, GI/GU tract defects, cerebral infarctions, placental abnormalities Chapter 4 Physiological Aspects of Antepartum Care  G/P System o Gravida: # times a woman has been pregnancy including current pregnancy o Para: # of births after 20 weeks’ gestation whether live or stillbirths o Abortions are not accounted for in this system  GTPAL o G: # times pregnancy o T: # of term infants born after 37 weeks o P: # of preterm infants between 20 and 37 weeks o A: # of abortions either spontaneous or induced before 20 weeks o L: # of living children  Nulligravida: woman who has never been pregnant or given birth  Primigravida: woman who is pregnant for the first time  Multigravida: someone who is pregnant for at least the second time  Prenatal period  entire time period during which a woman is pregnant through birth of baby  Nurse places emphasis on health education and health promotion  Family-centered maternity care is a model of obstetrical care based on a view of pregnancy and childbirth as a normal life event, a life transition that is not primarily medical but rather developmental  First trimester o Woman learns frequency of follow-up visits and what to expect from pregnancy visits as pregnancy progresses during initial visit o Comprehensive health and risk assessment; currently pregnancy history; complete physical and pelvic examination; nutrition assessment; psychosocial assessment; assessment for intimate partner violence o Assessment of uterine growth after 10-12 weeks is measured by height of fundus with centimeter measuring tape; zero point of tape is placed on the symphysis pubis and tape is extended to top of fundus; MEASUREMENT SHOULD EQUAL # OF WEEKS PREGNANT o Certain types of fish (king mackerel, shark, swordfish, tilefish) should be avoided due to high levels of methylmercury o Chart review; interval history; focused physical assessment; pelvic exam/sterile vaginal exam if indicated; confirm EDD o Triple/quad screen (neural tube defect); US; screening for gestational diabetes; hemoglobin and hematocrit; antibody screen if Rh-negative (Administration of RhoGAM if Rh-negative and anti-body screen negative)  Administered prophylactically at 28 weeks to prevent isoimmunization from potential exposure to Rh- positive fetal blood during normal course of pregnancy  Adverse reaction  pain at IM site; fever o Slight lower body edema is normal due to decreased venous return o At 20 weeks, fetus is 8 inches long and weights 1 pound o Chart review; interval history; nutrition follow-up; focused physical assessment; pelvic exam/sterile vaginal exam if indicated o Group B Strept at 35-37 weeks; H&H if not done in second trimester; repeat GC, chlamydia, RPR, HIV HbSAg; 1- hour glucose challenge test at 24-28 weeks o At term, fetus is 17-20 inches long, 6-8 pounds Chapter 6 Antepartal Tests   aspiration of a small amount of placental tissue for chromosomal, metabolic, or DNA testing o to detect fetal abnormalities caused by genetic disorders o Supine position for transabdominal aspiration with US to guide placement o Lithotomy for transvaginal aspiration with US to guide placement o Small biopsy of chorionic (placental) tissue is removed o Assess fetal and maternal well-being post-procedure; FHR is auscultated twice in 30 minutes o Instruct woman to report abdominal pain/cramps, leaking of fluid, bleeding, fever, chills o Results within 1 week  o Needle is inserted through maternal abdominal wall into uterine cavity to obtain amniotic fluid o Genetic testing, fetal lung maturity, assessment of hemolytic disease in fetus or for intrauterine disease o Results within 2 weeks  Delta OD 450 o Evaluation of amniotic fluid obtained via amniocentesis to predict life-threatening anemia in fetus during second and third trimester o Used in a lab to determine if there is a deviation of optical density at 45 nm  Fetal blood sampling/percutaneous umbilical blood sampling (CORDOCENTESIS) o Removal of fetal blood from umbilical cord  used to test for metabolic and hematological disorders, fetal infection, fetal karyotyping o may be done as early as 11 weeks but usually done in second trimester o results within 48 hours o POSITION WOMAN IN LATERAL/WEDGED POSITION TO AVOID SUPINE HYPOTENSION DURING FETAL MONITORING TESTS o Have terbutaline ready as ordered in case uterine contractions occur during procedure o Assess fetal well-being post-procedure 1-2 hours via external fetal monitoring o Done at 15-20 weeks gestation o Assessed in maternal blood to screen for certain developmental defects in the fetus (NTD, ventral abdominal wall defects) o Abnormal findings require additional testing  amniocentesis, VNS, US  Multiple marker screen o Combination of AFP, human chorionic gonadotropin (hCG), estriol levels o Detects for some trisomies and NTDs o done at 15-16 weeks gestation o maternal blood is drawn and sent to lab o low levels of maternal serum alpha-fetoprotein and unconjugated estriol levels suggest an abnormality o Instruct woman to palpate abdomen and track fetal movements daily for 1-2 hours o 10 distinct fetal movements within 2 hours is normal  once movement is achieved, counts can be d/c for the day o FEWER THAN 4 FETAL MOVEMENTS IN 2 HOURS SHOULD BE REPORTED o Uses electronic fetal monitoring to assess fetal condition/well-being o Looking for accelerations; baby is nice and active o Used in women with complications such as HTN, diabetes, multiple gestation, trauma and/or bleeding, woman’s report of lack of fetal movement, placental abnormalities o Monitored with external FHR until reactive (up to 40 minutes) while running FHR contraction strip for interpretation o In fetuses less than 32 weeks, two accelerations peaking at least 10 bpm above baseline and lasting 10 seconds in a 20-minute period is reactive o Nonreactive NST is one without sufficient FHR accelerations in 40 minutes  followed up for further testing o Presence of repetitive variable decelerations that are >30 seconds requires further assessment of amniotic fluid  Vibroacoustic stimulation o Uses auditory stimulation to assess fetal well-being with EFM when NST is nonreactive  Used to elicit a change in fetal behavior, fetal startle movements, increased FHR variability o Used only when baseline rate is determined to be within normal limits o Conducted by activating an artificial larynx on the maternal abdomen near the fetal head for 1 second in conjunction with NST;  Contraction stress test o Assess fetal well-being and uteroplacental function with EFM in women with nonreactive NST at term gestation o Identify a fetus that is at risk for compromise through observation of the fetal response to intermittent reduction in utero placental blood flow associated with stimulated uterine contractions o Monitor FHR and fetal activity for 20 minutes o If no spontaneous UCs, initiate contractions by having woman brush nipples for 10 minutes  Unsuccessful  oxytocin via IV until 3 UCs in 10-20 minutes lasting 40 seconds  Amniotic fluid index o Measures volume or amniotic fluid with ultrasound to assess fetal well-being and how well the placenta is working o AFI above 24 cm is indicative of polyhydramnios  May indicate fetal malformation  NTDs, obstruction of fetal GI tract, fetal hydrops o One or more episodes of rhythmic breathing movements of 30 seconds or movement within 30 minutes is expected o Three or more discrete body/limb movements within 30 minutes are expected o One or more fetal extremity extension with return to fetal flexion or opening and closing of hand is expected o Pocket of amniotic fluid that measures at least 2 cm in 2 planes perpendicular to each other is expected o Score of 2 is assigned to each component  6/10 is equivocal and may indicate need for delivery depending on gestational age  4/10 delivery is recommended because of a strong correlation with chronic asphyxia  2/10 or less prompts immediate delivery  modified biophysical profile o combines NST as an indicator of short term fetal well-being and AFI as indicator of long-term placental function o considered normal when NST is reactive and AFI is greater than 5cm Chapter 8 Intrapartum Assessment and Interventions  true labor o occur at regular intervals and increase in frequency, duration and intensity o bring about changes in cervical effacement and dilation  false labor o irregular contractions with little or no cervical changes  spontaneous rupture of the membranes can occur before onset of labor but typically occurs during labor o woman should deliver within 24 hours to reduce risk of infection  confirmation of rupture of membranes (ROM) o speculum exam to asses for fluid in the vaginal vault o Nitrazine paper  paper turns blue when in contact with amniotic fluid o Ferning  ferning pattern confirms ROM o AmniSure testing kit  Normal amniotic fluid is clear/cloudy with normal odor (similar to ocean water or loam of a forest floor)