CPNRE chapter 7 - maternity nursing
(mother)
placenta structure - membrane weight 1lb
-formation completed at 3 months
-develop cotyledons that act as areas for nourishing fetus
-maternal part beefy red
-fetal part shiny grey
umbilical cord technique - evaluates condition of fetus
-fetal blood can be analyzed at 18 weeks
-evaluate blood count, liver function ABG, acid-base
-risk for fetus injury
amniocentesis possible findings - 1. lecithin/sphingomyelin ratio
2. creatinine
3. billirubin
4. cytological testing
5. defects (DS, tay-sach), fetal status
procedures to diagnose maternal and fetal problems - 1. alpha-fetoprotein
2. hemoglobin electrophoresis
3. ultrasound
4. amniocentesis
5. chorionic villi test
6. fetoscopy
7. umbilical cord technique
8. estriol level
9. heterozygote testing
,10. contraction stress test
11. nonstress test
12. ultrasound procedure
13. biophysical profile
14. doppler flow studies
15. fetal movement
alpha-fetoprotein (AFP) - -taken at 16/18 weeks & two samples
-elevated level can indicate open neural tube defect or down syndrome
-elevated level can be r/t multiple gestation, missed abortions
ultrasound - -performed when high risk of fetal loss suspected
-evaluates pregnancy
-determines age of fetus
amniocentesis - insert needle through abdomen/uterus to withdraw amniotic fluid after 14th
week
lecithin/sphingomyelin ratio - test for fetal lung maturity
-tests surfactant at 35th week
-lecithin double spingomyelin = mature lungs
creatinine - tests fetal muscle mass and renal function
-large amount = large fetus
billirubin - determines fetal liver maturity
-should decr as term progresses
,cytological testing - determines percentage of lipid globules present in amniotic fluid indicating
fetal age
chorionic villi testing - -test for biochemical/chromosomal defects
-this test is high risk and incr risk of baby being born with missing fingers/toes
-catheter in vaginally to uterus
fetoscopy - visualize fetus/placenta for abnormalities and obtain fetal skin/blood
-test high risk and can cause miscarriage or premature labour
-insert cannula into abdomen
estriol level study - 24 hr urinalysis from mom
-determine fetal well-being/placental functioning
-at third trimester
-below 12mg indicates infant is in jeopardy r/t placental dysfunction
-help diagnose down syndrome
heterozygote testing - 1. tay sach
-fatal genetic disease of ashkenazi jews
2. sickle cell anemia
-common among african americans
3. b-thalassesmia
-common among mediterranean
contraction stress test - measures placental insufficiency/fetal reaction to uterine contractions
-done after due date has passed
-IV oxytocin given
-breast stimulation in place of IV
, -deceleration during 3 contractions = +ve
nonstress test (NST) - assess fetal heart tone response to uterine movement or incr fetal activity
-observe for fetal heart accelerations
-in 20mins expect 2 fetal heart accelerations with movement (15 beats above baseline)
fetal movement - kick counts - -best done when baby typically active -> after a meal
-lie on side & record amount of time to feel 10 fetal movements -> if it takes more than 2hrs call dr
deceleration - -fetus holding cord or cord wrapped around fetus
-low amniotic fluid
ultrasound procedure - determines fetal size, amniotic volume, neural tube defects, limb
abnormalities, breech
-second trimester
-sound waves can stimulate inactive fetus during NST
biophysical profile - tests fetal breathing, body movements, muscle tone, amniotic fluid volume
and heart rate
doppler flow studies - evaluate blood flow in deep vessels
obstetrical pelvis types - 1. gynecoid
-ideal pelvis for vaginal birth
2. anthropoid
-narrow from side to side
3. android
-male pelvis not adequate for vaginal birth
4. platypelloid
(mother)
placenta structure - membrane weight 1lb
-formation completed at 3 months
-develop cotyledons that act as areas for nourishing fetus
-maternal part beefy red
-fetal part shiny grey
umbilical cord technique - evaluates condition of fetus
-fetal blood can be analyzed at 18 weeks
-evaluate blood count, liver function ABG, acid-base
-risk for fetus injury
amniocentesis possible findings - 1. lecithin/sphingomyelin ratio
2. creatinine
3. billirubin
4. cytological testing
5. defects (DS, tay-sach), fetal status
procedures to diagnose maternal and fetal problems - 1. alpha-fetoprotein
2. hemoglobin electrophoresis
3. ultrasound
4. amniocentesis
5. chorionic villi test
6. fetoscopy
7. umbilical cord technique
8. estriol level
9. heterozygote testing
,10. contraction stress test
11. nonstress test
12. ultrasound procedure
13. biophysical profile
14. doppler flow studies
15. fetal movement
alpha-fetoprotein (AFP) - -taken at 16/18 weeks & two samples
-elevated level can indicate open neural tube defect or down syndrome
-elevated level can be r/t multiple gestation, missed abortions
ultrasound - -performed when high risk of fetal loss suspected
-evaluates pregnancy
-determines age of fetus
amniocentesis - insert needle through abdomen/uterus to withdraw amniotic fluid after 14th
week
lecithin/sphingomyelin ratio - test for fetal lung maturity
-tests surfactant at 35th week
-lecithin double spingomyelin = mature lungs
creatinine - tests fetal muscle mass and renal function
-large amount = large fetus
billirubin - determines fetal liver maturity
-should decr as term progresses
,cytological testing - determines percentage of lipid globules present in amniotic fluid indicating
fetal age
chorionic villi testing - -test for biochemical/chromosomal defects
-this test is high risk and incr risk of baby being born with missing fingers/toes
-catheter in vaginally to uterus
fetoscopy - visualize fetus/placenta for abnormalities and obtain fetal skin/blood
-test high risk and can cause miscarriage or premature labour
-insert cannula into abdomen
estriol level study - 24 hr urinalysis from mom
-determine fetal well-being/placental functioning
-at third trimester
-below 12mg indicates infant is in jeopardy r/t placental dysfunction
-help diagnose down syndrome
heterozygote testing - 1. tay sach
-fatal genetic disease of ashkenazi jews
2. sickle cell anemia
-common among african americans
3. b-thalassesmia
-common among mediterranean
contraction stress test - measures placental insufficiency/fetal reaction to uterine contractions
-done after due date has passed
-IV oxytocin given
-breast stimulation in place of IV
, -deceleration during 3 contractions = +ve
nonstress test (NST) - assess fetal heart tone response to uterine movement or incr fetal activity
-observe for fetal heart accelerations
-in 20mins expect 2 fetal heart accelerations with movement (15 beats above baseline)
fetal movement - kick counts - -best done when baby typically active -> after a meal
-lie on side & record amount of time to feel 10 fetal movements -> if it takes more than 2hrs call dr
deceleration - -fetus holding cord or cord wrapped around fetus
-low amniotic fluid
ultrasound procedure - determines fetal size, amniotic volume, neural tube defects, limb
abnormalities, breech
-second trimester
-sound waves can stimulate inactive fetus during NST
biophysical profile - tests fetal breathing, body movements, muscle tone, amniotic fluid volume
and heart rate
doppler flow studies - evaluate blood flow in deep vessels
obstetrical pelvis types - 1. gynecoid
-ideal pelvis for vaginal birth
2. anthropoid
-narrow from side to side
3. android
-male pelvis not adequate for vaginal birth
4. platypelloid
