1
HESI REVIEW
MATERNAL, NEWBORN
INTRAPARTUM, LABOR
& DELIVERY STUDY
NOTES 2026-27 LATEST
VERSION
Daily kick counts
• Fetal movement is a good sign of fetal well-being.
• Clients do not always feel the fetus movement; however, they should
be able to feel at least 10 movements in any given 2-hour period.
• Client teaching should be done by the third trimester and needs to include
instructions on how
to count movement and to notify the provider if they have no fetal
movement for a period (like 12 hours).
• If fetal movement does not reach 10 movements in one hour, the client is
instructed to drink a
few ounces of orange juice and monitor for another hour (total 2 hours).
• Remember, anything that depresses the mom’s CNS will also depress the
fetal CNS.
Ultrasound
• Ultrasound is a non-invasive procedure that is safe throughout the
pregnancy. The test checks different things in each of the 3
trimesters. Remember: 1st trimester is 1 through 13 weeks; 2nd
trimester is 14 through 26 weeks; and 3rd trimester is 27 through 40
weeks. Review your HESI manual on page 251 to see what is assessed
during each of the trimesters!
• One of the most common reasons for doing an ultrasound in the 2nd
trimester (14-26 weeks) is
to assess if fetal growth matches the gestational age. Remember that
all normal fetus grows the same up to 20 weeks because organs are
being formed. Individual growth and weight vary after 20 weeks.
• Nursing consideration for an ultrasound: full bladder until 22 weeks, then
after that, they
should have an empty bladder.
• An ultrasound is an ideal test if the pregnant client is unsure of the
date of her last menstrual period.
Biophysical Profile (BPP)
• BPP is an accurate indicator of fetal well-being. Higher the score the
,2
better.
• There are five assessments done do determine a BPP score. Four
ultrasound data includes fetal breathing, movement, heart rate,
amniotic fluid index, and then the result of a non-stress test.
Amniocentesis
• An amniocentesis may be done for several reasons. It is an invasive
procedure so there needs to be a medical indication for one. The risk
may be minimized by using ultrasound during the procedure. If a
client complains of low back pain with pelvic cramping following the
procedure, it is imperative that they are assessed for complications
from the procedure.
• RhoGam should be given following the procedure if the client is RH
negative.
• If done for genetic concerns, remember that a high
alphafetalprotein (AFP) may indicate a neural tubal defect; low
may indicate trisomy 21
• Nursing consideration for an ultrasound: full bladder until 22 weeks, then
after that, they
should have an empty bladder.
• Also used for assessing fetal lung maturity - L/S & S/A ratios 2:1 (see table
10-4)
1
,3
Maternal serum (MS)
A. Alpha-fetoprotein (AFP)
• Neural tube defects (NTD’s)
• All pregnant women should receive testing.
• Folate taken preconceptionally and during early pregnancy has lowered the
incidence of NTD.
• Alpha-fetoprotein is detected in mom’s serum from 14-34 weeks gestation.
B. Multiple marker screens for chromosomal abnormalities
• Tested between 11-14 weeks gestation.
C. Coombs’ test for
RH incompatibility
• A coombs test is to determine if a Rh negative mom has built
antibodies against a Rh positive fetus after delivery. If mom has a
negative indirect coombs and her baby is Rh positive, then she
should receive RhoGam within 72 hours of delivery.
Non-Stress Test (NST) used antepartum
• Purpose is to evaluate if fetus is receiving enough oxygen to respond
to movement. This can be a valuable test to assess fetal well-being
in the high risk individuals.
• Interpretation criteria: FHR must increase with fetal movement for 15
seconds by 15 beats per
minute. Reactive = 2 acceleration in 20 minute period. Nonreactive = Heart
rate did not respond adequately to fetal movement
Contraction Stress Test (CST) used antepartum
• Purpose is to evaluate if fetus can tolerate the stress of contractions.
Evaluation of fetal heart rate response to contraction by looking for
any pattern of fetal heart rate deceleration (Late decels) that
indicate that the fetus does not have enough oxygen in reserve to
make it completely through the contractions.
• Interpretation criteria: requires 3 contractions in 10 minutes.
o Negative ~ No late decels or variable decels noted ~ IDEAL results
o Positive ~ late decels are present with 50% or more contraction.
, 4
Diabetes mellitus (DM)
• DM is a common risk factor in the childbearing age that
automatically becomes a high risk pregnancy. There can be
complications for mom as well as for the baby.
• It is important that the client is educated about the change in insulin
requirements as a result
of the pregnancy. During the first trimester, maternal insulin needs
decrease; during the second and third trimester, maternal insulin
needs increase due to insulin resistance. After delivery, placental
hormone levels drop abruptly, and insulin requirements decrease. It
is important that the mom does not experience DKA because it can
lead to fetal death! This client may require a cesarean section due to
the risk of having a macrosomia fetus. Also, the diabetic client needs
to be assessed closely for infection because it could lead to mom
becoming hyperglycemic. The use of oral contraception after
delivery is contraindicated in the diabetic.
• The goal is to maintain the maternal glucose under control during the
pregnancy. Fluctuation
can affect the fetus.
2
HESI REVIEW
MATERNAL, NEWBORN
INTRAPARTUM, LABOR
& DELIVERY STUDY
NOTES 2026-27 LATEST
VERSION
Daily kick counts
• Fetal movement is a good sign of fetal well-being.
• Clients do not always feel the fetus movement; however, they should
be able to feel at least 10 movements in any given 2-hour period.
• Client teaching should be done by the third trimester and needs to include
instructions on how
to count movement and to notify the provider if they have no fetal
movement for a period (like 12 hours).
• If fetal movement does not reach 10 movements in one hour, the client is
instructed to drink a
few ounces of orange juice and monitor for another hour (total 2 hours).
• Remember, anything that depresses the mom’s CNS will also depress the
fetal CNS.
Ultrasound
• Ultrasound is a non-invasive procedure that is safe throughout the
pregnancy. The test checks different things in each of the 3
trimesters. Remember: 1st trimester is 1 through 13 weeks; 2nd
trimester is 14 through 26 weeks; and 3rd trimester is 27 through 40
weeks. Review your HESI manual on page 251 to see what is assessed
during each of the trimesters!
• One of the most common reasons for doing an ultrasound in the 2nd
trimester (14-26 weeks) is
to assess if fetal growth matches the gestational age. Remember that
all normal fetus grows the same up to 20 weeks because organs are
being formed. Individual growth and weight vary after 20 weeks.
• Nursing consideration for an ultrasound: full bladder until 22 weeks, then
after that, they
should have an empty bladder.
• An ultrasound is an ideal test if the pregnant client is unsure of the
date of her last menstrual period.
Biophysical Profile (BPP)
• BPP is an accurate indicator of fetal well-being. Higher the score the
,2
better.
• There are five assessments done do determine a BPP score. Four
ultrasound data includes fetal breathing, movement, heart rate,
amniotic fluid index, and then the result of a non-stress test.
Amniocentesis
• An amniocentesis may be done for several reasons. It is an invasive
procedure so there needs to be a medical indication for one. The risk
may be minimized by using ultrasound during the procedure. If a
client complains of low back pain with pelvic cramping following the
procedure, it is imperative that they are assessed for complications
from the procedure.
• RhoGam should be given following the procedure if the client is RH
negative.
• If done for genetic concerns, remember that a high
alphafetalprotein (AFP) may indicate a neural tubal defect; low
may indicate trisomy 21
• Nursing consideration for an ultrasound: full bladder until 22 weeks, then
after that, they
should have an empty bladder.
• Also used for assessing fetal lung maturity - L/S & S/A ratios 2:1 (see table
10-4)
1
,3
Maternal serum (MS)
A. Alpha-fetoprotein (AFP)
• Neural tube defects (NTD’s)
• All pregnant women should receive testing.
• Folate taken preconceptionally and during early pregnancy has lowered the
incidence of NTD.
• Alpha-fetoprotein is detected in mom’s serum from 14-34 weeks gestation.
B. Multiple marker screens for chromosomal abnormalities
• Tested between 11-14 weeks gestation.
C. Coombs’ test for
RH incompatibility
• A coombs test is to determine if a Rh negative mom has built
antibodies against a Rh positive fetus after delivery. If mom has a
negative indirect coombs and her baby is Rh positive, then she
should receive RhoGam within 72 hours of delivery.
Non-Stress Test (NST) used antepartum
• Purpose is to evaluate if fetus is receiving enough oxygen to respond
to movement. This can be a valuable test to assess fetal well-being
in the high risk individuals.
• Interpretation criteria: FHR must increase with fetal movement for 15
seconds by 15 beats per
minute. Reactive = 2 acceleration in 20 minute period. Nonreactive = Heart
rate did not respond adequately to fetal movement
Contraction Stress Test (CST) used antepartum
• Purpose is to evaluate if fetus can tolerate the stress of contractions.
Evaluation of fetal heart rate response to contraction by looking for
any pattern of fetal heart rate deceleration (Late decels) that
indicate that the fetus does not have enough oxygen in reserve to
make it completely through the contractions.
• Interpretation criteria: requires 3 contractions in 10 minutes.
o Negative ~ No late decels or variable decels noted ~ IDEAL results
o Positive ~ late decels are present with 50% or more contraction.
, 4
Diabetes mellitus (DM)
• DM is a common risk factor in the childbearing age that
automatically becomes a high risk pregnancy. There can be
complications for mom as well as for the baby.
• It is important that the client is educated about the change in insulin
requirements as a result
of the pregnancy. During the first trimester, maternal insulin needs
decrease; during the second and third trimester, maternal insulin
needs increase due to insulin resistance. After delivery, placental
hormone levels drop abruptly, and insulin requirements decrease. It
is important that the mom does not experience DKA because it can
lead to fetal death! This client may require a cesarean section due to
the risk of having a macrosomia fetus. Also, the diabetic client needs
to be assessed closely for infection because it could lead to mom
becoming hyperglycemic. The use of oral contraception after
delivery is contraindicated in the diabetic.
• The goal is to maintain the maternal glucose under control during the
pregnancy. Fluctuation
can affect the fetus.
2
