NUR 318 Exam 2 (Labor/Delivery/Early Postpartum,
Management of discomfort in labor, assessment for high-risk
pregnancies, newborn nutrition and feeding) Questions With
Complete Solutions
management of BPP results
- 10 = repeat weekly or biweekly
- 8 = repeat biweekly
- 6 = consider delivery especially if oligohydramnios is present
- 4 = delivery if 36 weeks, repeat test if <32 weeks
- 0-2 = extend testing time to 120 mins; if <4 deliveries
regardless of age
Modified BPP
- aka quick BPP
- use the components that are most predictive of fetal wellbeing
- NST (nonstress test)
- AFI (amniotic fluid)
- amniotic fluid
indicators of fetal well-being
- fetal movement and amniotic fluid are both very good
indicators of fetal well-being
- if not good, both need further assessment
nonmedical ultrasounds
- 3D and 4D ultrasounds
- insurance doesn't cover and ACOG strongly discourages them
,- not intended to be diagnostic (not looking for abnormalities)
- can cause unnecessary exposure to high-frequency sound
waves and false reassurance of fetal well-being
MRI vs CT
- MRI does not require ionizing radiation and is similar in safety
to an ultrasound
- for CT san, ionized radiation medium (dye) must be injected to
visualize vascular structure (therefore is not as safe to use in
pregnancy)
Biochemical assessments
- maternal blood sampling
- intrauterine tissue or liquid sampling
- vaginal fluid sampling
maternal blood sampling
- indications: malformations of organs
- types: Coomb's test, Cell-free DNA, AFP (alpha fetoprotein)
intrauterine tissue or liquid sampling
- types: amniocentesis, chorionic villi sampling, PUBS
vaginal fluid sampling
fetal fibronectin for preterm labor
Amniocentesis
- type of intrauterine tissue or liquid sampling
- procedure used to obtain amniotic fluid for testing
- use ultrasound to find big pocket of amniotic fluid (avoid
,placenta, baby, and cord)
- done after 14 weeks gestation when uterus rises above the
symphysis pubis and fluid amounts are adequate to get sample
fluid in amniocentesis is analyzed for the presence/absence of:
- lecithin/sphingomyelin (L/S ratio) or shake test for fetal lung
maturity
- phosphatidylglycerol (PG) for fetal lung maturity
- LBC (lamellar body count) for fetal lung maturity
- chromosome analysis
- Rh antibodies (for evidence of isoimunization)
- Intrauterine infection
risks/complications of amniocentesis
- hemorrhage
- maternal Rh isoimmunization (baby can get hydros and die,
give a dose of RhoGam to avoid)
- infection
- labor
- abrupt placenta
- damage to fetus, bladder, or intestines
- amniotic fluid embolus
- leakage of amniotic fluid
amniocentesis tests for:
- chromosomal disorders
- infection of amniotic fluid
- fetal lung maturity
- diagnosis of fetal hemolytic disease (anemia)
, - enzymes that can predict errors in metabolic (alpha
fetoprotein)
nursing responsibilities with amniocentesis
- have mother empty bladder prior to procedure
- FHR monitoring before procedure and for at least 1 hour post
(know baseline)
- observe for vaginal bleeding, leakage of amniotic fluid, severe
cramping, or fever (educate that she should not have these things
when she goes home)
- mild physical discomfort, most women fear procedure
- give Rhogam to Rh negative mother unless fetus is Rh-
chorionic villus sampling
- type of intrauterine tissue or liquid sampling
- indication: used to diagnose chromosomal and genetic defects
- procedure: sample of blood and tissue is taken from the
chorionic villi (accessed vaginally or abdominally by taking a
placental sample)
- cells from the villi have the same genetic make-up as the cells
from the embryo
advantages of chorionic villus sampling
- can be done early in pregnancy (10-13 weeks)
- tissue sample from fetal side of placenta gives
genetic/chromosomal data (no amniotic fluid is collected)
- a first trimester alternative to amniocentesis since it can be
done earlier
Management of discomfort in labor, assessment for high-risk
pregnancies, newborn nutrition and feeding) Questions With
Complete Solutions
management of BPP results
- 10 = repeat weekly or biweekly
- 8 = repeat biweekly
- 6 = consider delivery especially if oligohydramnios is present
- 4 = delivery if 36 weeks, repeat test if <32 weeks
- 0-2 = extend testing time to 120 mins; if <4 deliveries
regardless of age
Modified BPP
- aka quick BPP
- use the components that are most predictive of fetal wellbeing
- NST (nonstress test)
- AFI (amniotic fluid)
- amniotic fluid
indicators of fetal well-being
- fetal movement and amniotic fluid are both very good
indicators of fetal well-being
- if not good, both need further assessment
nonmedical ultrasounds
- 3D and 4D ultrasounds
- insurance doesn't cover and ACOG strongly discourages them
,- not intended to be diagnostic (not looking for abnormalities)
- can cause unnecessary exposure to high-frequency sound
waves and false reassurance of fetal well-being
MRI vs CT
- MRI does not require ionizing radiation and is similar in safety
to an ultrasound
- for CT san, ionized radiation medium (dye) must be injected to
visualize vascular structure (therefore is not as safe to use in
pregnancy)
Biochemical assessments
- maternal blood sampling
- intrauterine tissue or liquid sampling
- vaginal fluid sampling
maternal blood sampling
- indications: malformations of organs
- types: Coomb's test, Cell-free DNA, AFP (alpha fetoprotein)
intrauterine tissue or liquid sampling
- types: amniocentesis, chorionic villi sampling, PUBS
vaginal fluid sampling
fetal fibronectin for preterm labor
Amniocentesis
- type of intrauterine tissue or liquid sampling
- procedure used to obtain amniotic fluid for testing
- use ultrasound to find big pocket of amniotic fluid (avoid
,placenta, baby, and cord)
- done after 14 weeks gestation when uterus rises above the
symphysis pubis and fluid amounts are adequate to get sample
fluid in amniocentesis is analyzed for the presence/absence of:
- lecithin/sphingomyelin (L/S ratio) or shake test for fetal lung
maturity
- phosphatidylglycerol (PG) for fetal lung maturity
- LBC (lamellar body count) for fetal lung maturity
- chromosome analysis
- Rh antibodies (for evidence of isoimunization)
- Intrauterine infection
risks/complications of amniocentesis
- hemorrhage
- maternal Rh isoimmunization (baby can get hydros and die,
give a dose of RhoGam to avoid)
- infection
- labor
- abrupt placenta
- damage to fetus, bladder, or intestines
- amniotic fluid embolus
- leakage of amniotic fluid
amniocentesis tests for:
- chromosomal disorders
- infection of amniotic fluid
- fetal lung maturity
- diagnosis of fetal hemolytic disease (anemia)
, - enzymes that can predict errors in metabolic (alpha
fetoprotein)
nursing responsibilities with amniocentesis
- have mother empty bladder prior to procedure
- FHR monitoring before procedure and for at least 1 hour post
(know baseline)
- observe for vaginal bleeding, leakage of amniotic fluid, severe
cramping, or fever (educate that she should not have these things
when she goes home)
- mild physical discomfort, most women fear procedure
- give Rhogam to Rh negative mother unless fetus is Rh-
chorionic villus sampling
- type of intrauterine tissue or liquid sampling
- indication: used to diagnose chromosomal and genetic defects
- procedure: sample of blood and tissue is taken from the
chorionic villi (accessed vaginally or abdominally by taking a
placental sample)
- cells from the villi have the same genetic make-up as the cells
from the embryo
advantages of chorionic villus sampling
- can be done early in pregnancy (10-13 weeks)
- tissue sample from fetal side of placenta gives
genetic/chromosomal data (no amniotic fluid is collected)
- a first trimester alternative to amniocentesis since it can be
done earlier
