1. Prenatal Care Fetal/Maternal Assessment Techniques

2. Maternal Risk Factors 1. Age under 17 or over 34 2. Parity >5 3. Pregnancy (3 months since last oregnancy) 4. Multiple gestation 5. Rh incompatibility 6. Hx of dystocia or C/S 7. Under 5 feet of height 8. 15% under ideal weight or 20% over ideal weight 9. Medical disease (hyperthyroidism, clotting disorders) 10. Infection in pregnancy ( TORCH, HIV, Chlamydia) 11. Hx family violence

3. Techniques to determine F/M wellbeing Ultrasonography – During first trimester: # of fetuses, presence of fetal cardiac movement, uterine abnormalities, assessment of gestational age – During 2 nd and 3 rd trimester: gestational age, size and date discrepancies, amniotic fluid volume, placental location/maturity, used in amniocentesis – Biophysical Profile (BPP) for Fetal well being: (FYI) Breathing movements Gross body movements Fetal tone Amniotic fluid volume Reactive NST For each, a score of 2 or 0, an overall score of 10 means fetus is well the day of the exam

4. Techniques Nursing Responsibilities for UTZ: – Explain the procedure to the client – Instruct to drink 3-4 glasses of water prior to exam and not to urinate (the bladder must be full to support the uterus for imaging) Have bedpan or bathroom ready Position her with pillows under her neck and knees to keep pressure off bladder

5. Chorionic Villi Sampling (CVS) !Done between 8-12 weeks, removal of a small piece of villi under ultrasound guidance !To determine genetic diagnosis early in the first trimester Needs informed consent, placed woman in lithotomy position, may inflect a slight sharp upon catheter insertion Complications: spontaneous abortion (5%), controversy regarding fetal anomalies

6. Amniocentesis !Removal of amniotic fluid sample from uterus as early as 14-16 weeks To determine fetal genetic diagnosis (second trimester), fetal maturity (last trimester), fetal well being Usually takes 10 days to 2 weeks to develop cultured cell karyotype….could be well into 2 nd trimester before diagnosis is made (making abortion more dangerous)

7. Amniocentesis Genetic Disorders Karyotype: determines Down Syndrome (trisomy 21) and sex-linked disorders Biochemical Analysis: metabolic disorders (Tay Sachs Disease) !Alpha-fetoprotein (AFP): elevations may be associated with neural tube defects, low level may be trisomy 21

8. Amniocentesis Fetal Maturity: – !L/S ratio (lecithin/sphingomyelin): 2:1 ratio indicates fetal lung maturity unless mother is diabetic, has Rh disease, or fetus is septic (3:1 at 38 weeks) – Presence of Phosphatidylglycerol (PG): most accurate determination of fetal maturity..usually after 35 weeks – Creatinine: renal maturity indicator >1.8 Fetal Well Being: – Meconium in amniotic fluid may indicate fetal distress

9. Amniocentesis Nursing Responsibilities: – Baseline V/S and FHR – Patient in supine position – Draw maternal blood sample for comparison with post- procedure blood sample to determine maternal bleeding – Provide emotional support, explain procedure, remain with client – Monitor FHR X 1 hr after procedure and assess for uterine irritability – Instruct on PTL and SROM

10. Amniocentesis Complications: – Spontaneous abortion – Fetal injury – Infection Remember!!!! When done in early trimester, the bladder must be full to support the uterus for easy access, when done in late pregnancy…the bladder must be empty to avoid puncturing the bladder.

11. Fetal pH Blood Sampling !Only performed in the intrapartum period when the membranes are ruptured and the cervix is dilated 2-3 cm. Used to determine true acidosis when FHR is non-reassuring

12. Questions?????