Explain Fetal Circulation
Unlike in normal circulation, the vein carries oxygenated blood to the fetus from the placenta (the respiratory organ of the fetus) and the arteries carry de-oxygenated blood away from the fetus, through the cord to the placental chorionic villi, where the wastes are given back to the maternal circulation for excretion.
Possible effect of smoking while pregnant
Smoking can interefere with the fetus getting adequate nourishment and oxygen, resulting in newborn problems like being Small for Gestational Age (SGA)
What can cause aging of the placenta?
diabetes
How to cope with nausea/vomiting
- Eat five or six small meals
* Avoid fried foods or foods with odors
* Eat dry toast or crackers without liquids
How to cope with increased urinary frequency
- Wear a pad if leakage
* Do the Kegel exercise (Teach her how this is done)
How to cope with increased vaginal discharge
- Cleanliness – daily bathing
* Absorbent cotton underpants
* No douching
* If foul odor contact health provider
How long do pregnancies usually last?
40 weeks or 10 lunar months
How to obtain EDC or EDD?
First day of her last menstrual period
- 3 months
+ 7 days
What are some landmarks used to estimate EDD?
*Fundal heights
*When fetal heart is heard
–Normal is 120 - 160 beats per minute.
–Heard as early as 16 weeks, always by 19-20 weeks with a fetoscope. Can be heard as early as 8 weeks with a doppler, always by 10-12 weeks
*When the mother feels the baby move called “Quickening” - usually felt by 18 - 20 weeks
*Ultrasonography - gestational sac can be seen 5-6
weeks after Last Menstrual Period (LMP)
Primary Prevention during pregnancy?
Consists of education the client about healthy behaviors, screening test and monitoring for risk. (nutrition, exercises, sexual activities, discomfort, preparation)
Secondary Prevention during pregnancy?
The main focus is on providing the client with information about pregnancy and answering questions.
Tertiary Prevention during pregnancy?
During pregnancy the main focus of tertiary prevention is referring the client to existing systems for support. Examples would be WIC, Social Services, La Leche League, Healthy Start, and childbirth classes.
During pregnancy, a client should be assessed for the following risk factors:
- Age less then 16 years or over 35
- Anemia
- Poor physical state (e.g., obesity, low weight for height)
- Any sexually transmitted disease
- Use of tobacco, alcohol, or street drugs
- Poverty
- Lack of social support
- Poor medical conditions that pregnancy may complicate
(e. g., diabetes, epilepsy, asthma)
Which medication given for morning sickness caused limb deformities on the fetus?
Thalidomide
Clinical applications of ultrasounds..
- Early identification of pregnancy (5 to 6 wks following LMP)
- Identify ectopic pregnancies
- Measure biparietal diameter of the fetal head or the fetal femur length - confirm gestational age and
identify Inter Uterine Growth Retardation (IUGR) - Identify or confirm nonviable pregnancies
- Detection of fetal anomalies especially Anecephaly & Hydrocephalus (neural tube defects)
- Detect hydramnios or oligohydramnios
- Identify anmiotic fluid pockets - pocket less than 1
cm or absence of pocket are associated with perinatal
death - Locate the placenta prior to amniocentesis, guide
for Chorionic Villus Sampling, and for fetal therapy - Observe FRH beat and respirations
- Placental grading - measure calcification of placenta – grade III is correlated with fetal lung maturity (good if amniocentesis can’t be done)
- Detect fetal position and presentation; number of infants
How should a client prepare for a fetal ultrasound?
- -Must have full bladder except with location of placenta during amniocentesis
- -Drink 1 qt of water 2 hrs before; If NPO, catheterize and fill bladder with fluid
- If placenta previa do both with full and empty bladder
Risks of ultrasound?
Use only if necessary. Avoid during 1st trimester. No harmful effects on humans, but in animals-retarded fetal growth, cell damage, processing in brain changed & impaired immune system
Fetal Activity Records– how its done?
- Count the number of fetal movements within a selected period of time.
- Less than three fetal movements within an hour – further assessment needed
- No movements for 12 hours or very active (thrashing) may indicate a problem.
–Good for assessment with high risk pregnancies
Nonstress test
Mother is placed on a fetal heart monitor and assessed for response of the fetal heart rate when the fetus moves. *Start when 30 - 32 weeks; 1 to 2 times a week
- Reactive test— 2 or more fetal movements in 20 minutes ..FHR increase of 15 beats above baseline lasting at least 15 seconds from beginning of acceleration to end Long-term variability of 10 or more
- Nonreactive— No accelerations or less that 15 beats/min or lasting less than 15 sec. associated with movement in 20 minutes (some say 40 min)
- If reactive, repeat in 1 week
- If nonreactive – Contraction Stress Test (CST) same day (or repeat in 24 hours)
- If unsatisfactory - eat and return or CST
Indications for Nonstress test
Diabetic
Toxemia (PIH)
Decrease in fetal activity
Postmature
Nursing Interventions for Nonstress test
- May have to feed mom to get infant moving
- May have to use sound and/or vibration to make fetus wake up
Stress Test/Contraction Test
*Can be by nipple stimulation or oxytocin
*Around 32 - 34 weeks; 1 X week
*Results
—Negative test - no late or variable decelerations during 3 contractions, lasting 40 - 60 seconds, in 10 minutes
—Positive test - late decelerations in 50% of uterine
contractions
—Equivocal/Suspicious - more information needed
Amniocentesis
a procedure recommended to detect genetic abnormalities in early pregnancy, and fetal lung maturity in later pregnancy.
–Amniotic fluid is withdrawn from needle inserted through abdominal wall, into uterus. Patient is under local anesthesia, guided by ultrasound to prevent injury to mother or fetus. Must be more than 14 weeks to have enough fluid.
Implications for Amniocentesis
–Prenatal diagnosis of congenital disorders - need for
genetic counseling
–Evaluate Rh sensitized pregnancies - breakdown
products of RBC destruction especially concentrations of
bilirubin in amniotic fluid. Indicate condition of
infant and if interventions like intrauterine
transfusion is needed.
–Evaluate fetal maturity
*Lung = Lecithin/Sphingomyelin ratio
maturity 2:1
**With stress conditions like diabetes would need a 3:1 level
–Identification of meconium - color of fluid. If found,
assess further for hypoxia
–Sex of infant - sex linked disorders
–Infection
–Relief of polyhydramnios
–Fetal transfusion or other therapy
–Second trimester abortions
