Chapter 10: Antepartum Fetal Assessment
Antepartum Fetal Assessment
1. Review all medications from list given during week 1—Clinical Simulation
a. Magnesium sulfate:Magnesium levels → normal: 1.8-3.0; therapeutic: 4-8; reflex
depression: 8-12; respiratory & cardiac arrest: 15+
Description: Magnesium sulfate is a CNS depressant used to prevent
seizure activity (anticonvulsant) in the preeclamptic patient. The
medication is excreted via the kidneys, when a client’s output is low (as in
20 cc/hr; well below urinary output of 30 cc/hr), the concentration of the
medication can increase to toxic levels in the bloodstream. Calcium
gluconate should be kept at the bedside while a client is receiving
magnesium sulfate infusion. If magnesium toxicity occurs, calcium
gluconate is administered as an antidote.
Considerations: Magnesium sulfate should be withheld if the client’s
urine output falls or if reflexes are diminished/absent.
Adverse response to mag sulfate: decreased RR
Normal deep tendon reflexes indicate therapeutic level
Magnesium toxicity altered sensorium, RR < 12 breath/min,
absence of deep tendon reflexes
Also flushing/feeling warm
Magnesium sulfate crosses the placenta & adverse effects are:
respiratory depression, hypotonia, and bradycardia.
Draw mag levels every 4,6,8 hrs
b. Hemabate:
Description: Hemabate is an oxytocic agent that acts on the myometrial
tissue of the uterus. During the postpartum it acts directly at the site of
placental separation to stop uncontrolled bleeding. Hemabate is a type of
prostaglandin.
Adverse effects: Hemabate can cause nausea, vomiting, diarrhea, and
hyperthermia.
c. Methergine:
Description: Methergine is an oxytoxic agent that works directly on the
myofibrils of the uterus. The smooth muscle of the vascular tree is also
affected. The BP may elevate, therefore, to dangerous levels. The BP
should be assessed before administering methergine. The medication
should be held if the blood pressure is 130/90 or higher and the woman’s
HCP should be notified if appropriate.
Indications: Methergine is administered to postpartum clients to
stimulate their uteruses to contract. As a consequence, clients frequently
complain of cramping after taking the medication. Hence cramping is an
, expected outcome of the administration of Methergine. The nurse can
administer the prn pain medication to the client at the same time the
Methergine is administered to help to mitigate the client’s discomfort.
The fundal response indicates that the medication was effective in
contracting the uterus.
Considerations: When the uterus is noted to be well contracted and at
the appropriate position in the abdomen, the nurse can conclude that the
medication action was successful.
d. Cytosec:
Description: is a prostaglandin medication used to ripen the cervix for
induction.
Adverse effects: Gastrointestinal side effects are commonly seen when
prostaglandin is used since the gastrointestinal system is adjacent to the
vagina where the medication is inserted. In addition, the nurse must be
watchful for signs of labor.
Interventions: Assess the uterus for excessive contractions and
Monitor the fetal heart rate for at least 30 minutes
e. Nubain
Description: is an opioid analgesia. It has markedly depressed the client’s
respiratory response.
Indications: It may be administered to a depressed baby at delivery.
f. Narcan (naxolone):
Description: 0.1 milligram/kg is the correct dosage. This dosage can also
be expressed as 100 microgram/kg. Do not confuse micrograms and
milligrams. There are 1000 micrograms in 1 milligram. Naloxone is an
opiate antagonist admin to reverse respiratory distress.
g. Oxytocin
Description: is the synthetic form of the naturally occurring pituitary
hormone used to initiate or augment uterine contraction
Considerations: Continuous electronic fetal monitoring is used when
oxytocin is administered because uteroplacental exchange may be
compromised.
Adverse effects:
Maternal hyponatremia
Uterine tachysystole
Maternal hypotension
h. RhoGAM:
Description: Rho (D) gamma globulin is administered within 72 hrs of
delivery. When RhoGAM is given, the nurse is administering Rh antibodies
to Rh negative mothers. If the nurse should make a mistake and
administer the dosage to an Rh positive mother, the client would then
have been injected with antibodies that would act to destroy her own
blood. If the mother is antigen negative—that is, Rh - , when exposed to
, Rh + blood, her immune system develops antibodies. RhoGAM is
composed of Rh + antibodies. It acts as passive immunity. Because
antibodies are already present in the mother’s bloodstream, her immune
system is suppressed and fails to develop antibodies via the active
immune response. An Rh-negative mother delivering an Rh-positive baby
may develop antibodies to fetal cells that entered her bloodstream when
the placenta separated. The Rho(D) immune globulin works to destroy
the fetal cells in the maternal circulation before sensitization occurs.
When the blood types are alike as with mother Rh-negative, baby Rh-
negative, no antibody formation would be anticipated. If the Rh-positive
blood of the mother comes in contact with the Rh-negative blood of the
infant, no antibodies would develop because the antigens are in the
mother’s blood, not the infant’s.
Considerations: An Rh negative unsensitized woman should be given 300
mcg of RhoGAM IM at 28 weeks after an indirect Coombs test is done to
verify that sensitization hasn't occurred.
For a 1st trimester abortion or ectopic pregnancy, 50 mcg of RhoGAM is
given.
i. Vitamin K
Description: Is deficient in the neonate, is needed to activate clotting
factors II,IV,IX and X. In the event of trauma, the neonate would be at risk
for excessive bleeding. Vitamin k doesn’t assist the gut to mature but the
gut produces vitamin K once maturity is achieved.
2. Chorionic villus sampling: what is it, why is it used, when is it done? What are the
advantages/disadvantages. How long does it take for the results to be available? Outline the care
after the procedure is complete.
Chorionic Villus Sampling:
I. What is it?
Chorionic Villus is microscopic projections from the outer membrane (chorionic) that develop
and burrow into endometrial tissue as the placenta is formed. The villi are fetal tissues and
reflect the chromosomes, metabolic, and genetic makeup of the fetus.
II. Why is it used and when is it done?
CVS is usually performed between 10 and 12 weeks gestation to diagnose fetal chromosomal,
metabolic or deoxyribonucleic acid (DNA) abnormities. CVS is not used to detect open body
wall defects such as spinal bifida, which require an amniotic fluid sampling.
III. What are the advantages and disadvantages?
a) Advantages:
1. CVS offers prenatal diagnosis to women who find later procedures unacceptable
2. If CVS results are abnormal and the women chooses abortion, she may consider the
earlier abortion less physically, emotionally traumatic that a later procedure
Antepartum Fetal Assessment
1. Review all medications from list given during week 1—Clinical Simulation
a. Magnesium sulfate:Magnesium levels → normal: 1.8-3.0; therapeutic: 4-8; reflex
depression: 8-12; respiratory & cardiac arrest: 15+
Description: Magnesium sulfate is a CNS depressant used to prevent
seizure activity (anticonvulsant) in the preeclamptic patient. The
medication is excreted via the kidneys, when a client’s output is low (as in
20 cc/hr; well below urinary output of 30 cc/hr), the concentration of the
medication can increase to toxic levels in the bloodstream. Calcium
gluconate should be kept at the bedside while a client is receiving
magnesium sulfate infusion. If magnesium toxicity occurs, calcium
gluconate is administered as an antidote.
Considerations: Magnesium sulfate should be withheld if the client’s
urine output falls or if reflexes are diminished/absent.
Adverse response to mag sulfate: decreased RR
Normal deep tendon reflexes indicate therapeutic level
Magnesium toxicity altered sensorium, RR < 12 breath/min,
absence of deep tendon reflexes
Also flushing/feeling warm
Magnesium sulfate crosses the placenta & adverse effects are:
respiratory depression, hypotonia, and bradycardia.
Draw mag levels every 4,6,8 hrs
b. Hemabate:
Description: Hemabate is an oxytocic agent that acts on the myometrial
tissue of the uterus. During the postpartum it acts directly at the site of
placental separation to stop uncontrolled bleeding. Hemabate is a type of
prostaglandin.
Adverse effects: Hemabate can cause nausea, vomiting, diarrhea, and
hyperthermia.
c. Methergine:
Description: Methergine is an oxytoxic agent that works directly on the
myofibrils of the uterus. The smooth muscle of the vascular tree is also
affected. The BP may elevate, therefore, to dangerous levels. The BP
should be assessed before administering methergine. The medication
should be held if the blood pressure is 130/90 or higher and the woman’s
HCP should be notified if appropriate.
Indications: Methergine is administered to postpartum clients to
stimulate their uteruses to contract. As a consequence, clients frequently
complain of cramping after taking the medication. Hence cramping is an
, expected outcome of the administration of Methergine. The nurse can
administer the prn pain medication to the client at the same time the
Methergine is administered to help to mitigate the client’s discomfort.
The fundal response indicates that the medication was effective in
contracting the uterus.
Considerations: When the uterus is noted to be well contracted and at
the appropriate position in the abdomen, the nurse can conclude that the
medication action was successful.
d. Cytosec:
Description: is a prostaglandin medication used to ripen the cervix for
induction.
Adverse effects: Gastrointestinal side effects are commonly seen when
prostaglandin is used since the gastrointestinal system is adjacent to the
vagina where the medication is inserted. In addition, the nurse must be
watchful for signs of labor.
Interventions: Assess the uterus for excessive contractions and
Monitor the fetal heart rate for at least 30 minutes
e. Nubain
Description: is an opioid analgesia. It has markedly depressed the client’s
respiratory response.
Indications: It may be administered to a depressed baby at delivery.
f. Narcan (naxolone):
Description: 0.1 milligram/kg is the correct dosage. This dosage can also
be expressed as 100 microgram/kg. Do not confuse micrograms and
milligrams. There are 1000 micrograms in 1 milligram. Naloxone is an
opiate antagonist admin to reverse respiratory distress.
g. Oxytocin
Description: is the synthetic form of the naturally occurring pituitary
hormone used to initiate or augment uterine contraction
Considerations: Continuous electronic fetal monitoring is used when
oxytocin is administered because uteroplacental exchange may be
compromised.
Adverse effects:
Maternal hyponatremia
Uterine tachysystole
Maternal hypotension
h. RhoGAM:
Description: Rho (D) gamma globulin is administered within 72 hrs of
delivery. When RhoGAM is given, the nurse is administering Rh antibodies
to Rh negative mothers. If the nurse should make a mistake and
administer the dosage to an Rh positive mother, the client would then
have been injected with antibodies that would act to destroy her own
blood. If the mother is antigen negative—that is, Rh - , when exposed to
, Rh + blood, her immune system develops antibodies. RhoGAM is
composed of Rh + antibodies. It acts as passive immunity. Because
antibodies are already present in the mother’s bloodstream, her immune
system is suppressed and fails to develop antibodies via the active
immune response. An Rh-negative mother delivering an Rh-positive baby
may develop antibodies to fetal cells that entered her bloodstream when
the placenta separated. The Rho(D) immune globulin works to destroy
the fetal cells in the maternal circulation before sensitization occurs.
When the blood types are alike as with mother Rh-negative, baby Rh-
negative, no antibody formation would be anticipated. If the Rh-positive
blood of the mother comes in contact with the Rh-negative blood of the
infant, no antibodies would develop because the antigens are in the
mother’s blood, not the infant’s.
Considerations: An Rh negative unsensitized woman should be given 300
mcg of RhoGAM IM at 28 weeks after an indirect Coombs test is done to
verify that sensitization hasn't occurred.
For a 1st trimester abortion or ectopic pregnancy, 50 mcg of RhoGAM is
given.
i. Vitamin K
Description: Is deficient in the neonate, is needed to activate clotting
factors II,IV,IX and X. In the event of trauma, the neonate would be at risk
for excessive bleeding. Vitamin k doesn’t assist the gut to mature but the
gut produces vitamin K once maturity is achieved.
2. Chorionic villus sampling: what is it, why is it used, when is it done? What are the
advantages/disadvantages. How long does it take for the results to be available? Outline the care
after the procedure is complete.
Chorionic Villus Sampling:
I. What is it?
Chorionic Villus is microscopic projections from the outer membrane (chorionic) that develop
and burrow into endometrial tissue as the placenta is formed. The villi are fetal tissues and
reflect the chromosomes, metabolic, and genetic makeup of the fetus.
II. Why is it used and when is it done?
CVS is usually performed between 10 and 12 weeks gestation to diagnose fetal chromosomal,
metabolic or deoxyribonucleic acid (DNA) abnormities. CVS is not used to detect open body
wall defects such as spinal bifida, which require an amniotic fluid sampling.
III. What are the advantages and disadvantages?
a) Advantages:
1. CVS offers prenatal diagnosis to women who find later procedures unacceptable
2. If CVS results are abnormal and the women chooses abortion, she may consider the
earlier abortion less physically, emotionally traumatic that a later procedure
