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Maternal Newborn ATI Proctored Study Guide
Prenatal Lab Tests and Discomforts During Pregnancy
IMPORTANT: Rh Factor of mother and baby through indirect Coombs test. If mom is Rh
negative and baby is Rh positive, causes mom to build up antibodies that may not affect this
pregnancy but WILL attack the next baby’s RBC’s causing them to lyse.
If mom is Rh negative and baby Rh positive: Repeat Coombs test at 24-28 weeks. Rhogam will
be administered at 28 weeks gestation, which prevents the development of antibodies.
Group B Streptococcus: will be checked by taking a vaginal and anal culture around 35-37
weeks gestation.
One-hour glucose tolerance test done at 24-28 weeks gestation. No fasting required, if results
come back over 140, requires a follow-up 3-hour glucose tolerance test: fasting is required.
Maternal serum alpha-fetoprotein: Taken at 15-22 weeks gestation, screens for Down
Syndrome of neural tube defects. If LOW: could mean down syndrome. If HIGH: Neural tube
defect.
Other: CBC, Rubella titer, HIV, Hepatitis B, HPV, STI’s (gonorrhea, chlamydia, syphilis), PPV
(check for TB), TORCH infections, and urinalysis
Expected Discomforts:
- N/V: usually in first trimester. Eat dry toast or crackers in the morning before getting
up
- Urinary frequency: Empty bladder frequently, use Kegel exercises if stress
incontinence’
- UTI’s: Notify if foul smelling or cloudy urine
- Heartburn: Advice to eat small, frequent meals, sit up for at least 30 minutes after
eating
- Fatigue and difficulty breathing: Take frequent rest periods
- Constipation: Increase intake of fluid and fiber
- Hemorrhoids: Use warm Sitz baths, witch hazel pads
- Varicose veins: elevate legs, were compression hose, walk frequently, and avoid
standing
- Gingivitis, indigestion, and epistaxis (nose bleed): Good oral hygiene, NS spray
Nutrition, Weight Gain, and PKU
Weight Gain:
- Normal weight: total 25-35 pounds. 1st: 2-4lbs. 2nd and 3rd: 1lb per week
- Obese: 15-25lbs.
- Underweight: 28-40lbs.
, 2
Calories: No additional calories needed during first trimester.
2nd trimester: extra 340 calories per day
3rd trimester: extra 460 calories per day
Breastfeeding: extra 450-500 calories per day
Nutrition:
FOLIC ACID (IMPORTANT): Prevents neural tube defects. Recommended: 600mcg per day.
Increase protein intake, possibly iron supplements (vitamin C increases absorption), calcium
1000mg per day (bone and teeth formation, vitamin D increases absorption). Fluid intake (2-3L
per day). Caffeine reduced (200mg per day). NO alcohol.
Phenylketonuria (PKU): A genetic disease that causes amino acid Phenylalanine to build up in
body which can cause a risk for birth defects in the fetus.
IMPORTANT teaching: Adhere to PKU diet 3 months prior to pregnancy and throughout
pregnancy. Needs frequent blood Phenylalanine drawn.
PKU diet: Very low in protein. Avoid: No meat, fish, poultry, nuts, eggs, or dairy.
Ultrasound, BPP, NST, and CST
Ultrasound: Noninvasive: Confirm pregnancy, site of implantation, assess baby growth and
development and movement.
Teaching: Have mom drink a full quart of water prior to procedure to better reflect sound waves.
Biophysical Profile: Uses real time ultrasound technology to assess for fetal well-being. Score
of 0-10. 8-10 = normal; less than 8 = fetal asphyxia due to insufficient oxygen. FIVE areas:
reactive fetal heart rate, fetal breathing movements, gross body movements, fetal tone, and
amniotic fluid volume.
Non-Stress Test: Non-invasive test that measures fetal HR response to fetal movement. Done in
3rd trimester, acoustic vibration device may help awaken fetus or orange juice. Mom pushes
button when she feels movement, provider assesses HR during movement to see if increasing
when moving. Preformed when mom reports decreased fetal movement, diabetes, gestational
HTN, or post-maturity.
Results (IMPORTANT): Reactive: normal finding (HR normal rate, moderate variability, and
accelerates at least 2 times in a 20-minute time period). Non-reactive: Abnormal finding, fetal
HR does not accelerate sufficiently with fetal movement further assessment is needed
Contraction Stress Test: Done after Non-stress test is abnormal or high risk pregnancy. More
invasive, help measures fetal HR in response to contractions. Done through nipple stimulation or
oxytocin to induce contractions.
Maternal Newborn ATI Proctored Study Guide
Prenatal Lab Tests and Discomforts During Pregnancy
IMPORTANT: Rh Factor of mother and baby through indirect Coombs test. If mom is Rh
negative and baby is Rh positive, causes mom to build up antibodies that may not affect this
pregnancy but WILL attack the next baby’s RBC’s causing them to lyse.
If mom is Rh negative and baby Rh positive: Repeat Coombs test at 24-28 weeks. Rhogam will
be administered at 28 weeks gestation, which prevents the development of antibodies.
Group B Streptococcus: will be checked by taking a vaginal and anal culture around 35-37
weeks gestation.
One-hour glucose tolerance test done at 24-28 weeks gestation. No fasting required, if results
come back over 140, requires a follow-up 3-hour glucose tolerance test: fasting is required.
Maternal serum alpha-fetoprotein: Taken at 15-22 weeks gestation, screens for Down
Syndrome of neural tube defects. If LOW: could mean down syndrome. If HIGH: Neural tube
defect.
Other: CBC, Rubella titer, HIV, Hepatitis B, HPV, STI’s (gonorrhea, chlamydia, syphilis), PPV
(check for TB), TORCH infections, and urinalysis
Expected Discomforts:
- N/V: usually in first trimester. Eat dry toast or crackers in the morning before getting
up
- Urinary frequency: Empty bladder frequently, use Kegel exercises if stress
incontinence’
- UTI’s: Notify if foul smelling or cloudy urine
- Heartburn: Advice to eat small, frequent meals, sit up for at least 30 minutes after
eating
- Fatigue and difficulty breathing: Take frequent rest periods
- Constipation: Increase intake of fluid and fiber
- Hemorrhoids: Use warm Sitz baths, witch hazel pads
- Varicose veins: elevate legs, were compression hose, walk frequently, and avoid
standing
- Gingivitis, indigestion, and epistaxis (nose bleed): Good oral hygiene, NS spray
Nutrition, Weight Gain, and PKU
Weight Gain:
- Normal weight: total 25-35 pounds. 1st: 2-4lbs. 2nd and 3rd: 1lb per week
- Obese: 15-25lbs.
- Underweight: 28-40lbs.
, 2
Calories: No additional calories needed during first trimester.
2nd trimester: extra 340 calories per day
3rd trimester: extra 460 calories per day
Breastfeeding: extra 450-500 calories per day
Nutrition:
FOLIC ACID (IMPORTANT): Prevents neural tube defects. Recommended: 600mcg per day.
Increase protein intake, possibly iron supplements (vitamin C increases absorption), calcium
1000mg per day (bone and teeth formation, vitamin D increases absorption). Fluid intake (2-3L
per day). Caffeine reduced (200mg per day). NO alcohol.
Phenylketonuria (PKU): A genetic disease that causes amino acid Phenylalanine to build up in
body which can cause a risk for birth defects in the fetus.
IMPORTANT teaching: Adhere to PKU diet 3 months prior to pregnancy and throughout
pregnancy. Needs frequent blood Phenylalanine drawn.
PKU diet: Very low in protein. Avoid: No meat, fish, poultry, nuts, eggs, or dairy.
Ultrasound, BPP, NST, and CST
Ultrasound: Noninvasive: Confirm pregnancy, site of implantation, assess baby growth and
development and movement.
Teaching: Have mom drink a full quart of water prior to procedure to better reflect sound waves.
Biophysical Profile: Uses real time ultrasound technology to assess for fetal well-being. Score
of 0-10. 8-10 = normal; less than 8 = fetal asphyxia due to insufficient oxygen. FIVE areas:
reactive fetal heart rate, fetal breathing movements, gross body movements, fetal tone, and
amniotic fluid volume.
Non-Stress Test: Non-invasive test that measures fetal HR response to fetal movement. Done in
3rd trimester, acoustic vibration device may help awaken fetus or orange juice. Mom pushes
button when she feels movement, provider assesses HR during movement to see if increasing
when moving. Preformed when mom reports decreased fetal movement, diabetes, gestational
HTN, or post-maturity.
Results (IMPORTANT): Reactive: normal finding (HR normal rate, moderate variability, and
accelerates at least 2 times in a 20-minute time period). Non-reactive: Abnormal finding, fetal
HR does not accelerate sufficiently with fetal movement further assessment is needed
Contraction Stress Test: Done after Non-stress test is abnormal or high risk pregnancy. More
invasive, help measures fetal HR in response to contractions. Done through nipple stimulation or
oxytocin to induce contractions.
