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NUR 370 MATERNITY EXAM 2 STUDY
GUIDE Latest updated 2021/2022
Chapter 10 – Assessment of high risk
pregnancy Risk Factors:
• Biophysical
o Genetic: chrom abnormalities, poor nutrition (young age, fad diets,
drugs/alcohol, chronic illness), diabetes, obesity, hypertensive
disorders
• Sociodemographic
o Income, prenatal care, age, ethnicity,
environmental factors
(infection/radiation/chemicals/drugs), age,
parity,
o Dystocia – difficult birth, caused by a large or awkwardly positioned
fetus
• Psychosocial
o Emotional distress, lack of supportive relationships
Specific pregnancy problems:
• Oligohydramnios – not enough amniotic fluid
o Maternal hypertension, prolonged pregnancy
• Polyhydramnios – too much amniotic fluid
o Uncontrolled diabetes mellitus
• IUGR – intra uterine growth
restriction
o Poor weight gain, hypertension, chronic disease,
smoking/alcohol/drugs, high altitude
ANTEPARTUM TESTING:
• Daily fetal movement count
o Count once a day for 60 mins, 2-3 times daily, 10 movements in 12
hour period
o FETAL ALARM SIGN – WHEN MOVEMENTS CEASE ENTIRELY FOR 12
HOURS
• Ultrasound
o Fetal HR activity, gestational age, fetal growth, fetal anatomy,
genetic disorders, placental position/function, visual
assistance
o Head and abdominal circumference – gestational age and fetal growth
o Nursing role – education and guidance regarding procedure
, o Fetal well-being
▪ Doppler blood flow
▪ Amniotic fluid
▪ Biophysical profile
• MRI – soft tissues
• Biochemical assessment – AMNIOCENTESIS (AFTER 14 WEEKS)
o Fetomaternal hemorrhage – fetal blood enters maternal
bloodstream – dangerous with Rh
o Amniotic fluid embolism – amniotic fluid enters maternal
bloodstream – emergency, super dangerous
o Used to check for lung maturity
, • Chronic Villus Sampling – 10-13 weeks gestation
o Removal of small tissue specimen from fetal portion of placenta
• Percutaneous umbilical blood sampling – replaced in many centers by
placental biopsy
MATERNAL ASSAYS
• Alpha-fetoprotein
o Maternal serum screened for neural tube defects (80-85% can be
detected early)
• Maternal marker screening – 11-14 weeks
o Detects chromosomal abnormalities (downs)
• Contraction stress test – provides warning of fetal compromise earlier than
NST
• OLIGOHYDRAMNIOS – associated with fetal renal abnormalities
• POLYHYDRAMNIOS – GI, brain/spinal abnormalities
CH. 11 – HIGH RISK PRENATAL CARE – PREEXISTING CONDITIONS
• Diabetes – strict maternal glucose control
• INSULIN NEEDS DURING PREGNANCY ARE DIFFERENT
o Lower than normal during weeks 13-20
o Spikes between weeks 26-36
o Drops off after baby is delivered
o Non-breastfeeding mother needs more insulin!
• Thyroid disorders
o Hyperthyroid – Grave's disease – risk for miscarriage and preterm
birth
o Hypothyroidism – risk for infertility
• Maternal phenylketonuria
o Baby will have reaction to protein
o Prevention – identification of women during childbearing years
• Cardiovascular disorders
o Heparin – drug that does not cross into the placenta
• Anemia
o Iron deficiency
o Folic acid deficiency
o Sickle cell
o Thalassemia
• Epilepsy – all medications carry risk of congenital abnormalities
CHAPTER 12: HIGH RISK: GESTATIONAL CONDITIONS
Disorders that did not exist before pregnancy
• Most common is hypertension
NUR 370 MATERNITY EXAM 2 STUDY
GUIDE Latest updated 2021/2022
Chapter 10 – Assessment of high risk
pregnancy Risk Factors:
• Biophysical
o Genetic: chrom abnormalities, poor nutrition (young age, fad diets,
drugs/alcohol, chronic illness), diabetes, obesity, hypertensive
disorders
• Sociodemographic
o Income, prenatal care, age, ethnicity,
environmental factors
(infection/radiation/chemicals/drugs), age,
parity,
o Dystocia – difficult birth, caused by a large or awkwardly positioned
fetus
• Psychosocial
o Emotional distress, lack of supportive relationships
Specific pregnancy problems:
• Oligohydramnios – not enough amniotic fluid
o Maternal hypertension, prolonged pregnancy
• Polyhydramnios – too much amniotic fluid
o Uncontrolled diabetes mellitus
• IUGR – intra uterine growth
restriction
o Poor weight gain, hypertension, chronic disease,
smoking/alcohol/drugs, high altitude
ANTEPARTUM TESTING:
• Daily fetal movement count
o Count once a day for 60 mins, 2-3 times daily, 10 movements in 12
hour period
o FETAL ALARM SIGN – WHEN MOVEMENTS CEASE ENTIRELY FOR 12
HOURS
• Ultrasound
o Fetal HR activity, gestational age, fetal growth, fetal anatomy,
genetic disorders, placental position/function, visual
assistance
o Head and abdominal circumference – gestational age and fetal growth
o Nursing role – education and guidance regarding procedure
, o Fetal well-being
▪ Doppler blood flow
▪ Amniotic fluid
▪ Biophysical profile
• MRI – soft tissues
• Biochemical assessment – AMNIOCENTESIS (AFTER 14 WEEKS)
o Fetomaternal hemorrhage – fetal blood enters maternal
bloodstream – dangerous with Rh
o Amniotic fluid embolism – amniotic fluid enters maternal
bloodstream – emergency, super dangerous
o Used to check for lung maturity
, • Chronic Villus Sampling – 10-13 weeks gestation
o Removal of small tissue specimen from fetal portion of placenta
• Percutaneous umbilical blood sampling – replaced in many centers by
placental biopsy
MATERNAL ASSAYS
• Alpha-fetoprotein
o Maternal serum screened for neural tube defects (80-85% can be
detected early)
• Maternal marker screening – 11-14 weeks
o Detects chromosomal abnormalities (downs)
• Contraction stress test – provides warning of fetal compromise earlier than
NST
• OLIGOHYDRAMNIOS – associated with fetal renal abnormalities
• POLYHYDRAMNIOS – GI, brain/spinal abnormalities
CH. 11 – HIGH RISK PRENATAL CARE – PREEXISTING CONDITIONS
• Diabetes – strict maternal glucose control
• INSULIN NEEDS DURING PREGNANCY ARE DIFFERENT
o Lower than normal during weeks 13-20
o Spikes between weeks 26-36
o Drops off after baby is delivered
o Non-breastfeeding mother needs more insulin!
• Thyroid disorders
o Hyperthyroid – Grave's disease – risk for miscarriage and preterm
birth
o Hypothyroidism – risk for infertility
• Maternal phenylketonuria
o Baby will have reaction to protein
o Prevention – identification of women during childbearing years
• Cardiovascular disorders
o Heparin – drug that does not cross into the placenta
• Anemia
o Iron deficiency
o Folic acid deficiency
o Sickle cell
o Thalassemia
• Epilepsy – all medications carry risk of congenital abnormalities
CHAPTER 12: HIGH RISK: GESTATIONAL CONDITIONS
Disorders that did not exist before pregnancy
• Most common is hypertension
