JULIA ANDREA C. QUIAO
BSN 2I Unit 1: High Risk Prenatal Client
2nd sem PRELIM Marie Vanesa Yap, RN
S.Y 2021-2022
Care of Mother, Child and
Population Group at Risk/With
Problems
NCM 209 3rd: 40 weeks = q wee
Care of Mother, Child, and Population Group at Risk or with postpartum: 2x a week
Problems 4. FHT
PREGNANCY 5. FUNDIC HEIGHT
How to conceive a BOY or a GIRL? •
th
5 month = 20 cm
X= before evolution, shallow penetration, no orgasm •
th
6 month = 21-24 cm
Y= day of evolution, deep penetration, w/ orgasm •
th
7 month = 25-28 cm
th
• 8 month = 29-30 cm
IDENTIFYING CLIENT RISK •
th
9 month = 30-34 cm
Schedule of Prenatal Check-up:
• 1-7 month – every month
PRENATAL CARE • 8-9 months – every 2 weeks
THE PURPOSE OF PRENATAL CARE IS TO ENSURE AN • 40 weeks – every day
UNCOMPLICATED PREGNANCY AND THE DELIVERY OF • If, post-term – twice a week
AN ALIVE AND HEALTHY INFANT.
6. LEOPOLD’S MANEUVER
BALANCE OF FORCES IN PREGNANCY
● FETAL SURVIVAL
● All possible consequences will be discussed to the family
(options, greater chance of survival)
● MATERNAL SURVIVAL
5 Branches of Maternal Health:
• Nutrition
• Prenatal Care
• Safe Delivery
• Breastfeeding
• Family Planning
Prenatal Care 1. FIRST MANEUVER (Funda
• Regular prenatal care increases the chances of a healthy consistency: shape, mobility
mother and child after birth. 2. SECOND MANEUVER (Um
• Early detection of congenital & birth defects @ fetal back for FHT, Positi
• Prenatal immunizations can prevent mother-to-child 3. THIRD MANEUVER (Pawl
transmission and infection 🠒 most vaccination should 4. FOURTH MANEUVER (Pe
, 12. POSTPARTUM CARE BLOOD GLUCOSE TEST
⮚ FBS
HIGH-RISK MOM ⮚ HGT/CBG = routine test f
What is High-Risk Pregnancy? ⮚ OGTT = evaluate how the
poor maternal or fetal outcome due to: body. Fasting for 8-12/8-1
🢭 medical = (illness prior to pregnancy) hypertension, entering clinic) in clinic 5
cardiac, diabetes glucose q 1hr
🢭 reproductive = PCOS, myoma, CIS ⮚ OGCT = Fasting 8-14/8-1
🢭 Psychosocial = 🠓 coping mechanism/ support system taken
🢭 Obstetrical = (illness caused by pregnancy) develop ⮚ 2 hrs. POST PRANDIAL
diseases during preg e.g PIH, GDM
🢭 SCREENING
Diagnostic and Laboratory Examinations
Complete Blood Count
⮚ Hemoglobin – N: above 11mg/dl (pregnant; d/t physiologic
anemia); more than 12 (healthy person)
⮚ Hematocrit
⮚ Leukocyte = 🠓 para hindi contrahin si baby – decrease →
growing fetus is a foreign body so mother needs to lower
her immune system to avoid expulsion of baby
● Increase in immunoglobulin
⮚ Thrombocytes
⮚ Blood Typing
⮚ Rhesus Factor - Rh incompatibility problem
URINALYSIS
⮚ Pus cells = UTI
⮚ Bacteria = UTI
⮚ Protein/albumin = macromolecules;it should not
pass-through glomerulus if naka pasok problem will arise
e.g Hypertension
⮚ Sugar = GDM, hyperglycemia
⮚ Squamous epithelial cells = bleeding inside the
vascular/mother
PAP SMEAR ULTRASONOGRAPHY
, Early screening effective Diagnosis ⮚ fetal tone = extension- fle
Maternal Alpha-Feto Protein BPS RESULT INTERPRETAT
= protein develops in fetus liver carried by the mother system, 8 – 10 - Normal fetus
accumulate in the maternal site. 6 - chronic asphyxia; repea
N: 35-45 nanogram per deciliter 4 - abnormal result
o Decrease: down syndrome 2 - ill fetus, terminate preg
o Increase: NTD SCORING: 2 for each marker
Recommended: green leafy vegetables (high in folic acid); liver is not Non Stress Test (NST)
given in pregnant women d/t content of Vit. A (teratogenic in 2 - 2 or more FHT accelera
development) 1 - <2 accelerations per mo
Fetal neural tube defect: 0 - no acceleration
⮚ anencephaly = no brain; anencephalic Fetal Breathing
⮚ gastroschisis = intestine are outside in the sac or 2 - 1 episode/30 minutes las
membrane (problem w/ infection) 0 - no episode; more than 30
⮚ omphalocele = abdominal contents; liver, spleen part of AMNIOTIC FLUID INDEX
kidney intestine are intact in a membrane 2 - fluid-filled pocket of 1 c
• both has an absence of abdominal wall; txt for early surgery 0 - no amniotic fluid or less t
rearrangement = oligohydramnios - a
⮚ spina bifida = a condition that affects the spine and is less than expected for ges
usually apparent at birth; can happen anywhere along the
spine if the neural tube does not close all the way. FETAL BODY MOVEMENT
• occulta = w/o cis; just missing vertebrae; dimpling skin; 2 - 3 or more discrete move
minutes
hairy patch
1 - less than 3 movements
• meningocele = cis CSF leaking; no paralysis; no nerve
0 - no movements
fibers
• myelomeningocele = protrusion of spinal cord/nerve
FETAL TONE
fibers in cis, causes paralysis to the BB
2 - 1 or more episodes of ac
AFP - develops normal in fetus 35-45 mg/dl
flexion of limbs and trunk
🠓 Down syndrome; Chromosomal defects = d/t 🠓 folic acid and vit.
1 - slow extension with a re
B9
0 - no movements
🠑 meningitis/ neural tube defect = 🠑 development of fetus
NOTE TO CONSIDER: d
DOPPLER VELOCIMETRY
q now & then; by the time they obs
PERCUTANEOUS UMBILICAL BLOOD SAMPLING
immediately seek for consultation
HEPATITIS B DETERMINAT
1 Hepatitis B Antigen (HBS
2 reactive - positive
3 non-reactive – negative
, - May perform intrauterine fetal surgery ⮚ pulmonary hypertension
- External = listening to FHT/FM side of the heart- pulmon
FETAL MOVEMENT COUNTING ● 🠑 pulmonary blood fl
- Done after 27 weeks AOG pulmonary artery to t
- Twice daily for 20-30 minutes = padulong timester go back to the deoxyg
- Normal – 5-6movements in 20-30 minutes oxygenated
- Abnormal – less done 3 movements in 1 hour ASSESSMENT:
● the murmur will be h
space murmur is hea
MEDICAL COMPLICATIONS DURING PREGNANCY ● echocardiography = u
I. CARDIOVASCULAR DISORDERS VENTRICULAR SEPTAL D
PREGNANCY
⮚ most common; Acyanoti
⮚ Increase blood volume 40 – 50%
there is still oxygenation
⮚ Increase cardiac output
⮚ left ventricular hypertrop
⮚ Decrease during first trimester d/t developing fetus
bld. in left ventricles sinc
⮚ Increase size of the ventricular chamber to accommodate
one who will exert much
increase in blood volume
pulling in it
➢ LEFT TO RIGHT SHUNTING = GRAVIDOCARDIC CLIENT
⮚ pulmonary hypertension
⮚ biventricular hypertrophy
the 2 ventricles
PATENT DUCTUS ARTER
⮚ rare
⮚ early surgical repair
⮚ similar with VSD
⮚ Ductus Arteriosus open
⮚ Postpartum: should be cl
flow
⮚ Remain open d/t hormon
● usually after 2 days 4
arteriosus in PDA hi
fetal life)
● 8 weeks of life pinaka
prostaglandins
RHEUMATIC HEART DIS
⮚ d/t Group A Beta Hemoly
causes of sore throat (stre
⮚ Inflammatory process
⮚ Autoimmune disease
BSN 2I Unit 1: High Risk Prenatal Client
2nd sem PRELIM Marie Vanesa Yap, RN
S.Y 2021-2022
Care of Mother, Child and
Population Group at Risk/With
Problems
NCM 209 3rd: 40 weeks = q wee
Care of Mother, Child, and Population Group at Risk or with postpartum: 2x a week
Problems 4. FHT
PREGNANCY 5. FUNDIC HEIGHT
How to conceive a BOY or a GIRL? •
th
5 month = 20 cm
X= before evolution, shallow penetration, no orgasm •
th
6 month = 21-24 cm
Y= day of evolution, deep penetration, w/ orgasm •
th
7 month = 25-28 cm
th
• 8 month = 29-30 cm
IDENTIFYING CLIENT RISK •
th
9 month = 30-34 cm
Schedule of Prenatal Check-up:
• 1-7 month – every month
PRENATAL CARE • 8-9 months – every 2 weeks
THE PURPOSE OF PRENATAL CARE IS TO ENSURE AN • 40 weeks – every day
UNCOMPLICATED PREGNANCY AND THE DELIVERY OF • If, post-term – twice a week
AN ALIVE AND HEALTHY INFANT.
6. LEOPOLD’S MANEUVER
BALANCE OF FORCES IN PREGNANCY
● FETAL SURVIVAL
● All possible consequences will be discussed to the family
(options, greater chance of survival)
● MATERNAL SURVIVAL
5 Branches of Maternal Health:
• Nutrition
• Prenatal Care
• Safe Delivery
• Breastfeeding
• Family Planning
Prenatal Care 1. FIRST MANEUVER (Funda
• Regular prenatal care increases the chances of a healthy consistency: shape, mobility
mother and child after birth. 2. SECOND MANEUVER (Um
• Early detection of congenital & birth defects @ fetal back for FHT, Positi
• Prenatal immunizations can prevent mother-to-child 3. THIRD MANEUVER (Pawl
transmission and infection 🠒 most vaccination should 4. FOURTH MANEUVER (Pe
, 12. POSTPARTUM CARE BLOOD GLUCOSE TEST
⮚ FBS
HIGH-RISK MOM ⮚ HGT/CBG = routine test f
What is High-Risk Pregnancy? ⮚ OGTT = evaluate how the
poor maternal or fetal outcome due to: body. Fasting for 8-12/8-1
🢭 medical = (illness prior to pregnancy) hypertension, entering clinic) in clinic 5
cardiac, diabetes glucose q 1hr
🢭 reproductive = PCOS, myoma, CIS ⮚ OGCT = Fasting 8-14/8-1
🢭 Psychosocial = 🠓 coping mechanism/ support system taken
🢭 Obstetrical = (illness caused by pregnancy) develop ⮚ 2 hrs. POST PRANDIAL
diseases during preg e.g PIH, GDM
🢭 SCREENING
Diagnostic and Laboratory Examinations
Complete Blood Count
⮚ Hemoglobin – N: above 11mg/dl (pregnant; d/t physiologic
anemia); more than 12 (healthy person)
⮚ Hematocrit
⮚ Leukocyte = 🠓 para hindi contrahin si baby – decrease →
growing fetus is a foreign body so mother needs to lower
her immune system to avoid expulsion of baby
● Increase in immunoglobulin
⮚ Thrombocytes
⮚ Blood Typing
⮚ Rhesus Factor - Rh incompatibility problem
URINALYSIS
⮚ Pus cells = UTI
⮚ Bacteria = UTI
⮚ Protein/albumin = macromolecules;it should not
pass-through glomerulus if naka pasok problem will arise
e.g Hypertension
⮚ Sugar = GDM, hyperglycemia
⮚ Squamous epithelial cells = bleeding inside the
vascular/mother
PAP SMEAR ULTRASONOGRAPHY
, Early screening effective Diagnosis ⮚ fetal tone = extension- fle
Maternal Alpha-Feto Protein BPS RESULT INTERPRETAT
= protein develops in fetus liver carried by the mother system, 8 – 10 - Normal fetus
accumulate in the maternal site. 6 - chronic asphyxia; repea
N: 35-45 nanogram per deciliter 4 - abnormal result
o Decrease: down syndrome 2 - ill fetus, terminate preg
o Increase: NTD SCORING: 2 for each marker
Recommended: green leafy vegetables (high in folic acid); liver is not Non Stress Test (NST)
given in pregnant women d/t content of Vit. A (teratogenic in 2 - 2 or more FHT accelera
development) 1 - <2 accelerations per mo
Fetal neural tube defect: 0 - no acceleration
⮚ anencephaly = no brain; anencephalic Fetal Breathing
⮚ gastroschisis = intestine are outside in the sac or 2 - 1 episode/30 minutes las
membrane (problem w/ infection) 0 - no episode; more than 30
⮚ omphalocele = abdominal contents; liver, spleen part of AMNIOTIC FLUID INDEX
kidney intestine are intact in a membrane 2 - fluid-filled pocket of 1 c
• both has an absence of abdominal wall; txt for early surgery 0 - no amniotic fluid or less t
rearrangement = oligohydramnios - a
⮚ spina bifida = a condition that affects the spine and is less than expected for ges
usually apparent at birth; can happen anywhere along the
spine if the neural tube does not close all the way. FETAL BODY MOVEMENT
• occulta = w/o cis; just missing vertebrae; dimpling skin; 2 - 3 or more discrete move
minutes
hairy patch
1 - less than 3 movements
• meningocele = cis CSF leaking; no paralysis; no nerve
0 - no movements
fibers
• myelomeningocele = protrusion of spinal cord/nerve
FETAL TONE
fibers in cis, causes paralysis to the BB
2 - 1 or more episodes of ac
AFP - develops normal in fetus 35-45 mg/dl
flexion of limbs and trunk
🠓 Down syndrome; Chromosomal defects = d/t 🠓 folic acid and vit.
1 - slow extension with a re
B9
0 - no movements
🠑 meningitis/ neural tube defect = 🠑 development of fetus
NOTE TO CONSIDER: d
DOPPLER VELOCIMETRY
q now & then; by the time they obs
PERCUTANEOUS UMBILICAL BLOOD SAMPLING
immediately seek for consultation
HEPATITIS B DETERMINAT
1 Hepatitis B Antigen (HBS
2 reactive - positive
3 non-reactive – negative
, - May perform intrauterine fetal surgery ⮚ pulmonary hypertension
- External = listening to FHT/FM side of the heart- pulmon
FETAL MOVEMENT COUNTING ● 🠑 pulmonary blood fl
- Done after 27 weeks AOG pulmonary artery to t
- Twice daily for 20-30 minutes = padulong timester go back to the deoxyg
- Normal – 5-6movements in 20-30 minutes oxygenated
- Abnormal – less done 3 movements in 1 hour ASSESSMENT:
● the murmur will be h
space murmur is hea
MEDICAL COMPLICATIONS DURING PREGNANCY ● echocardiography = u
I. CARDIOVASCULAR DISORDERS VENTRICULAR SEPTAL D
PREGNANCY
⮚ most common; Acyanoti
⮚ Increase blood volume 40 – 50%
there is still oxygenation
⮚ Increase cardiac output
⮚ left ventricular hypertrop
⮚ Decrease during first trimester d/t developing fetus
bld. in left ventricles sinc
⮚ Increase size of the ventricular chamber to accommodate
one who will exert much
increase in blood volume
pulling in it
➢ LEFT TO RIGHT SHUNTING = GRAVIDOCARDIC CLIENT
⮚ pulmonary hypertension
⮚ biventricular hypertrophy
the 2 ventricles
PATENT DUCTUS ARTER
⮚ rare
⮚ early surgical repair
⮚ similar with VSD
⮚ Ductus Arteriosus open
⮚ Postpartum: should be cl
flow
⮚ Remain open d/t hormon
● usually after 2 days 4
arteriosus in PDA hi
fetal life)
● 8 weeks of life pinaka
prostaglandins
RHEUMATIC HEART DIS
⮚ d/t Group A Beta Hemoly
causes of sore throat (stre
⮚ Inflammatory process
⮚ Autoimmune disease
