Maternal Health Nursing Actions

Considerations in High-Risk Pregnancy

• Premature rupture of membranes can lead to complications.
• Maternal infections pose risks to both mother and fetus.
• Decreased fetal movement may indicate fetal distress.
• Intrauterine growth restriction can signal abnormal fetal development.

Nursing Actions for Ultrasounds

Abdominal Ultrasound

• Educate about the non-invasive nature and lack of risk for both mother and fetus.
• Advise a full bladder to improve imaging quality.
• Position client supine with support for comfort.
• Use warmed ultrasonic gel to enhance image acquisition.
• Allow bladder emptying post-procedure and provide materials for cleanup.

Transvaginal Ultrasound

• Position client in lithotomy for optimal access.
• Probe preparation includes a protective covering and lubrication.
• Adjust probe position as necessary for thorough examination.
• Inform client of potential pressure sensations during the procedure.

Biophysical Profile (BPP)

• Utilizes real-time ultrasound to gauge fetal responses and structures.
• Combines fetal heart rate monitoring with ultrasound observations.

Indications for BPP

• Nonreactive nonstress test results.
• Suspected oligohydramnios or polyhydramnios.
• Concerns about fetal hypoxemia or hypoxia.

BPP Scoring System

• Scores assigned for five variables:
  • FHR Reactive (2) / Nonreactive (0)
  • Fetal breathing movements (2) / Absent (0)
  • Gross body movements (2) / Less than 3 episodes (0)
  • Fetal tone (2) / Absent movement or slow (0)
  • Amniotic fluid volume (2) / Insufficient pockets (0)
• Total Scores:
  • 8 to 10 is normal, indicating low risk for chronic fetal distress.
  • 4 to 6 is abnormal; further assessment needed.
  • Less than 4 suggests strong suspicion of chronic fetal distress.

Reactive Nonstress Test (NST)

• Evaluates fetal central nervous system function in the third trimester.
• Important for clients with gestational diabetes to assess fetal safety.

Nursing Actions for NST

• Prepare client in a semi-reclining position and apply conduction gel.
• Attach ultrasound transducer and tocotransducer to monitor fetal heart activity.
• Instruct client to mark fetal movements electronically.
• Use vibroacoustic stimulation if fetal movements are absent.

Interpretation of NST Findings

• Reactive if FHR shows acceleration of at least 15 beats/min for 15 seconds, occurring twice in 20 minutes.
• Nonreactive requires follow-up testing such as CST or BPP.

Contraction Stress Test (CST)

• Indicated for high-risk pregnancies and nonreactive NST outcomes.

Client Presentation for CST

• Signs include decreased fetal movement, intrauterine growth restriction, and conditions such as diabetes or hypertension.

Nursing Actions for CST

• Obtain FHR baseline and monitor movements for 10-20 minutes pre-test.
• Use nipple stimulation to initiate contractions if needed.
• Educate the client about potential sensations during nipple stimulation.
• Monitor closely to avoid complications like tachysystole.

Amniocentesis Overview

• Procedure involves collecting amniotic fluid for analysis.
• Indicated when chromosomal anomalies or fetal disorders are suspected.

Nursing Actions for Amniocentesis

• Ensure bladder is emptied before the procedure to minimize risk of puncture.
• Maintain client comfort and monitor vitals during the process.
• Educate clients to anticipate slight pressure during needle insertion.

Interpretation of Amniocentesis Findings

• High alpha-fetoprotein levels suggest neural tube defects.
• Low levels may indicate chromosomal disorders like Down syndrome.

High-Risk Pregnancy Testing

Chorionic Villus Sampling (CVS)

• Conducted in the first trimester for earlier diagnoses of genetic issues.
• Risks include potential miscarriage and fetal limb loss.

Quad Marker Screening

• Blood test assessing risk for birth defects, not definitive diagnosis.
• Measures hCG, AFP, estriol, and inhibin A.

Maternal Serum Alpha-Fetoprotein (MSAFP)

• Screening tool for neural tube defects, preferably performed at 16-18 weeks.

Umbilical Sampling (Cordocentesis)

• Analyzes fetal blood for abnormalities, antibodies, and chromosome analysis.

Nursing Interventions and Client Education

• Provide emotional support and monitor fetal heart rate following procedures.
• Instruct clients to report concerning symptoms post-testing such as fever or decreased movement.