Maternal Nutrition and Drug Risks in Pregnancy

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Questions and Answers

What characterizes a reactive Non-Stress Test (NST)?

Three accelerations of 20 BPM lasting 20 seconds over a 15-minute period

One acceleration of 10 BPM lasting 10 seconds

No accelerations with fetal movement after 40 minutes

Two accelerations of 15 BPM lasting 15 seconds over a 20-minute period (correct)

What does a nonreactive Non-Stress Test (NST) imply?

The fetus is definitely hypoxic

The fetal heart rate is permanently low

Further assessments are needed, often with a Contraction Stress Test (CST) (correct)

The test must be repeated within 24 hours

During a Contraction Stress Test (CST), what observation indicates potential fetal hypoxia?

Late deceleration of fetal heart rate at the peak of a contraction (correct)

Acceleration of fetal heart rate during contractions

Consistent fetal heart rate with no disturbances

Increased blood flow through the uterus

What procedure is used to monitor fetal heart rate during a Non-Stress Test (NST)?

Electronic fetal monitor Signup and view all the answers

In a Non-Stress Test (NST), what indicates that the fetus has adequate oxygenation and an intact CNS?

Accelerations of fetal heart rate with movements Signup and view all the answers

What is a risk associated with insufficient maternal nutrition during pregnancy?

Development of spina bifida Signup and view all the answers

Which substance is specifically linked to Fetal Alcohol Syndrome (FAS)?

Alcohol Signup and view all the answers

Which of the following drug categories indicates that animal studies show fetal risk but lack human studies?

Category C Signup and view all the answers

Which complication is NOT associated with cocaine use during pregnancy?

Increased appetite Signup and view all the answers

What is a potential consequence of smoking during pregnancy?

Risk of cerebral palsy Signup and view all the answers

Which of the following substances is associated with decreased psychomotor performance in newborns?

Marijuana Signup and view all the answers

What is NOT a risk associated with the use of illegal drugs during pregnancy?

Higher birth rates Signup and view all the answers

What effect does maternal drug addiction have on infants?

Potential for seizures Signup and view all the answers

What is the primary purpose of chorionic villus sampling (CVS)?

To obtain a sample of placental tissue for genetic analysis Signup and view all the answers

How does an ultrasound distinguish between fluid and tissue?

Fluid is represented as dark, while tissue appears bright white Signup and view all the answers

Which of the following is NOT an indication for electronic fetal monitoring?

Healthy pregnancy Signup and view all the answers

What is the significance of monitoring fetal heart rate during electronic fetal monitoring (EFHM)?

To assess fetal well-being and timely detect fetal distress Signup and view all the answers

What is categorized as a normal fetal heart rate (FHR)?

110 – 160 bpm Signup and view all the answers

Which statement regarding transvaginal ultrasound is true?

It requires no need for bladder filling unlike transabdominal ultrasound Signup and view all the answers

What should be the first nursing intervention when non-reassuring fetal heart rate is detected?

Optimize maternal positioning Signup and view all the answers

When should a mother contact her healthcare provider regarding fetal movement?

When there are no fetal movements in the morning Signup and view all the answers

What characteristic of an ultrasound makes it advantageous for use in obstetrics?

It is a non-invasive and painless procedure with immediate results Signup and view all the answers

Which of the following actions should be taken if fetal tachycardia is detected for more than 10 minutes?

Elevate the head of the bed by 30 degrees Signup and view all the answers

During a transabdominal ultrasound, what position should the patient be placed in for optimal results?

On her back with a towel roll under one hip Signup and view all the answers

What can be identified through cardiotocography (CTG)?

Monitoring fetal heart rate accelerations and decelerations Signup and view all the answers

What is the recommended position for daily fetal movement counts?

Lying in a side-lying position Signup and view all the answers

What is the expected normal fetal heart rate range during monitoring?

110 – 160 bpm Signup and view all the answers

Which of the following can be a reason for decreased fetal movement?

Baby's sleep cycles Signup and view all the answers

Which imaging technique is used to evaluate fetal growth and amniotic fluid quantity?

Ultrasound Signup and view all the answers

What characterizes a positive contraction stress test (CST)?

Persistent late decelerations accompanying most contractions Signup and view all the answers

What defines hyperstimulation during a contraction stress test?

Contractions lasting longer than 90 seconds with late decelerations Signup and view all the answers

In which scenario would a contraction stress test be deemed unsatisfactory?

An inadequate uterine contraction pattern or bad tracing Signup and view all the answers

What is the correct protocol for nipple-stimulated contractions?

10-minute massage, then 2 minutes of break, repeated Signup and view all the answers

What is a critical consideration when interpreting a contraction stress test result?

A positive result shows increased risk for perinatal complications Signup and view all the answers

Study Notes

Inadequate Maternal Nutrition

Inadequate maternal nutrition can lead to learning disabilities in the child.
Folic acid is essential for the development of the fetal nervous system. A lack of folic acid could result in spina bifida.
Without proper nutrition during pregnancy, the baby may be born prematurely, weigh less than expected, have nervous system problems, and be more susceptible to illness.

General Risk Factors: Drugs

Over-the-counter drugs like aspirin can cause hemorrhaging during pregnancy.
Prescription drugs - always consult with a doctor before taking any prescription medications during pregnancy.
Alcohol consumption during pregnancy can lead to Fetal Alcohol Syndrome (FAS), which causes brain injury, growth impairment, facial deformities, congenital heart defects, short attention spans, and behavioral problems.
Cocaine use during pregnancy can lead to prematurity, neonatal intoxication and withdrawal symptoms (jitteriness, excessive crying, irritability), cerebrovascular problems, learning disabilities, and behavioral problems.
Narcotics can cause low birth weight, withdrawal symptoms, central nervous system damage, irritability, gastrointestinal dysfunction, and respiratory distress.
Marijuana use can lead to low birth weight, decreased psychomotor performance, impaired cognitive function, learning disabilities and deformities.
Smoking can cause to low birth weight, increased susceptibility to infections, increased mortality, cerebral palsy, malformations, developmental disabilities, and high risk of SIDS.

Illegal Drugs

Addiction can be passed on to the baby.
Low birth rate.
Premature delivery.
Risk of seizures.
Sudden Infant Death Syndrome.
Heart disease.
Stillbirth.
Stroke.
Brain damage.
Developmental delays.
Physical abnormalities.
Death.

Food & Drug Administration classification (FDA)

Category A: Controlled studies in humans demonstrated no fetal risk. Examples include prenatal vitamins, KCL, and Thyroxin.
Category B: Animal studies indicate no fetal risk; no controlled studies in humans. Examples include Penicillin, Antacids, Insulin, Ampicillin, and Metronidazole.
Category C: Animal studies indicate fetal risk; no human studies. These drugs are administered only when their benefits outweigh the potential fetal harm.

Chorionic Villus Sampling (CVS)

CVS is a prenatal test that can detect chromosomal abnormalities in the fetus.
Two methods are available:
- A biopsy needle is inserted through the abdominal wall and guided by ultrasound.
- A plastic catheter is inserted through the cervix and guided by ultrasound.

Ultrasound (U/S)

Ultrasound uses sound waves to create images of structures within the body.
Fluid appears dark, while tissue appears white.
Ultrasound can be performed abdominally or transvaginally.
Ultrasound can be used to: - Confirm pregnancy. - Determine gestation length. - Asses the placement and structure of the placenta. - Determine the baby’s gender. - Identify multiple pregnancies. - Detect anatomical abnormalities.
Ultrasound is a non-invasive and painless procedure.
Results are immediate.
Allows the mother and family to “see” the baby.

Ultrasound Nursing Care

Transabdominal Ultrasound:
- Ensure the patient has a full bladder.
- Place the patient on their back with a towel roll under one hip to improve blood flow to the placenta.
- The procedure takes approximately 20-30 minutes.
Transvaginal Ultrasound:
- Same as above except the bladder does not need to be full.

Electronic Fetal Monitoring- EFHM

Provides continuous data and is routinely used for high-risk clients.
The normal fetal heart rate is between 110-160 bpm.
EFHM can be performed externally or internally.
Assess for tachycardia or bradycardia.
Cardiotocography (CTG) is used during pregnancy to monitor the fetal heart rate and uterine contractions.
CTG is a valuable tool for monitoring fetal well-being and detecting fetal distress early.
Common patterns observed:
- Accelerations: temporary increases in fetal heart rate.
- Decelerations: temporary decreases in fetal heart rate. - Early Decelerations: occur before the peak of uterine contraction. - Late Decelerations: occur after the peak of the contraction. - Variable Decelerations: are abrupt, temporary drops in fetal heart rate. - Prolonged Decelerations: last longer than 2 minutes but less than 10 minutes.

Electronic Fetal Monitoring: Indications

Previous history of stillborn.
Presence of a pregnancy complication.
Induction of labor or preterm labor.
Decreased fetal movement.
Non-reassuring fetal status.
Meconium staining of amniotic fluid.
Trial of labor following a C-section.

Category 1 - Normal Fetal Heart Rate

Fetal Heart Rate: 110-160 bpm.
No late or variable decelerations.
May see early decelerations

Nursing Interventions for Non-reassuring Fetal Heart Rate

Considered when one or more of the following occur:
- Tachycardia or bradycardia for more than 10 minutes.
Optimize maternal positioning - side-lying preferred.
Discontinue oxytocin if indicated.
Give supplemental oxygen if indicated.
Notify the physician or midwife.
Administer IV fluids as needed.
Monitor maternal vital signs for hypotension and treat as necessary.
Elevate the head of the bed by 30 degrees.
Initiate continuous monitoring.
Provide explanation to the client and family.

Daily Fetal Movement Counts

Assessment of fetal activity by the mother.
Non-invasive, inexpensive, simple to understand, and does not interfere with routine at home.
Daily record beginning at 27 weeks gestation.
Count at the same time each day (ideally after meals).
Lie in a side-lying position.
Contact the health care provider when:
- Fewer than 10 movements in 2 hours using the daily movement record.
- No fetal movement in the morning.
- Fetal movements become slower.
Healthy babies have sleep cycles. If the baby doesn't seem to kick, or kicks less than usual, drink a glass of fluid or walk for 5 minutes to wake up the baby and repeat the kick count.

Fetal Movement Counts (Kick Counts)

The evaluation may include:
- Ultrasound: to evaluate the growth of the baby, amniotic fluid quantity, placenta, blood flow pattern, etc.
- Non-stress test (NST): Baby's heart rate monitoring in response to its movements.
- Contraction stress test (CST): Baby’s heart rate monitoring in response to uterine contractions

Non-Stress Test (NST) -Evaluation of Fetal Status

Observation of fetal heart rate associated with fetal movement.
With movement of the fetus, the fetal heart rate should increase, or accelerate.
This test is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are accelerations of fetal heart rate with movement.

Procedure for the NST

Electronic fetal monitor is applied.
Fetal movements are documented as the test is performed.
Compare the fetal heart rate with fetal movements.
Results:
- Reactive: Two accelerations of 15 beats per minute (BPM) lasting 15 seconds, over a 20-minute period associated with fetal movement. This is an indication of fetal well-being.
- Nonreactive: If the test does not meet the criteria after 40 minutes, further assessments are needed with a CST.

Non-Stress Test (NST)

Example of a nonreactive NST: There are no accelerations of fetal heart rate with fetal movement. The baseline fetal heart rate is 130 beats per minute.

Contraction Stress Test (CST)

Uterine contractions decrease uterine blood flow and placental perfusion. If this decrease is sufficient to produce fetal hypoxia, a deceleration in fetal heart rate will result, beginning at the peak of the contraction and persisting after its conclusion (late deceleration).
Two methods for stimulating contractions:
- Nipple-Stimulated: 10 min massage, 2 min massage followed by 5 min break.
- Oxitocin-Stimulated: 10 U in 1000 ml fluid IV.

CST

NEGATIVE: No late decelerations, with a minimum of three uterine contractions lasting 40 to 60 seconds within a 10-minute period.
POSITIVE: Persistent and consistent late decelerations occurring with more than half of contractions.
- A positive test result indicates that the fetus is at increased risk for perinatal morbidity and mortality. The physician may perform a vaginal birth after successful induction or proceed directly to a cesarean birth.
HYPERSTIMULATION: Late decelerations occurring with excessive uterine activity (contractions more often than every 2 minutes or lasting longer than 90 seconds) or persistent increase in uterine tone.
UNSATISFACTORY: Inadequate uterine contraction pattern or tracing too poor.

Contraction Stress Test (CST) Example

Example of a positive contraction stress test (CST): Repetitive late decelerations occur with each contraction. Note that there are no accelerations of fetal heart rate with three fetal movements. The baseline fetal heart rate is 120 beats per minute. Uterine contractions occurred four times in 12 minutes.

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Description

This quiz explores the impact of inadequate maternal nutrition and drug use during pregnancy on fetal development. Learn about the essential nutrients needed, the consequences of deficiencies, and the risks associated with common medications and substances. Understand how these factors can affect the health and wellbeing of both mother and child.