ANTEPARTUM

DIAGNOSTIC
TESTING
ANTEPARTUM DIAGNOSTIC
TESTING
 The usual schedule for antepartum health care visits is every
4 weeks for the first 28 to 32 weeks, every 2 weeks from 32
to 36 weeks, and every week from 36 to 40 weeks
A. Blood type and Rh factor

 ABO typing is performed to determine the woman’s blood type in the

ABO antigen system.
 Rh typing is done to determine the woman’s blood type in the rhesus
antigen system. ( Rh positive indicates the presence of the antigen:
Rh negative indicates the absence of the antigen
 If the client is Rh negative and has anegative antibody screen, the
client will need repeat antibody screens and should receive Rho (D)
immunoglobulin (RhoGAM) at 28 weeks of gestation.
 The client will also requireRhoGAM within 72 hours after delivery if
the infant is Rh positive.
 RhoGAM may also be prescribed following termination of pregnancy:
such as following a miscarrige
B. Complete blood cell ( CBC)
count levels
 White blood cells ( WBC) can be slightly increased during pregnancy
 Leukocytosis can be a normal finding in pregnancy.
 Hemoglobin and hematocrit levels decline during gestation as a result
of increased plasma volume.
 A decrease in the hemoglobin level to less than 10g/dl ( 100mmol/L )
or in the hematocrit level to less than 30% indicates anemia.
C. Glucose challenge test (GCT)

 Screening for gestational diabetes mellitus begins at the initial

prenatal visit and is diagnosed by a fasting blood glucose greater
than 126mg/dl (7.0 mmol/L) HbA1c greater than 6.5% or a random
plasma glucose level greater than 200mg/dl ( 11.1 mmol/L ) then
subsequently confirmed by another elevated fasting glucose level
or HbA1c. The glucose challenge test is performed between 24
and 28 weeks gestation.
 According to the American Congress of Obstetricians and
Gynecologist (ACOG) a GCT using a two- step approach should be
used in screening for gestational diabetes mellitus (GDM)
 A 50-g oral glucose load without regard to time of day is given.
After 1 hour a plasma or serum glucose level is drawn and is
considered elevated if it is greater than 140 mg/dl ( 7.8 mmol/L): a
3- hour GCT may also be done.
Glucose challenge test (GCT)

 If the 3- hour GCT is above 130 to 140 mg/dl. ( 7.2 to 7.8

mmol/L), it is considered a positive result and be indicative
of GDM.
 It is important to note that the GCT has 86% sensitivity and
some false positives may be noted.
D. URINALYSIS AND URINE
CULTURE
 A urine specimen for glucose and protein determinations
should be obtained at every antepartum visit.
 Glycosuria is a common result of decreased renal threshold
that occurs during pregnancy.
 If glycosuria persist, it may indicate diabetes.
 White blood cells in the urine may indicate infection.
 Ketonuria may result from insufficient food intake or
vomiting.
 Levels of 2+ to 4+ protein in the urine may indicate infection
or pre eclampsia.
E. ULTRASONOGRAPHY

 Outlines and identifies fetal and birthing parent structures

 Assists in confirming gestational age and estimated date of
delivery and in evaluating amniotic fluid volume ( amniotic
fluid index), Which is done via special measurements
 Maybe done abdominally or transvaginally during pregnancy.
 Can be used to determine the presence of premature dilation
of the cervix ( incompetent cervix), A transvaginal ultrasound
is used during the first trimester to check the length of the
cervix.
INTERVENTIONS:

 If an abdominal ultrasound is being performed, the client may

need to drink water to fill the bladder before the procedure to
obtain a better image of the fetus.
 If a transvaginal ultrasound is being performed. A lubricated
probe is inserted into the vagina.
 The client should be informed that the test presents no
known risks to the client or the fetus.
F. DOPPLER BLOOD FLOW
ANALYSIS
 Non invasive ( ultrasonography) method of studying the blood
flow in the fetus and placenta.
G. CHORIONIC VILLUS
SAMPLING
 Performed for the purpose of detecting genetic
abnormalities; The PHCP aspirates a small sample
of chorionic villus tissue at 10 to 13 weeks of
gestation.
 a prenatal diagnostic procedure used to detect
genetic disorders in a developing fetus
 small tissue sample from the placenta, specificaly
the chorionic vili, which contain fetal genetic material
INTERVENTIONS:

 Ensure informed consent was obtained.

 The client may need to drink water to fill the bladder before
the procedure to aid in the visualization of the uterus for
catheter insertion.
 Obtain baseline vital signs and fetal heart rate; Monitor
frequently after the procedure.
 Rh- negative individuals may be given Rho(D) immune
globulin, because chorionic villus sampling increases the risk
of Rh sensitization
 After the procedure, the client is instructed to rest for 24
hours and to avoid exercise, Heavy lifting, and sexual
intercourse for the amount of time prescribed.
H. AMNIOCENTESIS:

 Aspiration of amniotic
fluid by insertion of a
needle into the abdomen,
guided with ultrasound
imaging
 best performed between
15 and 20 weeks of
pregnancy because:
(amniotic fluid volume is
adequate and many viable
fetal cells are present in
the fluid by this time).
 Performed to determine
genetic disorders,
metabolic defects, and
fetal lung maturity,
Risk factors:

 Hemorrhage in the birthing parent

 Miscarriage
 Fetal injury
 Infection
 Rh isoimmunization
 Abruptio placentae
 Amniotic fluid emboli
 Premature rupture of the membranes
INTERVENTIONS:

 Ensure that informed consent was obtained.

 If the procedure is performed at less than 20 weeks of
gestation, the client should have a full bladder to support the
uterus . If performed after 20 weeks of gestation, the client
should have an empty bladder to minimize the chance of
puncture.
 Prepare the client for ultrasonography, which is performed to
locate the placenta and avoid puncture.
 Obtain base line vital signs and fetal heartrate: monitor
every 15 minutes.
 Position the client supine during the examination and on the
left side after the procedure.
I. BIOPHYSICAL PROFILE:
 Non invasive assessment of the
fetus using ultrasound and
electronic fetal monitoring
( EFM) that includes fetal
breathing movement, fetal
movements, amniotic fluid
index, and fetal heart rate
patterns via nonstress test
 Normal fetal biophysical
activities indicate that the
central nervous system is
functional and that the fetus is
not hypoxemic
 Scoring System:
Body MOVEMENT, MUSCLE TONE;
BREATHING MOVEMENTS &
AMNIOTIC FLUID VOLUME
I. BIOPHYSICAL PROFILE:
 high risk or goes beyond 40 weeks. They may also suggest a biophysical
profile if you have any of the following conditions:
 Hypertension, Lupus, renal disease or Thrombocytopenia.
 There's a decrease in the fetus’ movements.
 Previous stillbirth or other negative pregnancy outcomes.
 Expecting multiples (twins or triplets)
 Pregnancy-related hypertension (high blood pressure) or preeclampsia.
 Possible intrauterine growth restriction. (The fetus is measuring smaller
than average.)
 Diabetes before pregnancy or diabetes associated with pregnancy
(gestational diabetes).
 Too much or too little amniotic fluid.
 You're Rh negative.
 You’re 35 or older at the time of delivery.
 You have obesity (a body mass index or BMl, of 30 or higher).
 J. DEOXYRIBONUCLEIC ACID
( DNA) GENETIC TESTING
 Can be used to detect abnormalities related to an
inherited condition.
 Assists in determining if the client is at risk for
having a fetus with down syndrome ( trisomy 21).
Edward’s syndrome ( trisomy 18). Or Pataus
syndrome ( trisomy 13 )
 Prenatal genetic testing is commonly performed on
maternal blood can be done as early as 7 weeks of
gestation.
INTERVENTIONS:

 This type of testing can be done as early as 7 weeks of

gestation, and a blood sample is used.
H. NONSTRESS TEST
H. NONSTRESS TEST

 A prenatal non-stress test (NST) is a common test done

before birth (prenatal). It is used to ensure the health of the
fetus before labor. The test assesses fetal heart rate and
movement after 28 weeks of gestation but usually is done
later in the third trimester.
 Test is performed to assess placental function and
oxygenation.
 Test determine fetal being.
 Test evaluates the fetal heart rate (FHT) response to fetal
movement.
INTERVENTIONS:

 An external ultrasound transducer and tocodynamometer are

applied to the client,20 minutes duration is obtained so that
the FHT and uterine activity and tracing of at least can be
observed.
 Baseline blood pressure is obtained, and blood pressure is
monitored frequently.
 The client is placed in the lateral ( sidelying) position to avoid
vena cava compression.
 The client maybe asked to press a button every time the
client feels fetal movement: the monitor records a mark at
each point of fetal movement, which is used as a reference
point to assess the FHT.
RESULTS:

 Reactive Non stress test (normal, negative)

 “REACTIVE” indicates a healthy fetus.
 The result requires 2 or more FHR accelerations of at least 15
beats per minute, lasting at least 15 seconds from the
beginning of the acceleration to the end, in association with
fetal movement, during a 20 minute period.

 NON REACTIVE NONSTRESS TEST (Abnormal)

 No accelerations or accelerations of less than 15 beats per
minute or lasting less than 15 seconds in duration occur
during a 40 minute observation.
RESULTS:

 UNSATISFACTORY
 The result can not be interpreted because of the poor quality
of the FHR tracing.
I. CONTRACTION STRESS TEST
 Test assess placental oxygenation and
function.
 Test determines fetal ability to tolerate
labor and determines fetal well being.
 Fetus is exposed to the stress of
contractions to assess the adequacy of
placental perfusion under simulated
labor conditions.
 Test is performed if it is believed that
the fetus needs to be delivered and the
fetal ability to tolerate labor is unclear
due to failed non stress test.
INTERVENTIONS:

 External fetal monitor is applied to the client, and a 20 – to 30

minute baseline strip is recorded.
 The uterus is stimulated to contract by the administration of
a dilute dose of oxytocin or by having the client use nipple
stimulation until three palpable contractions with a duration
of 40 seconds or more in a 10minute period have been
achieved.
 Frequent blood pressure readings are done, and the client is
monitored closely while increasing doses of oxytocin are
given.
RESULTS:

 NEGATIVE CONTRACTION STRESS TEST ( NORMAL)

 A negative result is presented by no late decelerations of the fetal
heart rate (FHT)

 POSITIVE CONTRACTION STRESS TEST (ABNORMAL)

 A positive result is presented by late decelerations of the FHT, with
50% or more of the contractions in the absence of hyperstimulation
of the uterus
OBSTETRICAL PROCEDURES

 A. AMNIOTOMY
 Artificial rupture of the membranes is performed by the obstetrician
or nurse – midwife to stimulate labor
 Amniotomy is performed if the fetus is at 0 or a plus station.
 Amniotomy increases the risk prolapsed cord and infection
 Monitor FHT before and after amniotomy
 Record time of amniotomy, FHT and characteristics of fluid.
 Meconium-stained amniotic fluid may be associated with fetal
distress.
 Bloody amniotic fluid may indicate abruptio placenta or fetal
trauma.
 An unpleasant odor to amniotic fluid is associated with infection.
OBSTETRICAL PROCEDURES
 A. AMNIOTOMY
AMNIOTOMY

 Polyhydramios is associated with maternal diabetes and

certain congenital disorders.
 Oligohydramios- is associated with intrauterine growth
restriction and congenital disorders.
 Expect more variable decelerations after rupture of the
membranes as a result of possible cord compression during
contractions.
 Limit client activity if prescribed.
B. EPISIOTOMY

 An episiotomy is an incision made into the perineum to

enlarge the vaginal outlet and facilitate birth.
 The use of this procedure has declined dramatically in recent
years.
 Check the episiotomy site.
 Institute measures to relieve pain.
 Provide ice packs during the first 24 hours.
 Instruct the client in the use of ice pack for the first 24 hours,
and then sitz baths thereafter.
 Apply analgesics spray or ointment as prescribed.
 Provide perineal care, using clean technique.
B. EPISIOTOMY

 Instruct the client to dry the perineal area from front to back
and to blot the area rather than wipe it.
 Instruct the client in the proper care of the incision.
 Instruct the client to shower rather than bathe in a tub.
 Apply a perineal pad without touching the inside surface of
the pad.
 Report any bleeding or discharge from the episiotomy site to
the PHCP.
C. FORCEPS DELIVERY
C. FORCEPS DELIVERY

 Two double crossed, spoon like articulated blades are used to

assist in the delivery of the fetal head.
 Reassure the client and explain the need for forceps.
 Monitor client and fetus during delivery.
 Check the neonate and the client after delivery for any
possible injury.
 Assist with repair of any lacerations
D. VACUUM EXTRACTION
D. VACUUM EXTRACTION

 A cap like suction device is applied to the fetal head to

facilitate contraction.
 Suction is used to assist in delivery of the fetal head.
 Traction is applied uterine contractions until descent of the
fetal head is achieved.
 The suction device should not be kept in place any longer
than 25 minutes.
 Monitor for developing cephallhematoma.
 Caput succedaneum is normal and resolves in 24 hours.
H. CESAREAN DELIVERY
 CESAREAN SECTION – is delivery of the fetus usually through
a transdominal, low segment incision of the uterus
 Pre – operative nursing care
 Post operative nursing care

 Cesarean section, C-section, or cesarean birth is the surgical

delivery of a baby through a cut (incsion) made in the birth
parent’s abdomen and uterus. Healthicare providers use it
when they believe it’s safer for the birth parent, the baby, or
both.
 The incsion made in the skin may be:
Up-and-down (vertical).
Across from side-to-side (horizontal).
H. CESAREAN DELIVERY
 Several conditions make a cesarean delivery more likely, These
include:
 Abnormal fetal heart rate.
 Abnormal position of the fetus during birth.
 Problems with labor.
 Size of the fetus.
 Placenta problems.
 Certain conditions in the mother, such as diabetes, high
bloodpressure, or HIV infection
 Active herpes sores in the mother's vagina or cervix
 Twins or other multiples
 Previous C-section