Prenatal Lab Tests and Discomforts During Pregnancy
IMPORTANT: Rh Factor of mother and baby through indirect Coombs test. If mom is Rh
negative and baby
... [Show More] is Rh positive, causes mom to build up antibodies that may not affect this
pregnancy but WILL attack the next baby’s RBC’s causing them to lyse.
If mom is Rh negative and baby Rh positive: Repeat Coombs test at 24-28 weeks. Rhogam will
be administered at 28 weeks gestation, which prevents the development of antibodies.
Group B Streptococcus: will be checked by taking a vaginal and anal culture around 35-37
weeks gestation.
One-hour glucose tolerance test done at 24-28 weeks gestation. No fasting required, if results
come back over 140, requires a follow-up 3-hour glucose tolerance test: fasting is required.
Maternal serum alpha-fetoprotein: Taken at 15-22 weeks gestation, screens for Down
Syndrome of neural tube defects. If LOW: could mean down syndrome. If HIGH: Neural tube
defect.
Other: CBC, Rubella titer, HIV, Hepatitis B, HPV, STI’s (gonorrhea, chlamydia, syphilis), PPV
(check for TB), TORCH infections, and urinalysis Expected Discomforts:
- N/V: usually in first trimester. Eat dry toast or crackers in the morning before getting
up
- Urinary frequency: Empty bladder frequently, use Kegel exercises if stress
incontinence’
- UTI’s: Notify if foul smelling or cloudy urine
- Heartburn: Advice to eat small, frequent meals, sit up for at least 30 minutes after
eating
- Fatigue and difficulty breathing: Take frequent rest periods
- Constipation: Increase intake of fluid and fiber
- Hemorrhoids: Use warm Sitz baths, witch hazel pads
- Varicose veins: elevate legs, were compression hose, walk frequently, and avoid
standing
- Gingivitis, indigestion, and epistaxis (nose bleed): Good oral hygiene, NS spray
Nutrition, Weight Gain, and PKU Weight Gain:
- Normal weight: total 25-35 pounds. 1st: 2-4lbs. 2nd and 3rd: 1lb per week - Obese:
15-25lbs.
- Underweight: 28-40lbs.
Calories: No additional calories needed during first trimester.2
2nd trimester: extra 340 calories per day
3rd trimester: extra 460 calories per day
Breastfeeding: extra 450-500 calories per day
Nutrition:
FOLIC ACID (IMPORTANT): Prevents neural tube defects. Recommended: 600mcg per day.
Increase protein intake, possibly iron supplements (vitamin C increases absorption), calcium
1000mg per day (bone and teeth formation, vitamin D increases absorption). Fluid intake (2-3L
per day). Caffeine reduced (200mg per day). NO alcohol.
Phenylketonuria (PKU): A genetic disease that causes amino acid Phenylalanine to build up in
body which can cause a risk for birth defects in the fetus.
IMPORTANT teaching: Adhere to PKU diet 3 months prior to pregnancy and throughout
pregnancy. Needs frequent blood Phenylalanine drawn.
PKU diet: Very low in protein. Avoid: No meat, fish, poultry, nuts, eggs, or dairy.
Ultrasound, BPP, NST, and CST
Ultrasound: Noninvasive: Confirm pregnancy, site of implantation, assess baby growth and
development and movement.
Teaching: Have mom drink a full quart of water prior to procedure to better reflect sound waves.
Biophysical Profile: Uses real time ultrasound technology to assess for fetal well-being. Score
of 0-10. 8-10 = normal; less than 8 = fetal asphyxia due to insufficient oxygen. FIVE areas:
reactive fetal heart rate, fetal breathing movements, gross body movements, fetal tone, and
amniotic fluid volume.
Non-Stress Test: Non-invasive test that measures fetal HR response to fetal movement. Done in
3rd trimester, acoustic vibration device may help awaken fetus or orange juice. Mom pushes
button when she feels movement, provider assesses HR during movement to see if increasing
when moving. Preformed when mom reports decreased fetal movement, diabetes, gestational
HTN, or post-maturity.
Results (IMPORTANT): Reactive: normal finding (HR normal rate, moderate variability, and
accelerates at least 2 times in a 20-minute time period). Non-reactive: Abnormal finding, fetal
HR does not accelerate sufficiently with fetal movement further assessment is needed
Contraction Stress Test: Done after Non-stress test is abnormal or high risk pregnancy. More
invasive, help measures fetal HR in response to contractions. Done through nipple stimulation or
oxytocin to induce contractions.3
Results (IMPORTANT): Negative result: Normal finding, no late decelerations with 3
contractions within a 10-minute period. Positive result: Abnormal finding, late decelerations are
present for 50% or more of contractions. Can indicate uteroplacental insufficiency.
Complications: per-term labor
Amniocentesis, CVS, Abortion/Miscarriage, and Ectopic Pregnancy
Amniocentesis: Invasive test to test for chromosomal abnormalities and fetal lung maturity.
Amniotic fluid is aspirated under ultrasound guidance, performed after 14 weeks gestation.
Results: Looking for levels of alpha-fetoprotein, LS ratio (2:1 = fetal lung maturity)
Care: Empty bladder prior to procedure, after: administer Rhogam to Rh negative moms,
encourage lots of fluid and rest for next 24 hours.
Complications: Amniotic fluid emboli, hemorrhaging, infection, leakage of amniotic fluid,
premature rupture of membranes, miscarriage.
Chorionic Villus Sampling: Portion of placenta is aspirated through a catheter to assess for
chromosomal abnormalities. Done between 10-13 weeks gestation. It can be done early!
Complications: chorioamnionitis (infection of amniotic fluid and membrane), premature rupture
of membranes, miscarriage.
Spontaneous abortion: before 20 weeks gestation
- Threatened: spotting, no tissue passed, cervix is closed. Fetus can survive this
- Inevitable: mild to severe bleeding, no tissue is passed, cervix is dilated and tissue
bulging. Abortion will occur.
- Incomplete: Severe bleeding, partial fetal tissue past, cervix is dilated
- Complete: minimal bleeding, complete fetal tissue passed, cervix is closed
Inevitable and incomplete require surgery to clear out contents. DNC procedure, prostaglandins
and oxytocin can help remove
Ectopic Pregnancy: fertilized ovum is implanted in fallopian tube instead of uterus. Very
dangerous for tube rupture and fatal hemorrhaging. S/S (IMPORTANT): Unilateral stabbing
pain in LLQ or RLQ, vaginal spotting and bleeding, referred shoulder pain (when ruptured),
hemorrhaging (low BP, tachycardia, and pallor)
Procedures: Salpingectomy (removal of fallopian tube) or give methotrexate to help dissolve
pregnancy and preserve fallopian tube.
Trophoblastic Disease, Placenta Previa, and Abruptio Placenta
Gestational Trophoblastic Disease: (Molar pregnancy). Abnormal growth of trophoblastic villi
in the placenta. Look like grape-like clusters. Prevent embryo from developing and can lead to
choriocarcinoma which is a type of cancer.4
S/S (IMPORTAMT): Dark brown bleeding, N/V. abnormally high hcg levels
Diagnose: ultrasound
Treatment: evacuation of the mole via cartage or chemo therapy.
Placenta Previa: Placenta implants on or near the cervical os vs attaching to fundus at the top.
This results in BRIGHT red bleeding during the 3rd trimester.
Types:
- Complete: covers entirely
- Incomplete: covers part of it
- Marginal or low-lying: Attaches to lower uterus but does not cover at all
S/S: Painless, bright red bleeding in 2nd or 3rd trimester, decreased hematocrit (37-48) and
hemoglobin (12-15.5) levels
Nursing care (IMPORTANT): Do not perform vaginal examinations or insert anything
vaginally, administer IV and blood products as prescribed, educate on bed rest, and if delivery
anticipated:
give corticosteroids to promote fetal lung growth.
Abruptio Placenta: Premature separation of the placenta from the uterus usually in 3rd trimester.
High risk form mom and baby morbidity and mortality.
Risk factors: HTN, trauma, cocaine use, smoking
S/S: intense uterine pain with dark red bleeding, decreased hematocrit (37-48) and hemoglobin
(12-15.5) levels, signs of hypovolemic shock (hypotension, tachycardia, pallor), fetal distress
Nursing care: Administer IV fluids and blood products, oxygen, corticosteroids. [Show Less]