Screening and assessment of high-risk pregnancies involves identifying women at increased risk of complications through non-invasive tests like ultrasounds, NSTs and CSTs. Diagnostic tests then establish or rule out conditions and include invasive procedures like amniocentesis and cord blood sampling. Ultrasounds provide fetal images and assess growth while NSTs and CSTs monitor the fetal heart rate during rest and contractions. Amniocentesis analyzes amniotic fluid for genetic disorders while cord blood sampling draws fetal blood for similar tests when earlier methods were inconclusive. Both invasive procedures have a risk of miscarriage but can diagnose many conditions affecting the developing baby.
Post maturity, also known as post-term pregnancy, is defined as pregnancy continuing more than two weeks past the expected due date of 294 days or 42 completed weeks of gestation. The incidence of post-term pregnancy ranges from 4-14%, averaging around 10%. Potential causes include incorrect dating, biological variability, and maternal factors like primiparity or advanced maternal age. Diagnosis involves assessing menstrual history and clinical findings. Assessment of fetal maturity can be done through sonography, amniocentesis, or x-ray while fetal well-being is evaluated using tests like NST and biophysical profile. Complications for both mother and baby can include fetal hypoxia, meconium aspiration, labor dysfunction, and increased
The first stage of normal labour begins with the onset of true labour pains and ends with full dilatation of the cervix. For primi-gravida women this stage typically takes 12 hours, and for multi-gravida women it takes around 6 hours. Nursing care during this stage includes admission assessment, perineal care, monitoring contractions and vital signs, allowing rest and ambulation as tolerated, and shifting the patient to the delivery table once full dilatation is reached. Evidence shows that practices like ambulation during labour, support from a companion, and restricted vaginal exams and enemas can help make the first stage of labour safer and more comfortable.
A high risk pregnancy is one complicated by factors that adversely impact maternal or fetal outcomes. Initial screening considers maternal age and reproductive history, including prior miscarriages, preterm births, or babies with health issues. Medical disorders like infections, cardiac issues, and pre-eclampsia can also increase risk. Examinations evaluate uterine size and pelvic structure, while special tests may be needed. High risk pregnancies face greater risks of complications during labor, delivery, postpartum, and for the newborn. Care involves counseling, specialized antenatal and delivery management.
This document discusses the partograph, which is a composite graphical record used to monitor labor. It is used to assess the progress of normal and abnormal labor and the fetal response. The partograph allows providers to visualize cervical dilation over time and identify issues early. It includes components like maternal information, fetal well-being, labor progress, medications, and maternal condition. Using a partograph has benefits like early detection of problems, prevention of prolonged labor, and improved outcomes for mothers and babies.
Induction of labor involves initiating uterine contractions through medical, surgical, or combined methods to facilitate vaginal delivery after the fetus reaches viability. Common reasons for induction include preeclampsia, post-term pregnancy, premature rupture of membranes, and non-reassuring fetal status. It is important to confirm the indication for induction and rule out any contraindications. The document then discusses various methods for induction, including medical induction using prostaglandins or mifepristone, surgical induction through artificial rupture of membranes or membrane stripping, and combined methods. Risks of induction include iatrogenic prematurity and increased cesarean rates if induction fails. Proper patient counseling and assessment of cervical ripeness are important factors for
This document discusses obstetric forceps, which are metal instruments used to extract a baby's head during delivery. It describes different types of forceps and their proper application techniques. Forceps are indicated for prolonged second stage of labor, maternal distress, or fetal distress. Correct application involves inserting one blade along each side of the baby's head. Potential complications include laceration, hemorrhage, nerve injury, or problems for the baby such as skull fractures. Failure to deliver with forceps may require removal and assessment to determine if cesarean section is needed.
Breast engorgement occurs when milk production causes swelling and hardness in the breasts. It is usually caused by a delay in breastfeeding after milk comes in around 3-4 days postpartum. Symptoms include pain, swelling, redness, and difficulty latching. Treatment involves frequent breastfeeding or milk expression, applying hot or cold compresses, wearing a supportive bra, and in severe cases medications like pain relievers or drugs to reduce milk production. Preventing engorgement requires initiating breastfeeding early and frequently to empty the breasts regularly.
The human placenta is a discoid, haemochorial organ that develops during pregnancy to connect the developing fetus to the uterine wall for nutrient/waste exchange. At term, the placenta is a circular disc about 15-20cm in diameter and 2.5cm thick that weighs around 500g. It has both a fetal side covered by amnion/umbilical cord and a rough, spongy maternal side with lobes. The placenta facilitates gas/nutrient exchange between maternal and fetal blood supplied by the umbilical cord and establishes a connection between the mother and developing fetus.
This document provides information on postpartum maternal nursing assessments using the BUBBLE mnemonic. It describes assessing the breasts, uterus, bladder, bowels, lochia, Homan's sign, and episiotomy/perineum. For each component, it outlines what to evaluate, normal findings, teaching points for breastfeeding and bottle feeding, and warning signs. Nursing interventions are described to promote healing and prevent complications like infection or hemorrhage.
This document summarizes minor disorders that can occur in newborns. It defines a newborn as an infant from birth until 28 days old. It then describes and provides treatment recommendations for common minor issues newborns may experience such as stuffy nose, sticky eyes, skin rashes, oral thrush, jaundice, engorgement of the breast, vomiting, diarrhea, hiccups, sneezing, failure to pass urine or meconium, excessive crying, excessive sleepiness, caput succedaneum, umbilical granuloma, pink eye, baby acne, and genital issues. The document stresses the importance of not neglecting minor health problems in newborns.
This document discusses various destructive operations that can be performed on a dead fetus to facilitate delivery through the birth canal when the fetus is too large to pass intact. It defines destructive operations and describes their purposes. It then discusses different procedures like craniotomy, decapitation, evisceration, cleidotomy, and spondylectomy. For each procedure, it provides indications, prerequisites, steps to perform the procedure, and risks. It notes that most destructive operations are no longer recommended and have been replaced by caesarean section for safety reasons.
1) Cephalo-pelvic disproportion (CPD) occurs when the fetal head is too large to fit through the mother's pelvis, while a contracted pelvis has diameters smaller than normal.
2) Causes of contracted pelvis include nutritional deficiencies, injuries, diseases, and developmental defects. Contracted pelvises are classified based on architecture (e.g. flat) and degree of contraction.
3) Diagnosis involves history, examination, and pelvimetry. Management depends on degree of disproportion, and may include induction, trial of labor, or cesarean section. Complications can arise from prolonged labor. Close monitoring is needed during labor for those with CPD or contracted pel
This document discusses various tests used during pregnancy to monitor the health of the mother and fetus. It describes blood tests, ultrasounds, and non-stress tests that can detect issues like hypertension or abnormal fetal growth. For high-risk pregnancies, more invasive prenatal tests are discussed like amniocentesis, which analyzes amniotic fluid for chromosomal issues. The risks and procedures for these various medical tests are outlined to closely monitor pregnancy and fetal development.
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
This document discusses preconception care, including its definition, components, elements, benefits, and the role of midwives. Preconception care involves providing health interventions to women and couples before conception to detect risks, manage health conditions, promote nutrition and family planning. Key elements addressed include nutritional needs, genetic history, maternal age, environmental hazards and maternal history. The benefits of preconception care are reducing unintended pregnancy and birth defects, as well as promoting healthy behaviors and pregnancy outcomes. Midwives play an important role in educating and screening women to identify risks and plan interventions.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Many complications can occur during pregnancy and affect health of mother and fetus as well as outcomes. Hemorrhage is the first ten causes of maternal mortality and morbidity, affect about 32% of all maternal deaths. Abortion represents 4.5% of all maternal death. Many women do not understand the bleeding is abnormal and dangerous signs and they come late to health care facilities.
Pregnancies can be designated as high risk for any of several undesirable outcomes. In the past, risk factors were evaluated only from a medical standpoint. Therefore only adverse medical, obstetric,or physiologic conditions were considered to place the woman at risk. Today a more comprehensive approach to high-risk pregnancy is used, and the factors associated with high risk childbearing are grouped into broad categories based on threats to health and pregnancy outcome.
SCREENING
Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.
ASSESSMENT
Assessment is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations.
FETAL ULTRASOUND OR ULTRASONIC TESTING
Fetal ultrasound is a test done during pregnancy that uses reflected sound waves to produce a picture of a fetus camera.gif, the organ that nourishes the fetus (placenta), and the liquid that surrounds the fetus (amniotic fluid). The picture is displayed on a TV screen and may be in black and white or in color. The pictures are also called a sonogram, echogram, or scan, and they may be saved as part of your baby's record.
Genetics Series Prenatal Diagnosis.pptxMathew Joseph
This document provides information on various methods of prenatal diagnosis, including noninvasive, minimally invasive, and invasive methods. It focuses on amniocentesis and chorionic villus biopsy, describing their indications, processes, and disadvantages. Amniocentesis involves extracting amniotic fluid through the abdomen at 14-20 weeks gestation to test for genetic abnormalities. Chorionic villus sampling extracts placental tissue through the cervix or abdomen at 10-12 weeks for early genetic testing, but carries a higher miscarriage risk than amniocentesis. Both aim to detect conditions like Down syndrome but cannot find all structural defects.
Ultrasound is a widely used and safe imaging technique in obstetrics and gynecology. In obstetrics, it can diagnose pregnancies as early as 4-5 weeks and assess fetal growth and anatomy. It is used to detect fetal abnormalities, placental location, and amniotic fluid levels. Doppler ultrasound assesses fetal well-being. In gynecology, ultrasound evaluates ovarian reserve, pelvic masses, endometrial thickness, and guides invasive procedures. Other imaging techniques like MRI and CT provide additional anatomical details in certain conditions while x-rays are used to assess specific organ systems. Overall, ultrasound is a primary tool for evaluating the female reproductive system in both non-pregnant and pregnant patients.
This document provides information about amniocentesis, including:
1. Amniocentesis is a prenatal procedure used to detect chromosomal abnormalities in the fetus by examining the amniotic fluid and fetal cells.
2. It is usually performed between 16-22 weeks of pregnancy by extracting a small sample of amniotic fluid using a long needle guided by ultrasound.
3. The fluid contains fetal cells that are grown and analyzed to check for genetic disorders like Down syndrome or cystic fibrosis. Results usually take 1-3 weeks.
CHORIONIC VILLUS SAMPLING (CVS) Group Presentation.pptxRuvimboMarikano
Chorionic villus sampling (CVS) is a prenatal test performed between 10-14 weeks of pregnancy to obtain cells from the placenta for genetic testing. A small sample of cells is removed from the placenta, which shares the fetus's genetic makeup, using either a needle through the abdomen or a thin tube through the cervix under ultrasound guidance. CVS can provide early results within 1-2 weeks to test for genetic conditions and chromosomal abnormalities like Down syndrome, but it carries a small risk of miscarriage around 1-3%. While offering critical health information, CVS also raises ethical issues regarding informed consent, privacy, and potential psychosocial impacts.
Genetic screening involves testing individuals to identify those at higher risk of genetic disorders. It determines risk of having or passing on such disorders. There are three main types: prenatal screening of fetuses, carrier screening, and newborn screening. Prenatal screening uses techniques like amniocentesis, chorionic villus sampling, and ultrasound to detect fetal abnormalities. Carrier screening identifies risk of recessive disorders. Newborn screening tests for conditions like phenylketonuria. Genetic screening provides information but also risks anxiety and lack of treatments. It should only be performed when the condition is serious and diagnostic methods adequate.
Genetic testing allows for the diagnosis of genetic disorders and vulnerabilities to inherited diseases. There are several types of genetic tests including carrier screening, prenatal diagnostic testing, newborn screening, and diagnostic testing. Common diagnostic tests include ultrasonography, amniocentesis, chorionic villi sampling, and analysis of maternal serum markers. Genetic testing can help people take preventive measures but also carries risks like physical risks from invasive tests and emotional risks from results. Nurses play a role in ensuring informed consent, counseling, and maintaining privacy and confidentiality with genetic testing.
A high risk pregnancy is one with greater risks to the mother or fetus than an uncomplicated pregnancy. Factors that can increase risk include maternal age under 18 or over 35, weight under 55kg or over 85kg, smoking, alcohol use, pre-existing medical conditions, and prior pregnancy complications. Diagnosis may involve ultrasounds, blood tests, amniocentesis, chorionic villus sampling, or umbilical cord blood sampling to check for chromosomal abnormalities or other issues. The goals are to provide optimal care for both the mother and growing fetus and help the family understand and cope with the high risk situation.
Definition of Prenatal diagnosis
Importance of prenatal diagnosis
Risks factors associated with prenatal diagnostic techniques
Antenatal screening tests
Types of prenatal diagnostic tests
Complications associated with diagnostic tests
Invasive and non invasive techniques
Genetic screening involves testing samples of blood, tissue or fluid to check for genetic conditions or risks of transmitting genetic disorders. It can confirm suspected genetic disorders, help determine risk of developing or passing on disorders, and guide healthcare decisions. Common screening tests examine chromosomes from amniotic fluid or placental tissue, measure markers in maternal serum, or check for physical abnormalities via ultrasound. Screening helps manage pregnancies and plan for newborn health issues.
Prenatal diagnostic techniques allow for the diagnosis of genetic disorders in unborn babies. The two main invasive techniques are amniocentesis and chorionic villus sampling. Amniocentesis involves extracting amniotic fluid from the amniotic sac between 15-17 weeks using ultrasound guidance. Chorionic villus sampling involves sampling placental tissue between 10-12 weeks either through the abdomen or cervix. Both techniques carry risks of miscarriage but can detect chromosomal abnormalities with high accuracy.
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The document discusses various tests used to screen for cervical dysplasia and cancer, including the Pap test and liquid-based cytology. It explains that the Pap test collects cervical cells on a slide, while liquid-based cytology places cells in preservative liquid. Both aim to detect abnormal cell changes, but liquid-based cytology provides a more concentrated sample through laboratory processing. The document also outlines other conditions that can affect the cervix, such as infections, polyps, and cervicitis.
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Lecture on prenatal genetic diagnostic techniques and their value in detection of prenatal genetic anomalies. This lecture details techniques employed in the common diagnostic interventions used in prenatal period and their usefulness.
This document provides information about performing a gynecological examination. It discusses taking a patient history, including gynecological, medical, surgical, social, and family histories. It describes the positions a patient can be in for examination and the equipment needed, including speculums. Procedures covered include speculum examination, bimanual or rectal examination, Pap smear for cervical cytology, and colposcopy. The goal of examination is to make an accurate diagnosis to determine appropriate treatment or management.
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3. what is screening?
• Screening is a process of identifying
apparently healthy people who may be at
increased risk of a disease or condition.
• They can then be offered information, further
tests and appropriate treatment to reduce
their risk and/or any complications arising
from the disease or condition.
4. what is assessment?
• Assessment is a process for defining the
nature of that problem, determining a
diagnosis, and developing specific treatment
recommendations.
5. What is a diagnostic test?
• It is a test is to establish the presence (or
absence) of disease as a basis for treatment
decisions in symptomatic or screen positive
individuals (confirmatory test).
6. Diagnostic tests for high risk pregnancy
Noninvasive
• Fetal ultrasound or
ultrasonic testing
• Cardiotocography
• Non stress test (NST)
• Contraction stress test (CST)
invasive
• Chorionic villus sampling
• Amniocentesis
• Embryoscopy
• Fetoscopy
• Percutaneous umblical cord
blood sampling.
8. Fetal ultrasound or ultrasonic testing
• Fetal ultrasound is a test done during
pregnancy that uses reflected sound waves to
produce a picture of a fetus camera.gif, the
organ that nourishes the fetus (placenta), and
the liquid that surrounds the fetus (amniotic
fluid). The picture is displayed on a TV screen
and may be in black and white or in color. The
pictures are also called a sonogram,
echogram, or scan, and they may be saved as
part of your baby's record.
10. Fetal ultrasound camera is done to learn about the health
of the fetus. Different information is gained at different
times (trimesters) during your pregnancy.
1st-trimester fetal ultrasound is done to:
Determine how your pregnancy is progressing.
Find out if you are pregnant with more than 1 fetus.
Estimate the age of the fetus (gestational age).
Estimate the risk of a chromosome defect, such as Down
syndrome.
Check for birth defects that affect the brain or spinal cord.
11. • 2nd-trimester fetal ultrasound is done to:
• Estimate the age of the fetus (gestational age).
• Look at the size and position of the fetus, placenta, and amniotic
fluid.
• Determine the position of the fetus, umbilical cord, and the
placenta during a procedure, such as an amniocentesis camera.gif
or umbilical cord blood sampling.
• Detect major birth defects, such as a neural tube defect or heart
problems.
• 3rd-trimester fetal ultrasound is done to:
• Make sure that a fetus is alive and moving.
• Look at the size and position of the fetus, placenta, and amniotic
fluid.
13. cardiotocography
• cardiotocography (CTG) is a technical means
of recording (-graphy) the fetal heartbeat
(cardio-) and the uterine contractions (-toco-)
during pregnancy, typically in the third
trimester. The machine used to perform the
monitoring is called a cardiotocograph, more
commonly known as an electronic fetal
monitor (EFM).
15. Interpretation
interpretation of a CTG tracing requires both
qualitative and quantitative description of:
• Uterine activity (contractions)
• Baseline fetal heart rate (FHR)
• Baseline FHR variability
16. Non stress test
• A nonstress test is a common prenatal test used to
check on a baby's health. During a nonstress test, also
known as fetal heart rate monitoring, a baby's heart
rate is monitored to see how it responds to the baby's
movements.
• Typically, a nonstress test is recommended for women
at increased risk of fetal death. A nonstress test is
usually done after week 26 of pregnancy. Certain
nonstress test results might indicate that you and your
baby need further monitoring, testing or special care.
18. Contraction stress test
• A contraction stress test (CST) is performed
near the end of pregnancy to determine how
well the fetus will cope with the contractions
of childbirth. The aim is to induce contractions
and monitor the fetus to check for heart rate
abnormalities using a cardiotocograph.
20. Chorionic villus sampling
• Chorionic villi are small structures in the
placenta that act like blood vessels. These
structures contain cells from the developing
fetus. A test that removes a sample of these
cells through a needle is called chorionic villus
sampling (CVS).
22. • Cvs is a form of prenatal diagnosis to
determine chromosomal or genetic disorders
in the fetus. It entails sampling of the
chorionic villus (placental tissue) and testing it
for chromosomal abnormalities, usually with
FISH or PCR. CVS usually takes place at 10–12
weeks' gestation, earlier than amniocentesis
or percutaneous umbilical cord blood
sampling. It is the preferred technique before
15 weeks.
24. amniocentesis
• Amniocentesis is a test that can be done
during pregnancy to look for birth defects and
genetic problems in the developing baby.
• Amniocentesis removes a small amount of
fluid from the sac around the baby in the
womb (uterus). It is most often done in a
doctor's office or medical center. You do not
need to stay in the hospital.
25. • Amniocentesis is most often offered to women who are at
increased risk for bearing a child with birth defects. This includes
women who:
• Will be 35 or older when they give birth
• Had a screening test result that shows there may be a birth defect
or other problem
• Have had babies with birth defects in other pregnancies
• Have a family history of genetic disorders
• You may choose genetic counseling before the procedure. This will
allow you to:
• Learn about other prenatal tests
• Make an informed decision regarding options for prenatal diagnosis
• This test:
26. • Is a diagnostic test, not a screening test
• Is 99% accurate for diagnosing Down syndrome
• Is usually done between 14 and 20 weeks
• Amniocentesis can be used to diagnose many different
gene and chromosome problems in the baby, including:
• Anencephaly
• Down syndrome
• Rare, metabolic disorders that are passed down
through families
• Other genetic abnormalities, like trisomy 18
28. Embryoscopy
• Embryoscopy is the examination of the embryo at
9-10 weeks' gestation through the intact
membranes by introducing an endoscope into the
exocoelomic space transcervically or
transabdominally. This is likely to remain confined
to the management of early pregnancy in
selected families affected by recurrent genetic
syndromes with recognizable external fetal
abnormalities. The procedure-related risk of fetal
loss is around 12 per cent.
29. fetoscopy
• Fetoscopy is the examination of the fetus after 11
weeks' gestation. This is performed
transabdominally in the amniotic fluid. The
technique has evolved with the miniaturization of
the optical device by using fibre-optics
technology. This procedure is likely to find new
applications with the development of ultrasound
examination at 10-14 weeks' gestation in order
to, either confirm, or rule out suspected external
fetal abnormalities.
31. Percutaneous umblical cord blood
sampling
• Cordocentesis, also sometimes called Percutaneous Umbilical
Cord Blood Sampling (PUBS), is a diagnostic test that examines
blood from the fetus to detect fetal abnormalities.
• An advanced imaging ultrasound determines the location
where the umbilical cord inserts into the placenta. The
ultrasound guides a thin needle through the abdomen and
uterine walls to the umbilical cord. The needle is inserted into
the umbilical cord to retrieve a small sample of fetal blood.
The sample is sent to the laboratory for analysis, and results
are usually available within 72 hours.
• The procedure is similar to amniocentesis except the objective
is to retrieve blood from the fetus versus amniotic fluid.
32. • Cordocentesis is usually done when diagnostic information
can not be obtained through amniocentesis, CVS, ultrasound
or the results of these tests were inconclusive. Cordocentesis
is performed after 17 weeks into pregnancy.
• Cordocentesis detects chromosome abnormalities (i.e. Down
syndrome) and blood disorders (i.e. fetal hemolytic disease.).
Cordocentesis may be performed to help diagnose any of the
following concerns:
• Malformations of the fetus
• Fetal infection (i.e. toxoplasmosis or rubella)
• Fetal platelet count in the mother
• Fetal anemia
• Isoimmunisation