Hemorrhagic Conditions

First-half of pregnancy

–   Abortion

–   Ectopic Pregnancy

–   Gestational Trophoblastic Disease

Hemorrhagic Conditions

Second-half of pregnancy

–   Placenta previa

–   Abruptio placentae

Abortion

Termination of pregnancy before the 20^th week. 

Abortion 

Threatened:

bleeding or cramping, no tissue,

occures in 20% of all pregnacys

Abortion

Incomplete: 

Abortion

Complete: 

Abortion

Missed: 

fetus dies but is still retained

Abortion

Recurrent pregnancy loss

3 or more 

take a baby aprine so help next pregnacy

Abortion

Imminent: 

Abortion

Septic: 

Assessment

–   VS # 1

–   Bleeding

–   Level of comfort

–   General health

–   FHTs

Abortion

Nursing Interventions

l Treatment

–   Outpatient: BR, no intercourse, sedation

–   Hospitalization: IV, D&C, induction

–   RhoGAM

Abortion

Nursing Interventions

Diagnosis

–   Ultrasound

–   hCG

Ectopic Pregnancy (EP)

l Implantation other than the endometrial lining of the uterus

–   Most common: ampulla of fallopian tube

Ectopic Pregnancy (EP)

Causes

–  PID–   Tubal surgery–   Congenital anomalies of the tube–   Endometriosis–   Previous EP–   IUD

Ectopic Pregnancy (EP)

Nursing Interventions

Assessment

–    Pain–    Bleeding–    VS

–    Progesterone levels–    hCG levels

–    Ultrasound

Ectopic Pregnancy (EP)

Nursing Interventions

l  Diagnosis

–    LMP

–    Pelvic Exam

Ectopic Pregnancy (EP)

Nursing Interventions

l  Treatment

–    Medical: methotrexate

–    Surgical: Laparoscopic l salpingostomy

l Laparoscopic salpingectomy

–    Rhogam

Gestational Trophoblastic Disease

Hydatidiform mole

–   Abnormal development of placenta (fluid-filled, grapelike cluster)

–   Trophoblastic tissue proliferates

50% of pt's with this will get cancer gose to the lungs

can not get prego for atlest one year to scan for ↑ HCG

Gestational Trophoblastic Disease

 Hydatidiform mole

Complete:

 Empty egg

Gestational Trophoblastic Disease

Hydatidiform mole

Partial:

Gestational Trophoblastic Disease

Invasive mole

Gestational Trophoblastic Disease

Choriocarcinoma

–   Malignant, associated with complete mole

Assessment

–   Bleeding

–   Uterine enlargement

–   Hyperemesis gravidarum

–   PIH prior to 24 weeks gestation

–   No FHT or fetal movement

–   hCG levels 4x the norm

Gestational Trophoblastic Disease

Nursing Interventions

 Diagnosis

–   Hydropic vesicles

–   hCG levels 4X the norm

–   Transvaginal ultrasound

Gestational Trophoblastic Disease Nursing Interventions

Treatment

–   Chest x-ray–   hCG levels–   D&C–   Prevent pregnancy

–   Rhogam

Incompetent Cervix

Premature dilation of cervix

Incompetent Cervix

causes

–   Cervical trauma–   Infection

–   Congenital cervical or uterine anomalies

–   Increased uterine volume

Incompetent Cervix

Diagnosis

–   Hx of relatively painless repeated 2^nd trimester abortions

Incompetent Cervix

Treatment

 Cerclage

Premature Rupture of Membranes

l prior to onset of labor

Premature Rupture of Membranes

Premature Rupture of Membranes

Maternal risk

Infection, abruptio placentae

Premature Rupture of Membranes

Fetal implications

–   RDS (PPROM), sepsis, malpresentation, prolapsed cord, ↑ morbidity & mortality

Premature Rupture of Membranes

Nursing Interventions

 Assessment

–   Duration of ROM

–   S/S of infection

–   Uterine activity & FHTs

Premature Rupture of Membranes

Nursing Interventions

 Diagnosis

–   Sterile speculum exam: pooling,

(ferning # 1 way to comferm)

nitrazine

Premature Rupture of Membranes

Nursing Interventions

 Treatment

Infection: abx and–   delivery

–  

No infection: conservative:

l Prophylactic Abx X 48 hours

l BR, CBC, UA, NST, VS

l Corticosteroids

Betamethasone

Purpose: 

Betamethasone

Route:

Betamethasone

Dose: 

l 12 mg 

Betamethasone

Frequency: 

Q24 hours x2 

Betamethasone

l Contraindications

–   Adequate L/S ratio,   rule out infection before giving, use with caution in DM,   Gestation age >34 weeks

Betamethasone

 Maternal Side effects

–   Hyperglycemia, pulmonary edema

Betamethasone

Effects on Fetus or Neonate

Hypoglycemia, sepsis

Betamethasone

l Nursing Considerations

–   Give deep in gluteal muscle

it will absorb fastest in this injection sight

Preterm Labor

l Labor that occurs between 20 & 37 weeks gestation

Preterm Labor

Risk factors–   Nonrecurrent

l placenta previa, abruptio placentae, hydramnios, 2^nd trimester bleeding, fetal anomaly or death

Preterm Labor

Risk factors

–   Recurrent or treatable factors

 genital tract infection, incompetent cervix, uterine malformations, uterine fibroids, low socioeconomic status, limited prenatal care, poor nutritional status, low prepregnancy weight, tobacco or drug use, occupation or work requirement, sexual activity, anemia

Preterm Labor

Risk factors–   Recurrent but not treatable

 hx PTL, race, DES exposure

Preterm Labor

Nursing Interventions

l  Assess for Signs and Symptoms

–    UC’s q 10 minutes, menstrual-like cramps, pelvic pressure, ROM, backache, change in vaginal discharge, abdominal cramping

Preterm Labor

Nursing Interventions

–    Screening Tests

l FFN-fetal fibronecton -proten that helps keep cervix shut. if levels ↓ causes preterm labor

l Transvaginal ultrasound

Preterm Labor

Nursing Interventions

l  Diagnosis

–    Documented UC’s 6-8/hour; Cervical change of 1cm or more; Cervical effacement of 80% or more

Preterm Labor

Nursing Interventions

l  Treatment

–    BR, VS, continuous FHTs and uterine contractions

–    Tocolysisl B-adrenergic agonists: terbutaline

l MGSO4 l Prostaglandin synthetase inhibitors: indomethacin l CCB: nifedipine

Medications for Pre Term Labor

Tocolysis

Terbutaline

          MGSO4 Magnesium Sulfate

          Indomethacin

Terbutaline

bronco dialator, relaxes smooth muscels, 

cause tremmors and anxity, ↑ hr, dypnia, 

dont give if hr is > 110 or has sob

given SQ Q30 min X3 or PO at home

Indomethacin

prostoglanen synthisizer inhibitor

prostoglandens are requierd for labor

antiinfamitent

contraindicated: asthma, renal/hepatic insifesincy

side effects: constiction of ductus arteriouses at 32 or>

never give if > 32 weeks prego

only used for 72 h

Nifedipine

Ca chanal blocker, relaxes smooth muscel, 

side effects: ha, face flushing, hypotention 

# 1 drug used

Magnesium Sulfate

l CNS depressant, relaxes smooth muscle

l Use

–   PTL

–   PIH Gestational Hypertension

l Contraindications: myasthenia gravis

l Normal Side Effects

Toxic  Doses of Magnesium Sulfate

Magnesium Sulfate

Effects on Fetus or Neonate

–   Hypotonia & lethargy

Magnesium Sulfate

nusrsing interventions

 Magnesium levels–   Monitor respirations–   Reflexes

–   Urine output–  

Antagonist of MGSO4: Calcium gluconate -1gram IVP over 3 min

-Observe newborn for: sings of tox

–   FHR: continuous-Continue infusion PP X 24

Metabolic Conditions

l Hyperemesis Gravidarum

l Anemia

Hyperemesis Gravidarum

Hyperemesis Gravidarum

l Cause

–   ↑ hCG levels

Hyperemesis Gravidarum

ASSESS

–   Hydration: I/O, hypovolemia

–   Fluid-electrolyte balance: potassium, alkalosis

–   VS: hypotension, tachycardia, FHTs

–   Hct, BUN

–   Nutrition status: protein & vitamin deficiency

Hyperemesis Gravidarum

TREATMENT

–   IV fluids, NPO X 48 hours, antiemetics

Iron Deficiency Anemia

 Hgb: <11g/dL

Iron Deficiency Anemia

CAUSE

Iron Deficiency Anemia

Treatment:

Iron Deficiency Anemia

l Maternal Implications

–   Tires easily, susceptible to infection, ↑ chance of PIH & PPH

Iron Deficiency Anemia

Fetal/Neonatal Implications

Severe anemia (hgb<6 g/dL): ↑chance of low birth weight, prematurity, stillbirth, neonatal death

l Recessive autosomal disease

–   Abnormally formed adult hgb

Sickle Cell Anemia

l Assess for Crisis

–   Anemia, jaundice, high temperature, infarction, acute pain

Sickle Cell Anemia

TREATMENT

–   Crisis: rehydration, O2, abx, analgesics

–   Prevention: additional folic acid supplement (1 mg/day)

–   Labor: O2, IV fluids, antiembolism stocking PP

Sickle Cell Anemia

Maternal Implications

–   Infection, CHF, ARF adult respiratory failure

Sickle Cell Anemia

Fetal/Neonatal Implications

Folic Acid Deficiency Anemia

Cause:

Folic Acid Deficiency Anemia

Prevention:

Folic Acid 

400 mcg/day

Folic Acid Deficiency Anemia

Treatment:

Folic Acid 

1 mg/day

Folic Acid Deficiency Anemia

 Maternal Implications

–   Severe: ↑ need for blood transfusion PP, hemorrhage, susceptible to infection

Folic Acid Deficiency Anemia

Fetal/Neonatal Implications

–   NTD: spina bifida, meningomyelocele, anencephaly

Hypertensive Disorders

Pregnancy Induced Hypertension PIH

Gestational Hypertension

Preeclampsia and eclampsia

HELLP

Chronic hypertension

Pregnancy Induced Hypertension

Risk Factors for PIH

Primagravida – significantly higher

Pregnant for the first time after an abortion

Family history

Large Placental mass:Multiple pregnancy,Diabetes,  Gestational Trophoblastic Disease

Rh incompatibility

Previous preeclampsia

Chronic hypertension or renal disease

Age extremes(<16 or >35)

Pathophysiology of PIH

Cause: unknown

l ↓ resistance to angiotensin II (vasoconstrictor)

–   ↓ Prostacyclin (vasodilator)

–   Thromboxane (vasoconstrictor)

l ↓ nitric oxide (vasodilator)

l ↓ placental perfusion

l ↓ renal perfusion (↓ GFR)

–   ↑ BUN, creatinine, uric acid

–   ↓ urine output

–   ↑ Sodium

–   Proteinurea

l ↓ intravascular volume

–   ↑ Hct

PIH

Maternal Risks

–   CNS changes: Hyperreflexia, HA, Seizures

–   Renal failure

–   Abruptio Placentae

–   DIC

–   Ruptured Liver

–   Pulmonary embolism

PIH

Fetal Risks

–   SGA-small for gesttional age

–   Prematurity

–   Oversedation

–   Mortality rates ↑

Mild PIH 

Hypertension–   140/90

Proteinuria–   1+ to 2+–   300 mg/dL to 1g/dL

 Edema

–   Generalized (hands or face), dependent areas

–   Weight gain: 1.1 lb / week (3^rd trimester)

Treatment of PIH

Home care

–   BP, weight, urine protein daily

–   NST- nonstrees test

–   Modified bed rest 

Treatment of PIH

Hospitalization

Bed rest

Diet: moderate to high protein, moderate sodium

Treatment of PIH

tests

l Fetal movement record, NST, Ultrasound, BPP, serum creatinine, amniocentesis, doppler velocimetry 

Severe PIH

S/S

–   Visual or cerebral disturbances (frontal HA, blurred vision, scotomata), cyanosis or pulmonary edema, epigastric pain, impaired liver function, thrombocytopenia IUGR, N/V, irritability, hyperreflexia, retinal edema

Severe PIH

Hypertension: 160/110

Proteinuria: 3+ to 4+; >5 g/L in 24 hour urine

Laboratory changes: ↑ Hct, serum creatinine, uric acid

 Oligouria: < 500 mL/24 hours

Treatment of Severe PIH

Delivery OR, Bed rest: complete

Diet: high protein, moderate sodium

Anitconvulsants, Magnesium Sulfate, Fluid and electrolytes: balince betweenecorrecting hypovolemia and preventing circulatory overload

Corticosteroids 

the most common hypertensive disorder in pregnancy

defined as an increase in blood pressure after 20 weeks' gestation accompanied by proteinuria.

Preeclampsia

risk

teenagers

women over age 35,

primigravidas

history of preeclampsia

 large placental mass: multiple gestation,, Rh incompatibility, diabetes mellitus and GTD Gestational trophoblastic disease

Preeclampsia

before giving MGSO4

assess:

Eclampsia

deff/treatment

l Seizure

l Treatment–   4-6 grams bolus of MGSO4

–   Valuim–   Dilantin

–   Assess for abruptio placentae

–   ICU

HELLP

l Multiple-organ-failure syndrome

–   Hemolysis

–   Elevated Liver Enzymes

–   Low Platelets

Preeclampsia

assessment, Subjective, Objective

Subjective: Headache, irritability, scotomata 

Objective: Blood pressure 148/90, deep tendon reflexes 3+, 600 cc of urine collected over the last 24 hours with a protein level of 5 g/L; weight gain of 3 Ib over last 4 days; 2+ pitting edema on lower extremities

Disseminated Intravascular Coagulation (DIC)

Cause: overactivation of the normal clotting process. Preeclampsia, abruptio placentae, IUFD, amniotic fluid embolism, maternal liver disease, septic abortion

 Imbalance between coagulation and fibrinolytic systems. Hemorrhage and shock

Chronic Hypertension

BP 140/90 or higher

Chronic Hypertension

Before pregnancy or 20^th week

 Persists indefinitely after pregnancy

Chronic Hypertension

Treatment 

l Treatment of BP >160/110

–   Methyldopa (Aldomet)

Lapediol

 Congenital heart defects

–   atrial septal defect, ventricular septal defect, PDA, coarctation of the aorta, tetralogy of fallot.

–   Abx prophylaxis recommended

–   rheumatic fever, untreated group A strep 

MVP

–   usually asymptomatic;

Peripartum cardiomyopathy

–   dysfunction of left ventricle in last month of pregnancy or first 5 months PP

Heart Disease

Category 

–   Category I-uncompromised

–   Category II-slightly compromised

–   Category III-markedly compromised

–   Category IV-unable to perform physical activity without discomfort

Heart Disease-Assessment

Observe signs of cardiac  problems–   Second trimester

 Evaluate for signs of infection

l Assess for stress

l Vital signs

l Fetal heart tones

l Evaluate activity level

Heart Disease

l Care for labor

–   Gestational Diabetes Mellitus

l Any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy

Carbohydrate metabolism in normal pregnancy

Early pregnancy 

–   ↑ insulin production

–   ↑ tissue response to insulin

–   estrogen, progesterone

Carbohydrate metabolism in normal pregnancy

Second half of pregnancy 

–   ↑ resistance to insulin

–   ↓glucose tolerance

–   hPL, prolactin, cortisol, glycogen levels

Pathophysiology of Diabetes

l Pancreas does not produce adequate insulin

l Glucose does not enter the cells

l Energy depleted

l Hyperglycemia

l cells break down protein & fat

–   Polyuria

–   Polydipsia

–   Polyphagia

–   Weight loss

Maternal Risks with Diabetes

l Hydramnios   l Preeclampsia

l Ketoacidosis    l Yeast infection

l UTI

Fetal-Neonatal Risks with Diabetes

l Congenital anomalies  l Stillbirth

l LGA  l Hypoglycemia  l IUGR

l RDS  l Polycythemia  l Hyperbilirubinemia

Screening for Diabetes

Average risk: 24-28 weeks gestation

Screening for Diabetes

High risk: 

High risk: earlier then 24 weeks

–   >40; obese; Fam Hx of DM in first degree relative; hx poor obstetric outcome (macrosomic, malformed, stillborn infant); HTN

Antepartum Management of Diabetes

 Dietary regulation

Antepartum Management of Diabetes

 Glucose monitoring

–   SS hypoglycemia: pallor, perspiration, tachycardia, palpitation, nervousness, irritability, weakness, trembling, hunger, HA, blurred vision, diplopia, fatigue, mental confusion, convulsions, coma

–   SS hyperglycemia: malaise, hunger, dehydration

Antepartum Management of Diabetes

 Insulin administration

–   Regular or lispro

–   NPH, Lente

Antepartum Management of Diabetes

Evaluation of fetal status

–   AFP, US, BPP, Fetal activity: 28 weeks, NST

Intrapartal Management of 

Diabetes

–   Maternal insulin requirements decrease dramatically during labor

–   Measure glucose hourly, may need insulin drip

–   Insulin requirements fall significantly

–   Type 1 or 2 diabetes: Sliding scale for first 24 hours

–   GDM: discontinue insulin, monitor glucose levels

–   Reassess at 6 weeks PP and a minimum of 3-year intervals

Rh Alloimmunization (Sensitization)

l Mother Rh-, Infant Rh+

•    Erythroblastosis fetalis: CHF, Jaundice → kernicterus  

•    Anemia → Hydrops fetalis

Rh Alloimmunization (Sensitization)

•     Screening

•    Blood type, RH factor, Rh antibody screen

Rh Alloimmunization (Sensitization)

•    Indirect Coomb’s test

Rh Alloimmunization (Sensitization)

•    Direct Coomb’s test

•   Infant’s blood to detect antibody-coated Rh+ RBC’s

Rhogam

•    Immune globulin that provides passive antibody protection against Rh antigens

Rhogam action

•   Tricks the body to not produce antibodies

•   Not effective for a previously sensitized woman

Rhogam

•    Administration

•   PP: Give within 72 hours after birth

•   28 weeks gestation

•   Abortion, ectopic pregnancy, amniocentesis

•   1^st trimester: smaller dose (50 ug)

•   2^nd trimester:  full dose (300 ug)

ABO Incompatibility

l Mother type O

l Infant type A, B, or AB

l Does not cause severe anemia

l Assess for hyperbilirubinemia in infant

HIV

l Screening

–   Standard part of prenatal care – pt can refuse

–   ELISA, confirmed with Western blot test

HIV

Maternal Risks

–   Pregnancy is not accelerated

HIV 

l Fetal-Neonatal Risks

–   Perinatal transmission

l Transplacentally, at birth, breastfeeding

HIV 

 Treatment

–   Antepartum: Oral ZDV daily

–   Intrapartum: IV ZDV

–   Postpartum: Oral ZDV for infant X 6 weeks

–   C/S for viral load > 1000 copies/mL 

TORCH

l Toxoplasmosis

l Other

l Rubella

l Cytomegalovirus

l Herpes Simplex

 Toxoplasmosis

Maternal Infection

Toxoplasmosis

l Fetal-Neonatal Risks

Rubella (German measles)

l Maternal effects

–  Asymptomatic OR

–  Maculopapular rash, lymphadenopathy, muscle aches and joint pain

Rubella (German measles)

l Fetal effects

–  Congenital cataracts, sensorineural deafness, heart defects, mental retardation, cerebral palsy

Rubella (German measles)

l Treatment

–  Prevention l Immune: positive titer (>1:16)

l Nonimmune: negative titer (< 1:8)

l Immunization: PP, do not get pregnant for 3 months

Cytomegalovirus

l Maternal effects

–  Possible asymptomatic

–  Harbor the infection in the cervix; ascending infection after birth

–  Crosses placenta

Cytomegalovirus

l Fetal effects

–  Fetal death

–  Severe neurological problems

Eye abnormalities  –  Hearing loss

–  Mental retardation

Cytomegalovirus

treatment

–  None

Herpes Simplex Virus

l Transmission

–  After ROM or during vaginal birth

–  Transplacental infection is rare

Herpes Simplex Virus

l Maternal effects

–  Vesicular lesions, vulvar pain or burning

–  Spontaneous abortion, low birth weight, preterm birth

Herpes Simplex Virus

l Fetal effects

–  Microcephaly, mental retardation, seizures, retinal dysplasia, apnea, coma

Herpes Simplex Virus

l Treatment

–  Antiretroviral therapy

l Acyclovir, valacyclovir, famciclovir

–  C/S with active signs of infection

GBS- group B strep

l  Transmission

–    Vertical: during birth

–    Horizontal: nursing personnel or other infants

GBS

l  Risk factors

–    PTL, maternal intrapartum fever, prolonged ROM, previous birth of infected infant, GBS bacteruiria

GBS

l  Fetal/Neonatal Effects

–    Early onset: pneumonia, overwhelming septicemia, long-term neurologic complications

–    Late onset: meningitis or pneumonia, long-term neurologic complications

GBS

l  Treatment

–    Urine culture

–    Vaginal/rectal culture at 35-37 weeks

–    PCN G for positive urine culture, vaginal/rectal culture, previous infant with invasive GBS disease, no screening

UTI

•     S/S•    Dysuria, urgency, frequency, low-grade fever, hematuria

•     Treatment•    Sulfonamides early in pregnancy Ampicillin & nitrofurantoin in late pregnancy

Syphilis

l Primary stage–   Chancre, light fever, malaise

l Secondary stage–   Skin eruptions, acute arthritis, liver enlargement, iritis chronic sore throat

l Tertiary stage–   Invade organs

Syphilis

l Fetal Implications

–   Passed transplacentally

–   2^nd trimester abortion, stillborn, congenital infection, or uninfected live infant

Chlamydia

l S/S

–   Asymptomatic OR

–   Thin or purulent discharge, urinary burning & frequency, lower abdominal pain

Chlamydia

l Implications for pregnancy

–   Newborn conjuctivitis, chlamydial pneumonia, premature labor & fetal death

Gonorrhea

l S/S

–   Most are asymptomatic  OR

–   Purulent discharge, dysuria, urinary frequency, inflammation, swelling of the vulva

Gonorrhea

l Fetal Implications

–   Ophthalmia neonatorum in the newborn

l Age <16 or > 35 l HTN l Preeclampsia

l Diabetes l Heart disease  l Rh alloimmunization

l Hx of unexplained stillbirth  l IUGR

l >42 weeks gestation l Multiple gestation

l Hx of PTL l Previous incompetent cervix

Maternal Assessment of Fetal Activity

l Provides information about fetal well-being

–  Vigorous fetal movements indicates well-being

–  Decreased fetal movements indicates possible fetal compromise

l Associated with fetus’s sleep-wake cycles

l Outside factors that elicit a fetal response

Methods for Counting Fetal Movements

l Assess between 28 and 38 weeks’ gestation

l Count one hour after meals for 20 minutes

l Same time each day l Record three times a day

l Should record 10 movements in a 3-hour period

Doppler Velocimetry

l Possible clinical findings

–  Suspected uteroplacental insufficiency Beginning

  at 16 to 18 weeks’ gestation

Nonstress Test (NST)

l Procedure

Assesses fetal well-being

–    Electronic fetal monitor applied to abdomen

Nonstress Test (NST)

Interpretation

–    Reactive: 2 accelerations (15 beats above X 15 sec) within 20 minutes

–    Nonreactive: reactive criteria not met

Contraction Stress Test (CST)

l Initiation of contractions

–  Oxytocin

–  Nipple stimulation

l Negative CST results

–  3 UCs in 10 minutes lasting >40 sec without decelerations

l Positive CST results

–  Late decelerations with more than 50% of UCs

Biophysical Profile

l Assessment of five biophysical variables

–  2 points for Fetal breathing movements

–  2 points for Fetal movements of body or limbs

–  2 points for Fetal tone

–  2 points for Amniotic fluid volume

–  2 points for Reactive nonstress test

l Identifies compromised fetus

l Desired BPP score

–  8-10 with normal AFI

Evaluating Amniotic Fluid with Amniocentesis

l Purpose of amniotic fluid testing

–  Evaluates health status of fetus, genetic disorders, lung maturity

–  Mostly used to screenl Down syndrome (trisomy 21) l Trisomy 18 l Neural tube defects

Evaluation of Lung Maturity

–  Achieved by 35 weeks

–  Risk of RDS is very low

Evaluation of Lung Maturity

–  Appears when fetal lung maturity has been attained

–  Achieved by 35 weeks

Chorionic Villus Sampling (CVS)

Indication

–   1^st trimester diagnosis (10-12 weeks)

l Genetic, metabolic, deoxyribonucleic acid (DNA) studies

Chorionic Villus Sampling (CVS)

l Procedure

–   Obtain sample of chorionic villi

–   Transabdominally or transcervically

Chorionic Villus Sampling (CVS)

l Risks

–   ROM, bleeding, infection, Rh alloimmunization, abortion, fetal lim defects, abnormalities of fetal face & jaw

–   Does not detect neural tube defects