1. fetal breathing movements
2. fetal body movements
3. fetal muscle tone
4. FHR
5. amniotic fluid volume

• non-invasive
• easily interpreted
• can be performed in outpatient setting at low cost
• good indicator of fetal well-being

• High number of false-positive results caused by fetal sleep cycles. medications, and fetal immaturity
• Not a good predictor of poor fetal outcomes

• semi-fowler's position
• ultrasound transducer and toco record contractions of FHR
• client presses handheld button that graphs FHR when fetal movement is felt 

• 2 or more accelerations of 15 bpm lasting for 15 seconds over a 20 minute period
• normal baseline
• long-term variability of 10 or more bpm

Factors placing fetus at risk for asphyxia, such as IUGR, diabetes, postdates, nonreactive NST, and BPP score <6

• 3rd trimester bleeding and previous c-section with classical uterine incision
• Risk of preterm labor
• PROM
• Incompetent cervix

• explain procedure
• obtain informed consent
• electronic contraction & FHR monitoring
• obtain baseline FHR
• initiate contractions with IV oxytocin or breast self-stimulation

At least 3 contractions for 40-60 sec duration occur in a 10 min time period

A late deceleration with 1 of 3 contractions q2min for 10 min (hyperstimulation pattern)

• prenatal dx of genetic disorders or congenital anomalies
• assessment of pulmonary maturity
• dx of fetal hemolytic disease

• maternal hemorrhage, infection, labor, abruptio placentae, damage to intestines or bladder, and amniotic fluid leakage or embolism
• fetal death, hemorrhage, infection, and direct needle injury 

• explain procedure 
• obtain informed consent
• empty bladder (if > 20 wks gestation)
• assume supine position
• using sterile technique, MD inserts needle through abdomen into uterus
• US assists in guiding needle
• 15-20 mL of fluid are withdrawn 

• monitor FHR and maternal V/S throughout procedure and 30 min post-procedure
• administer RhoGAm following procedure to Rh-negative clients r/t risk of isoimmunization from fetal blood
• instruct client to contact MD if complications occur
• inform client test results are available in 2 wks

• fluid loss
• bleeding
• fever
• abdominal pain
• increased or decreased fetal movement

• transcervically
• transabdominally

• age over 35 years (increased risk for down syndrome)
• frequent spontaneous abortions
• fetuses with chromosomal anomalies or other defects
• or client with genetic defect 

• earlier dx & rapid return of results compared to amniocentesis 
• can be performed at 10-12 weeks gestation
• results returned in 1-2 wks

• full bladder necessary
• explain procedure/obtain consent
• assume lithotomy position

• sterile technique
• MD visualizes cervix using US guidance
• Suction cannula is used to collect specimen transvaginally or transabdominally 
• Rh-neg clients should recieve RhoGAM post-procedure

• vaginal spotting or bleeding
• miscarriage
• ROM
• chorioamnionitis
• limb anomalies if done before 10 wks gestation

• edema of varying degree (pedal, pitting, generalized (anasarca), & pulmonary)
• Dyspnea on exertion, increasing fatigue, dyspnea at rest, moist cough, basilar crackles, cyanosis of nail beds, circumoral cyanosis 
• Tachycardia, irregular pulse, pulmonary edema

1. auscultation
2. ECG
3. Echocardiogram 
4. cardiac catheterization

Diuretic: furosemide (Lasix)

* Take care to ensure adequate circulating volume to maintain uteroplacental perfusion

• vaginal delivery
• epidural anesthesia
• continuous maternal O2 administration
• low-forceps delivery to decrease maternal straining 

• Fetus produces own insulin
• Fetus obtains glucose from mother
• Amount of glucose in maternal circulation stimulates fetal pancreas to produce insulin

1. Blood glucose control (70-120 mg/dL)
2. Degree of vascular involvement 

1. Polyhydramnios, preeclampsia, eclampsia, ketoacidosis and worsening retinopathy
2. Dystocia and stillbirth (usually after 36 wks)
3. Neonatal macrosomia, hypoglycemia, hyperbilirubinemia, delayed fetal lung maturity resulting in RDS, and increased incidence of congenital anomalies (NTD)

1. FH of diabetes
2. maternal obesity
3. previous LGA infants
4. Previously unexplained stillbirth

1. Polyuria
2. Polydipsia
3. Polyphagia

1. 1 hr, 50-gram oral glucose tolerance test (GTT)
2. 3 hr, 100-gram oral GTT 

1. AFP at 16-18 wks
2. US for anomalies 
3. amniotic fluid volume
4. fetal size
5. fetal movement counts
6. weekly NST from 28-32 wks
7. possible oxytocin challenge test (OCT)
8. BPP
9. amniocentesis for lung maturity
10. L/S ratio needs to be at least 1:3 
11. PG should be present 

1. infection
2. preeclampsia
3. diabetic ketoacidosis 

• Rh-neg women who have Rh-pos embryo/fetus (from an Rh-pos father) may become sensitized to the Rh antigen with contact between maternal and fetal blood
• Sensitized Rh-neg women develop anti-Rh antibodies, which may cross placenta in subsequent Rh-pos pregnancies and attack and destroy fetal RBCs

Amniocentesis and percutaneous umbilical cord blood sampling (PUBS) 

* both carry risk of causing maternal exposure and sensitization so RhoGAM should be given

• abnormal development
• IUGR
• death from lack of nutrition
• hypoxia
• maternal ketoacidosis

• ketosis
• confusion
• drowsiness
• muscle weakness
• cramps
• clumsiness
• tremors
• irregular heart beat
• decreased LOC

• muscle wasting 
• ketonuria
• jaundice
• bleeding gums (vitamin deficiency)

• Ascending infections
• PID
• use of IUD contraception
• Tubal surgery 

• unilateral lower abdominal pain (may be slow or sudden and severe
• abdominal rigidity
• referred right shoulder pain
• irregular vaginal bleeding
• signs of hypovolemic shock if fallopian tube has ruptured
• + B-hCG test (confirmation of pregnancy)
• US confirming extrauterine pregnancy

• variable vaginal bleeding (may be brown, like prune juice), may contain grapelike vesicles
• Unusual uterine growth 
• no fetal parts can be palpated 
• No FHR heard; ("snowstorm") pattern on US
• Abnormal labs: very HIGH hCG levels and very LOW maternal AFP levels 

• hyperemesis gravidarum
• severe hypertension during first half of pregnancy
• hyperthyroidism
• trophoblastic pulmonary embolism

• Maternal DES exposure
• congenital uterine anomalies
• cervical inflammation
• previous cervical trauma

• chromosomal abnormalities in embryo
• teratogen exposure
• inadequate implantation
• maternal endocrine disorders
• chronic illness

episodic painless vaginal bleeding after 20th wk of pregnancy without contractions

• maternal hypertension
• cocaine abuse
• abdominal trauma

• bluish-purple
• extremely irritable
• distended
• rigid
• does not contract efficiently after delivery
• leads to postpartum hemorrhage 

• young primigravidas
• women over 35
• multiple gestation
• DM
• hydatidiform mole

• CVA
• DIC
• Renal failure
• Hepatic rupture
• hemorrhage

• BP higher than 140/90 after 20 wks 
• proteinuria of 1-2+ by dipstick

• BP higher than 180/110
• Proteinuria 3+ or greater

• hemorrhage
• pulmonary edema
• hepatic rupture 

• IUGR
• fetal distress from hypoxia
• death

• severe or continuous h/a
• hyperreflexia (greater than +2, baseline, or clonus)
• visual disturbance 
• renal damage indicated by oliguria (< 30 mL/hr)
• portal hypertension resulting in epigastric pain that may precede to hepatic rupture 

• increased hct
• serum uric acid and BUN
• increased liver enzymes (ALT, AST)
• decreased RBCs and platelets