Alpha-feto Protein Levels
Purpose: To assess the presence of neural tube defects and Down's syndrome.
Nursing alert: An elevated alpha-feto protein level indicates neural tube defects and a decreased level indicates Down's syndrome.
- maternal serum screens for open neural tube defects
- alpha-feto protein is glucoprotein produced by fetal yolk sac, GI tract and liver
- test is done between 16 and 18 weeks of gestation
Purpose: To assess the fetal growth and maturity, and to determine the genetic disorders and sex of the fetus.
Nursing alert: If done between 14 and 16 weeks of gestation, the purpose is to assess for chromosomal aberration or other disorders. If done after 35 weeks of gestation, the purpose is to assess the fetal lung maturity.
Instruct the client to void before the procedure, if gestation is greater than 20 weeks. Position the client on supine.
A lecithin/sphingomyelin (L/S) ratio of 2:1 indicates fetal lung maturity.
Advise the client to report:
- fetal hyperactivity or hypoactivity
- vaginal bleeding
- chills and fever
- fluid leakage
- vaginal discharge
Complications: placental, cord and bladder puncture.
Assessment of Lochia
Purpose: To detect the presence of infection and bleeding.
Nursing alert: The normal color of lochia is as follows:
- Lochia rubra (reddish) - 1-3 days post-partum
- Lochia serosa (brownish or pinkish) 4-10 days post-partum
- Lochia alba (whitish) 10-14 days post-partum
- The longest possible time for the client to have lochial discharge (alba) can be up to three weeks to sixty days post-partum.
Purpose: To collect data on fetal breathing movement, body movements, muscle tone, reactive heart rate and amniotic fluid volume; to identify fetuses at risk for asphyxia.
Nursing alert: A score of 0-2 is given in each category and the total is interpreted by the physician.
Chronic Villi Sampling (CVS)
Purpose: To determine the chromosomal or genetic disorders in the fetus. It is the earliest test possible on fetal cells.
Nursing alert: Sample obtained by slender catheter passed through the cervix to the implantation site.
Purpose: To estimate the fetal renal maturity and function.
Nursing alert: It uses amniotic fluid. Monitor abnormal levels. The mother's blood creatinine level should be known before the amniotic fluid creatine value is interpreted.
Contractions Stress Test (CST)
Purpose: Based on the principle that a healthy fetus can withstand decreased oxygen during contraction, but a compromised fetus cannot.
Nursing alert: Types of Contraction Stress Test
- Nipple-stimulated CST: Massage or rolling of one or both the nipples to stimulate uterine activity and check the effect FHR.
- Oxytocin challenge test (OCT): Infusion of calibrated dose of IV oxytocin "piggy backed" to main IV line. This is controlled by infusion pump and the amount infused increased every 15-20 minutes until three good uterine contractions are observed within 10-minute period.
- CST is never done unless a mother is willing to deliver the fetus.
Fetal Movement Count
Purpose: Teach the mother to count 2-3 times daily, 30-60 minutes each time.
Nursing alert: There should be 5-6 movements per coming time. Mother should notify the caregiver immediately of abrupt change or absence of movement.
Fetal Heart Monitoring
Purpose: To assess the fatal heart rate abnormalities.
- Early decelerations indicate fetal had compression; reflects mirror image in the monitor, no treatment required.
- Late decelerations indicate placental insufficiency; reflects reverse mirror image in the monitor. Change the client's position to left lateral recumbent and administer oxygen.
Guthrie Capillary Blood Test
Purpose: To screen for phenylketonuria.
Nursing alert: Normal level is 2 mg/dl, provide the client a high protein diet, 24-48 hours before the test.
Purpose: To determine patency of the fallopian tube and to detect pathology in the uterine cavity.
Nursing alert: Involves X-ray examination and administration of a radiopaque dye into the urine cavity. It should be done in the pre-ovulatory phase of the cycle. Contraindicated in pregnancy.
- to estimate the fetal size
- to locate parts
- to determine presentation, position, engagement and attitude
Preparation of client:
- place in the dorsal recumbent position to relax the abdominal muscle.
- palate with warm hands because cold hands cause muscle contraction.
- use palm not fingers because it will tickle the client.
1st maneuver: Facing the head part, palpate for fetal part found in the fundus (a hard, smooth ballotable mass in the fundus means breech presentation).
2nd maneuver: Palpate sides of the uterus to determine location of fetal back.
3rd maneuver: Grasp lower portion of the abdomen just above symphysis pubis to determine the degree of engagement.
4th maneuver: Facing the feet of the client. Cross fingers downward on both sides of the uterus above the inguinal ligaments to determine attitude.
Lecithin-Sphingomyelin (L/S) Ratio
Purpose: To ascertain fetal lung maturity.
Nursing alert: Lung surfactants include lecithin and sphingomyelin. At 35-36 weeks, L/S ratio of 2:1 is achieved, the newborn is less likely to develop respiratory distress syndrome. Phosphatidylglycerol (PG) is found in amniotic fluid after 35 weeks of gestation.
Non-stress Test (NST)
Purpose: To assess the fetal activity and well-being.
- Reactive test: acceleration of fetal heart rate of more than 15 beats per minute above baseline FHR lasting 15 seconds or more.
- Non-reactive test: acceleration of fetal heart rate of less than 15 beats per minute above baseline FHR. May indicate fetal jeopardy.
- Acceleration in heart rate accompany normal fetal movement.
- In high risk pregnancies, NST may be used to assess FHR on a frequent basis in order to ascertain fetal well-being.
Purpose: To detect abnormalities of the organs in the abdomen.
Nursing alert: Increase the fluid intake 30 minutes to 1 hour before the test in order to distend the bladder, as it is necessary to promote visualization of the organs. The client would, therefore, need further teaching if she voids before the test.
Percutaneous Umbilical Blood Sampling (PUBS)
Purpose: To locate the umbilical cord with the help of ultrasound and to detect chromosomal abnormalities.
Nursing alert: Cord blood aspirated and tested. Used during second and third trimesters. The mother should be made to understand why she should not void before the test.
Sweat Chloride Test
Purpose: To detect cystic fibrosis.
Nursing alert: Normal chloride level is 90-100 mg/dl (serum), 10-35 mEq/L (sweat). Serum reading of 140 mg/dl and sweat reading of >60 mEq/dl may reflect cystic fibrosis. Pulsations is administered to induced sweating.
Purpose: To identify intrabody structures.
Nursing alert: Useful in early pregnancy to identify gestational sac(s). Later uses include assessment of fetal viability, growth patterns, anomalies and adnexal masses. Used as an adjunct to amniocentesis; safe for fetus (no ionizing radiation).