high risk 2

• Laboratory Assessment


  • Blood Analysis
  • Urinalysis
  • Ultrasound
  • Tuberculosis
• Several laboratory studies are included in assessment measures at a first prenatal visit to confirm general health and rule out sexually transmitted infection that could injure the growing fetus
• Blood Studies


  • Complete blood count
  • Genetic screen
  • VDRL or rapid plasma reagin test
  • Blood typing & Rh factor
  • Maternal serum for alpha-fetoprotein (MSAFP)
  • Indirect Coombs' test
  • Antibody titers for rubella & Hepatitis B (HBsAg)
  • HIV screening
  • FBS (Fasting Blood Sugar Test) or 1-hour glucose loading or tolerance test
• Hemoglobin concentration at term

  Averages at 11.0 g/dL up to 12.5 g/dL
• Urinalysis


  • Test for proteinuria, glycosuria, & pyuria
• Tuberculosis Screening


  • Purified protein derivative (PPD) tuberculin test for a woman without BCG vaccine & no history of TB
  • Chest radiograph (X-ray) will be ordered instead
• RT-PCR Test (Covid Screening)


  Done starting at 37 weeks AOG then repeated weekly until delivery
• Ultrasonography


  • Diagnostic test that involves the use of sound having a frequency higher than that detectable by humans to examine structures inside the body
  • An important, safe technique in antepartum fetal surveillance that uses sound frequency
  • Considered as the most valuable diagnostic tool in obstetrics
  • Can be performed abdominally and transvaginally
• Ultrasonography


  • Diagnose pregnancy as early as 6 weeks' gestation
  • Confirm the presence, size, and location of the placenta and amniotic fluid
  • Establish that a fetus is growing and has no gross anomalies
  • Establish sex if a penis is revealed
  • Establish the presentation and position of the fetus
  • Predict maturity by measurement of the biparietal diameter of the head
• Types of Ultrasound Scan

  • Two-Dimensional (2D)
  • Three-Dimensional (3D)
  • Four-Dimensional (4D)
• Two-Dimensional (2D)


  • The standard medical scan used in pregnancy
  • Sound waves are sent straight down from the ultrasound transducer
  • The image produced includes only two dimensions (length and width), so it appears flat
  • The image is viewed in black, white, or shades of gray
• Three-Dimensional (3D)


  • Sound waves are sent out at different angles
  • The returning echoes are processed by a computer program, which adds a third dimension (depth) to the 2D scan, producing a three dimensional image
  • The image is usually displayed in sepia tones rather than in black and white
• Four-Dimensional (4D)


  • Adds a fourth dimension (time) to the 3D scan
  • The images produced are recorded and played back in succession
  • As the image is continuously updated, the fetus is viewed in real time
• Types of Ultrasound Approaches

  • Abdominal
  • Transvaginal
• Abdominal


  • More useful after the first trimester when the pregnant uterus becomes an abdominal organ
  • The woman usually should have a full bladder to displace the uterus upward to provide a better image of the fetus
  • Transmission gel or paste is applied to the woman's abdomen to enhance the transmission and reception of the sound waves before a transducer is moved over the skin
  • The woman is positioned with small pillows under her head and knees
  • The display panel is positioned so the woman or her partner (or both) can observe the images on the screen if they desire
• Transvaginal


  • Probe is inserted into the vagina, allows pelvic anatomic features to be evaluated in greater detail and intrauterine pregnancy to be diagnosed earlier
  • Is well tolerated by most pregnant women because it removes the need for a full bladder
  • Especially useful in obese women whose thick abdominal layers cannot be penetrated adequately with an abdominal approach
  • A protective cover such as a condom, the finger of a clean surgical glove, or a special probe cover provided by the manufacturer is used to cover the transducer probe
  • Is optimally used in the first trimester to detect ectopic pregnancies, monitor the developing embryo, help identify abnormalities, and help establish gestational age
  • May be used along with abdominal scanning to evaluate preterm labor in second- and third-trimester pregnancies
• Assessing Fetal Well-being


  • Fetal Movement
  • Fetal Heart Rate
  • Nonstress Testing
  • VibroacousticStimulation
  • Contraction Stress Testing
  • Electrocardiography
  • Magnetic Resonance Imaging
  • Maternal Serum Alpha-Fetoprotein
  • Triple Screening
  • Chorionic Villi Sampling
  • Amniocentesis
  • Percutaneous Umbilical Blood Sampling
  • Amnioscopy
  • Fetoscopy
  • BiophysicalProfile
• Biophysical Assessment


  • Fetal Movement
  • Fetal Heart Rate
  • Nonstress Testing
  • Vibroacoustic Stimulation
  • Contraction Stress Testing
  • Electrocardiography
  • Magnetic Resonance Imaging
  • Amnioscopy
  • Fetoscopy
  • Biophysical Profile
• Biochemical Assessment


  • Maternal Serum Alpha-Fetoprotein
  • TripleScreening
  • Chorionic Villi Sampling
  • Amniocentesis
  • Percutaneous Umbilical Blood Sampling
• Common Maternal and Fetal Indications for Antepartum Testing

  • Diabetes
  • Chronichypertension
  • Preeclampsia
  • Fetalgrowth restriction
  • Multiple gestation
  • Oligohydramnios
  • Pretermpremature rupture ofmembrane
  • Postdates or postterm gestation
  • Previous stillbirth
  • Decreased fetal movement
  • Systemic lupus erythematosus
  • Renal disease
  • Cholestasis of pregnancy
• Nagele's Rule


  To calculate the date of birth, count backward 3 calendar months from the first day of a woman's last menstrual period and add 7 days
• Health History


  • Nutritional intake
  • Personal habits such as cigarette smoking, recreational drug use, and exercise
  • Any accidents or experienced
  • Intimate partner abuse
• McDonald's rule


  The distance from the uterine fundus to the symphysis pubis in centimeters is equal to the week of gestation between the 20th and 31st weeks of pregnancy
• Biophysical Assessment


  • Fetal Movement
  • Fetal Heart Rate
  • Nonstress Testing
  • VibroacousticStimulation
  • Contraction Stress Testing
  • Electrocardiography
  • Magnetic Resonance Imaging
  • Amnioscopy
  • Fetoscopy
  • BiophysicalProfile
• Fetal Movement Counting (FMC or Kick count)


  • Fetal movement occurs at approximately 16 to 20 weeks of pregnancy and peaks in intensity at 28 to 38 weeks
  • A healthy fetus moves with a degree of consistency, or at least 10 times a day
  • A fetus not receiving enough nutrients because of placental insufficiency has greatly decreased movements
• Approaches used for fetal movement counting

  • Sandovsky method
  • Cardiff method
• Sandovsky method


  • Asking the woman to lie in a left recumbent position after a meal and record how many fetal movements she feels over the next hour
  • A fetus normally moves a minimum of twice every 10 minutes or an average of 10–12 times an hour
  • If less than 10 movements occur within an hour, the woman repeats the test for the next hour
  • Advised woman to call her health care provider if she feels fewer than 10 movements (half the normal number) during the chosen 2 hours
• Cardiff method


  • Another protocol is "Count-to-Ten"
  • Advised a woman to record the time interval it takes for her to feel 10 fetal movements
  • Usually, this occurs within 60 minutes
  • Make sure to assure a woman that fetal movements do vary, especially in relation to sleep cycles
• Significant Findings for Fetal Movement Counting

  • Establishing a very low number of daily fetal movements
  • Trend toward decreased motion
  • Fetal movements cease entirely for 12 hours (fetal alarm signal)
  • Count of fewer than three (3) FMs within 1 hour warrants further evaluation (non-stress/contraction stress test/ BPP)
• Fetal hearts beat at 120 to 160 beats per minute throughout pregnancy
• Nonstress Testing


  • Involves the use of Doppler-detected fetal heart rate acceleration coincident with fetal movements perceived by the mother
  • The nonstress test was easier to perform, and normal results were used to further discriminate false-positive contraction stress tests
  • The nonstress test is primarily a test of fetal condition
• Nonstress Testing Procedure


  • Both a FHR & a uterine contraction monitor & the woman is instructed to push a button attached to the monitor whenever she feels the fetus move
  • The FHR should increase about 15 beats/minute & remain elevated for 15 seconds
  • A nonstress test usually is done for 10 to 20 minutes
  • Reactive NST = if two accelerations of FHR after movement within the chosen time period
  • Nonreactive NST = if no accelerations of FHR occur with the fetal movements
• Nonstress Testing Interpretation


  • If a 20-minute period passes without any fetal movement, it may mean only that the fetus is sleeping
  • Other reasons for lessened variability are maternal smoking, drug use, or hypoglycemia
  • The fetus also may be stimulated by a loud sound to cause movement
  • Nonstress testing are noninvasive procedure & cause no risk to either mother or fetus, they can be used as screening procedures in all pregnancies
• Non-stress test (NST)


  A test to assess fetal well-being by monitoring fetal heart rate in response to fetal movement
• Non-stress test procedure


  1. Performed for 10-20 minutes

  2. Reactive NST: 2 accelerations of fetal heart rate after movement within the time period

  3. Nonreactive NST: No accelerations of fetal heart rate with fetal movements, or low short-term fetal heart rate variability (less than 6 beats per minute) throughout the testing period
• If a 20-minute period passes without any fetal movement, it may mean only that the fetus is sleeping
• Other reasons for lessened variability are maternal smoking, drug use, or hypoglycemia
• The fetus also may be stimulated by a loud sound to cause movement
• Non-stress testing


  • Noninvasive procedure
  • Cause no risk to either mother or fetus
  • Can be used as screening procedures in all pregnancies
• Vibroacoustic stimulation


  1. A specially designed acoustic stimulator is applied to the mother's abdomen to produce a sharp sound of approximately 80 decibels at a frequency of 80 Hz, startling and waking the fetus

  2. During a standard non-stress test, if a spontaneous acceleration has not occurred within 5 minutes, apply a single 1- to 2-second sound stimulation to the lower abdomen

  3. This can be repeated again at the end of 10 minutes if no further spontaneous movement occurs, so that two movements within the 20-minute window can be evaluated