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A. Davis. 51 ■ ■ ■ ■ Place patient in side-lying position Record vital signs Apply EFM and record baseline fetal heart rate for 20 minutes Stimulate uterine contractions until three contractions occur within 10 minutes lasting 40 seconds each ■ Contractions can be stimulated with ■ Nipple stimulation or ■ IV Oxytocin per hospital protocol ■ Document FHR response to contractions EXPECTED FINDING: NEGATIVE Three contractions that last at least 40 seconds within 10 minutes without the presence of late or significant variable decelerations Biophysical Profile (BPP) ■ Ultrasound exam observing four specific fetal criteria ■ Nonstress test included as a fifth parameter ■ Scoring of Biophysical Profile (BPP) Parameter Measured Fetal tone Fetal breathing Gross fetal movement Amniotic fluid volume FHR reactivity per NST Expected Findings (within 30 minutes) Active flexion/extension One or more episodes lasting 30 seconds Three or more discrete movements Single vertical pocket Ͼ 2 cm Reactive EXPECTED FINDING: NEGATIVE BPP Score of at least 6/8 if NST omitted BPP Score of at least 8/10 if NST included ANTEPARTUM Score 2 2 2 2 2 03Holloway (F)-03 INTRAPARTUM 12/28/05 12:25 PM Copyright © 2006 by F.

Nursing Health Assessment: A Critical Thinking, Case Study Approach. A. ) ■ Provide appropriate education for gestational age ■ Discuss procedure for lab testing ANTEPARTUM 02Holloway (F)-02 ANTEPARTUM 12/28/05 12:24 PM Page 26 Copyright © 2006 by F. A. Davis. 5 mg/dL Ͼ33% 150,000–400,000 mm3 5,000–12,000 mm3 Negative Negative 1:8 Immune AA, unaffected Negative Negative Normal cytology 02Holloway (F)-02 12/28/05 12:24 PM Page 27 Copyright © 2006 by F. A. Davis. 27 Diagnostic Testing in Early Pregnancy Diagnostic Test Ultrasound Performed throughout pregnancy Clinical Applications: ■ Confirm and date pregnancy ■ Verify pregnancy location ■ Detect fetal cardiac activity ■ Measure fetal growth ■ Detect fetal anomalies ■ Measure amniotic fluid index ■ Determine fetal position ■ Determine placental position ■ Measure cervical length ■ Adjunct to invasive procedures Chorionic villi sampling (CVS) Performed at 10–12 weeks Clinical Application: ■ Chromosomal analysis Amniocentesis Performed throughout pregnancy Clinical Applications: ■ Chromosomal analysis is desired ■ Measure AFP ■ Measure bilirubin level ■ Determine lung maturity ■ Lecithin/Sphingomyelin Ratio (L/S Ratio) ■ Phosphatidylglycerol (PG) ■ L/S Ratio of 2:1 and positive PG indicative of fetal lung maturity Maternal Serum Triple Screen (tests maternal serum for AFP, hCG, and estriol) Nursing Considerations Position to avoid supine hypotension; folded towel under right hip if supine Review blood type, Rh and antibody status Administer Rh (D) immune globulin if indicated Monitor patient for postprocedure cramping or bleeding Monitor fetal heartbeat NOTE: This is a screening method only.

A. Davis. Preterm Labor Onset of regular labor before the 37th completed week of gestation ■ Clinical Findings ■ Rhythmic lower abdominal cramping ■ Complaints of backache ■ Increased vaginal discharge ■ Downward pelvic pressure ■ Leaking of amniotic fluid ■ Vaginal spotting ■ Cervical effacement/dilation ■ Shortening cervical length ■ Nursing Care ■ Determine gestational age ■ Assess uterine tone ■ Auscultate fetal heart tones and apply EFM ■ Obtain vaginal/urine cultures ■ Assess for leaking amniotic fluid • Ferning—Microscopically, amniotic fluid will resemble the leaves of a fern plant • Nitrazine paper—Due to the alkaline nature of amniotic fluid, the nitrazine paper will change from yellow to blue ■ Perform vaginal exam to determine dilation and effacement of the cervix ■ Position side-lying ■ Initiate IV fluids as ordered ■ Administer corticosteroid to mother • Accelerates maturity of fetal lungs • Most benefit 24 hours after administered ■ Initiate tocolytic therapy 46 02Holloway (F)-02 12/28/05 12:24 PM Page 47 Copyright © 2006 by F.

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[Article] A sample size adjustment procedure for clinical trials based on conditional power by Li G.

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