NgCM109

BASIC
META-
BOLIC
PANEL
(BMP)
Glucose Glu 70-110 mg/
dL
Sodium Na 135-145
mE q/L
Potassium K 3.5-5 mEq/
L
Creatinine n/a 0.6-1.2 mg/
dL
Blood Urea BUN 10-20 mg/
Nitrogen dL
COOMB’S TEST
Indirect Coomb's Test
● Used in prenatal testing of pregnant
women and in testing blood prior to a
blood transfusion
● A negative indirect Coombs test for Rh
factor (Rh antibody titer) in a pregnant
woman means that she has not
developed antibodies against the Rh-
positive blood of her baby.

DIRECT & INDIRECT COOMBS TEST

DIRECT COOMBS INDIRECT

TEST COOMBS TEST
A type of clinical Another type of
blood test used to Coombs test used
detect the to detect
antibodies or antibodies
complement produced against
proteins attached foreign red blood
to the red blood cells
cells
Detects Detects the
antibodies or
 Detects the
antibodies or developed
complement antibodies against
proteins attached foreign red blood
to the red blood cells
cells
Uses washed red Uses serum
blood cells
without plasma
Detects Used prior to the
autoimmune blood transfusion
hemolytic anemia and in prenatal
testing of
pregnant women

Antibody Titers for Hepatitis B ( HBsAg)

● HBsAg test looks for the presence of
the hepatitis B virus.
● A person who receives a positive
result on this test has an active
hepatitis B infection.

Diagnostic Tests For High Risk Pregnancy

Noninvasive :
● Fetal ultrasound or ultrasonic testing
● Cardiotocography
● Non stress test (NST)
● Contraction Stress Test (CST)
Invasive:
● Chorionic viluus sampling
● Amniocentesis
● Embryoscopy
● Fetoscopy
● Percutaneous umbilical
cord blood sampling

Fetal Ultrasound
● A test done during pregnancy that
uses reflected sound waves.

Cardiotocography or CTG :
● Monitor the fetal heartbeat and
contractions of the uterus, and provide
a continuous recording or baby's
heartbeat and contractions on a strip
 of paper or on a computer.

Interpretation
interpretation of a CTG tracing requires both
qualitative and quantitative description of:
● Uterine activity (contractions)
● Baseline fetal heart rate (FHR)
● Baseline FHR variability

Duration- from beginning of one contraction

to the end of the same contraction
Frequency- from beginning of one
contraction to the beginning of another
contraction
Interval - resting time between contractions
allows for placental perfusion

Fetal Deceleration
● Refer to temporary but distinct
decreases of the fetal heart rate (FHR)
identified during electronic fetal heart
monitoring.
● FHR baseline usually ranges from
120-160 beats per minute (bpm);
however, with fetal decelerations, the
heart rate usually drops about 40bpm
below baseline.

Fetal decelerations are classified into three

categories:
1. Early
deceleration
2. Late
deceleration
3. Variable
deceleration
Non stress test
● A nonstress test is a common
prenatal test used to check on a
baby's health. During a nonstress test,
also known as fetal heart rate
monitoring, a baby's heart rate is
monitored to see how it responds to
the baby's movements.
● Typically, a nonstress test is
recommended for women at increased
risk of fetal death. A nonstress test is
usually done after week 26 of
pregnancy. Certain nonstress test
results might indicate that you and
your baby need further monitoring,
testing or special care.

Contraction Stress Test

– A method of observing the response
of the
FHR to the stress of uterine
contractions
A FHR response to 3 spontaneous or
induced uterine contractions in 10
minutes may occur
● Spontaneously
● Use of nipple stimulation
● Use of Pitocin
– The desired result: Negative CST (no
late decelerations)
Interpretation of the CST
● Negative: no late decelerations and
adequate FHR recording
● Positive: Late decelerations present
with the majority of contractions
(without excessive uterine activity)
● Equivocal test results: Suspicious,
hyperstimulation, unsatisfactory.

Chorionic villus Sampling

1. The physician aspirates a small sample of
chorionic villus tissue at 10 to 13 weeks'
gestation.
2. The test is performed for the purpose of
detecting genetic abnormalities.
Interventions
● Obtain informed consent.
● The client may need to drink water to
fill the bladder before the procedure to
aid in the visualization of the uterus for
catheter insertion.
● Obtain baseline vital signs and fetal
heart rate; monitor frequently after the
procedure.
● Rh-negative women may be given
Rho( D) immune globulin because
chorionic villus sampling increases the
risk of Rh sensitization.

Amniocentesis
● Amniocentesis is a test that can be
done during pregnancy to look for birth
defects and genetic problems in the
developing baby.
● Amniocentesis removes a small
amount of fluid from the sac around
the baby in the womb (uterus). It is
most often done in a doctor's office or
medical center. You do not need to
stay in the hospital.
● 1. Aspiration of amniotic fluid; best
performed between 15 and 20 weeks
of pregnancy because amniotic fluid
volume is adequate and many viable
fetal cells are present in the and 20
weeks of pregnancy because amniotic
fluid volume is adequate and many
viable fetal cells are present in the fluid
 by this time
● 2. Performed to determine genetic
disorders, metabolic defects, and fetal
lung maturity
Risks
● a. Maternal hemorrhage
● b. Infection
● c. Rh isoimmunization
● d. Abruptio placentae
● e. Amniotic fluid emboli
● f. Premature rupture of the
membranes
Interventions
● a. Obtain informed consent.
● b. If less than 20 weeks' gestation,
the client should have a full bladder to
support the uterus; if performed after
20 weeks' gestation, the client should
have an empty bladder to minimize
chance of puncture.
● c. Prepare the client for
ultrasonography, which is performed to
locate the placenta and avoid
puncture.
● d. Obtain baseline vital signs and fetal
heart rate; monitor every 15 minutes.
● e. Position the client supine during
the examination and on the left side
after the procedure.
● After chorionic villus sampling and
amniocentesis, instruct the client that
if chills, fever, bleeding, leakage of
fluid at the needle insertion site,
decreased fetal movement, uterine
contractions, or cramping occurs, she
must notify the physician or nurse

Embryoscopy
● Embryoscopy is the examination of the
embryo at 9-10 weeks' gestation
through the intact membranes by
introducing an endoscope into the
exocoelomic space transcervically or
transabdominally. This is likely to
remain confined to the management of
early pregnancy in selected families
affected by recurrent genetic
syndromes with recognizable external
fetal abnormalities. The procedure-
related risk of fetal loss is around 12
 per cent.

Fetoscopy
● Fetoscopy is the examination of the
fetus after 11 weeks' gestation. This is
performed transabdominally in the
amniotic fluid. The technique has
evolved with the miniaturization of the
optical device by using fibre-optics
technology. This procedure is likely to
find new applications with the
development of ultrasound
examination at 10-14 weeks' gestation
in order to, either confirm, or rule out
suspected external fetal abnormalities.

Percutaneous Umbilical Cord Blood

Sampling
● Percutaneous umbilical blood sampling
. performed if fetal blood sampling is
necessary; it involves insertion of a
needle directly into the fetal umbilical
vessel under ultrasound guidance.
. Fetal heart rate monitoring is
necessary for 1 hour after the
procedure, and a follow-up ultrasound
to check for bleeding or hematoma
formation is done 1 hour after the
procedure.
Percutaneous umblical cord blood sampling
● Cordocentesis, also sometimes called
Percutaneous Umbilical Cord Blood
Sampling (PUBS), is a diagnostic test
that examines blood from the fetus to
detect fetal abnormalities.
● An advanced imaging ultrasound
determines the location where the
umbilical cord inserts into the
placenta. The ultrasound guides a thin
needle through the abdomen and
uterine walls to the umbilical cord. The
needle is inserted into the umbilical
cord to retrieve a small sample of fetal
blood. The sample is sent to the
laboratory for analysis, and results are
usually available within 72 hours.
● The procedure is similar to
amniocentesis except the objective is
to retrieve blood from the fetus versus
amniotic fluid.
 ● Cordocentesis is usually done when
diagnostic information can not be
obtained through amniocentesis, CVS,
ultrasound or the results of these tests
were inconclusive. Cordocentesis is
performed after 17 weeks into
pregnancy.
● Cordocentesis detects chromosome
abnormalities (i.e. Down syndrome)
and blood disorders (i.e. fetal
hemolytic disease). Cordocentesis may
be performed to help diagnose any of
the following concerns:
● Malformations of the fetus
● Fetal infection (i.e. toxoplasmosis or
rubella)
● Fetal platelet count in the mother
● Fetal anemia
● Isoimmunisation

PREGESTATIONAL AND GESTATIONAL

CONDITIONS
Pre-gestational Conditions
. Rheumatic heart disease
. Diabetes Mellitus
. Substance Abuse
. HIV/AIDS
. Rh sensitization
. Anemia

Gestational Conditions
1. Hyperemesis Gravidarum
2. Ectopic pregnancy
3. Gestational Trophoblastic Disease
(H-mole)
4. Incompetent cervix
5. Spontaneous Abortion
6. Placenta Previa
7. Abruptio Placenta
8. Premature Rupture of Membranes
9. Pregnancy-induced Hypertension
Rheumatic fever
● is an inflammatory autoimmune
disease that affects the connective
tissues of the heart, joints,
subcutaneous tissues, and blood
vessels of the central nervous system.
● The most serious rheumatic heart
disease, which affects the cardiac
valves, particularly the mitral valve.
● Rheumatic fever manifests 2 to 6
weeks after an untreated or partially
treated group A beta-hemolytic
streptococcal infection of the upper
respiratory tract.
● Jones criteria are used to help
determine the diagnosis

Rheumatic heart disease in pregnancy

● During pregnancy time heart pumps
30% - 50% of blood in to the body.
This makes heart to work hard and the
heart valves starts increasing pressure.
This pressure leads to Rheumatic
Heart Disease in pregnant women.
● The one with pre-rheumatic heart
disease can expect a successful
pregnancy till end with extra
monitoring, medication and support
will helps to improve the pregnancy.
But this will affect both woman and
baby and increases the heart risks.
● This can be managed with different
treatments depending upon the woman
situation and the seriousness of the
disease.

Rheumatic Fever and Rheumatic Heart

Disease
Symptoms of Rheumatic Heart Disease
● Fever
● Swollen and red joints
● Nodules over the swollen joints
● Skin rashes
 ● Breathlessness
● Fatigue
● Chest pain
● Fainting attacks
● Palpitations
● Uncontrolled movements of facial
muscles, legs and arms

Gestational Diabetes Mellitus

– It is unknown whether gestational
diabetes results from inadequate
insulin response to carbohydrate or
from excessive resistance to insulin
– A combination of both may occur

CLASSIFICATION OF DM

Diabetes mellitus Destruction of

type l cells in the
pancreatic islets
Diabetes in
women <30 years
old
Family history of
other autoimmune
diseases
Diabetes mellitus Decreased
type ll secretion of
insulin or
increased
resistance to
insulin
Diabetes in
 women> 30 years
old
Coexistent with
obesity
Family history of
DM type ll
Gestational Any kind of
diabetes homeostasis
imbalance of
glucose detected
or discovered for
the 15 time during
the pregnancy
● Gestational diabetes occurs in
pregnancy (during the second or third
trimester in clients not previously
diagnosed as diabetic and occurs
when the pancreas cannot respond to
the demand for more insulin.
● Pregnant women should be screened
for gestational diabetes between 24
and 28 weeks of pregnancy.
● A 3-hour oral glucose tolerance test
is performed to confirm gestational
diabetes mellitus.
● Gestational diabetes frequently can be
treated by diet alone; however, some
clients may need insulin.
Manifestation
. Excessive thirst
. Hunger
. Weight loss
. Frequent urination
. Blurred vision
. Recurrent urinary tract infections and
vaginal yeast infections
. Glycosuria and ketonuria
. Signs of gestational hypertension
. Polyhydramnios
. Large fetus for gestational age

SUBSTANCE ABUSE
Substance Abuse Pregnancy…
● "The fetus grows & develops d/t the
nourishment from the mother via the
placenta.
● Toxins in the mother's system may be
 ●

delivered to the fetus.

● Can cause damage to the fragile,
developing fetal organs.
● Long-term effects = mental problems
such as retardation and seizures."
Substance Abuse
● Threatens normal fetal growth and
successful term completion of the
pregnancy.
● Places the pregnancy at risk for fetal
growth restriction, abruptio placentae,
and fetal bradycardia.
● Substances cross the placenta and
can be teratogenic; no drugs, including
tobacco and over-the-counter
medications, should be taken unless
prescribed by a health care provider.
● Smoking (tobacco) can result in low
birth weight, a higher incidence of
birth defects, and stillbirths.
● The full extent of the effects of
prenatal drug exposure on a child is
not known, however studies show that
various drugs of abuse may result in
premature birth, miscarriage, low
birth weight, and a variety of
behavioral and cognitive problems
NEONATAL WITHDRAWAL / NEONATAL
ABSTINENCE SYNDROME (NAS)
– is a withdrawal syndrome of infants
after birth caused by in utero exposure
to drugs
NAS Symptoms in full-term babies may
include:
• Tremors
(trembling)
• Irritability • Poor feeding
(excessive and suck
crying) • Vomiting
• Sleep problems • Diarrhea
• High-pitched • Dehydration
crying
• Tight muscle • Sweating
tone
• Hyperactive • Fever or
reflexes unstable
• Seizures temperature
• Yawning, stuffy
nose, and
sneezing

HIV and AIDS

Human Immunodeficiency Virus (HIV)
Acquired Immunodeficiency Syndrome

● HIV is a virus that attacks immune

cells called CD-4 cells, which are a
subset of T cells.
● AIDS is the syndrome, which may or
may not appear in the advanced stage
of HIV infection.
● The human immunodeficiency virus
(HIV) is a lentivirus (a subgroup of
retrovirus) that causes HIV infection
 and over time acquired
immunodeficiency syndrome (AIDS).
● AIDS is a condition in humans in which
progressive failure of the immune
system allows life-threatening
opportunistic infections and cancers to
thrive.

How is HIV transmitted?

● Sexual transmission
– Happens when there is contact with
infected sexual fluids (rectal, genital,
or oral mucous membranes). This can
happen while having sex without a
condom, including vaginal, oral, and
anal sex, or sharing sex toys with
someone who is HIV-positive.
● Perinatal transmission
– A mother can transmit HIV to her child
during childbirth, pregnancy, and also
through breastfeeding.
● Blood transmission
– The risk of transmitting HIV through
blood transfusion is extremely low in
developed countries, thanks to
meticulous screening and precautions.
– However, among people who inject
drugs, sharing and reusing syringes
contaminated with HIV-infected blood
is extremely hazardous.

ELISA
● An enzyme-linked immunosorbent
assay, also called ELISA or EIA, is a
test that detects and measures
antibodies in your blood.
● This test can be used to determine if
you have antibodies related to certain
infectious conditions.
● An ELISA test may be used to
diagnose: HIV, which causes AIDS.

A. Description
. Testing detects HIV, which is the
cause of AIDS.
. Common tests used to determine the
presence of antibodies to HIV include
ELISA, Western blot, and
immunofluorescence assay (IFA).
 . A single reactive ELISA test by itself
cannot be used to diagnose HIV and
should be repeated in duplicate with
the same blood sample; if the result is
repeatedly reactive, follow-up tests
using Western blot Or IFA should be
performed.
. A positive Western blot or IFA result
is considered confirmatory for HIV.
. A positive ELISA result that fails to be
confirmed by Western blot or IFA
should not be considered negative,
and repeat testing should take place in
3 to 6 months.
B. CD4- T-cell counts
1. Monitors the progression Of HIV
G. Oral testing for HIV
. Uses a device that is placed against
the gum and cheek for
2 minutes
. Fluid (not saliva) is drawn into an
absorbable pad, which, in an HIV-
positive individual, contains
antibodies.
. The pad is placed in a solution and a
specified observable change is noted if
the test result is positive.
. If the result is positive, a blood test is
needed to confirm the results.
H. Home test kits for HIV
. In one at-home test kit, a drop of
blood is placed on a test card with a
special code number; the card is
mailed to a laboratory for testing for
HIV antibodies.
. The individual receives the results by
calling a special telephone number and
entering the special code number; test
results are then given.
I. Nursing considerations
. Maintain issues of confidentiality
surrounding HIV and AIDS testing.
. Follow prescribed state regulations
and protocols related to reporting
positive tostresults.

● Infection with HIV, the organism

responsible for AIDS, is the most
serious of the STIs because it can be
fatal to both mother and child.
● The infected person develops
opportunistic infections Pneumocystis
carinii pneumonia, Candida
esophagitis, and wasting syndrome) or
malignancies that ultimately are fetal.
● The time from infection with HIV to
development of AIDS is approximately
10 years with current antiretroviral
therapy, although the interval may be
much longer for some individuals.