Normal Diagnostic

Laboratory
Findings and
Deviation
 Describe Describe the process of confirming and estimating the date of birth

Identify Identify the typical nursing assessments, diagnosis, interventions, and methods
of evaluation in providing care for the pregnant woman.

Learning
Objectives
Use critical thinking to analyze the data yielded by laboratory examination of
Use specimens obtained during the examination and important information
concerning the symptoms of pregnancy and woman’s health status.

Identify areas of nursing care related to the normal diagnostic laboratory

Identify findings that could benet from additional nursing research or application of
evidence-based practice.
A medical diagnosis of pregnancy serves to date
when the birth will occur and also helps predict
the existence of high-risk status.
● With advancements in science and technology,
pregnancy tests today are commercially available
and can be performed by the trained personnel
that are highly accurate and precise, if done with
the correct technique.
Pregnancy testing – relies
on the detection of an
antibody to the hormone
human chorionic
gonadotropin (hCG) or a
subunit in the urine or
serum
Human Chorionic Gonadotropin – the first placental
hormone produced and can be found shortly after
implantation
Specimens:
1. Urine – test to yield accurate results and it should be
done 10 to 14 days after the missed menstrual period.
This period guarantee level of hCG and prevents false
negative results.
a. Gravindex and Pregnosticon - are immunologic
pregnancy test and approximately 95% accurate in diagnosing
pregnancy and 98% accurate in determining the absence of
pregnancy
b. Radioimmunoassay – tests for the beta subunit of
hCG and considered to be so accurate as to be diagnostic for
pregnancy.
Urine Tests: (hCG)
Collect first voided urine using clean, dry bottle free of
detergent or contamination.
Do not drink fluids from 8pm the night before to concentrate
the urine
Refrain from taking any drug 24 hrs. before the test
Label the specimen with the woman’s name, date, and time
of voiding.
Bring the specimen to the laboratory immediately
Refrigerate urine specimen-if more than one hour is pass
before the specimen gets to the laboratory because room
temperature is high enough to destroy hCG
2. Blood – with sensitive
assays hCG can be
detected in maternal
blood at 7 days after
conception and are
accurate close to 100%
of the time
3. Progesterone Withdrawal
test – a contraceptive pill is
taken OD or TID (3xdays)
● If menstruation occurs within 10-15 days, the
woman is not pregnant.
● If corpus luteum produces enough hormones
to neutralize the effect of withdrawn synthetic
progesterone and no bleeding occurs, the
woman is pregnant
4. Ultrasound imaging – (Ultrasound
scanning or Scanning) involves exposing a part
of the body to high frequency sound waves to
produce pictures of the inside of the body

● It is a popular and safe diagnostic tool in the

care of the pregnant woman and her fetus.
● It provides the physician, and other members
of the health team the ability to approach the
developing fetus as a separate patient with an
identifiable set of reflexes reactions to outside
stimuli and activity patterns.
● 7-11 wks. if the date of LMP is unknown,
between 16-20 wks. gestation to verify fetal
structures and gender
Types of Pelvic Ultrasound
➢ Abdominal or Transabdominal – with the
woman in supine position, the
sonographer/radiologist applies the
transducer on the lower abdomen
Vaginal or transvaginal – with the woman in
lithotomy position, the
sonographer/radiologist inserts into the vagina
2-3 inches of the vaginal transducer’s end with
the protective cover and lubricating gel
Purpose:
❖Diagnose pregnancy as early as 6 wks. Gestation.
❖Confirm the size, location of the placenta and amniotic fluid.
❖Discover complications of pregnancy.
❖Establish if fetus is growing and no congenital anomalies.
❖Predict maturity by measurement of biparietal diameter of the head
Ultrasonography
1. Biparietal diameter – used to predict fetal maturity. a. Measurement of fetal head (8.5 cm. or
greater) b. Weight. 2500 g (5.5 lb.)
2. Doppler Umbilical Velocimetry – measures the velocity at which RBC in the uterine and fetal
vessels to assess blood flow
3. Placental grading for maturity – graded based on the amount of calcium deposits present in
the base of the placenta
◦ Placental grading for maturity
◦ Grades: 0 – between 12 and 24 wks.
◦ Grade 1: 30 – 32 wks.
◦ Grade 2: 36 wks.
◦ Grade 3: 38 wks. – suggest fetus is mature
Ultrasonography
4. Amniotic fluid volume – the amount of amniotic fluid present estimate fetal health
● 20-24 cm. – indicates Hydramnios
● < 5-6 cm – Oligohydramnios

5. Nuchal translucency – described the appearance of a collection of fluid under the skin behind
fetal neck

6. Magnetic resonance Imaging (MRI) – can identify structural anomalies or soft tissue disorder
Lateral Pelvimetry
– in suspected cephalopelvic disproportion (CPD) with a danger
sign of absence of lightening in a primigravida in active labor
Indications for lateral Pelvimetry
✓Suspected CPD
✓ Previous difficult delivery
✓ History of severe vitamin D and calcium deficiency in childhood
✓ History of pelvic or spine injury
✓Cases of severe scoliosis
LABORATORY ASSESSMENT
 LABORATORY ASSESSMENT
a. Urinalysis – tested for proteinuria, glycosuria, nitrates, pyuria
b. Complete blood count
c. Genetic screen (G6PD glucose6phosphate dehydrogenase)
d. VDRL serologic test for syphilis
e. Blood typing (Rh factor)
f. Maternal serum a-fetoprotein – done between 16-18 wks. of pregnancy
g. Combs test – determination of whether Rh antibodies are present in an Rh (-) woman
h. HIV screening
i. Serum antibody titers for rubella, hepatitis, varicella
j. Blood Serum Studies
k. Tuberculosis Screening (Mantoux Test)
ASSESSING FETAL WELLBEING
Fetal Biophysical Profile
➢ Is a noninvasive method of assessing the general well
being of the fetus and the fetal assessment.
➢ BPP may be used as early as 26-28 weeks for the
surveillance of high risk pregnancy.
➢ The test requires the use of an ultrasound and the
electronic fetal monitor and the observation time takes
about 30 minutes.
Fetal Biophysical Profile
Indications:
1. Mother with gestational hypertension
2. Fetus appears to be small or not growing properly
3. Fetus is less active than normal (movement)
4. Too much or too little amniotic fluid
Fetal Biophysical Profile
Five Parameters: Results:
1. Fetal reactivity 8 - 10 fetus is considered to be doing
well
2. Fetal breathing movements
6 - is considered suspicious
3. Fetal body movements
4 - denotes a fetus probably in
4. Fetal tone
jeopardy
5. Amniotic fluid volume
Biophysical Profile Scoring
1. Fetal breathing - at least one episode of 30secs. of sustained breathing
movement w/in 30mins
2. Fetal movement - at least 3 episodes of fetal limb or trunk movement w/in
30mins.
3. Fetal tone - Observation must extend and then flex extremities or spine at
least once in 30 mins.
4. Fetal heart reactivity - 2 or more heart accelerations at least 15 beats/min
5. Amniotic fluid volume - A range of amniotic fluid between 5 and 25 cm must
be present
Fetal Heart Rate
Fetal heart sounds
a. 10 – 11 wks. – ultrasound
b. 10 wks. – Doppler
Daily fetal
Movement Count
(Kicks Count)
a. 18 – 20 wks. – quickening felt by
the mother
b. 28 – 38 wks. – 10 x / hr. peaks in
intensity
Rhythm Strip testing – use
for assessment of the fetal
heart rate
➢ Average FHR – 130 beats/ min.
➢ Average fetal moves – twice every 10 mins. -
causes heart rate to increase
Vibroacoustic Stimulation – for
acoustic (sound) stimulation
Acoustic stimulator applied to the mother’s
abdomen to produce sharp sound (80 db.),
startling and waking the fetus
Amniocentesis
➢ Amnion for sac and kentesis for puncture. Scheduled
between the 14th and 16th week
➢ Amniocentesis is the removal of fluid from the amniotic
cavity by needle puncture. An ultrasound is performed first to
determine the safe site where the needle can be inserted.
➢ During the procedure, the fetus is continuously monitored
by ultrasound to ensure its wellbeing.
➢ Complications includes hemorrhage from the penetration
of the placenta, infection of the amniotic fluid and puncture
of the fetus
 Purposes of Amniotic
Fluid Analysis
➢ Detection of fetal abnormalities early in pregnancy
➢ To determine fetal lung maturity
➢ Lecithin/Sphingomyelin ratio
➢ Lung Profile
➢ Amniotic Fluid Bilirubin
➢ Rh incompatibility
➢ For detection of certain infections
➢ Detection of fetal abnormalities early in pregnancy
Nursing Care during Amniocentesis
➢ Assist client to empty her bladder before the procedure
➢ Place in supine position and drape properly
➢ Put rolled towel under right hip to tip body to the left and remove
pressure of uterus on vena cava
➢ Instruct not to take a deep breath and hold it while the needle is being
inserted as it will shift the uterus and needle may hit placenta or fetus.
Nursing Care during Amniocentesis
➢Inform the patient that it is not painful because anesthesia will be applied at
the insertion site. She may experience pressure sensation during the insertion of
the needle.
➢ Monitor FHT before, during and in 30 minutes after the test.
➢ Instruct patient to observe for:
➢- Infection
➢- Uterine cramping
➢- Vaginal bleeding
 Chorionic Villi Sampling
➢ Is a transcervical or transabdominal insertion of a needle into the fetal portion of
the placenta, at the area of the chorion frondosum
➢ CVS is performed at 8-12 weeks gestation under ultrasound guidance to ensure
that the fetus is unharmed.
➢ Chorionic villi cells are examined to detect chromosome abnormalities such as
Down syndrome and genetic disorders such as cystic fibrosis
➢ Is a biopsy & analysis of chorionic villi for chromosomal analysis done at 8 to 10
weeks of pregnancy chorion cells are located by ultrasound
➢ A thin catheter is inserted vaginally or needle biopsy is inserted intravaginally or
inserted abdominally, and a number of chorionic cells are removed chromosone
analysis (genetic defect)
Chorionic Villi Sampling
➢ Instruct client to report bleeding, infection or leakage of
fluid after procedure
➢ Some instances of limb reduction syndrome
➢Less than 1% risk leading to excessive bleeding, or
pregnancy loss
➢ Reportable s/sx:
➢ Chills or fever (infection)
➢ Uterine contraction or vaginal bleeding (threatened miscarriage)
 AFP/Triple Screen
➢This test involves measurement of AFP, estriol and HCG in maternal serum at 15-20
weeks of gestation to screen for fetal structural & chromosomal abnormalities.
➢Alpha-feto protein is a substance produced by the liver that is present in amniotic
fluid and maternal serum.
➢ Estriol is initially tested. If the result is abnormal, the woman is next referred for
ultrasound to confirm gestational age and to evaluate for neural tube defects (NTD)
and other structural abnormalities.
➢ A low estriol, elevated HCG, and low AFP finding is often associated with Trisomy 21
(Down syndrome).
➢ High in the maternal serum (MSAFP) if the fetus has an open spinal or abdominal
defect.
Non- Stress Test (NST)
➢ An assessment of fetal well-being that analyses the
response of the fetal heart to fetal movement
➢ When the fetus has adequate oxygenation and intact
CNS, the are accelerations of FHR with fetal
movement.
➢ The baby’s heart rate should accelerate, by 15 beats
for at least 15 seconds, twice in a twenty minute
period. This is called a reactive NST and is a good sign
that the fetus is healthy.
➢ A reactive NST indicates intrauterine survival for one
week. The doctor may order a CST if the NST is
nonreactive. The usual preparation is to feed the
mother with food or fluids before the test to stimulate
fetal movements
Contraction Stress Test
➢ Assess the ability of the fetus to withstand the stress of uterine contraction
done during labor
➢ CST is a means of evaluating the respiratory function of the placenta.
➢ Induced or spontaneous contraction decrease transport of O2 to the fetus. A
healthy fetus maintains a steady heart rate.
➢ If placental reserve is insufficient, fetal hypoxia and decrease in FHR occur.
➢ Testing is initiated when 3 contractions in every 10 minutes are attained. The
test takes about 60-90 minutes to perform.
Periodic Changes
a. Accelerations - temporary normal increases in FHR caused by fetal movement
or compression of the umbilical vein during contraction
b. Early Decelerations - periodic decreases in FHR resulting from pressure of the
fetal head during contractions.
◦ - Beginning when the contractions begins and ending when the contractions
end (mirror image)
◦ - Normal – late in labor
 Periodic Changes
c. Late Decelerations - delayed decelerations until 30 to 40 seconds after the onset of a
contraction and continue beyond the end of the contraction
- Ominous pattern in labor (uteroplacental insufficiency) or ↓ blood flow through the intervillous
spaces of the uterus during contraction
- - The lowest point of the deceleration (nadir) occurs near the end of the contraction instead of at its
peak
- - Occur with hypertonia or with abnormal uterine tone caused by administration of oxytocin
- Stop or slow the administration of oxytocin
- Change the position from supine to lateral to relieve pressure from the Vena Cava
- Administer IVF or O2 as prescribed
- If late decelerations persist – prepare for possible prompt birth of the infant
d. Variable Decelerations - Decelerations that occur at unpredictable times in relations to
contractions.
◦ - Indicate compression of cord - Cord prolapsed
◦ - Fetus is lying on the cord
◦ - Occurs more frequently: - after rupture of membranes
◦ - Oligohydramnios
◦ - U, V or W – shaped waves
◦ - Position: lateral or T-position
◦ - Administer fluids and O2 as prescribed
◦ - If not relieved, amnioinfusion may be prescribed
Interpretation Results of CST
➢ Positive : there is persistent late decelerations w/ more than half the
contractions; maybe associated w/ minimal or absent variability. A positive CST
means that the fetus is no longer receiving adequate oxygen and needs to be
delivered.
➢ Negative : There is no late deceleration in a 10-minute period and this means
that it is safe for the fetus to remain in utero for the next 7 days