NCM 109 A

“DIAGNOSTIC
TESTS”
DEFINITION OF TERMS
PRENATAL (Antenatal) – pertaining to any event that exist in the embryo or the mother
during the period between conception & delivery of the infant.
SCREENING TEST – any test that separates those who are not, or who would not be,
affected by the disease from those who are at risk for it & who will be given further
test. A simple test for the purpose of uncovering a disease condition that is treatable.
DIAGNOSTIC TEST (Clinical Diagnosis) – based on physical examination, & the patients
history; does not include laboratory test.
LABORATORY EXAMINATION – diagnosis arrived after laboratory study of specimens
taken from the patient.
HIGH RISK PREGNANCY – one in which a concurrent disorder, pregnancy related
complication or external factor jeopardizes the health of the mother, fetus or both.
• Etiology - study of causation/ from the Greek word etio-, which
means 'causation' and -ology, which refers to the scientific study of
something/ the cause or origin of a disease or abnormal condition
• Risk factor (RF)- a causative factor/ attributes, characteristics or
exposures that increase the likelihood of a person for developing a
disease or health disorder (age, sex, family health history -----
linked to disability, disease or death)
• Contributing factor (CF)- the practices and environmental
conditions that lead to outbreaks/ preventable causes of
outbreaks--- lifestyle, poor health habits
• Signs and Symptoms (S/Sx) - Signs are objective and externally
observable (a doctor, or other person, notices); symptoms are a
person's reported subjective experiences (an individual
experiences)
Predisposing factors- Factors or areas of susceptibility that promote the risks of the
presenting problem are termed as predisposing factors---
Ex. exposure to alcohol of the fetus in prenatal life and any genetic predisposition of
mental illness
Precipitating factors- These are factors, events, or stressors that initiate/ cause/
trigger/precipitate or promote the onset of any illness, disease, accident, or behavioral
response (aggressive behavior)---
Ex. conflict about relationships, transitions, or identity
Perpetuating factors - factors that maintain the disabling symptoms. Any condition or
factors, either in the family or community that exaggerate the problem rather than
solve it are perpetuating factors
Ex. lack of education, occupation, or financial stress
Protective factors - factors that take into account the person’s skill, competency, talent,
or any supportive element that helps the patient in facing and overcoming the
predisposing, precipitating, and perpetuating factors.
◦Tocolysis - an obstetrical procedure carried out
with the use of medications with the purpose of
delaying the delivery of a fetus in women
presenting preterm contractions.
◦Tocolytics - medications used to suppress
premature labor (used to slow or stop the
contractions of a woman's uterus during
pregnancy; they are typically given to women
who are in preterm labor to try to delay birth for
1 to 2 days).
Common Tocolytics Agents
THE MOTHER
IDENTIFYING CLIENTS AT RISK
Ways for identifying clients at risk
a. Physiological (in accordance with natural processes of the body)
b. Psychological (pertaining to emotions, mental processes, & behavior)
c. Social (related to or involving activities in which people spend time talking to each other)

DIAGNOSTIC TEST
1. ULTRASONOGRAPHY
2. TRANSABDOMINAL ULTRASOUND
3. CHORIONIC VILLI SAMPLING (CVS)
4. AMNIOCENTESIS
5. NON-STRESS TEST (NST)
6. CONTRACTION TEST
7. PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS)
8. LECITHIN-TO-SPHINGOMYELIN (L/S) RATIO
1. ULTRASONOGRAPHY (UTZ) – a diagnostic technique where ultrasound waves are
passed over a body area, the reflection or echo of the sound waves as they passed over the
junction of tissues of differing intensities is converted into a visual pattern.
A. TRANSVAGINAL (TVS) (EMPTY BLADDER)
 Uses a probe inserted into the vagina
 Used to visualize the baby
 NR: inform consent, provide comfort & privacy
B. TRANSABDOMINAL (FULL BLADDER)
 The transducer is moved across the woman’s abdomen
 NR: inform consent, provide comfort & privacy

2. ALPHA-FETOPROTEIN TESTING
 Level of fetal CHON in the pregnant woman’s serum or in a sample of AF
 Done in 16-18 weeks of pregnancy
 Major protein produced by baby (liver of the fetus)
 AFP is found in elevated amounts in the AF in the 2nd trimester of pregnancy if the fetus
has an open neural defect; can be defected & measured by amniocentesis
 LEVELS OF PROTEIN LEVELS OF PROTEIN

- Spina bifida (defect in the closure - Chromosome abnormalities (Mutations which

of the spine and membranes) change the number of chromosomes)

- Anencephaly (absence of major - Gestational Throphoblastic Disease/

portion of the brain, skull, & scalp
drg. Embryonic dev’t.- 23rd to 26th
day of conception)
- Gastroschisis (intestines are found
outside the body, exiting thru a hole
beside the belly button)
(Hydatidiform mole) H-Mole (overgrowth of tissue
from the placenta)
- Down Syndrome/ Trisomy 21 (gen. d/o caused by
the presence of a third copy of chromosomes 21)

3. CHORIONIC VILLI SAMPLING

 Obtaining a small part of the placenta to analyze fetal cells at 10-12 weeks of
gestation
 Use: Chromosomal Abnormalities (but can not detect spinal cord abnormalities)
 NR: Rh immune globulin (RhoGam) is given to the Rh Negative woman ; it inhibits
AB production of the mother against the Rh positive or negative of the baby
- assess for bleeding, spontaneous abortion
- provide rest
4. AMNIOCENTESIS
 Done when in 15-17 weeks of gestation
 Aspirates 20 ml of fluid from the amnion of the mother
 NR: - instruct mother to increase oral fluid
- informed consent
- provide comfort & privacy
- observe aseptic technique
- assess for infection, FHR, fetal movement, vital signs of mother
- if 20 weeks AOG up (Empty bladder), if 20 weeks AOG below (Full
bladder)
- adm. RhoGam
 Uses :
Early pregnancy – to identify chrom. Abnormalities & to check color of
AF (yellow indicates Rh
incompatibility)
Late pregnancy – to identify severity of maternal fetal blood
incompatibility & assess fetal lung
5. Non-Stress Test (NST)
- it measures the response of the fetal HR to the fetal movement
- test monitors an unborn baby's heart rate for 20 to 30 minutes
to see if it changes as the fetus moves and during contractions.
- it is usually done when a health care provider wants to check on
the health of the fetus, such as in a high-risk pregnancy or when
the due date has passed. The test checks to see if the baby
responds normally to stimulation and is getting enough oxygen.
- It is called "nonstress" because doing it places no stress on the
fetus.
6. CONTRACTION TEST- means of evaluating the respiratory function of the placenta
Uses: identifies the fetus at risk for intrauterine asphyxia by observing the
response of the FHR to the stress of the uterine contractions
(spontaneous or induced) (perform nipple rolling)
◦ Interpretation:
NEGATIVE (GOOD) –shows 3 contraction of good quality lasting for 40/more sec. on 10
min. (fetus can handle the hypoxic stress of uterine contractions)
POSITIVE (BAD)- shows repetitive persistent late decelerations with more than 50 % of
contractions (the hypoxic stress of the uterine contraction causes
slowing of the FHR
EQUIVOCAL / SUSPICIOUS- shows non-persistent late deceleration or decelerations
assoc.
with hyperstimulation
NR: - explain the procedure
- position patient on semi-fowlers
- assess & monitor
Cardiotocography (CTG) is a technique used to monitor the fetal heartbeat and
the uterine contractions during pregnancy and labor. The machine used to
perform the monitoring is called a cardiotocograph. CTG monitoring is widely
used to assess fetal wellbeing by identifying babies at risk of hypoxia (lack of
oxygen).
The display of a cardiotocograph- the
fetal heartbeat is shown in orange,
uterine contractions are shown in green,
and the small green numbers (lower
right) show the mother's heartbeat.
7. PERCUTANEOUS UMBILICAL BLOOD SAMPLING/ Cordocentesis
- obtaining a fetal blood sample from a placental vessel via UC (results usually
available within 72 hours)
- may be used to give a blood transfusion to anemic fetus
- Uses: * identifies fetal conditions that can be diagnosed only with a blood sample
* blood transfusion for fetal anemia

8. LECITHIN-TO-SPHINGOMYELIN (L/S) RATIO

- Use: * evaluate lung maturity (a test of fetal amniotic fluid)
- 22nd -24th week of pregnancy (production of SURFACTANT) (2:1) (2L:1S)
- Amniocentesis is done (SHAKE the bottle) (if there are bubbles, it means the lungs
are mature)