Question

Ruba is a 39 years old, pregnant woman at 8 weeks gestation, and her husband, Ali, is 50 years old, arrives at antenatal clinic for follow-up. The couples have been married for 12 years. Ruba completes the initial paperwork, and the nurse notes the following obstetric history: G6 T0 P0 A5 L0 M0.  Ruba and Ali asked the nurse many questions regarding Down syndrome as Ali’s sister, recently, has a boy with Down syndrome.

1. What are the questions in the history taking are the highest priority for the nurse to ask, given Ruba’s obstetric history?

2.What are the initial prenatal assessment and screening tests would the nurse anticipate for Ruba at this antenatal visit?   

3.What are the fetal screening and diagnostic procedures would the nurse anticipate for Ruba?   

4.What are the possible screening tests can be performed to reassure Ruba and Ali regarding the possibility of having a child with Down syndrome?   

5.As Ruba has many questions regarding her pregnancy, including the physiological and psychological changes, labor process and postpartum period. The nurse advice Ruba and Ali to attend antenatal classes.
List six topics should be covered in the childbirth preparation program that may help to answer Ruba’s inquiries.

6.After 7 months, Ruba is approximately 37 weeks gestation. She comes for antenatal follow-up visit complaining of backache, leg cramps, heartburn, constipation, and difficulty sleeping at night. Describe three nursing management for each Ruba’s complain (minor discomfort).       

Answer 1

1) The questions in the history taking that are the highest priority for the nurse to ask, given Ruba’s obstetric history :-

The course of a pregnancy depends on a number of factors, including the past pregnancy history (if this is not a first pregnancy), prepregnancy health of the woman, presence of disease/illness states, family history, emotional status, and past health care.

The body mass index is an important part of the current medical history to be assessed and documented.

Homeopathic and herbal medication use is important for the nurse to assess and document in the current medical history.

The blood type must be assessed and documented in the current medical history, as must the Rh factor.

2) Prenatal screening tests can identify whether your baby is more or less likely to have certain birth defects, many of which are genetic disorders. These tests include blood tests, a specific type of ultrasound and prenatal cell-free DNA screening.

The assessments which are performed during the initial prenatal visit :-

Prenatal lab panels, including complete blood count (CBC), rapid plasma regain (RPR), hemoglobin and hematocrit (H&H), human immunodeficiency virus (HIV), hepatitis B (Hep B), and Rubella, are drawn at the initial prenatal visit.

The following screening methods are available during pregnancy:

Alpha-fetoprotein (AFP) test or multiple marker test.

Amniocentesis.

Chorionic villus sampling.

Cell-free fetal DNA testing.

Percutaneous umbilical blood sampling (withdrawing a small sample of the fetal blood from the umbilical cord)

Ultrasound Scan

3) Fetal screening tests includes :-

Alpha-fetoprotein (AFP) test or multiple marker test.

Amniocentesis.

Chorionic villus sampling.

Cell-free fetal DNA testing.

Percutaneous umbilical blood sampling (withdrawing a small sample of the fetal blood from the umbilical cord)

Ultrasound Scan

4) Down syndrome screening includes the following tests done during pregnancy:

First trimester screening includes a blood test that checks the levels of certain proteins in the mother's blood. If levels are not normal, it means there is a higher chance of the baby having Down syndrome. The screening also includes an ultrasound, an imaging test that looks at the unborn baby for signs of Down syndrome. The test is done between the 10th and 14th week of pregnancy.

Second trimester screening. These are blood tests that also look for certain substances in the mother's blood that may be a sign of Down syndrome. A triple screen test looks for three different substances. It is done between the 16th and 18th week of pregnancy. A quadruple screen test looks for four different substances and is done between the 15th and 20th week of pregnancy. Your provider may order one or both of these tests.

If your Down syndrome screening shows a higher chance of Down syndrome, you may want to take a diagnostic test to confirm or rule out a diagnosis.

Down syndrome diagnostic tests done during pregnancy include:

Amniocentesis, which takes a sample of amniotic fluid, the fluid that surrounds your unborn baby. It is usually done between the 15th and 20th week of pregnancy.

Chorionic villus sampling (CVS), which takes a sample from the placenta, the organ that nourishes your unborn baby in your uterus. It's usually done between the 10th and 13th week of pregnancy.

Percutaneous umbilical blood sampling (PUBS), which takes a blood sample from the umbilical cord. PUBS gives the most accurate diagnosis of Down syndrome during pregnancy, but it can't be done until late in pregnancy, between the 18th and 22nd week.