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NARM Exam > from NARM quizlet > Flashcards

from NARM quizlet Flashcards

1
Q

What is the most prevalent sexually transmitted disease in the United States?

A

Chlamydia

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2
Q

What makes a tampon more likely to be indicated in TSS (Toxic Shock syndrome)?

A

The higher the absorbency of the tampon, the greater the risk.

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3
Q

What bacteria causes TSS (Toxic Shock Syndrome)?

A

A strain of Staphylococcus Aureus

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4
Q

What are the symptoms of TSS?

A

Sudden and severe fever of 102 degree of higher, vomiting, copious watery diarrhea, dizziness and fainting or near fainting when standing. There may also be sore throat, headache, severe myalgia (muscle pain), and bloodshot eyes. Uncared for, the disease can lead to cardiac dysfunction, respiratory distress, and death within a week of onset.

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5
Q

If you do a bimanual exam and note that a woman’s uterus bends backwards at the isthmus you would classify it as…

A

Retro flexed

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6
Q

Which Natural Family Planning Methods are the most effective?

A

The ovulation method (the Billings method/CM method) and the sympto-thermal method

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7
Q

When using the Billings method (cervical mucus method, ovulation method) how many days after ovulation (peak day) are counted as fertile days?

A

3

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8
Q

Describe the sympto-thermal method of birth control.

A

The sympto-thermal method of birth control utilizes all the signs and symptoms that ovulation is impending or has occurred- mucus observation, basal body temp, mittelschmerz, libido, cervical mucus ferning (spinnbarkeit) and cervial changes.

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9
Q

What are the three important guidelines for using the LAM (Lactation Amenorrhea Method) of birth control in order to achieve its purported 98% effectiveness?

A
  1. Baby must be less than 6 months old
  2. The woman has no vaginal bleeding after 56 days PP
  3. Breastfeeding must be the exclusive source of nourishment for the baby
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10
Q

What is the active ingredient in spermicide? What sexually transmitted diseases does it help protect women from? Why?

A

The active agent in most spermicidal preparations is nonoxynol-9, which is lethal to the organisms that cause chlamydia, gonorrhea, syphilis and genital herpes.

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11
Q

How long before intercourse is vaginal contraceptive film (VCF) inserted, and how long does it remain effective?

A

5 minutes, and 1 hour. A new film should be inserted with each act of intercourse.

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12
Q

Diagnose this position:
The lie is longitudinal, the head is at or in the pelvis,
the back is on the left & toward the mother’s flank,
the small parts of on the right and sometimes can felt clearly, the breech is in the fundus, the cephalic prominence (forehead) is on the right, FHT loudest in L lower quadrant

A

LOT- Left Occiput Transverse. This is the most common position at the onset of labor.

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13
Q

What do you determine in the first Leopold’s maneuver?

A

The presenting part/what occupies the fundus

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14
Q

What do you determine in the second Leopold’s maneuver?

A

location of the fetal back

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15
Q

What do you determine in the third Leopold’s maneuver?

A

Determines the part of the fetus at the inlet and its mobility

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16
Q

What do you determine in the fourth Leopold’s maneuver?

A

The cephalic prominence, which is felt on the side where there is greater resistance to the descent of the fingers into the pelvis

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17
Q

When the widest diameter of the presenting part has passed through the inlet, we call this-

A

engagement

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18
Q

Attitudes of extension lead to what presentations?

A

brow and face

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19
Q

What is the least common type of pelvis among women?

A

Platypelloid

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20
Q

The pelvis is comprised of how many bones?

A

4: two innominate bones, the sacrum and coccyx

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21
Q

What is the increase in the number of cells by cell division called?

A

Mitosis (hyperplasia?)

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22
Q

At what gestational age is it important to reevaluate a client’s nutrition to ensure adequate diet during the peak in cellular growth of the fetal brain?

A

28 weeks

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23
Q

What is the age of viability?

A

24 weeks

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24
Q

FHT reactivity is a developmental milestone of the fetus that is usually achieved -

A

28 to 32 weeks gestation

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25
Q

During the first half of pregnancy, ultrasound predicts gestational age within ______ days.

A

10 (except in the first 12 weeks) This accuracy is improved earlier in pregnancy and diminishes as pregnancy progresses.

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26
Q

What is the modified BPP (Biophysical profile)?

A

A combination of the NST (non stress test) with AFV (amniotic fluid volume) Less comprehensive than the full BPP, to save time and money.

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27
Q

What is the most common use of amniocentesis in the third trimester?

A

testing for lung maturity

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28
Q

What are the components of the full BPP?

A

Fetal breathing movements, gross body movements, fetal tone, reactive fetal hear rate, qualitative amniotic fluid volume
Each one is scored from 0 to 2, maximal score 12

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29
Q

What test is the most accurate predictor of uteroplacental insufficiency?

A

contraction stress test

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30
Q

For how long should sexual intercourse be avoided following a first trimester spontaneous abortion?

A

2-4 weeks

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31
Q

A client who has just had a first trimester spontaneous abortion asks why she needs to wait to resume sexual intercourse. What is the answer?

A

increased risk of infection

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32
Q

When is the most likely timing of a pregnancy loss due to incompetent cervix?

A

second trimester

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33
Q

What tests would best confirm a suspected hydatidiform mole?

A

Single serum quantitative hCG level and sonogram. hCG will be high.

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34
Q

Which type of viral hepatitis is transmitted via the fecal-oral route?

A

hepatitis A not transmitted from mother to fetus

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35
Q

Which type of hepatitis is transmitted via blood and bodily fluids?

A

Hepatitis B. Vertical transmission from mother to fetus is common and is serious. Hep B virus is present in all of an infected woman’s body fluids except breast mil.

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36
Q

How should you manage newborn infants of Hep B infected mothers?

A

Immediate bath, immunization with Hep B immune Globulin (HBIG), and immunization with Hep B vaccine.

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37
Q

In what stage of pregnancy is maternal infection with rubella most likely to cause congenital malformations?

A

the first month

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38
Q

In which days surrounding childbirth is it most likely that maternal varicella infection will be passed to the newborn?

A

day 6 before birth to day 2 after birth

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39
Q

In which stage of pregnancy is maternal infection with varicella (chicken pox) most likely to cause congenital varicella syndrome in the fetus?

A

In the first 20 weeks. Between 25 to 40 percent of fetuses exposed to varcella in utero will be affected and demonstrate congenital varicella syndrome. This is syndrome is associated with cataracts, chorioretinitis, limb hypoplasia, hydronephrosis, micro cephaly. mental retardation, dermatome lesion, and cutaneous scars.

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40
Q

What physiological change of pregnancy makes pregnant women more susceptible to UTIs?

A

Hydronephorsis (build up of urine in kidneys) and increased progesterone which relaxes the muscles.

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41
Q

What urine bacterial count indicates the presence of a UTI?

A

50,000 bacteria of same species per milliliter of urine.

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42
Q

What should you screen a black woman with recurrent UTIs for?

A

sickle cell anemia

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43
Q

What is the most common cause of true anemia in pregnancy?

A

iron deficiency

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44
Q

What is the hemoglobin level that indicated anemia in a pregnant woman?

A

Hemoglobin level less than 10.0 g per 100 mL (10g/dL)

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45
Q

What is the cause of hemodilution of pregnancy?

A

Normal increase in plasma volume that outpaces increases in erythrocyte production (which exhibits itself in a lowered hemoglobin).

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46
Q

What is the daily recommended amount of elemental iron supplementation in pregnancy?

A

30 mg. (150 mg ferrous sulfate, 300 mg ferrous gluconate, or 100 mg ferrous fumarate)

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47
Q

What factors can cause a woman’s hemoglobin to have a higher lower limit of normal hemoglobin levels?

A

Women who smoke and women who live at higher altitudes, because they need a greater red cell mass in order to maintain tissue oxygen levels.

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48
Q

What kind of anemia constitutes 95% of anemias related to pregnancy?

A

Iron deficiency anemia (microcytic anemia)- decreased red cell size

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49
Q

What is the cause of macrocytic anemia (increased red cell size)?

A

Vitamin B12 deficiency or folic acid deficiency

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50
Q

During pregnancy, when does cardiac output peak, making it most likely for a woman with cardiac disease to decompensate?

A

20-24 weeks

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51
Q

Does cardiac output increase or decrease during pregnancy?

A

The major pregnancy-related hemodynamic changes include increased cardiac output, expanded blood volume, and reduced systemic vascular resistance and blood pressure.

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52
Q

When in pregnancy should a woman with no identified risk factors for diabetes mellitus be screened for gestational diabetes?

A

28 weeks

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53
Q

Why should a fasting blood sugar not be used as the sole screening criteria for gestational diabetes in pregnancy?

A

because fasting blood sugar may be normal even in the presence of gestational diabetes

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54
Q

Describe the normal changes in amniotic fluid volume during pregnancy?

A

A gradual increase through 33 to 35 weeks gestation and then a decrease until term.

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55
Q

Name three complication associated with polyhydramnios:

A

Cord prolapse, placental abruption, post partum hemorrhage

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56
Q

Following intrauterine demise, onset of labor usually occurs within 2 to 3 weeks. This is believed to be due to what?

A

Cessation of placenta function

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57
Q

Proteinuria

A

Protein in the urine in excess of 1 g/L

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58
Q

What are the classical signs of HELLP syndrome?

A

Hemolysis, elevated liver enzymes, low platelets. Hemolysis is the destruction of red blood cells.

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59
Q

Risk factors for HELLP syndrome include:

A

Age greater than 35
Obesity
History of preeclampsia
History of diabetes or renal disease
History of multiple births
History of high blood pressure
occurs in 1-2 of every 1,000 pregnancies
10-20% of women with preeclampsia develop HELLP

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60
Q

Symptoms of HELLP

A

Fatigue or feeling unwell
Fluid retention and excess weight gain
Headache
Nausea and vomiting that continues to get worse
Pain in the upper right or mid part of the abdomen
Blurry vision
Nosebleed or other bleeding that will not stop easily (rare)
Seizures or convulsions (rare)

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61
Q

If a woman develops preeclampsia before 36 weeks the midwife should monitor for what associated condition?

A

Intrauterine growth restriction (IUGR)

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62
Q

Approximately what percentage of women with untreated syphilis infection experience fetal or neonatal loss?

A

40%

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63
Q

What is the treatment for syphilis in pregnancy?

A

Parenteral penicillin G is the only drug effective and safe in pregnancy. Tetracycline and doxycyclin are contraindicated in pregnancy, and erthromycin will not cure an infected fetus.

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64
Q

What are the possible results of a syphilis infection in pregnancy?

A

AB, stillbirth, premature delivery, non-immune hydrops, generalized congenital disease, or neonatal death. An infant is presumed infected if the mother had untreated syphilis at the time of delivery.

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65
Q

Trichomoniasis

A

A pattern of petechiae (bleeding under the skin can occur from broken blood vessels that form tiny pinpoint red dots) on the vaginal walls and cervix, a condition referred to as “strawberry cervix”

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66
Q

Name two vulvovaginal/cervical infections that are NOT usually transmitted sexually.

A

Candidiasis (yeast) and Bacterial Vaginosis. Pregnancy almost doubles the incidence of candida, most often in 3rd trimester.

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67
Q

Active HSV necessitates…

A

cesarean delivery

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68
Q

Which forms of birth control DECREASE the risk of PID (pelvic inflammatory disease)?

A

Diaphragms and cervical caps used with vaginal spermicides, and condoms.

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69
Q

When are eclamptic seizures most likely to occur?

A

in the third trimester and in labor

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70
Q

What is the cardinal sign of placenta previa?

A

Painless bleeding that is usually sudden in onset

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71
Q

Placenta previa

A

when the placenta completely or partially covers the opening of the uterus (cervix

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72
Q

What percentage of pregnancies labeled postdates are actually postdates?

A

30%

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73
Q

What most likely causes postmaturity syndrome?

A

Decreasing uteroplacental function

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74
Q

Postmaturity syndrome is

A

a fetus whose weight gain in the uterus after the due date has stopped, usually due to a problem with delivery of blood to the fetus through the placenta, leading to malnourishment.

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75
Q

When in pregnancy do Braxton-Hick contractions begin?

A

6 weeks’ gestation

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76
Q

What percentage of women at or near term will start labor spontaneously within 24 hours of premature rupture of membranes?

A

80%

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77
Q

What happens to the uterus in labor?

A

The upper zone of the uterus shortens and thickens, while the lower zone lengthens and thins.

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78
Q

What landmark of the fetal head would you use to determine station in well-flexed cephalic presentation?

A

occipital bone

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79
Q

Give three characteristics of true labor contractions

A

They are regular
They increase in frequency, duration and intensity
They radiate from the fundus to the back
Longer, stronger, and closer together

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80
Q

In a normal labor, the fetal head enter the pelvis with a moderate degree of

A

Posterior asynclitism

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81
Q

Asynclitism

A

Asynclitism means asymmetrical. It’s when a baby’s head is tipped towards one shoulder. The tipped head has a harder time passing through the narrow part of the pelvis, the ischial spines.

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82
Q

What fetal heart rate is the cut off for marked tachycardia?

A

180 BPM

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83
Q

What is the best method for the midwife to intermittently listen to fetal heart tones during labor?

A

Start listening midway between two contractions and continue listening through the next contraction to the midpoint between it and the following contraction.

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84
Q

What is a normal rise of blood pressure during contractions for a woman in labor?

A

A systolic rise of 10-20 mm Hg and a diastolic rise of 5-10 mm hg.

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85
Q

How often should the FHT pattern be evaluated through auscultation during a normal, active, first stage of labor

A

every 30 minutes

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86
Q

What is another term for second stage?

A

expulsion stage

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87
Q

Cardinal movements of labor (EDIEEE)

A

engagement,
descent, flexion,
internal rotation,
extension,
external rotation
expulsion

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88
Q

How often should you check BP in second stage

A

every 15 minutes

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89
Q

What is a sinusoidal pattern of FHT and what is its significance?

A

Undulating, repetitive, uniform FHR equally distributed 5 to 15 beats per minute above and below the baseline for at least 10 minute, with no relationship to either the contractions or fetal movement. It is associated with chronic fetal anemia as seen in isoimmunization and abruptio placenta, and severe hypoxia with acidosis.

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90
Q

What is the definition of premature rupture of membranes?

A

rupture of membranes before the onset of labor

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91
Q

What is the first step in the management of cord prolapse?

A

Place your hand into the woman’s vagina and hold up the presenting part off the umbilical cord.

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92
Q

What is the significance of a contraction pattern where the contractions are more frequent than every 2 minutes lasting more than 90 seconds?

A

hyperstimulation of the uterus

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93
Q

Decreased oxygen in the tissue is called…

A

hypoxia

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94
Q

Decreased oxygen in the tissue and metabolic acidosis is called…

A

asphyxia

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95
Q

During a breech delivery, a hands off approach is recommended until the baby is born spontaneously up to which body part?

A

the umbilicus

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96
Q

What is a predictive factor for shoulder dystocia?

A

An estimated fetal weight 1 pound or more greater than the woman’s largest baby

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97
Q

According to Varney, what is the average duration of the third stage of labor?

A

5-10 minutes

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98
Q

What two mechanisms are responsible for placental separation?

A

Uterine contractions and the abrupt decrease in the size of the uterine cavity.

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99
Q

Once you are sure that the placenta has separated, what is the next step you should take in managing the delivery of the placenta?

A

Assess whether the uterus is contracted

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100
Q

What time period is defined as the fourth stage of labor?

A

The period beginning with the birth of the placenta and ending one hour later.

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101
Q

A woman’s BP, pulse and respirations should be monitored how often during the normal fourth stage of labor?

A

At least every 15 minutes until stable at pre-labor levels.

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102
Q

Which of the following pelvic muscles comprises the largest portion of the pelvic floor

A

Levator Ani

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103
Q

What gauge suture should you use to repair a tear/incision of the vaginal mucosa?

A

3-0

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104
Q

What gauge suture should you use to repair a clitoral tear?

A

4-0

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105
Q

A sulcus tear is what degree laceration?

A

first degree

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106
Q

What is the most widely accepted definition of postpartum hemorrhage?

A

Loss of 500mL of blood or greater

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107
Q

Approximately what percentage of infants born with only one umbilical artery will have multiple, severe malformations?

A

30%

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108
Q

Premature rupture of membranes prior to term is called

A

Preterm premature ROM

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109
Q

Ruptured of the membranes more than 24 hours before delivery is called…

A

prolonged ROM

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110
Q

When a woman has premature rupture of membranes and a temp of 100.4 F or greater a presumptive diagnosis of___________ is made.

A

Chorioamniobitis

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111
Q

Signs and symptoms of amnionitis and chorioamnionitis are:

A

Maternal fever, maternal tachycardia, fetal tachycardia, tender uterus, vaginal wall unusually warm or hot to touch, foul smelling purulent aminotic fluid, elevated white blood cell count

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112
Q

Anytime the membranes rupture, your first action should be to….

A

check fetal heart tones

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113
Q

Anytime the membranes rupture, after you check the fetal heart rate, your next action should be to

A

check for cord prolapse

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114
Q

Why does “stripping the membranes” help to stimulate uterine contractions?

A

This action releases a surge of prostaglandins in the maternal circulation proportionate to the size of the area stripped.

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115
Q

Can the severity of fetal distress be measured by the depth of decelerations (in a late deceleration pattern)?

A

No. A shallow deceleration (10 BPM below the baseline) is as serious as a deep deceleration, and is, in fact, more dangerous because it is easier to miss.

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116
Q

The seriousness of variable decelerations depends on their…

A

Frequency
depth
rate of return
effect on baseline fetal heart rate and variability.
Variable decelerations that quickly return to a normal baseline with avg variability are NOT associated with hypoxemia and acidosis.

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117
Q

Early decelerations are…

A

Thought to be caused by head compression. Associated with cervical dilation. Shape of FHT pattern reflects shape of Uterine contractions.

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118
Q

Late decelerations are…

A

Thought to be caused by uteroplacental insufficiency. Onset occurs late in the contraction and extends beyond the end of the contraction. May or may not occur with each contraction.

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119
Q

Variable decels are…

A

Thought to be caused by cord compression. Onset unpredictable and may not be related to contractions. Length varies from a few seconds to minutes.

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120
Q

VEAL CHOP

A

Variable – Cord compression
Early –Head compression
Accelerations– OK
Late – Placental insufficiency

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121
Q

Lambda FHT pattern

A

An acceleration followed immediately by a deceleration and occurring with Uterine contractions. Unknown clinical significance. Benign, not associated with low Apgar scores or adverse outcomes. Main concern is its potential for confusing it with other patterns that do require intervention

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122
Q

Decreased oxygen in the blood is called…

A

hypoxemia

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123
Q

Meconium stained amniotic fluid in the absence of other clinical signs of distress is…

A

not a sign of fetal distress

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124
Q

CPD may be evidenced by…

A

A dysfunctional labor pattern, poorly flexed head, or an arrest of internal rotation and descent

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125
Q

Uterine dysfunction is a diagnosis made by observing…

A

A prolongation of any phase or stage of labor beyond its expected length. Identified by a lack of progress in cervical effacement or dilatation or in descent of the presenting part.

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126
Q

Hypotonic Uterine Dysfunction…

A

uterine contractions have a normal gradient pattern (greatest in the fundus, weakest in the lower uterine segment) but poor tone or intensity- too little pressure to dilate the cervix. Woman feels little pain, labor is prolonged.

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127
Q

Hypertonic Uterine Dysfunction…

A

uterine contractions have a distorted gradient pattern, with the midportion of the uterus contracting more forcefully than the fundus. Excessively painful from early labor, lack of progress in cervical effacement and dilatation.

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128
Q

Maternal exhaustion (Ketoacidosis)

A

The woman feels weak , apathetic, sick, anxious; labor is prolonged; she complains of dehydration. rising pulse, elevated temp, circumoral pallor, vomiting. Ketones in urine. Management should include correction of fluid and electrolyte imbalance.

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129
Q

The retraction of the head against the perineum is called..

A

turtle sign, and indicates possible shoulder dystocia

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130
Q

The incidence of true shoulder dystocia is

A

less than 1%

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131
Q

What is the Pinard Maneuver?

A

Used in frank breech delivery to bring down the feet and legs, one at a time. The Pinard maneuver (pressure in the popliteal space of the knee, which results in external rotation of the thigh and flexion of the knee) assists delivery of the legs.

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132
Q

In a breech delivery, after you have maintained a hands off approach until the baby is born up to the umbilicus you now do two things:

A

Pull down a loop of the cord to prevent stress on its insertion, and place a warm towel around the baby from just below the umbilicus down.

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133
Q

Maternal hemoglobin in labor…

A

Hemoglobin INCREASES an average of 1.2 gm/100mL during labor, returning to prelabor levels the first PP day in the absence of abnormal blood loss.

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134
Q

White blood cells in labor…

A

progressively increases throughout the first stage of labor by about 5000 to an avg total WBC count of 15,000 at the time of complete dilation.

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135
Q

With the decent of the fetal part into the true pelvis, the bladder is compressed so that distention occurs with only approximately _______ CC of urine in the bladder

A

100

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136
Q

Ketonuria in labor would indicate the need for an…

A

hydration via IV. Ketonuria indicates dehydration

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137
Q

What circumstances indicate the need for an additional FHT check in labor?

A

ROM
after expulsion of an enema
whenever there is any sudden change in the contractions or labor pattern
after giving the woman medication
whenever there is any indication that an obstetric or medical complication is developing.

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138
Q

A sterile vaginal exam involves…

A

Cleaning the perineum and using sterile exam gloves

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139
Q

What are the times when a vaginal exam is indicated?

A
  1. On admission, to establish a baseline
  2. before deciding on kind, route or amount of medication,
  3. to verify complete dilation in order to encourage or discourage maternal pushing effort,
  4. after SROM if a prolapsed cord is suspected or is a possibility,
140
Q

5 needs of a woman in labor are:

A
  1. Bodily or physical care,
    2.sustaining human presence,
  2. relief from pain,
  3. acceptance of attitudes and behaviors,
  4. information and reassurance of a safe outcome for herself and her baby.
141
Q

The average length of second stage according to Friedman is

A

1 hours for primigravidas and 15 minutes for multiparas.

142
Q

What are the eight basic positional movements that take place in a cephalic vertex presentation?

A

Engagement
Decent
Flexion
Internal Rotation
Birth of the head
Restitution (45 degrees),
External Rotation (45 degrees) ,
Birth of the shoulders and body by lateral flexion via the curve of Carus.

143
Q

What is the curve of Carus?

A

The lower exiting end of the pelvic curve

144
Q

What is the mean glucose level for newborns from 4 to 72 hours after birth?

A

60-70 mL

145
Q

What is approximated maximum capacity of the stomach of the term newborn?

A

30 cc ( some say less)

146
Q

The neonate can create heat in three ways. They are:

A

Shivering, voluntary muscle activty, and non-shivering thermogenesis.

147
Q

Which of the three ways the neonate creates heat- shivering, voluntary muscle activity, and non-shivering thermogenesis, is the most effective?

A

Non-shivering thermogenesis- this refers to the utilization of brown fat for heat production. Brown fat deposits (BAT- Brown Adipose Tissue) are located in and around the upper spine, the clavicles , the sternum, the kidneys and the major blood vessels.

148
Q

The amount of brown fat deposits in the newborn depends on

A

gestational age

149
Q

Foramen Ovale

A

a hole between the left and right atria (upper chambers) of the heart. This hole exists in everyone before birth, but most often closes shortly after being born.

150
Q

What is most directly responsible for the closure of the foramen ovale?

A

increased pressure in the left atrium

151
Q

What is the reasoning behind administering Vit K to newborns?

A

Newborns are naturally deficient in vitamin K Because the newborn gut, where the Vit K is synthesized, is immature. Vitamin K is important for blood clotting.

152
Q

What offers the best protection against opthalmic infection caused by gonorrhea or chlamydia?

A

0.5% erythromycin ointment

153
Q

What is the best time to apply eye prophylaxis against opthalmalic infection by gonorrhea or chlamydia?

A

At approximately 1 to 2 hours following the birth

154
Q

What is the most common cause of the need for resuscitation of the newborn?

A

fetal asphyxia

155
Q

What are three effects of hypoxia in the newborn?

A
  1. Persistent fetal circulation,
  2. Build up of carbon dioxide,
  3. Metabolic acidosis
156
Q

What is the pressure needed for the first newborn breath?

A

40 to 50 cm H2O

157
Q

At what rate should breaths be delivered with PPV during resuscitation of the newborn?

A

40-60 breaths per minute

158
Q

During cardiac compression of the newborn, the lower third of the sternum (the areas that would be directly below a line drawn between the nipples) should be compressed to a depth of…

A

1/2 inch to 3/4 inch

159
Q

At what rate should cardiac compression be delivered?

A

90 compressions per minute

160
Q

What is the ratio of compressions to ventilations?

A

3:1 every 2 seconds

161
Q

After 30 seconds of chest compression the caregiver should

A

pause and evaluate heart rate for 6 seconds

162
Q

How early can the New Ballard Scale (NBS) date newborns’ gestational age?

A

as low as 20 weeks gestation

163
Q

The presence of how many minor malformations is suggestive of a major underlying malformation in the newborn?

A

three

164
Q

What is the most common sign of neurological compromise in the newborn period?

A

seizure. The most frequent reason for seizures in the neonatal period is hypoxic-ischemic encephalopathy.

165
Q

What is the most common type of seizure activity in the newborn?

A

Subtle.
Signs of subtle seizures include sucking motions, chewing, bicycling of limbs, drooling, apnea, deviation of the eyes, and eyelid fluttering.

166
Q

The two primary signs of heart disease in the newborn are

A

Cyanosis (over the entire body) and Tachpynea (respiratory rate greater than 60 per minute)

167
Q

Name four visible congenital defects of the newborn:

A
  1. Gastroschisis- Eviscerated abdominal organs are not covered by a sac.
  2. Omphalocele: Abdominal organs are external but covered by a sac
  3. Meningocele: a bony defect of the spinal cord (neural tube defect)
  4. Meningomyeloceles: Vertebra is defective and the spinal cord and spinal roots are externally located in a sac.
168
Q

Approximately what percentage of a normal newborn’s time is spent sleeping?

A

60%

169
Q

The American Academy of Pediatrics Task Force on Infant Positioning and Sudden Infant Death Syndrome (SIDS) recommends what position for sleeping newborns?

A

supine on their back

170
Q

What is the rate of complications from circumcision of the male newborn?

A

1%

171
Q

At what age to formula-fed infants need to start receiving iron supplementation?

A

3 months

172
Q

At what age do breast-fed infants need to start receiving iron supplementation?

A

4-6 months

173
Q

Approximately how much breastmilk/formula should a term infant receive at each feeding during the first two weeks of life?

A

30-60 ml (1-2 oz)

174
Q

Healthy term newborns who are of avg weight of gestation age can be expected to gain _____ oz per day and _____ inches per month

A

1 oz / 1 inch

175
Q

During the first 3-5 days of life, newborns may normally lose how much of their birth weight? By what day should they gain it back?

A

5-10% regain by 10th day (14 day?)

176
Q

What is one reason for physiological rather than pathological jaundice?

A

Decreased life span of red blood cells

177
Q

What vaccination should not be given prior to 12 months of age?

A

MMR. Usually not given prior to 15 months of age but may be given at 12 months in high risk areas

178
Q

What is the best definition of the postpartum period?

A

From delivery of the placenta to the return of the woman’s reproductive tract to its non-pregnant condition (not pre-pregnant condition as is often said erroneously).

179
Q

The postpartum period is also called…

A

the puerperium. The puerperium lasts approximately 6 weeks.

180
Q

Regeneration of the endometrium is completed at _____ weeks at all sites except the placental site

A

3

181
Q

Complete regeneration of the endometrium at the placental site takes approximately ______ weeks.

A

6

182
Q

How long does it take the uterus to return to its nonpregnant weight of 70 grams (about 2 1/2 oz)?

A

8 weeks

183
Q

Lochia rubra

A

Red. First lochia after delivery -2-3 days PP. Contains primarily blood and decidual tissue.

184
Q

Lochia serosa

A

Starts pink around 4 days PP, ends 7 to 8 days later as pink, yellow or white color. Contains primarily serous fluid, decidual tissue, leukocytes and erythrocytes

185
Q

Lochia alba

A

Creamy white, starts around 10 days PP and dwindles to nothing in another weeks or so. Consists primarily of leukocytes and decidual cells

186
Q

Vaginal rugae returns by

A

3-6 weeks PP

187
Q

The external os assumes its nonpregnant form by

A

4 weeks PP

188
Q

How soon after a vaginal birth can a woman begin doing Kegel and chin-chest tucks for abdominal tightening?

A

1-2 days

189
Q

What is the primary hormone responsible for milk ejection?

A

Oxytocin. This is initiated by the baby’s sucking, which stimulates the production of oxytocin by the posterior pituitary.

190
Q

What hormone is essential for lactation and is produced by the anterior pituitary?

A

prolactin

191
Q

The movement of milk from the lactiferous sinuses is called

A

the let down

192
Q

What is a diaphragmatic hernia?

A

A surgical emergency in the newborn caused by herniation of abdominal contents into the chest cavity. Usually unilateral on the left. Symptoms: increased left sided breath sounds, heart sounds on the right, and severe respiratory distress at birth. The abdomen may have a concave appearance. Bag and mask will make it worse.

193
Q

What is the course of normal progesterone levels in pregnancy and labor?

A

Progesterone gets higher and higher in pregnancy and then falls to allow labor.

194
Q

Acutane

A

Acne medication that is a teratogen (causes malformation of the embryo)

195
Q

What is the Homan’s sign, and what is its significance?

A

Client lays flat on the bed, ask her to straighten her leg. Place one hand on the client’s knee, applying gentle pressure to keep the leg straight. With your other hand firmly dorsiflex her foot. If there is calf pain with this action, the sign is positive for thrombophlebitis (the swelling of a vein caused by a blood clot). Other symptoms are fever, elevated pulse, and edema. Heparin is prescribed.

196
Q

Leydig’s cells

A

Synthesizes and release the male hormone testosterone, which maintains spermatotogenesis

197
Q

In response to anterior pituitary stimulation, the graafian folicle secretes…

A

estrogen

198
Q

The increased activity of the endometrial glands during the luteal phase of the female reproductive cycle is stimulated by…

A

progesterone

199
Q

Increased levels of Gn-RH (Gonadotrophin releasing hormone) stimulate the anterior pituitary to secrete

A

FSH

200
Q

Testosterone production is stimulated by

A

Gonadotrophin releasing hormone (Gn-RH)

201
Q

Development of secondary sex characteristics, myometrial thickening, and maturation of ovarian follicles are all physiologic effects of

A

estrogen

202
Q

Increased basal metabolism, placenta growth, and development of acini cells in breasts are all physiologic effects of

A

progesterone

203
Q

Mitotic cell division and fetal sex determination start with

A

fertilization

204
Q

Cystic fibrosis, sickle cell anemia and Tay-Sachs disease are examples of…

A

Autosomal recessive disorders, and can be detects by CVS, amniocentesis, and NIPT

205
Q

What is the most common factor/indicator for performing CVS?

A

Maternal age. CVS is always performed in the first trimester

206
Q

What is normal after a CVS?

A

Bleeding. No sex for 48 hours

207
Q

How is endometriosis diagnosed?

A

laprascopy and biopsy

208
Q

How do combined oral contraceptives prevent pregnancy?

A

By inhibiting the production of FSH and LH

209
Q

Why do some women have edema while taking Oral contraceptives?

A

Because of the increased estrogen

210
Q

What symptom would mean a woman should discontinue her Oral contraceptive

A

headache with vision changes. The estrogen in the birth control can increase the risk of stroke

211
Q

What does the placenta form from?

A

The placenta forms from the chorionic villi and decidua basalis.

212
Q

What method allows for examination of the amniotic fluid through intact membranes?

A

Amnioscopy. Amnioscopy is an invasive exam employed to visualise the forebag of the amnionic sac and to look out for meconium staining.

213
Q

If MSAFP (Maternal Serum Alpha Fetal Protein) levels are above normal at 15 to 20 weeks it can indicate

A

Neural tube defects, multiple gestation, fetal demise

214
Q

What happens to the heart in a normal pregnancy?

A

it is displaced to the left

215
Q

Softening of the lower uterine segment is a sign of

A

early pregnancy, Hegar sign

216
Q

If a woman is having repeated yeast infections in pregnancy it could indicate…

A

gestational diabetes

217
Q

Chadwick sign…

A

a blue cervix, a sign of pregnancy

218
Q

Adequate placental perfusion is indicated in labor by

A

duration of rest phases between uterine contractions

219
Q

Fetal Vagal Nerve

A

Can be triggered by head compression as indicated by early decels in FHT- “fetal vagal nerve response”. Can also be elicited by scalp stimulation

220
Q

Esophageal atresia

A

birth defect in which part of a baby’s esophagus does not develop properly. A pocket in the esophagus that does not connect to the stomach. First sign is choking

221
Q

Priapism

A

persistent and painful erection of the penis.

222
Q

Sims position

A

side lying

223
Q

Dorsal position

A

on the back with knees bent and soles of feet flat on the floor

224
Q

Unequal bilateral femoral pulses in a neonate typically indicate

A

Coarctation of the aorta- (a birth defect) a narrowing of part of the aorta (the largest artery in the body).

225
Q

Elimination of green urine and greenish loose stools can indicate that..

A

A baby is excreting bilirubin and responding to photo therapy for jaundice

226
Q

What is the Goodell sign?

A

softening of the cervix in early pregnancy

227
Q

What is Chandelier sign?

A

Cervical motion tenderness, indicative of PID, ruptured tubal pregnancy and endometrious

228
Q

How soon after a full term delivery can a woman who is not breastfeeding safely start taking combination oral contraceptives?

A

3 weeks

229
Q

Can Norplant be used by lactating women?

A

No

230
Q

How long is Norplant effective? What is its main mechanism of action?

A

years. In women who weigh more than 154 pounds (70kg)- every 2 years. Norplant works primarily by thickening the cervical mucus, which prevents the passage of sperm.

231
Q

Can Depo Provera injections for contraception be used by breastfeeding women?

A

yes

232
Q

Describe the action of the Depo Provera

A

Progestin crystals in suspension are deposited in the tissue by injection and slowly absorbed. these are repeated every 3 months. the progestin supresses the LH surge, inhibits ovulation, makes cervical mucus inhospitable to sprem, and causes the endometrium to atrophy and be unreceptive to a blastocyst. After receiving DMPA, an average of 5 to 8 months is required to clear the body of hormones and resume normal fertility

233
Q

What is the most likely mechanism of action for the Copper T 30A (Paragard) intrauterine contraceptive device (IUD)?

A

It prevents fertilization from occurring by altering fallopian tubes motility and incapacitating the sperm.

234
Q

Why would you delay the initiation of combination oral contraceptives in a postpartum woman who is not breastfeeding?

A

Because earlier initiation of combination oral contraceptives can increase the risk of delayed postpartum hemorrhage.

235
Q

Hemopytsis

A

throwing up blood

236
Q

What are dangerous side effects of Oral contraceptives that should be immediately reported?

A

Severe headaches, visual disturbances, severe chest pain or shortness of breath, severe abdominal pain, severe calf or thigh pain, temporary numbness or paralysis of any part of the body, slurring of speech, coughing up bloody sputum, severe depression, or if you miss two periods or think you are pregnant.

237
Q

The human immuodeficiency virus (HIV) is what type of virus?

A

retrovirus

238
Q

What type of cells that comprise the human immune system does the HIV virus target?

A

T4 lymphocytes, also called CD4 cells

239
Q

What lab test is most commonly used as the first test in the initial evaluation of HIV status?

A

Enzyme-linked immunosorbent assay (ELISA). It is also the test most likely to give a false positive result, and is commonly followed by the western blot test, which has a much lower false-positive rate.

240
Q

What is the approximate risk of perinatal HIV transmission without antiretroviral treatment?

A

25%

241
Q

What is the approximate risk of perinatal HIV transmission with maternal zidovudine (ZDV) treatment during pregnancy and labor, and ZDV treatment for the newborn?

A

8%

242
Q

What is the average age of menopause in the USA?

A

51

243
Q

Which estrogen is predominant in the postmenopausal period?

A

Estrone

244
Q

What hormone increases in peri-menopause?

A

FSH

245
Q

Estrogen therapy reduces the risk of bone fracture by approximately what percent?

A

50%

246
Q

Implantation begins approximately how soon after fertilization?

A

6 days

247
Q

When does the embryonic period start and end?

A

It starts at the end of implantation, and continues through 48 days of fetal development

248
Q

How long do the eyelids of a fetus remain fused?

A

25 weeks gestation

249
Q

When is primitive placental circulation established?

A

4 weeks gestation

250
Q

The sex of the fetus is clearly distinguishable by direct examination at what gestational age?

A

14 weeks gestation

251
Q

According to ACOG, what score on the Bishop Pelvic scoring system is favorable and likely to result in a successful labor?

A

6

252
Q

What type of fetal growth retardation is associated with uteroplacental insufficiency?

A

With uteroplacental insufficiency fetal growth retardation is asymmetric; that is, the body and body organs are small, but the brain is of normal size with its full complement of cells.

253
Q

What type of fetal growth retardation is associated with malnutrition?

A

With malnutrition, fetal growth retardation is symmetric; that is, the body, body organs, and brain are all reduced in size, and in the number of cells by approximately the same percentage amount.

254
Q

When a non immune woman is exposed to varicella in pregnancy, what should you do?

A

Varicella-Zoster immune globulin (VZIG) given to the mother within 96 hours of exposure may offer some protection from more serious infection, including varicella pneumonia. VZIG provides no known benefit to the fetus. However an infant of a woman who develops Varicella infection 6 days before through 2 days after delivery should receive VZIG because of high associated neonatal mortality

255
Q

Non-pregnant women receiving the varicella vaccine should be counseled to avoid pregnancy for how long?

A

3 months

256
Q

The first stage of labor is divided into two sequential phases. They are:

A

Latent and Active

257
Q

Latent Phase

A

The period of time from the beginning of labor to the point when dilation begins to progress actively- generally from the onset of reg uterine contractions to 3 to 4 cm. Little or no descent of the presenting part occurs during latent phase.

258
Q

Active Phase

A

3 or 4 cm to 10cm. (now considered 6 cm?) Active phase is divided into three parts: Acceleration phase, Phase of maximum slope (the time when most rapid dialation is occuring- 3 cm per hour in nulliparas, and 5.7 cm per hours in multiparas), and Deceleration phase (1- 1.6 per hour in nulliparas and 2.1-5.4 cm per hour in multiparas), also know as transitional phase

259
Q

What is the most responsible for closure of the ductus arteriosus?

A

increase in O2 levels in the blood

260
Q

At what point in pregnancy should the maternal serum alphafetoprotein (AFP) of the triple screen be performed?

A

15-18 weeks

261
Q

What is the difference between a primigravida’s cervix and a multigravida’s cervix at the onset of labor?

A

A primigravida ‘s cervix effaces first (needs to) and a multigravida’s dilates first (doesn’t need to efface to start dilating.

262
Q

Describe a term primigravida’s cervix prior to labor:

A

50 to 60 % effaced and 1 cm dilated. She will finish effacing first and then dilate.

263
Q

What is the largest diameter of the fetal head?

A

Occipitomental- the distance from the posterior fontanel to the mentum (chin). Avg 12. 5 cm

264
Q

What is the smallest pelvic diameter to which the fetus has to accommodate itself?

A

interspinous diameter

265
Q

What maternal vital sign will normally remain elevated in the immediate postpartum and during the fourth stage of labor?

A

respirations

266
Q

What is DES and what is its significance?

A

Diethylstilbestrol is a nosteroidal estrogen that was widely used from 1948 to 1971 to prevent complications of pregnancy. Initially it was used for threatened abortion, later also for third trimester complications. FDA withdrew approval in 1971 when reports of structural and functional abnormalities came in from those who got DES in utero. Includes vaginal epithelial changes, cervical deformities, septum of the vagina, T shaped or hypoplastic uteri, infertility, preterm delivery and ectopic pregnancy.

267
Q

Define hypertension:

A

BP of 140/90 or higher or a rise of 30 mm systolic and/or rise of 15 mm diastolic over the woman’s baseline.

268
Q

Describe the Brandt-Andrews maneuver

A

For use AFTER PLACENTAL SEPARATION: Pushing down and toward the umbilicus on the uterus above the symphysis pubis with the palm of you abdominal hand to facilitate placental expulsion after separation with gentle cord traction.

269
Q

Describe the modified Brandt-Andrews maneuver:

A

To check to see if the placenta has separated: Hold the cord taut at the vaginal introitus with one hand, using the clamp for leverage. Bring the tips of your fingers on your other hand straight down into the lower abdomen just above the symphysis pubis and watch what happens to the umbilical cord. If the cord recedes into the vagina, then the placenta is not separated. If the cord has a feeling of give and remains the same length or extends, then the placenta has separated.

270
Q

What is the significance of larger and heavier than normal placentas?

A

May occur with excessively large fetuses, fetal syphilis or erthroblastosis (when mother and baby have different blood type and the mother develop antibodies that attack the baby’s red blood cells as in ABO incompatibility or Rh incompatibility).

271
Q

What is the significance of smaller and lighter than normal placentas?

A

Fetal anemia such as is found in erthroblastosis

272
Q

What causes placental tissue that is lighter in color?

A

Fetal anemia such as is found in erthroblastosis

273
Q

What is the significance of extensive infarction of entire cotyledons of a placenta?

A

Abnormal, usually the result of disease processes such as severe chronic maternal hypertension or severe preeclampsia or eclampsia.

274
Q

What is the significance of edema of the placenta?

A

With edema of the placenta, the placenta is mushy, thick, and pale, and fluid can be squeezed from it. Edema may be caused by severe maternal heart disease, diabetes, or nephritis and by severe erthroblastosis. The fetus usually dies in utero, either as a stillbirth or earlier as an abortion

275
Q

Are placental cysts normal?

A

Smaller cysts, a few millimeters in size are more common than larger cysts of up to 8 to 10 cm in diameter. Not usually significant except in the occasional instance when a cyst contains a blighted twin.

276
Q

What are placental tumors associated with?

A

Prematurity and polyhydramnios. Perinatal mortality and maternal hemorrhage are both increased.

277
Q

An abnormally large and pale yellowish gray placenta is…

A

a syphilitic placenta; expect a syphilitic fetus

278
Q

Lobulated placenta is…

A

One placenta divided into two or more parts that are either completely separated or joined in part. Either way, the lobes are held together by the one set of membranes and by the blood vessels. The number of lobes determines the name 2 lobes- placenta duplex, three lobes- placenta triplex. Though to be due to abnormalities in the blood supply to the decidua. Main significance- make sure all lobes have been expelled.

279
Q

Succenturiate placenta

A

One or more separated accessory lobes are in the membranes a variable distance away from the main placental mass. They are connected by blood vessels. If no connecting blood vessels = placenta spuria. Again, make sure all lobes are expelled.

280
Q

Extrachorial placenta

A

An anomaly on the fetal surface of a thick white ring. If it is on the edge or margin of the placenta it is called placenta marginata, and if it is between the margin and the middle of the placenta it is called placenta circumvallata. Significance not known

281
Q

Battledore placenta

A

Umbilical cord inserted in the edge or margin of the placenta. Occurs in less than 10 percent of placentas

282
Q

Velamentous insertion

A

Blood vessels in the umbilical cord separate and leave the cord prior to insertion into the surface of the placenta. Occurs 1% of the time. Dangerous, rupture of membranes may also rupture a fetal blood vessel. Vessels are also liable to compression which would cause fetal anoxia.

283
Q

Vasa previa

A

when unprotected umbilical vessels run through the amniotic membranes, and pass over the cervix. When unprotected blood vessels, covered only with amnion and coursing between chorion and amnion, present first at the cervical os by crossing the os ahead of the fetal presenting part. Usually occurs with velamentous insertion of the cord. Occurs in less than 0.2 % of pregnancies. With fetal descent and rupture of membranes, the vessels ar subject to compression and rupture with resulting exsanguination and anoxia of the fetus.

284
Q

Cord looping occurs how often? (nuchal cord)

A

In approximately 20% of all pregnancies

285
Q

According to Varney, when in labor are membranes most likely to rupture?

A

at the end of first stage

286
Q

The onset of preeclampsia generally occurs when?

A

after 26 weeks

287
Q

Early signs of preeclampsia are:

A

Hemoconcentration (abnormally high HCT), hypertension, generalized edema, sudden and excessive weight gain, and protein in the urine.

288
Q

Pitting edema of +2 or greater (4mm depression) is a sign of

A

preeclampsia

289
Q

Foods rich in iron

A

Dark green leafy vegetables, dried fruits, pumpkin sees, legumes, nuts (almonds), dark molasses, egg yolks, meat, including liver, poultry, fish, including shrimp and oysters, Fortified breads and cereals

290
Q

Foods rich in folic acid

A

Dark green leafy vegetables, asparagus, okra, brussels sprouts, broccoli, chili peppers, orange juice, yeast and enriched whole grains, organ meats, lean beef, fish, legumes, fresh fruits and vegetables, eggs, cheese and milk

291
Q

The Midwives Model of Care includes:

A

Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle, Providing the mother with individualized education, counseling and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support, Minimizing technological interventions, and Identifying and referring women who require obstetrical attention.

292
Q

The application of the Midwives Model of Care has been proven to reduce what?

A

The incidence of birth injury. trauma, and cesarean section.

293
Q

What are three documents/forms every CPM must have/use to practice under her guidelines?

A

Practice guidelines, an informed consent document, and an emergency care form

294
Q

Human cytomegalovirus (HCMV) is a member of the ____ family.

A

The herpes virus family. Humans are the only reservoir. It is found universally throughout all geographic location and in all socioeconomic groups.

295
Q

What percentage of pregnant women in developed countries are immune to Human cytomegalovirus (HCMV)?

A

75%

296
Q

What percentage of women acquire a primary infection of Human cytomegalovirus (HCMV) in pregnancy?

A

1-4%

297
Q

What are the symptoms of Human cytomegalovirus (HCMV)?

A

Most HCMV infections are asymptomatic. Primary infection may cause generally mild mononucleosis type symptoms such as myalgia (muscle pain) and fever. Following primary infection HCMV persists for life as a latent infection with periodic viral shedding in salvia, breastmilk, urine, semen and cervical secretions.

298
Q

How is HCMV transmitted?

A

The modes of transmission are incompletely understood, but it is assumed that the fetus can be infected with HCMV transplacentally or during the birth via cervical secretions or blood, and the noenate can be infected postnatally from breastmilk. The source of maternal HCMV is likely to be close contact with an asymptomatic child or sexual partner.

299
Q

What is the significance and outcome of HCMV infection in pregnancy?

A

In contrast to other damaging organisms, HCMV has its effect during the fetal period (10 to 40 weeks post LMP) rather than during the organogenesis of the embryonic period. 50% of fetuses will become infected, half of whom will have symptoms at birth. The prognosis is poor with 80% of these likely to suffer serious neurological sequelae and psychomotor retardation. Possible malformations include microcephaly or hydrocephaly, microphthalmia (abnormally small eyes) and congenital predisposition to seizures, blindness, endephalitis and learning disabilities

300
Q

What are the TORCH viruses, and what is their significance?

A

T- Toxoplamosis, O- Other (Hepatitis B, Coxsackievirus, Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19.) R- Rubellas C-Cytomegalovirsus (HCMV) H-Herpes. They are a group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream transplacentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion.

301
Q

Women who smoke are at increased risk of what?

A

Cardiovascular and respiratory disease as well as experiencing menopause at an earlier age. Lung cancer is the most common cause of cancer death among females

302
Q

Smoking prior to or early in pregnancy increases the risk of-

A

Spontaneous abortion, and abnormal placentation including abruptio and previa. Carbon monoxide diminshes the oxygen carried to the fetus, causes growth restriction. Smoking during pregnancy is closely associated with low birth weight, decreased birth length and preterm delivery.

303
Q

Infants of women who smoke have a higher incidence of

A

Apnea and sudden infant death syndrome, and respiratory problems in the first year. They also have increased risk of asthma and otis media

304
Q

Smoking only two cigarettes has been shown to decrease fetal activity for as long as—–

A

80 minutes

305
Q

Babies of women who smoke 15 cigarettes a day have a ____ times greater risk of dying from SIDS than babies of a non-smoker.

A

15

306
Q

What percentage of women have group B streptococcus (GBS) in their lower intestinal and urinary tracts?

A

20-30%

307
Q

What is the rate of newborn infection from women who are GBS positive?

A

The rate of newborn infection is 5%. Of these 6% will die. Midwives Handbook says 1 in 100 colonized mothers will have an affected baby.

308
Q

What are the symptoms of a GBS infected baby?

A

50% of neonates are symptomatic at birth. Early onset (usually within 6 to 12 hours): Cyanosis, apnea, hypotension, tachypnea, grunting, flaring, and retractions. pulmonary effusion, infiltrates, and cardiomegaly are present. Persistent fetal circulation, generalized sepsis, and meningitis may occur. Late onset: 7 days to several months after delivery: Sepsis and meningitis (60 %)

309
Q

When is it standard to culture a client for GBS?

A

35-37 weeks

310
Q

Under what circumstances are IV antibiotics (penicillin or ampicillin) advised for a GBS positive client?

A

During labor if it is preterm, if membranes are ruptured for more than 18 hours, or if the mother develops a fever. Some say GBS positive clients should always receive antibiotics.

311
Q

An incompetent cervix is comprised of more __ and less ____ than the normal cervix.

A

More muscle fibers and less connective tissue

312
Q

What are the most common high risk factors for pregnancy that would or could rule out a home birth?

A

Preexisting diabetes, thyroid disease, chronic lung disease or severe asthma, epilepsy, clotting abnormalities, Rh negative with antibodies, severe anemia, acute viral infections (rubella, herpes, hepatitis B or C, cytomegalovirus), congenital heart disease grades 2-4, renal disease, extreme obesity, tobacco use (more than 10 cigarettes daily), drug addiction, moderate to heavy alcohol use.

313
Q

What vitamins help iron absorption?

A

vitamin c and a

314
Q

How much supplemental iron in pregnancy?

A

75 mg

315
Q

How much supplemental folic acid in pregnancy?

A

800 mcg

316
Q

What are common relief measure to suggest for morning sickness?

A

unisom at night. 50 mg B-6 at bedtime and again at mid-day, ginger, peppermint or red raspberry leaf tea, and eating small continous meals high in protein throughout the day. For more sever vomiting, ginger capsules with meals. Diclegis can be prescribed by OBGYN

317
Q

What causes varicose veins of the legs and vulva in pregnancy?

A

Varicose veins are caused by high levels of progesterone relaxing smooth muscles and hindering venous return throughout the body. Hereditary factors also play a part.

318
Q

What relief measure can you recommend for varicose veins?

A

Exercise, elevating the legs and buttocks periodically, 600-800 units of Vitamin E daily (taken separately from other supplements) with milk cheese or other fatty food sources. Compression garments

319
Q

What causes indigestion and heartburn (pyrosis) in pregnancy?

A

Displacement of the stomach and intestines by the growing uterus, particularly in the last trimester. Also may be caused by the relaxing effect of progesterone on the cardiac sphincter of the stomach and decreased GI motility.

320
Q

What are some common remedies for heartburn?

A

Slippery elm lozenges, yogurt, chewing raw almonds, peppermint tea, raw papaya, or papaya enzyme tablets. Small meals, eaten slowly and chewed well. Avoiding very cold foods, spicy foods, coffee, alcohol, chocolate, fats. Avoid eating or lying down three hours before bedtime.

321
Q

How long does the moro reflex in the newborn last?

A

4 months

322
Q

When does the anterior fontanel close?

A

9-16 months

323
Q

When does the posterior fontanel close?

A

birth to 4 months

324
Q

Fontanels should be flat. If they are bulging or depressed it means:

A

Bulging indicates intra-cranial pressure and depression indicates dehydration

325
Q

Bulging indicates intra-cranial pressure and depression indicates dehydration

A

Respirations: 30 to 60 breaths per minute HR: 110- 160 BPM

326
Q

What should a woman’s fasting blood glucose be?

A

90 or less

327
Q

What should a woman’s 1 hour blood glucose be after a 50 gram glucose load?

A

140 or less

328
Q

Describe meconium aspiration syndrome:

A

Uneven breath sounds, a barrel chested appearance, rales and rhonchi, nasal flaring and grunting with exhale, retractions of the chest and abdomen and cyanosis.

329
Q

Describe Transient Tachypnea of the Newborn (TTN)

A

Caused by delayed absorption of fetal lung fluid. Abnormally high respirations- up to 120 per minute, and sometimes nasal flaring or intercostal retractions. If there are no other symptoms it will resolve spontaneously in 48-72 hours.

330
Q

Describe a pneumothorax in the newborn

A

Occurs when air from the lung is pushed outward into an atypical space, usually the tissue of the interstitial space of the lungs. NEWBORNS WHO ARE MECHANICALLY VENTILATED ARE AT HIGH RISK. Diminished breath sounds on one side, cyanosis, over distension of that side.

331
Q

Describe pneumonia of the newborn

A

Uneven breath sounds, barrel chested appearance, rales and rhonchi, cyanosis, hypothermia, color changes and apnea. (May be acquired in the intrauterine period of during the passage through the birth canal.)

332
Q

If a pregnant woman is showing blood and/or nitrates in her urine, this is suggestive of

A

UTI

333
Q

Define essential hypertension

A

A preexisting condition (from before pregnancy) indicated by initial and subsequent readings of 140/90 or more. Home birth is contraindicated for women with essential hypertension.

334
Q

Define gestational hypertension

A

When high BP readings first occur in the latter part of pregnancy

335
Q

How can you treat gestational hypertension?

A

Exercise, deep relaxation, avoid all stimulants (coffee, tea, black pepper, ginger), calcium/magnesium supplements, Foods:watermelon, cucumber, parsley, onions and garlic, Herbs: Hops, skullcap, passionflower, hawthorn, and chamomile, increased fluids. (protein every 2 hours and a pinch of salt in water)

336
Q

Epigastric (upper central region of the abdomen) pain is the early sign of a —

A

seizure

337
Q

Oxytocin

A

Produced in the posterior pituitary, causes urge to push, let down reflex, triggers onset of labor, and affects labor progress and uterine contractions.

338
Q

Estrogen

A

Produced in the ovaries (graafian follicle) (in response to the anterior pituitary), adrenal glands and fat tissues , and in the placenta during pregnancy, affects growth of uterine muscle and blood supply (myometrial thickening), produces vaginal mucus, ductal system and blood supply in breasts, skin pigmentation, H2O retention, body fat build up, maturation of ovarian follicles, secondary sex characteristics, protects female fetus from the effects of androgens.

339
Q

Relaxin

A

Relaxin is a reproductive hormone produced by your ovaries and the placenta. It loosens and relaxes your muscles, joints and ligaments during pregnancy to help your body stretch. Relaxin also helps your body prepare for delivery by loosening the muscles and ligaments in your pelvis. Produced in the ovaries, relaxes and softens ligaments, cartilage, cervix, and increased sperm motility

340
Q

HCG

A

Produced only in pregnancy in the placenta, maintains corpus luteum during 1st trimester, ensures that ovaries produce estrogen and progesterone

341
Q

Progesterone

A

Produced in ovaries, and the placenta during pregnancy, relaxes uterus, relaxes walls of blood vessels and walls of stomach and bowels, increased activity of endometrial glands during luteal phase of menses, helps placenta growth, increase basal metabolism, develops acini cells in breasts.

342
Q

Prostaglandins

A

Produced in amniotic membranes, softens and ripens the cervix, stimulates muscles in uterus and bowels

343
Q

Testosterone

A

In men it is synthesized and released by Leydig’s cells, located in the testes, and maintains spermatogenesis. In women it is produced in the ovaries and adrenal glands and is slightly increased in pregnancy.

344
Q

What might shoulder pain be a sign of in the first trimester?

A

A ruptured tubal pregnancy. Other signs are marked lower abdominal pain and vaginal bleeding.

345
Q

FSH

A

Produced by the anterior pituitary gland. A gonadotrophius that causes Graafian follicles to develop and enlarge during pregnancy.

346
Q

LH

A

Produced by the anterior pituitary gland. A gonadotrophius that is necessary to maintain luteal function for the first two weeks of pregnancy.

347
Q

What is the level for infant hypoglycemia?

A

40 mg/dL

NARM Exam (4 decks)

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