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Flashcards in ACNM Review Session Deck (84):
1

Pyrosis is caused by

Reflux of the acidic secretions into lower esophagus

2

a function of progesterone in pregnancy is to

suppress maternal immunologic response to fetal antigens

3

the softness and compressibility of the uterine isthmus is called

Heagar's sign

4

the disproportion of erythrocytes to plasma results in which type of anemia

physiologic anemia

5

the end of the eight postferilization week also marks the end of which period

embryonic period

6

oxygenated blood enters the placental intervillous space by way of the

spiral arteries

7

this pelvis type has an inlet which is characteristically oval with an AP diameter much larger then the transverse diameter

anthropoid

8

Naegele's rule is calculated by

first day of LMP minus 3 months,plus 7 days

9

CVS testing screens for all the following EXCEPT

neutral tube defects

10

women who do a lot of gardening are at an increased risk for

toxoplasmosis

11

Auscultation with a fetoscope should be possible at which gestion

18-20 weeks

12

exercise in pregnancy may help to prevent/treat which condition

gestational diabetes

13

when is the fetus seen as a separate object it's own identity

third trimester

14

a 25 yo G2P0101 at 8 weeks gestation reports her first baby was born at 33 weeks after going into spontaneous labor. what should she be offered

progesterone injections

15

a 36 yo at 36 weeks gestation reports having young some moderate bright red vaginal bleeding. Which is the best method to asses the bleeding

sterile speculum exam to evaluate at cervical os

16

a 33 yo G2P1001 at 34 weeks gestation is at her routine prenatal visit. her internal history to date has been bening. today her fundal height is measuring 31 cm. which is the best action at this visit

order an an abdominal ultrasound

17

what best describes growth of the uterus in the 2nd half of pregnancy

hypertrophy results in increased oxygen receptors and expression of those receptors

18

which medications will relax the uterus

calcium channel blockers, beta agonists, magnesium suflate

19

terutaline

is contraindicated beyond 48-72 hours of use for treatment of PTL

20

what is true concerning induction of labor

safety issues are a concern with elective induction prior to 39 completed weeks

21

what hormone initiates labor

prostaglandins

22

what may prevent a successful IOL for jennifer

nulliparity and unfavorable cervix

23

what is your treatment approach for GBS in this situation

obtain a GBS culture. start antibiotics. if the culture is negative, you may discontinue antibiotic prophylaxis

24

what is the appropriate treatment regimen

start vancomycin 1 g IV q 12 hours until delivery

25

engagement in cephalic presentation

involves the widest portion of the presenting part

26

what is the result of flexion

the presenting diameter changes from occipitofrontal to sboccipiotbregmatic

27

how would you appropriately monitor this patient

intermittent auscultation is acceptable

28

how frequently and when will you auscultation Cindy's FHR

Q 15-30 minutes, before and after interventions

29

what is true about electronic teal monitoring (EFM) and FHR patterns in a low-risk labor

reassuring FHR patterns indicate normal fetal acid-base balance

30

how would you classify the FHR

category ll

31

what management is needed for category ll

continued monitoring and further assesment

32

what describes a normal LOA position

longitudinal lie, attitude = flexed, denominator = occipit

33

in the same position (LOA), where is the ceohalic prominence

on the opposite side of the back

34

in the same position as (LOA), where is the cephalic prominence

on the same side of the back

35

how will you asses or diagnose he r progress

according to the friedman curve, this is a 1st stage protraction disorter

36

the patient is 9/100/+1 and you palpate the posterior fontanelle roughly in the 2:00 position. you cannot palpate the anterior fontanelle

the head is in LOA

37

Jeanine, a 41 y.o. G5 P4004 at 39.4 weeks is in active labor. BP upon admission was 120/70 and is consistent with her prenatal course. The nurse is concerned about her current readings: 130/75, 134/74. What do you tell the nurse?

A slight elevation is normal, especially duing contractions. Let's make sure she's as comfortable as possible.

38

What other changes in vital signs will you anticipate wit ha normal course of labor?

Slight elevation of pulse, temp and respiratory rate.

39

In LOA, during internal rotation:

the occiput rotates right toward the midline, the sagittal suture from the oblique to the AP diameter

40

Internal rotation

May be delayed with epidural anesthesia, fetopelvic disproportion, rigid perineum or maternal exhaustion

41

concerning uterine rupture:

Risk increases with use of pitocin
FHR abnormalitites are a positive sign
Risk increases with prior uterine surgery

42

what's the most common sign of uterine rupture?

fetal distress

43

considered a later maneuver in management for shoulder dystocia

Wood's Screw, Rubin

44

If effective, McRobert's maneuver:

flattens out sacrum and rotates symphysis pubis superiorly

45

Associated factors for shoulder dystocia

Large baby
Length of 2nd stage
Post-dates induction

46

What might be done to predict and prevent SD?

highly unpredictable and unpreventable

47

Most common cause of postpartum hemorrhage

uterine atony

48

Contributes to uterine atony

Myometrium
Smooth muscle
uterine fibers

49

Lidocaine is effective...

peaks at 5 minutes
duration 30 min- 2hr

50

After infiltration of the perineum, which signs or symptom is most concerning and why?

Metallic taste in mouth & dizziness.
Hypotension - rapid systemic effects

51

what complication may be encountered if a placenta is deliverd by the Duncan mechanism

increased bleeding

52

Involutional changes

Uterus:
immediately after delivery is between symphisis and umbilicus
At 12 hours rises to umbilicus
Decreases height by 1 cm/day
3 days pp = U/3
7 days pp = U/3-5
2 weeks pp = pelvic organ

53

placental eschar passage

10-14 days pp is NORMAL
not a period
will have small clots
may last 2-3 days

54

process of involution takes place over which of the following pp time frames

first 6 weeks

55

endometrium regenerates in...

3 weeks

56

placental site regenerates in...

6 weeks

57

hematological changes: interstitial fluid

3-4 days mobilizes, increases plasma volume

58

H/H & plasma protein end of 2nd week pp

decreased.
Normal by 6-8 weeks pp WITH or WITHOUT iron supplementation (unless already low and taking iron)

59

Hemodynamic changes during initial pp period include:

elevated cardiac output for up to 48 hours after birth
BP is stable
increase in WBC during first 72 hrs pp (then falls to 6-10K...normal by 6 days pp)

60

Hgb v blood loss

q 500 ml blood loss = 1 g reduction Hgb

61

Hgb first 24 hrs

slight decrease, plateaus for 4 days, slowly increases; normal by day 14

62

increased thromboembolism risk pp due to

changes in diameter and velocity of deep veins

63

Diuresis pp

most begins by days 2-5

64

systolic murmur

20% of all women will have persistent SM beyond 4 weeks pp

65

Pregnancy-associated proteinuria should be resolved by...

6 weeks
pre-e/eclampsia/HELLP

66

Pre-e pp

check pre-e labs daily postpartum to be sure stabilizing before d/c

67

fluid and electrolytes normal by...

21 days pp

68

temp pp

may have slight increase to 99.6 immediately pp; resolves spontaneously within 24 hours. May also elevate slightly with engorgement

69

Rubella <1:10 ratio

non-immune

70

infant with negative coombs/direct autoagglutination test

administer Rhogam

71

300 mg Rhogam covers...

30 ml fetal cells in maternal system

72

ex: 150 Kleinhauer -Betke from auto accident + major bleed= how many doses Rhogam?

5 doses at 300 mg each

73

how many women will have some fetal-maternal transplacental exchange of blood during pregnancy or at delivery?

75%

74

timing of Rhogam at end of pregnancy

does not have to be given pp if given within 3 weeks prior to delivery

75

rubella vaccine contraindicated if..

mom allergic to neomycin

76

reliable contraception for how long after administering Rubella vax?

1 month

77

pp hemorrhage

blood loss in excess of 500 ml or more after the 3rd stage of labor

78

risk factors for pp hemorrhage

hx of pp hemorrhage
overdistention
prolonged, induced or augmented labor
uterine or placental abnormalities (previa, fibroids)

79

early pp hemorrhage

>500 ml in 1st 24 hrs, or a 10% drop in Hct from admission

80

Late pp hemorrhage

>500 ml between 1st 24 hrs and 6 wks pp

81

reasons for late pp hemorrhage

lacerations, infection, placental fragments
Most often occurs in 2nd week when placental eschar sloughs off

82

s/s late pp hemorrhage

persistent lochia, subinvolution, painless bright red bleeding

83

early pp hemorrhage rx tx

oxytocin 10 U/500 ml IV
Methergine 0.2 mg IM (contraindicated with HTN, preeclampsia, eclampsia)
Hemabate 250 mcg IM (C/I with PID, renal/cardiac/hepatic dz or asthma)
Cytotec 800 mcg per rectum (not FDA approved)

84

Late pp hemorrhage rx tx

Methergine 0.2 mg PO q 4 hr x 24-48 hrs
(may require abx if infxn is causative agent)