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