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Antepartum > Antepartum > Flashcards

Antepartum Flashcards

0
Q

Polysystic ovary syndrome

Treatment

A

Varies + depends on the degree of infertility and desire for conception
Pcos in obese women has been treated with weight loss programs alone
Hormonal contraceptives to initiate normal orulatory function and suppress the continued physical enlargement

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1
Q

Poly cystic ovary syndrome
S/s
Cause

V406

A

Affects5% of women. Most common diagnosis implicated in ovarian dysfunction related to infertility
Hyperandrogenism
Menstrual irregularities amenorrhea, oligomen
Physical characteristics: obesity, acne, alopecia, hirsuitism
Often insulin resistant
Cause is unknown

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2
Q

What conditions are associated with the development of oligohydramnios?

A

Congenital anomalies
IUGR
Postmature syndrome

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3
Q

What is the shortest anteroposterior diameter of the pelvis?

A

The obstetrical conjugate

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4
Q

Congenital heart disease
Grades 2-4
Why a high risk factor

A

Increased blood volume and weight puts strain on the heart

Condition requires clinical, radiological surveillance

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5
Q

B/P

Systolic reading

A

Indicates the pressure in the arteries when the heart is actively pumping
Systolic pressure indicates cardiovascular tolerance for exertion

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6
Q

B/P

Diastolic reading

A

Indicates the pressure in the arteries when the heart is at rest
Diastolic pressure assesses baseline intravascular tension

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7
Q

MSAFP should be performed between what weeks?

What 3 anomalies could cause a level above normal?

A

15-20
Neural tube defects
Multiple gestation
Fetal demise

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8
Q

Fetal alcohol syndrome

S/S

A

Growth problems
Heart defects
Mental retardation
Facial abnormalities
Problems with muscle and nerve development
Less agile/athletic
Trouble with organization, concentration and impulse control

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9
Q

History of PID and effects

A 
Can cause scarring of the uterine lining
Predisposes to
Ectopic prey
Irregular placental implantation
3 rd stage hemorrhage
Scar tissue may form at the cervical os
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10
Q

LEEP

Consideration

A

A laser procedure similar in effect to cone biopsy

Correlated to incomplete cervix and premature labor

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11
Q

Macrocyclic anemias

V 684

A

Increased red cell size

Vitamin b12 deficiency
Folic acid deficiency 
Hypothyroidism
Alcoholism
Chronic liver or renal disease
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12
Q

Micro cystic anemias

V684

A

Decreased Rbc and size

Iron deficiency anemia
Thalalsemias 
Hemoglobin E disorders
Lead toxicity
Chronic disease infection neoplasm
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13
Q

Hemolytic anemia

V684

A

This is a normocytic anemia,where rbc’s are abnormal size

Hemolytic disorders
Sickle cell disease
Hemoglobin c disorders
Acquired medication side effect

Autoimmune

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14
Q

FetL heart rate reactivity is usually reached at what gestational age?

A

28-32 weeks

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15
Q

What are 3 changes in the cardiac system during pregnancy?

A

Increase in cardiac volume
Heart displacement to the left
Increase of 10 beats /min in resting heart rate

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16
Q

Complications with polyhydfamnios

A

Cord prolapse
Placental abruption
Pp hemorrhage

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17
Q

For how long does rho gam provide protection against developing antibodies?

A

12 weeks

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18
Q

Untreated a symptomatic bacteriuria can cause

A

Low. Orthodox weight infant
Pyclonephritis
Preterm labor

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19
Q

Which result of a uc bacterial count indicates the presence of a uti?

A

50,000 bacteria of same species per milliliter of urine

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20
Q

What is the physiological reason for increased chance of uti in pregnancy?

A

Hydronephrosis which causes urinary stasis

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21
Q

Frequency of SAB after the preg has been clinically diagnosed

A

1 in 20

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22
Q

Blood volume increases by approximately _____ during pregnancy?

A

40-45%

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23
Q

Exercise increases all of the following in the preg body?

3 answers

A

Blood volume
Vascular urge
Cardiac input

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24
Q

Two hormones the placenta produces are

A

Estrogen and progesterone

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25
Q

Three risk factors for an incompetent cervix?

A

Previous cervical cone biopsy
History of cervical laceration during a previous childbirth
History of 3 or more abortions using suction

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26
Q

Diabetes

Why is it a high risk factor

A

Fetal demise after 36 weeks
5x the normal incidences of fetal abnormalities
Increased polyhydramnios
30-50% higher incidence of pre eclampsia
Increased incidence of prematurity and nb respiratory difficulties

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27
Q

Thyroid disease

Why is it a high risk factor

A

Particularly hyperthyroidism

Dangers
Thyroid medication has potential for causing severe fetal complications
Miscarriage, premature labor, fetal anomalies

Untreated hypothyroidism can lead to cretinism in the newborn

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28
Q

Acute tuberculosis

Why a high risk factor

A

If under treatment prognosis is god
Baby must be imm. Separated from the mom if she is infectious
Dangers
Slightly higher risk of miscarriage or premature labor

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29
Q

TORCH illnesses

A 
T-toxoplasmosis
o- other syphillis, hep b, parvovirus, Epstein Barr and varicella
R-rubella
C-cytomegalovirus 
H-herpes simplex virus
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30
Q 
Hepatitis A
Definition
S/S
Transmission
Treatment 
Effects on baby
A

Infectious flu like symptoms
Fecal loran route contaminated water and food
99% require no treatment
No adverse fetal effects of active maternal infection have been identified
Breast feeding is okay

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31
Q 
Hepatitis B
Def
Transmission 
Screening
Effect on baby
A

Serum hep chronic or carrier state
Transmitted through blood, dirty needle, saliva, vag secretions, semen
Screening blod sample for hbsag
High risk of transmission to NB, who if infected have a high risk of becoming carriers. Should be immunized 12 hrs after birth

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32
Q

Hepatitis B
S/s
Treatment

A

Abdominal pain, chills, fever
Should be hospitalized and have all family members screened
Not responsive to any treatment and must run its natural course
A person with chronic hep b should be screened for liver disease

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33
Q

Hep b is present in all bodily fluids except

A

Breast milk

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34
Q

What is the best management of a NB of a hep b infected mother?

A

Immediate birth,immunization with hep b immune globulin and immunization hep b vaccination

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35
Q

Hepatitis C
Definition
Transmission
Effect on baby

A

20% of viral hepatitis in USA
Transmission is primarily via blood and blood products but can be a std
Signs of active infection are similar to HBV, but chronic conditions develop in 85% of cases
Perinatal transmission 5% depending on the amount I’d virus in bloodstream
Breast milk not affected
No immunization for hep C

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36
Q

How does hep c effect pregnancy and birth?

A

The woman will be monitored for signs of abnormal liver disease
That may affect her nutritional status

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37
Q

What kind of viral hepatitis is transmitted via the fetal oral route?

A

Hep A

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38
Q

Syphilis
Def
Cause/transmission
Effect on fetus

A

Std
Transmitted through the placenta at any stage of infection 40%with untreated disease have fetal or neonatal loss SAB or stillborn. Another 40% have babies with congenital syphillis
Crippling lesions on internal organs and bones to death
Placenta is large, heavy and a pale yellow gray color

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39
Q

Syphilis
Lab test
Management

A

Diagnosis lab tests depend on the stage the disease is in, antibody screening,,RPR
Preg should be tested at 1st appt and at 28 weeks, or if she has chlamydia, gonorrhea or hpv
Treatment goal of preventing transmission and preventing progression of disease
Preferred drug for any stage is penicillin
Risks to fetus of treatment ptl, fetal distress, stillbirth, jarisch here helmer reaction

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40
Q

Syphillis

Symptoms

A

Primary- chancre at site of infection painless heals spontaneously AB response present
Secondary- 4 weeks to 6 months after infection
Rash on palms of hands and soles of feet, hair loss, heals spontaneously in 2-10 weeks
Latent- no manifestations.
Tertiary- 1year-3 years after infection.
High morbidity 1 mortality. 2 forms: gumma: soft tissue tumors, or cardiovascular.

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41
Q

Cytomegalovirus

  • def
  • cause
  • effect on fetus
A

-fairly common infection- 60% pop. has antibodies
Most damaging in 1st trial
-Member of herpes virus group
- Spread thru contact with bodily fluids, within households, daycare centers, classrooms.
-Fetus at risk if primary infection for mom, usually not recognized until birth.
- 80%-90% will have complications that include hearing loss,vision impairment and varying degrees of mental retardation.

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42
Q

Cytomegalovirus

  • SIS in pregnant women
  • lab tests
  • management plan
A
  • most women have minimal if any symptoms and are unaware of the infection
  • symptoms of mononucleosis
  • signs of hepatis with negative test results for hepatis A,B,C
  • no treatment for CMV infection in healthy persons.
  • can be transmitted to the infant through genital secretions / breast milk
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43
Q

Toxoplasmosis

  • SIS in the pregnant women
  • lab tests
  • management plan
A
  • SIS vague, similar to mononucleosis
    Fatigue, muscle pain, fever, sore throat,
    Enlarged posterior cervical lymph nodes
  • serum testing for 1gM and 1gG, repeat x3 weeks
    -if suspected-
    imm. referral for uis to check for fetal anomalies
    Amniotic fluid and fetal blood can be sampled to confirm fetal infection
    -Tx: can reduce harmful fetal effects
    Anti-protozoal drugs
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44
Q

Toxoplasmosis

  • cause
  • effect on fetus/child
A
  • protozoal infection caused by toxoplasma gondii
  • humans are exposed thru exposure to cat feces, infected soil, or ingestion of raw or undercooked meats -> usually pork
  • can cause severe congenital malformations because it can cross the placenta. Most severe in 1st trial
  • many infants have no SIS at birth, bit can develop: seizures, motor and cognitive definite and mental retardation throughout childhood.
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45
Q

Sickle cell trait / disease and

Implications in the AP

A
  • primary complication is an increase in UTI and hematuria

- can be cared for by a midwife only collaboration with a physician experienced in dealing with sickle cell

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46
Q

How does pregnancy affect the course of sickle cell disease?

A

Pregnancy increases both the intensity and frequency of sickle cell crises.

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47
Q

Congenital rubella syndrome

A

Most common malformations: cataracts, cardiac defects, deafness.
May also be:
Glaucorna microcephaly, and other defects involving the eyes ears, heart, brain, and CNS.
Infants with CRS frequently exhibit intrauterine and post natal growth retardation.

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48
Q

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

A

In the first month.

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49
Q 
Explain the safety of the 
Rubella vaccine (for a woman 4 weeks pregnant, had vaccine 2 weeks ago)
A

Explain to the woman that there is a theoretical rick from the vaccine, but there is no demonstrated evidence of teratogenicity for the vaccine.

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50
Q

What is the best course of action when a woman has an active Varicella infection during delivery for the immediate postpartum?

A

Give VZIG to the infant immediately and consider isolation of infant from mother.

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51
Q

Rubella

-weeks gestation and risk of morbidity

A

-If contracted during the first trimester, there is a 52% chance the baby will be born with congenital rubella syndrome.
The risk increases to 85% if contracted during the first 8 weeks. Infection after the 20th week rarely causes defects.

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52
Q

Describe the rash of rubella

A

Pale or bright red, spreading rapidly from face to entire body, and then fading rapidly.

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53
Q

Weeks 17-24

A

Mother begins to feel movement
Vernix is formed
Lungs are well formed, capillaries develop around already
Hair develops on the head, eyebrows, eyelids, eyes are structurally complete

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54
Q

Weeks 25-28

A 
Subcutaneous fat is laid down
Eyes down
Lung physiology is sufficiently developed to enable gas exchange to begin
Nervous system can control temperature
Breathing movements
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55
Q

Week 29

A

The fetus is fully formed and the organs are able to function to some extent

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56
Q

Week 30 beyond

A

Organ physiology matures and the fetus continues to lay down fat and muscle
The nervous system continues myelinzation beyond term

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57
Q

Week 6

A 
Liver begins to function
Eyes migrate to the front of the face 
Rudimentary kidneys and genitalia form
Cartilage begins to form the skeleton 
Muscle differentiation begins
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58
Q

Week 5

A

Rapid brain growth continues
Limb buds appear
Umbilical cord is formed
Heart chambers divided by septa

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59
Q

Week 3-4

A

The heart begins to pump blood
Brain begins to divide into forebrain, midbrain, hindbrain
Lungs to begin to form
Features of the gi system can be identified
So mites (future vertebrae and muscles) appear to either side of the midline

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60
Q

Days 18-21

A

The primitive nervous system begins to fold into position
The heart begins to twitch
Primitive eyes and ears begin differentiation
Red blood cells begin development

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61
Q

Day 15

A

A thick band of cells, the primitive streak appears in the midline of the dorsal surface of the embryo
Blood vessels begin to form
Cell specialization occurs

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62
Q

Day 13 from LMP

A

Chronic villi begin to secrete hcg, which stimulates the corpus luteum in the ovary to continue producing the hormones necessary to maintain the pregnancy until the placenta is mature enough to take over this role

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63
Q

Physiological effects of estrogen

A

Development of secondary sex characteristics
Myometrial thickening
Maturation of ovarian follicles

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64
Q

Testosterone production is stimulated by:

A

Lutenizing hormone

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65
Q

Describe oogenesis

A

Ongoing differentiate into primary oocytes during early fetal life
The first maturation division results in a secondary oocytes and first polar body
Final maturation of the secondary oocytes is completed at fertilization

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66
Q

Gametogenesis

V. 556

A

Halving of the chromosomes number is a result of gametogenesis , the process by which mature ova and sperm are developed

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67
Q

Contraction stress test

A 
Checks to see if the fetus will withstand the decrease o2 levels with contractions and placental health
EFM
Done at 34+ weeks
I've pitocin
Indicated with abnormal BPP
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68
Q

Define Graafian follicle

f 176

A

A secondary follicle in the ovary will mature into a vestibular ovarian(Graafian) follicle which is ready for ovulation

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69
Q

Magnesium sulfate is administered primarily to

A

Decrease neuromuscular irritability

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70
Q

Define the fetal period

A

From 8 weeks gestation to birth

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71
Q 
Parvovirus B19
(Fifth disease, erythema infection)
S/s 
Lab tests
Management plan
A

Flushed red face “slapped cheek pattern”
Before rash
: mild fever, malaise, myalgia a, headache, itchy rash may start on trunk and extremities
Most contagious before symptoms
Diagnosis: parvovirus B19 specific 1gm serum 1gG shows previous infection and immunity
If seroconversion occurs fetus should be checked weekly with u/s for fetal hydrops, placentomegaly, and fetal growth restriction

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72
Q

Parvovirus
Def
Cause
Effect on fetus

A

Contagious virus common in school children
Transmitted by contact with respiratory secretions or exposure to blood and vertical transmission from mother to fetus
Congenital anomalies not associated with parvovirus
For those fetuses affected some will experience apastic anemia, non immune hydrops and rarely death

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73
Q

Which of the following is an accurate definition of proteinuria

A

Protein in the urine in excess of 1 g/l

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74
Q

Which change, besides restoration of the diploid number of chromosomes occurs at fertilization

A

Start of meitotic cell division and fetal sex determination

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75
Q

The largest portion of the uterus is the

A

Myometrium

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76
Q

Cystic fibrosis, sickle cell anemia, and Tay-Sachs disease, which can be diagnosed by prenatal genetic studies are examples of

A

Autosomal recessive disorders

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77
Q

The physiological effects of progesterone include

A

Increased basal metabolism
Placental growth
Development of acini cells in the breasts

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78
Q

Normal values for 1 hr and 3 hr GTT

A

1 hr 65-139 mg/dl

3 hr fasting 65-95
1 hr 65-180
2 hr 65-155
3 hr 65-140

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79
Q

A rubella titer of greater than 1:64 indicates

A

Infection

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80
Q

A rubella titer of greater than 1:10 indicates

A

Immunity

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81
Q

A rubella titer of less than 1:10 indicates

A

Not immune

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82
Q

Benign ovarian cysts

A

Most do not require intervention
Commonly asymptomatic
Cysts of significant size cause adnexal motion tenderness or pelvic pain and may grow large enough to cause ovarian torsion
Ox best with u/s

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83
Q

Which of the following demarcations divides the true and false pelvis?

A

The linea terminalis

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84
Q

Chronic lung disease

Why a high risk factor

A

Mother at risk for pulmonary complications, baby at risk for fetal acidosis and hypoxia

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85
Q

Severe asthma

Why a high risk factor

A

Resp infections and stress may intensify attacks
Cardiopulmonary function could be reduced affecting growth and we’ll being
Certain medications used to treat asthma are contraindicated for preg

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86
Q

Epilepsy

Why a high risk

A

There is controversy over whether or not this condition is exacerbated by preg.
Dangers:
Anticonvulsant drugs may cause Folic acid deficiency which when treated with Folic acid may cause seizures
The infant may develop deficiency of coagulation factors

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87
Q

Renal disease

Why a high risk factor

A

Impaired kidney function requires close medical surveillance in preg
Signs of renal disease include:
Protein in the urine, hypertension, edema, and elevated blood urea all before the 20th week
Dangers:
Acute adrenal failure

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88
Q

Extreme obesity
Why a high risk factor

Pre existing with a history of medical problems

A

Nearly 2/3 of extremely obese women have obstetrical implications, including diabetes, hypertension, pyclonephritis, uterine dysfunction, and hemorrhage

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89
Q

Tobacco use
Why a high risk factor

(More than 10 cig daily, although no amount can be considered without risk)

A

Associated with IUGR, miscarriage, congenital heart disease mad fetal hypoxia during labor

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90
Q

Malnutrition
Why a high risk factor
(Extreme dietary deficiencies- May be substance abuse, debilitating illness, eating disorders)

A

IUGR p, preeclampsia, maternal or fetal infection, prematurity, still birth, dysfunctional labor, hemorrhage

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91
Q

Tubal pregnancy
S/s
Timing of rupture

A

Bleeding/spotting
Non rhythmic pain
10-13 weeks.

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92
Q

Normal rate of weight gain

A

She should gain at least 10lbs by 20 weeks and about 1 lb a week afterwards

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93
Q

Sequential screen

A

Part 1: 10-12th week blood draw and u/s for unchallenged trans.

Part 2: btw 16-18th week 2nd blood test

Provides risk of having a baby with Down syndrome, trisomy, or neural tube defects
Hugh rate of false positives

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94
Q

Why are yeast infections more common in pregnancy

A

Yeast tends to overgrow in preg because of increased vaginal alkalinity, which in turn is caused by elevated progesterone levels

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95
Q

Vagina yeast infection
Management
Physiology

A

Increase of acidity of vaginal canal and extra discharge

-7 day monistat
Diflucan
No sugar or simple carbs
Garlic
Tea tree oil
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96
Q

How many days after fertilization is implantation

A

6 days

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97
Q

When diagnosing preeclampsia what is an accurate definition of hypertension

A

140/90 + either#

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98
Q

What predisposes a woman to develop preeclampsia

A

Trophoblastic disease
Maternal age greater than 35
Multiple pregnancy

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99
Q

S/s of preeclampsia

A 
Persistent headaches 
Visual disturbances 
Edema 
Protein urea 
Increased blood pressure 
Epigastric pain
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100
Q

Hypermesis gravidarium

A

Chronic and self perpetuating N+V
So disrupts the electrolyte balance that the woman cannot retain food/ liquid must be restabilized with IV fluids
Emotional underpinnings
Psychological conflicts regarding preg.
History of eating disorders/ body image issues

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101
Q

The heart begins beating in the embryo at (from conception)

___ weeks

A

3 weeks

5 weeks from LMP

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102
Q

B12

A

The vegan mother must be careful to ingest adequate ___, without which a serious for of anemia may develop and cause neurological damage to her and her baby

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103
Q

Of the babies whose mothers drank heavily while pregnant, ____% develop FAS

A

4%

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104
Q

Caffeines effect on the fetus

A

Elevate fhr

Reduce the amount of fluid and calcium available for baby’s optimal growth

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105
Q

To help prevent leg cramps from disturbing her sleep recommend:

A

Elevate and support her legs on pillows while sleeping

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106
Q

LAM

A

Baby must be 6 months or less
After 6 months the woman must find another form of contraception
On demand nursing, at least every 4 hrs during the day and. 6 hrs at night

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107
Q

With a history of gestational diabetes what is a woman’s chance of developing diabetes mellitus in the future

A

25%

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108
Q

PUPPP

A

Pruritic urticarial papules and plaques of pregnancy
Rare- late in pregnancy and resolves with birth
Comfort measures- oatmeal bath, vegetable based salve or lotion

109
Q

Placenta functions

A 
Provide fetus with a o2 co2 exchange
Passage of essential nutrients 
Excretion of metabolic waste products 
Transfers maternal antibodies
3 main functions
1. Organ of metabolism
2. Organ of transfer
3. Endocrine organ in synthesis, production and secretion of protein hormones and steroid hormones
110
Q

What causes shortness of breath in early pregnancy?

A

It is thought that an increased amount of progesterone acts directly on the respiratory center to lower the carbon dioxide levels and increase the o2 levels.
Increase o2 benefits the fetus
The increase of metabolic activity that occurs during pregnancy causes an increase in co2 levels; hyperventilation decrease in co2 levels
Women may experience this early in the 2nd trimester

111
Q

FHT minimal/absent variability

A

Causes: fetal sleep , drugs, hypoxia, anemia, prematurity less than 28 weeks, congenital neurological anomalies

Def: steady baseline even with contractions or movement. No reaction to stimuli

112
Q

Bradycardia
Mild
Marked

A

Mild 100-119

Marked 99 or less

113
Q

Late FHT decelerations

Type 2

A

Cause uteroplCental insufficiency: IUGR, PIH, hypertonic contractions, post dates, abnormal placenta, fetal anemia
The severity of the hypoxia cannot be measured by the depth of the deceleration
Treatment- position, IV fluids, o2, then re-check
Very serious, needs intervention
FHT’s decrease after peak. Contraction

114
Q

_____ is the relation of the fetal head to its trunk

A

Attitude

115
Q

What does the indirect Coomb’s testing show

A

It tests maternal blood for RH antibodies

116
Q

The uterine endometrium during pregnancy is called the

A

Decidua

117
Q

In clinical pelvimetry, if the pelvis is adequate, the angle of the pubic arch should be at least:

A

90 degrees

2 finger breadths

118
Q

The basic shape of the android pelvis is:

A

Heart shaped

119
Q

The pubic arch of the platypelloid pelvis is

A

Greater than 90 degrees

120
Q

The basic shape of the anthropoid pelvis is

A

Anterior posterior oval

121
Q

Two features of the android pelvis

A

Heart shaped inlet

Narrow pubic arch

122
Q

Missed abortion

A 
Fetus dies but the products are retained for a prolonged period (2+weeks)
S/s
Vaginal spotting at the time of death
Fundal height stops or decreases
Regression of mammory symptoms 
Loss of weight
Persistent amenorrhea 
No FHT's
123
Q

What term is used to describe an increase in the size of existing cells?

A

Hypertrophy

124
Q

What term is used to describe an increase in the number of cell ny cell division

A

Hyperplasia

125
Q

What is the shortest anteroposterior diameter of the pelvis

A

Obstetrical conjugate

126
Q

MSAFP should be performed between ___ to ___ weeks.

What 3 anomalies could cause a level above normal

A

15 to 20

Neural tube defect, multiple gestation, fetal demise

127
Q

Hemolytic anemia

A

This is a normocytic anemia, where RBC’s are a normal size

Disorders:
Sickle cell disease
Hemoglobin C disorders
acquired (medication side effect)
Autoimmune
128
Q

Fetal heart rate reactivity is usually reached at what gestational age

A

28-32 weeks

129
Q

Ectoderm

A 
Layer of the germ cell
Surface ectoderm:
Epidermis, hIr, nails, breast, enamel of the teeth, internal ear, lens of eye, anterior pituitary
Neural crest-
Cranial nerves
Pigment cells
Sensory ganglia

Neural tube-
CNS
Retina
Post pituitary

130
Q

Endoderm

A

Middle of the three germ layers
Endoderm forms the epithelial lining of the gi tract, pharynx, tonsils, thyroid, trachea, bronchi, lungs, liver, pancreas, bladder

131
Q

Zygote definition

A

The fusion of the pro nuclei of the sperm and ovum

132
Q

Two hormones the placenta produces are

A

Estrogen and progesterone

133
Q

Three risk factors for am incompetent cervix

A

Previous cervical cone biopsy
History of cervical laceration during previous childbirth
History if 3 or more abortions using suction

134
Q

Inflammation of sciatic nerve
Cause
Management

A

Largest nerve in the body
Cause irritation as pelvic joints move, hormonal influences, as weight of uterus increase

Chiropractic
Massage
Yoga/stretching

135
Q

Skin darkening
Cause
Management

A

Cause increase in production of estrogen and melanocytes stimulating hormone
No treatment p, disappears after birth

136
Q

Oily skin/acne
Cause
Management

A

Cause is increase in estrogen

Wash frequently with oil free products

137
Q

Normal FHT during a contraction

A

A slight rise at the peak, with a return to baseline by the end

138
Q

Sinusoidal pattern

A

Undulating, repetitive, uniform FHR equally distributed 5-15 boom above and below the baseline. No relationship to contraction pattern of fetal movement. 2-6 cycles/min
Rare
Cause: fetal anemia or hypoxia abruptio placentae
Treatment: immediate intervention to prevent fetal death

139
Q

Early decals are thought to be caused by

A

Head compression

140
Q

What FHR IS considered the cut off for marked tachycardia

A

180 bpm

141
Q

Poor recovery
Def
When to transport

A

The period of deceleration. Will extend past the end of the contraction
If detected during first stage, give the mother o2 and transport

142
Q

Wandering baseline

A

Def: a very late development in the progression of fetal deterioration. Usually within the normal range of 120-160 , but no short term variability, no consistency. Rare. Serious. Often prior to death
Treatment: immediate c section

143
Q

Prolonged deceleration pattern

A

Def: decels lasting longer than 60-90 secs usually occurring as an isolated event

Cause: cord compression, placental insufficiency, hypotension, maternal valsalva, pelvic exam, AROM, rapid rapid descent of fetal head

Treatment- if recurring then section

144
Q

Variable decelerations

A

Cause: umbilical cord compression/ entanglement or knots
Treatment: have the mother try a new position
A wide range of ht, with no relation to contraction, can be mild to severe, repetitive or random

145
Q

Accelerations

A

Def: transient increase above baseline, associated with fetal movement
Normal
Causes: movement, fetal scalp stimulation

146
Q

Early decelerations

Type 1

A

Def: lowest FHR at peak of contraction, quick recovery, no treatment needed
Cause: head compression, from 4-7 cm, and second stage
Initiated by pressure of dilating cervix on posterior fontanel
Frye: decel begins as ctx starts, lowest at peak, promptly returns to baseline as ctx tapers off

147
Q

The heart begins beating in the embryo at ____ weeks

A

4

148
Q

Weeks 13-16

A

Fetus grows rapidly, almost doubling in length
Facial features migrate to the correct place
Muscle and bone develop rapidly, enabling plenty of fetal movement to occur
Meconium begins to form in the gut

149
Q

Weeks 8-12

A

The head is 1/2 the fetal length
Teeth form in the gums and fingernails can be seen
Intestines become established
Fetus begins to swallow amniotic fluid and pass urine
Blood begins to form

150
Q

When is the embryo susceptible to teratogens

A

For the first 14 days after conception, the embryo is protected from harm by the zone pellucida
It is not until after implantation that the embryo is exposed to teratogens

151
Q

Week 8

A

Hands and feet are well formed
Heart has 4 chambers and beats at 40-60 bpm
Major blood vessels form, circulation begins through the umbilical cord
Male or female genitalia can be distinguished
All body systems and organs are formed

152
Q

Week 7

A

Eyelids, gall bladder, palate, and tongue form
Neck becomes visible
Bone cells begin to replace cartilage
Arms and legs begin movement

153
Q

Amniocentesis
Weeks gestation
Indications

A

Usually performed at 15-16 weeks, when indicated

Women at risk for open neural tube defects, genetic disorders, aneuploidies

154
Q 
Chorionic villus sampling 
Indications 
Timing 
Risks
Methods
A

To rule out a genetic/chromosomal disorder
( Tay/Sachs, sickle cell, cystic fibrosis)
Btw 10-12 weeks
Collected by either
Catheter thru cervix to placenta
With needle through belly with ultrasound

Villus cells taken for biopsy

155
Q

Chorionic villus sampling
When
Indications
Risks

A

10 weeks gestation
Testing for common genetic disorders
Done early for parents that may want to terminate
More risk of pregnancy loss than amniocentesis

156
Q

Maternal serum alpha fetoprotein should be done when

A

15-20 weeks

157
Q

Alpha fetoprotein testing
When
Why
What results

A

A blood draw done btw 14-22nd wk best at 16-18
High levels neural tube defects, anencephaly, esophageal defect, failure abdomen to close
Inaccurate dating of preg
Low levels trisomy 21 or 18

158
Q

Sign of the cervix is a sign of pregnancy called

A

Goodell’s sign

159
Q

When to start measuring fundal height

A

18

160
Q

Decidua basalis
Decidua capsularis
Decidua Vera

A

Beneath the site of implantation of the embryo, becomes maternal contribution to the placenta

Surrounds the remainder of the embryo with fetal growth, it bulges into the uterine cavity and fuses with the Decidua Vera

The Decidua lining of the rest of the uterus

161
Q

Generally maternal ingestion of over the counter drugs and prescribed drugs _______ increase fetal risk

A

Does

162
Q

A typical human gestation is _____ days (from LMP)

A

280

163
Q

Immediately following fertilization the product of conception is called a

A

Zygote

164
Q

At 28-30 weeks the cut off level for anemia

Measured by hemoglobin

A

11

165
Q

During the second trimester, the midwife can expect the woman to feel _____ about her baby and pregnancy

A

Identify the fetus as a separate human being

166
Q

What normal physiological change is responsible for intermittent nosebleeds.

A

Hyper mia of the nasal mucous membranes

167
Q

Exercise can ease these common pregnancy discomforts

A 
Constipation
Heartburn
Shortness of breath 
Leg cramps
Fatigue
Swollen ankles
Insomnia
168
Q

Emotional benefits of exercise during pregnancy

A

Reduction of mental stress and fatigue
Improve sense of well being
Stabilize hormone driven mood swings
Decreased risk of severity of depression and mood disorders with pregnancy and post partum

169
Q

Asthma is associated with the following complications

A

Hypermesis gravidarium
Preeclampsia
Low birth weight

170
Q

Causes of polyhydramnios

A 
Multiple pregnancy
IUGR 
diabetes mellitus 
Erythroblastosis
Fetal malformations 
(Esp. Of gi tract ex TEF or CNS EX. anencephaly, meningomyclocele
171
Q

Anemia in pregnancy treated with herbs

A 
Dandelion
Nettles
Kelp
Parsley
Alfalfa
172
Q

Effect of smoking on pregnancy

A

Greater risk of miscarriage, placental abruption, stillbirth, and infant death
The more a woman smokes, the greater the risk of placenta previa or ectopic preg
Low birth weigh, health problems, IUGR,
increased risk of SIDS

173
Q

Hemorrhoids natural remedies

A

Red clover and nettle infusion
Grated raw potatoe as a compress directly on
Witch hazel extract
Homeopathic hamamelis 30c

174
Q

Ethnicity and genetic screening

  • Greek or Italian descent
  • Asian or Filipino descent
  • African descent
  • Ashkenazi or Jewish descent
  • Northern European descent
A
  1. Thalassemia
  2. Thalamassemia
  3. Sickle cell anemia
  4. Tay-Sachs or Canavan diseases
  5. Cystic fibrosis
175
Q

Hemorrhoids
Management
Physiology

A

Cause: progesterone makes the walls of veins relax and expand, uterus presses on veins, slowing blood flow and causing expansion

Prevent constipation
Warm bath
Tucks pads
Ice packs
Avoid standing for long periods
176
Q

Sleep difficulties
Cause
Management

A

Causes urinary frequency, anxiety, fetal movement, muscle cramps

Comfy bed
Pillows
Warm bath
Hot tea
Massage
Regular exercise
177
Q

Nausea/vomiting

A

Cause: increase hormones, stress, empty stomach

Small frequent meals
Acupuncture/acupressure 
Avoid spicy/ greasy foods
Crackers before getting out of bed
Sea bands
Ginger ale
178
Q

Fluid retention/ swelling/edema
Physiology
Management

A

Cause: enlarging uterus puts pressure on pelvic veins and impairs the return of blood flow from legs. Pressure from this blood forces water into the tissue

Increase h2o intake 
Loose clothing 
Avoid prolonged siting/standing 
Rest with legs elevated 
Rest on side
Support hose
179
Q

Leg cramps
Management
Physiology

A

Cause: unknown, possibilities, added weight and pressure from uterus, circulation changes, calcium deficiency

Massage
Flex foot
Apply heat
Regular exercise
Calcium and K in diet
180
Q

Varicose veins
Management
Physiology

A

Cause progesterone makes vein walls relax and expand, hereditary

Loose clothing
Good posture no crossed legs 
Support hose 
Frequent breaks from standing
Exercise regularly 
Elevate legs
181
Q

Fatigue
Cause
Management

A

Cause: unknown, hormonal fluctuations

Daily exercise, healthy diet, rest and naps

182
Q

Flatulence
Cause
Management

A

Cause: increase amounts of progesterone affect digestion

Avoid large high fat meals, no gas causing foods, chew food thoroughly

183
Q

Breast tenderness
Cause
Management

A

Hormonal changes cause increase blood vessel and glandular development
They are growing in prep for milk production

Warm showers
Supportive bra, without underwire and sleep in bra

184
Q

Constipation
Management
Physiology

A

Cause: increase progesterone causes intestinal muscle walls to relax, causing increase absorption of h2o, increase iron in PNV

Increase fluid intake and fiber, exercise regularly, avoid straining, go to bathroom as you feel urge

185
Q

Round ligament pain
Cause
Management

A

Cause: ligament stretch as uterus enlarges

Flex knees into abdomen, bend toward pain, pelvic tilt, warm bath, heating pad, maternity girdle, pillow under uterus while sleeping

186
Q

Headache
Cause
Physiology

A

Cause: pregnancy increas
Hypoglycemia, dehydration,
Also: anemia, intake of caffeine

Eating frequently
H2o intake
Rest

187
Q

Skin itchiness
Cause
Management

A

Cause: stretching of skin and dryness

Humidify home, olive oil in a diet, avoid mineral oil skin products, oatmeal baths,massage yogurt into the skin

188
Q

What is the most common use of amniocentesis in the 3rd trimester

A

Testing for fetal lung maturity

189
Q

If the fetus suffers from malnutrition during the time of development when cells are increasing in size, the. The damage suffered by the fetus is best characterized as?

A

Irreversible

190
Q

What is the duration of the embryonic period?

A

8 weeks

191
Q

Measuring abdominal gain in a woman of average size is a helpful diagnostic tool when used in conjunction with Funchal,height for diagnosis of ____?

A

Polyhydramnios

192
Q

Funic soufflé

A

Synchronous whistling sound heard during normal fetal heart tones

193
Q

Define vulva

A

Refers collectively to the labia majora and minors, the shaft and glands of the clitoris,many the opening of the urethra and yoni

The vulva extends from the pubic bone to the point in the front of the anal opening

194
Q

Which genetic disorder cannot be detected by chronic villus sampling

A

Neural tube defects

195
Q

The vas deferens is a

A

Conduit for spermatozoa

196
Q

The almond shaped area enclosed laterally by the labia minors and extending from the clitoris to the fourchette is called the

A

Vestibule

197
Q

In which portion of the Fallopian tube is the site of sterilization

A

Isthmus (narrowest)

198
Q

Developing follicles and the Graafian follicle are found in the

A

Cortex of the ovaries

199
Q

Which principal factor causes vaginal ph to be acidic

A

The action of the doderleins’s bacillus

200
Q

In which portion of the Fallopian tubes does fertilization normally occur

A

The ampulla (widest portion)

201
Q

Labia minora

A

The frenulum and prepuce of the clitoris are formed by the

202
Q

The labia minora taper, extending posteriorly to form the:

A

Fourchette

203
Q

Which term refers to the thick folds of membranous stratified epithelium of the internal vaginal wall capable of stretching during the birth process to accommodate delivery of the baby

A

The rugae

204
Q

Which measure is essential after an rh-women undergoes cvs or amino?

A

Administering rho gam

205
Q

The uterine isthmus is essential during pregnancy in the formation of:

A

The lower uterine segment

206
Q

Which term refers to the upper triangular portion of the uterus

A

Corpus

207
Q

What is the most important factor affecting amniocentesis

A

Needle insertion site

208
Q

Which assessment during an exam would best support the diagnosis of pregnancy?

A

Softening of the lower uterus segment

209
Q

Eclamptic seizures are usually what type

A

Tonic-clonic

210
Q

What is the tocolytic of choice to treat PTL in multiple pregnancy?

A

Magnesium sulfate

211
Q

When an incomplete miscarriage occurs

A

Some fetal and placental parts are passed and some remain inside

212
Q

When would it be most appropriate to initiate suppressive therapy for asymptomatic bacteriuria?

A

When 2 complete courses of treatment have been completed without a cure.

213
Q

To reduce the risk of limb reduction defects related to cvs the midwife should recommend

A

Procedure should be performed at 10 weeks gestation

214
Q

During an abdominal exam of. Woman at term you feel the cephalic prominence on the same side of the fetal parts. This indicates what presentation?

A

Vertex occipital presentation

Loa lot etc.

215
Q

Threatened abortion

A

Vaginal bleeding in the first 1/2 of pregnancy

May have cramping

216
Q

Fetal kick counting

A

For late pregnancy (at least after 28 weeks)

At same time each day, time how long t takes your baby to make 10 movements

217
Q

Clonus

A

Definition- involuntary rapid, repetitive contractions and relaxation a of a muscle when it is simply stretched

Indicative of upper motor neuron disease and is never present except when there is a disease of the CNS

218
Q

If conception fails to occur, menstruation takes place about 2 weeks after ovulation as a result of

A

Degeneration of the corpus luteum

219
Q

Cytomegalovirus
Def-
Cause-
Effect on fetus-

A

Fairly common infection 60% of population has antibodies, most damaging in the first trimester
Member of the herpes virus group
Spread through contact with bodily fluids, within households, day care centers, classrooms
Fetus is at risk if primary infection for mom, usually not recognized until birth
80-90% will have complications that include hearing loss, vision impairment, varying degrees of mental retardation

220
Q

Cytomegalovirus
S/s
Lab tests
Management plan

A

Most women have minimal if any symptoms and are unaware of the infection
Symptoms of mononucleosis
Signs of hepatitis with negative test results for a,b,c
No treatment for CMV infection in healthy persons
Can be transmitted to the infant through genital secretions/breast milk

221
Q 
Hepatitis A 
definition 
signs and symptoms 
transmission 
treatment 
effects on baby
A

Definition infectious with flu like symptoms
fecal oral route, contaminated water/food
99% required no treatment
no adverse fetal effects of active maternal infection have been identified
breast-feeding is okay

222
Q 
Hepatitis B 
definition 
transmission 
screening 
effect on baby
A

Serum hep chronic or carrier state transmitted through blood, dirty needles, saliva, vaginal secretions, and semen
Screening blood sample for hbs AG
High risk of transmission to newborn who if infected have high risk of becoming carriers. Should be immunized within 12 hours of birth

223
Q

Hepatitis B is present in all bodily fluids except;

A

Breast milk

224
Q

Hepatitis B
signs/symptoms
treatment

A

Nausea and vomiting, abdominal pain, chills, fever
Should be hospitalized and have all family members screened
Not responsive to any treatment and must run its natural course
A person with chronic hepatitis B should be screened for liver disease

225
Q

Frequency of SAB after the pregnancy has been clinically diagnosed

A

One in 20

226
Q

What is the best management of a newborn of a hepatitis B infected mother?

A

Immediate birth, immunization with hep B be immune globulin and immunization for hepatitis B vaccine

227
Q

How does Hepatitis B effect pregnancy and birth?

A

The woman will be monitored for signs of abnormal liver disease that may affect her nutritional status

228
Q

Hepatitis C
definition
transmission
effect on baby

A

20% of viral hepatitis in USA
transmission is primarily via blood and blood byproducts but can be an STD
Signs of active infection are similar to HBV but chronic conditions develop in 85% of cases.
Perinatal transmission 5%, depending on the amount of virus in the bloodstream
Breastmilk not affected
no immunization for hepatitis C

229
Q

What kind of viral hepatitis is transmitted via the fecal oral route

A

Hepatitis A

230
Q

Inevitable abortion

A

When a spontaneous abortion is almost certain and cannot be stopped
cervical dilation and/or rupture membranes in addition to bleeding and cramping

231
Q

What is the reason for the use of Cordocentesis

A

It can be used to do fetal blood transfusions or to medicate the fetus

232
Q

What are three tests for fetal lung maturity

A
  1. Lecithin/ sphingomyelin ratios l/s should be twice
  2. Phosphatidylglycerol (pg test )
  3. The shake and tap tests
233
Q

Corticotropin releasing hormone CRH

A

Comes from the baby, placenta, and tissues within the uterus

Increased levels of CRH in late pregnancy change the ratio of estrogen to progesterone

234
Q

The male hormone testosterone, which maintains spermatogenesis is synthesized and released by;

A

Leydig’s cells

235
Q

In response to anterior pituitary stimulation, the graafian follicle secretes;

A

Estrogen

236
Q

Increased levels of GN/RH stimulates the anterior pituitary to secrete;

A

FSH

237
Q

What is the normal range of respirations for an adult?

A

15 to 20 per minute

238
Q

Organogenesis

A

Rapid development of organ formation

takes place until the eighth week of gestation

239
Q

Thyroid disease

why is it a high risk factor

A 
Particularly hyperthyroidism 
dangers:
 thyroid medication is potential for causing severe fetal complications miscarriage 
premature labor 
fetal anomalies

Untreated hypothyroidism can lead to cretinism in the newborn

240
Q

Chlamydia infection in the mother if untreated;

A

Can infect the urinary tract leading to premature labor

baby has a 70% chance of infection, which can result in conjunctivitis or pneumonia

241
Q

Incomplete abortion

A

The placenta is not expelled with the fetus at the time of the abortion
the retained placenta will eventually be the cause of bleeding or infection

242
Q

Epstein-Barr virus

O in Torch illnesses

A

One of the most common human viruses
when infection occurs during adolescence it causes infectious mononucleosis
Signs and symptoms of mono – fever, sore throat, swollen lymph glands. Almost never fatal
No known associations between active EBV and problems during pregnancy

243
Q

The only hormone produced by the posterior pituitary

A

Oxytocin released in a pulsatile fashion

244
Q

Entero virus

A

Small virus made of RNA and protein
second most common after the cold
Transmission; respiratory secretions or direct contact
Infection in mother; mild or no illness
A newborn/fetus; no clear evidence that maternal infection affects fetus. If ill during birth, newborn may get ill

245
Q

Physical factors that increase labor pain

A 
Hunger or thirst
 fatigue 
muscle tension 
full bladder 
discomfort from staying in the same position for too long
246
Q

What best describes the normal changes in amniotic fluid volume during pregnancy?

A

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

247
Q

Vitamin A

A

Eye health
helps prevent infections
sources; banana, alfalfa, dark green, yellow veggies and fruits, dairy, eggs

248
Q

Vitamin E

A

Aids lactation, prevents blood clots, good for varicose vein’s, prevents miscarriage, aids fertility
Sources; nuts, almonds, broccoli, carrots, brown rice

249
Q

Indigestion/heartburn
management
physiology

A

Cause:increased progesterone relaxes the valve between the stomach and the esophagus
late pregnancy the uterus is in the abdominal cavity
Avoid large/high-fat meals, dry meals, low-fat dairy to ease discomfort, chew food well, stay upright one hour after eating

250
Q

Triple screen

A

Combines AFP and hCG and unconjugated estrogen levels, is much more accurate then MS AFP
Detects 65% of down syndrome, 80 to 85% of neural tube defects
False positive rate of only 5%
If positive amniocentesis is the next step

251
Q

Gingivitis
cause
management

A

Cause: increased level of estrogen stimulates growth of blood vessels and body

Brush and floss regularly, at least one visit to dentist during pregnancy

252
Q

Hemoglobin
definition
normal levels

A

The amount of hemoglobin per red blood cell

should be above 11

253
Q

Hematocrit
definition
normal levels

A

The percent of red blood cells per total blood volume

should be 33+

254
Q

Quad screen

A

Blood draw done between 16 and 18th week
checks for level of: AFP, hCG, estriol, inhibin-A

V for possibilities of potential genetic disorders
Lower rate of false positive

255
Q

Hypericum imperforens (perforatum)

A

Latin name for St. John’s wort

contraindicated during pregnancy

256
Q

What condition is a contraindication for the contraction stress test

A

A woman with placenta previa

257
Q

What method of fetal assessment is the most accurate predictor of uteroplacental insufficiency

A

Contraction stress test

258
Q

Never ever do a vaginal exam when there is ______ in late pregnancy

A

Vaginal bleeding

259
Q

Which plane of the pelvis is known as the “plane of least dimensions?”

A

Mid plane

260
Q

The uterus grows by _______

A

Hyper trophy

261
Q

Where is hCG produced?

A

The placenta but specifically: A protein hormone produced early in the pregnancy by both the cytotrophoblast and the synchtiotrophoblast, primarily to maintain the corpus luteum and thus the endometrium and the pregnancy

262
Q

Condglomata aluminata

A

Genital warts caused by HPV
Frequently increase in size and number during pregnancy and regress after the woman gives birth
Avoid tearing or cutting as they may bleed excessively
Extensive growth in the vagina and over the cervix may necessitate C-section because of dystocia

263
Q

How does pregnancy affect the course of sickle cell disease

A

Pregnancy increases both the intensity and frequency of sickle cell crisis

264
Q

Sickle cell trait/disease and implications in the AP

A

Primary complications is an increase in UTI and hematuria

Can’t be cared for by midwife only with close collaboration with the physician experienced in dealing with sickle cell

265
Q

Describe the rash of rubella

A

Pale or bright red, spreading rapidly from face to entire body, and then fading rapidly

266
Q

Drinking 1 quart of milk daily will supply the woman with large amounts of

A

Riboflavin and vitamin A

267
Q

Congenital rubella syndrome

A

Most common malformations: cataracts, cardiac defects, deafness
May also be: glaucoma, microcephaly, and other defects involving the eyes, ears, heart, brain, and CNS
Infant with CRS frequently exhibit intrauterine and postnatal growth retardation

268
Q

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

A

In the first month

269
Q

Explain the safety of the rubella vaccine, for a woman four weeks pregnant and had the vaccine two weeks ago

A

Explain to the woman that there is a theoretical risk from the vaccine, but there is no demonstrated evidence of teratogenicity for the vaccine

270
Q

What is the best course of action when a woman has an active Varicella infection during delivery for the immediate postpartum

A

Give VZIG to the infant immediately and consider isolation of infant from mother

271
Q

Rubella

weeks gestation and risk of morbidity

A

If contracted during the first trimester, there is a 52% chance the baby will be born with congenital rubella syndrome
The risk increases to 85% if contracted during the first eight weeks
Infection after the 20 weeks rarely causes defects

Antepartum (3 decks)

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