Flashcards in CNM Varney's Review Book Part C Deck (60)
A woman come sto see you because she received a rubella vax 2 wks ago and has just found out that she is approximately 4 wks preg. What is your response?
Explain there is theoretical risk from the vax but that there is no demonstrated evidence of teratogenicity from the vax.
What are ways to avoid toxoplasmosis?
avoid contact with cat feces, wear gloves while gardening, and avoid eating raw or undercooked meat.
In which stage of pregnancy is maternal infection with varicella most likely to cause congenital varicella syndrome in the fetus?
the first 20 weeks
What is the most common cause of maternal mortality r/t varicella?
G1P0 at 39 wks GA exposed to varicella two weeks ago (not immune). You administered 1 dose varicella zoster immune globulin (VZIG) at that time. She calls today c/o fever, chills, muscle pain x 2 days. Appt to see you later today. What is best course of action?
have her come into your office after ovvice hours for PE and counseling/education.
About 16 days after being exposed to varicella (and not being priorly immune), a G1P0 at 39 wks develops vesicular rash on head and neck with occasional vesicle on abdomen. Goes into labor on foruth day after eruption of the vesicles and delivers 7 lb 12 oz male with no signs of distress or varicella infection. How do you manage woman and infant?
Give VZIG to infant immediately and consider isolation of infant from mother.
What physiological change of pregnancy makes pregnant women more susceptible to UTIs?
Hydronephrosis, which causes urinary stasis
A black woman with recurrent UTIs should first be screened for what?
sickle cell trait/dz
G3P1 at 29 wks with hx of recurrent UTIs in previous pregnancy leading to PTL/PTB at 30 wks had a repeat urine culture at 28 wks = +. Gave 10-day course ampicillin. TOC is positive. What is best course of action?
obtain careful hx of compliance with tx regime and prescribe another course of tx with different drug based on sensitivity testing.
When would it be most appropriate to initiate suppressive therapy for asymptomatic bacteriuria?
when 2 complete courses of tx have been completed without a cure
Who should nOT receive nitrofuantoin to tx asymptomatic bacteriuria?
Woman with G6PD deficiency
What are some expected findings from microsopic u/a of woman with cystitis?
bacteriuria, hematuria, pyuria
What is the most common cause of true anemia during pregnancy?
What is hemodilution of pregnancy?
normal increase in plasma volume that outpaces increase in erythrocyte production
What is the generally accepted, working definitiaon of anemia in pregnant women?
Hgb <10 g/dL
G1P0 at 8 wks has Hgb 10g/dL. Bulimia age 14. Currently asympotmatic for anemia; denies any bingeing and purging . Nl weight for height. What is best management option for her?
Iron, folic acid, PNV, nutrition counseling
Iron supplements causing G1P0 to become constipated. Solution?
continue iron supplementation, provide advice on relief measures for constipation, reevaluate Hgb level at 28 wks.
What is daily recommended amt of elemental iron supplementation in pregnancy?
Anemia labs results at 20 wk GA:
low reticulocyte count
MCV of 98
What kind of anemia does this suggest?
Hgb electrophoresis reveals woman has Hb AS. What does this result mean?
Shows that she has sickle cell trait
Woman with sickle cell dz wants to know how pregnancy will affect course of dz.
Pregnancy increases both intensity and frequency of sickle cell crises
Which group of women is most likely to have G6PD?
Woman of Turkish descent
When does cardiac output peak in pregnancy, making it most likely for a woman with cardiac dz to decompensate?
How will pregnancy affect asthma?
The clinical course of asthma in pregnancy cannot be predicted.
What pregnancy complications/outcomes is asthma associated with?
Why should a fasting blood sugar not be used as the sole screening crieteria in pregnancy
because the fasting bs in gestational diabetics may be normal
3hr GTT results:
1 hr: 200
2 hr: 150
3 hr: 130
What is the best interpretation and management?
This client is gestational diabetic. Refer to nutritionist; comanage with MD.
ADA/ACOG cutoff values:
1 hr: 180
2 hr: 155
3 hr: 140
50g, 1-hour glucose screen value which indicates need for the 3hr GTT
when is a glucose challenge test not necessary for the dx of DM?
fasting plasma glucose >126 mg/dL
casual plasma glucose >200 mg/dL on 2 separate days