Exam 3 OB

Question 1

With DM what are optimum specific blood glucose and A1C levels?

Answer 1

70-110
6% or less

Question 2

When do high-risk mothers start checking kick counts for fetal well-being?

Answer 2

around 28 weeks

Question 3

What are infants born to diabetic mothers chubby at birth?

Answer 3

insulin does not pass the placental barriers, but glucose does
glucose is managed by the baby and their insulin levels. the glucose store up

Question 4

Why do women have more frequent UTIs?

Answer 4

estrogen causes polyuria
urine retention and stasis
fever undiagnosed as infection because higher temp is expected with pregnancy

Question 5

What is an incompetant cervix?

Answer 5

cervix dilates prior to labor

Question 6

What are some of the interventions a nurse can expect with maternal heart failure?

Answer 6

serial ultrasound and nonstress tests after weeks 30 to 32 of pregnancy to monitor fetal health and to rule out poor placental perfusion

Question 7

What additional complications might a pregnant person experience with hepatomegaly from right-sided heart failure?

Answer 7

Extreme liver enlargement can cause dyspnea and pain in a pregnant patient because the enlarged liver, as it is pressed upward by the enlarged uterus, puts extreme pressure on the diaphragm.

ascites and peripheral edema can be exacerbated d/t the pressure as well.

Question 8

What might a nurse see with late-term treatment of a pregnant person with right-sided heart failure?

Answer 8

oxygen administration and frequent arterial blood gas assessments to ensure fetal growth

potential hospitalization for monitoring

During labor, they may need a pulmonary artery catheter inserted to monitor pulmonary pressure

Patients with this condition also need extremely close monitoring after epidural anesthesia to minimize the risk of hypotension.

Question 9

What is peripartal cardiomyopathy? What are risk factors? S/S? Treatment? What are recommendations if it persists after pregnancy?

Answer 9

originates in pregnancy in those with no previous history of heart disease

stress of the pregnancy on the circulatory system
Black multiparas
conjunction with gestational hypertension

shortness of breath
chest pain
nondependent edema
cardiomegaly

sharply reduce their physical activity
diuretic
arrhythmia agent
digitalis therapy to maintain heart function
LMWH

not attempt any further pregnancies because the condition tends to recur or worsen in additional pregnancies
oral contraceptives are contraindicated because of the danger of thromboembolism heart transplant

Question 10

Why is documenting edema important, especially with heart failure? What is the difference? What may also be present and should be compared to baseline?

Answer 10

usual innocent edema of pregnancy must be distinguished from the beginning of edema from heart failure

usual edema of pregnancy involves only the feet and ankles but becomes systemic with heart failure. It can begin as early as the first trimester

other symptoms such as irregular pulse, rapid or difficult respirations, and chest pain on exertion will likely be present

Question 11

What is the impact of lowered blood pressure due to heart disease on the fetus?

Answer 11

BP becomes insufficient to provide an adequate supply of blood and nutrients to the placenta, fetal health can be compromised

low birth weights or be small for gestational age because of acidosis
preterm labor
fetus may not respond well to labor (evidenced by late deceleration patterns on a fetal heart monitor)
potential for cesarean birth

Question 12

What are interventions during labor with heart disease?

Answer 12

side-lying position during labor to reduce the possibility of supine hypotension syndrome

elevate their head and chest (a semi-Fowler position) to ease the work of breathing

place a towel under the right hip to shift the uterus off the vena cava

Evaluate for fatigue

oxygen therapy

Question 13

Why is the period immediately after giving birth a critical time for heart patients? How can the increase be compensated for?

Answer 13

with delivery of the placenta, the blood that supplied the placenta is released into the general circulation, increasing the blood volume by 20% to 40%. During pregnancy, the increase in blood volume that occurred did so over a 6-month period, so the heart had time to gradually adjust to this change. After birth, the increase in pressure takes place within 5 minutes, so the heart must make a rapid and major adjustment

decreased activity
anticoagulant and digoxin therapy until the circulation stabilizes
Antiembolic stockings or intermittent pneumatic compression (IPC) boots
prophylactic antibiotics for subacute bacterial endocarditis caused by the introduction of microorganisms through the placental site

Question 14

Why is it more difficult to manage insulin/glucose levels during pregnancy with type 1 or 2 DM? What occurs with glucose and insulin filtration during pregnancy in all pregnancies? How is the natural resistance of the destruction of insulin beneficial in healthy pregnancies? What difficulty does it cause in diabetics?

Answer 14

all individuals experience several changes in the glucose–insulin regulatory system as pregnancy progresses

• glomerular filtration of glucose is increased causing slight glycosuria
• rate of insulin secretion is increased, and the fasting blood sugar level is lowered
• All patients appear to develop an insulin resistance as insulin does not seem as effective during pregnancy

prevents the patient’s blood glucose from falling to dangerous limits.

they must then increase their insulin dosage beginning at about week 24 of pregnancy to prevent hyperglycemia.
* they must guard against hypoglycemia and ketoacidosis caused by the constant use of glucose by the fetus

Question 15

Why are infants born to patients with poorly controlled diabetes tend to be LGA?

Answer 15

because the increased insulin the fetus must produce to counteract the overload of glucose they receive acts as a growth stimulant

Polyhydramnios may develop because a high glucose concentration causes extra fluid to shift and enlarge the amount of amniotic fluid

Question 16

What are negative outcomes in pregancy with poorly controlled diabetes?

Answer 16

congenital anomalies
caudal regression syndrome (failure of the lower extremities to develop)
spontaneous miscarriage
stillbirth
hypoglycemia developing at birth
respiratory distress syndrome, hypocalcemia
hyperbilirubinemia

Question 17

What are risk factors for developing gestational diabetes?

Answer 17

Obesity
Age over 25 years
History of large babies (10 lb or more)
History of unexplained fetal or perinatal loss
History of congenital anomalies in previous pregnancies
History of polycystic ovary syndrome
Family history of diabetes (one close relative or two distant ones)
Member of a population with a high risk of diabetes

Question 18

What is test do all patients take between 24-28 weeks to identify gestational diabetes? What is the threshold to need a 3 hour test? How is it administered and interpretted?

Answer 18

50-g glucose challenge test between

result of that test is 140 mg/dL (some providers use 130 mg/dL as the cutoff) at 3 hours

after a fasting glucose sample, patient drinks an oral 100-g glucose solution; a venous blood sample is then taken for glucose determination at 1, 2, and 3 hours later. If two of the four blood samples collected for this test are abnormal or the fasting value is above 95 mg/dL, a diagnosis of diabetes is made

Fasting: 95
1 hour: 180
2 hours: 155
3 hours: 140

Question 19

Is bleeding normal in pregnancy? How should it be treated and why? What is the risk of undiscovered bleeding? What is the risk specific to pregnancy with hypovolemic shock?

Answer 19

No

potential emergency because it may mean the placenta has loosened and cut off nourishment to the fetus
* the amount of blood visualized may be only a fraction of the blood actually being lost because an undilated cervix and intact membranes contain blood within the uterus

significant blood loss or developing hypovolemic shock.

fetal distress

Question 20

What 7 findings are assessed with blood loss and their significance?

Answer 20

Increased pulse rate: Heart attempts to circulate decreased blood volume.

Decreased blood pressure: Less peripheral resistance is present because of decreased blood volume.

Increased respiratory rate: Respiratory system attempts to increase gas exchange to better oxygenate decreased red blood cell volume.

Cold, clammy skin: Vasoconstriction occurs to maintain blood volume in central body core.

Decreased urine output: Inadequate blood is entering kidneys because of decreased blood volume.

Dizziness or decreased level of consciousness: Inadequate blood is reaching cerebrum because of decreased blood volume.

Decreased central venous pressure: Decreased blood is returning to heart because of reduced blood volume.

Question 21

What is the most common reason for miscarriage in the 1st trimester? Other causes?

Answer 21

abnormal fetal development, due either to a teratogenic factor or to a chromosomal aberration

rejection of the embryo through an immune response
implantation abnormalities
corpus luteum on the ovary fails to produce enough progesterone
alcohol use

Question 22

What is a threatened misscarriage? How is it monitored? If hCG doesn’t increase in 48hrs what does it likely indicate?

Answer 22

vaginal bleeding, initially only scant and usually bright red. A patient may notice slight cramping, but no cervical dilatation is present on vaginal examination

check fetal viability
test for human chorionic gonadotropin (hCG) hormone at the start of bleeding and again in 48 hours

pregnancy is more likely to be a miscarriage

Question 23

What is an imminent miscarriage? What will tissue be analyzed for? What may occur is fetus is determined not viable, no heart sounds or an empty sac?

Answer 23

A threatened miscarriage becomes an imminent (i.e., inevitable) miscarriage if uterine contractions and cervical dilatation occur

gestational trophoblastic disease (hydatidiform mole)

medication to help the pregnancy pass or perform a dilatation and curettage (D&C) or a dilatation and evacuation (D&E)

Question 24

What is a complete miscarriage? Missed miscarriage?

Answer 24

entire products of conception (fetus, membranes, and placenta) are expelled spontaneously without any assistance

early pregnancy failure, the fetus dies in utero but is not expelled
usually discovered at a prenatal examination when the fundal height is measured and no increase in size can be demonstrated or when previously heard fetal heart sounds can no longer be heard.

Question 25

What is an ectopic pregnancy? Where does the egg most commonly implant? What can cause obstructions that prevent the egg from traveling freely to the uterus?

Answer 25

implantation occurred outside the uterine cavity in the fallopian tube, most often in ampullar portion adhesion of the fallopian tube from a previous infection pelvic inflammatory disease salpingitis congenital malformations scars from tubal surgery uterine tumor pressing celiac disease

Question 26

What sign can show up at the umbilicus indicating an ectopic rupture? What point are included in the triad of symptoms?

Answer 26

abdomen gradually becomes rigid from peritoneal irritation. The umbilicus may develop a bluish-tinged hue (Cullen sign) Cullen sign lower pain shoulder pain

Question 27

What sign can show up at the umbilicus indicating an ectopic rupture? What point are included in the triad of symptoms?

Answer 27

abdomen gradually becomes rigid from peritoneal irritation. The umbilicus may develop a bluish-tinged hue (Cullen sign) Cullen sign lower pain shoulder pain

Question 28

How does gestational trophoblastic disease present? What happens to the embryo? Risk factors? How is it assessed? How must it be handled?

Answer 28

As the cells degenerate, they become filled with fluid and appear as clear fluid-filled, grape-sized vesicles The embryo fails to develop beyond a primitive start low dietary intake of animal fat older than 35 years younger than 15 years Asian heritage Because proliferation of the abnormal trophoblast cells the uterus tends to expand faster than usual or reach its landmarks all cells must be removed or they can become cancerous refrain from becoming pregnant for a year to ensure all ceels have been expelled

Question 29

What is an incompetent cervix? Risk factors? How is it identified? How is it managed? What is the purpose of the sutures? Patient instruction? When are suture removed?

Answer 29

Premature cervical dilation increased age congenital structural defects trauma to the cervix may be diagnosed by an early ultrasound before symptoms occur cervical cerclage at approximately weeks 12 to 14 and serves to strengthen the cervix bed rest (perhaps in a slight or modified Trendelenburg position) for a few days to decrease pressure on the new sutures. Usual activity and sexual relations can be resumed in most instances after this rest period. sutures are removed at weeks 36 to 37 of pregnancy so that the fetus can be born vaginally

Question 30

What is the steriod used to encourage surfactant and mature fetal lungs?

Answer 30

betamethasone

Question 31

What is placental abruption? What is the risk? When does it generally occur? Therapeutic management?

Answer 31

premature separation of the placenta and bleeding results most frequent cause of perinatal death late in pregnancy, even as late as during the first or second stage of labor emergency situation fluid replacement oxygen by mask to limit fetal anoxia Keep a patient in a lateral, not supine, position to prevent pressure on the vena cava and additional interference with fetal circulation do not perform any abdominal, vaginal, or pelvic examination to not further damage placenta cesarean birth most often hysterectomy

Question 32

What medications can aid in curbing preterm labor? Why is betamethasone indicated. What is the preffered dosage?

Answer 32

Tocalytic agents: Terbutaline (off label, normally used for bronchospasms in asthma) nifedipine indomethacin Magnesium sulfate primarily used to treat preeclampsia and prevent eclamptic seizures recent research does not support the use of magnesium as a tocolytic betamethasone, the formation of lung surfactant: two doses of 12 mg betamethasone IM 24 hours apart or four doses of 6 mg dexamethasone IM 12 hours apart.

Question 33

What is preterm rupture of membranes? What is the likely cause? What is the risk?

Answer 33

rupture of fetal membranes with loss of amniotic fluid before 37 weeks strongly associated with infection of the membranes (i.e., chorioamnionitis) major threat to the fetus as, after a rupture, the seal to the fetus is lost and uterine and fetal infections may occur increased pressure on the umbilical cord from the loss of amniotic fluid

Question 34

What is preeclampsia? Risk factors? What is eclamsia?

Answer 34

increased blood pressure and proteinuria Being a person of color multiple pregnancy Being primiparous when younger than 20 years or older than 40 years poor nutrition gravida five or more polyhydramnios underlying disease such as heart disease, diabetes resulting seizure

Question 35

What is dystocia? What 4 ways can cause a difficult labor?

Answer 35

A difficult labor (a) the power, or the force that propels the fetus (uterine contractions) (b) the passenger (the fetus) (c) the passageway (the birth canal) (d) the psyche (the birthing parent’s and family’s perception of the event)

Question 36

What are hypotonic contractions? what can contribute?

Answer 36

the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period) and the strength of contractions does not rise above 25 mm Hg administration of analgesia bowel or bladder distention is preventing descent or firm engagement uterus that is overstretched by a multiple gestation larger than usual single fetus, polyhydramnios uterus that is lax from grand multiparity.

Question 37

What is the dangeer of hypertonic contractions? What type a meds could be helpful in this circumstance?

Answer 37

uterus is unable to relax inbetween contractions sedation

Question 38

What constitutes a precipitate delivery? Complications?

Answer 38

cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara. or uterine contractions are so strong a parent gives birth with only a few, rapidly occurring contractions or labor that is completed in fewer than 3 hours placenta or lacerations maternal hemorrhage fetal subdural hemorrhage may result from the rapid release of pressure on the head.

Question 39

What is inductions labor? Augementation of labor?

Answer 39

labor is started artificially. assisting labor that has started spontaneously but is not effective

Question 40

What most commonly contributes to uterine rupture? What can factor in as well?

Answer 40

previous cesarean scar prolonged labor abnormal presentation multiple gestation unwise use of oxytocin obstructed labor traumatic maneuvers of forceps or traction.

Question 41

Why should you never aid the delivery of the placenta by pulling onthe umbilical cord?

Answer 41

can cause a uterine prolapse, uterine inversion

Question 42

What are contributing factors for umbilical cord prolapse?

Answer 42

Premature rupture of membranes Fetal presentation other than cephalic Placenta previa Intrauterine tumors preventing the presenting part from engaging A small fetus CPD preventing firm engagement Polyhydramnios Multiple gestation

Question 43

What two maneuvers are used to resolve shoulder dystocia? How are they executed?

Answer 43

McRoberts maneuver and suprapubic pressure McRobert's: the patient is asked to or assisted to deeply flex their thighs back toward their abdomen and then rotate the thighs laterally to make a wide V. This widens the pelvic outlet and may allow the anterior shoulder to be born. The second maneuver, suprapubic pressure, is often completed by nursing staff. The fetal back is identified and the nurse stands on the side of the patient that is closest to the fetal back. Downward and lateral pressure is applied just above the patient’s pubic bone to dislodge and rotate the fetal shoulder away from the midline. Applying suprapubic pressure may rotate the shoulder and help it escape from beneath the symphysis pubis.

Question 44

What is a placenta sucenturiata?

Answer 44

placenta that has one or more accessory lobes connected to the main placenta No fetal abnormality is associated with this type. However, it is important it be recognized because the small lobes may be retained in the uterus after birth, leading to severe obstetric hemorrhage.

Question 45

What is placenta circumvallata? How does this differ from an normal placenta?

Answer 45

the fetal side of the placenta is covered to some extent with chorion, the umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from there Ordinarily, the chorion membrane begins at the edge of the placenta and spreads to envelop the fetus; no chorion covers the fetal side of the placenta.

Question 46

What is battledore placenta?

Answer 46

the cord is inserted marginally rather than centrally

Question 47

What is a velamentous insertions of the cord? When is it most often found? What is the risk during delivery?

Answer 47

situation in which the cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion multiple gestations associated with fetal anomalies cord is more likely to avulse (tear) and brisk bleeding can occur

Question 48

What is placenta accreta? How should it be treated?

Answer 48

deep attachment of the placenta to the uterine myometrium, so deep that the placenta will not loosen and deliver Hysterectomy to remove the uterus or treatment with methotrexate to destroy the still-attached tissue may be necessary

Question 49

What is an amniotomy?

Answer 49

artificial rupturing of membranes during labor if they do not rupture spontaneously to allow the fetal head to contact the cervix more directly, which increases the efficiency of contractions and therefore increases the speed of labor.

Question 50

What is the benefit of internal electronic monitoring? How is it achieved?

Answer 50

most precise method for assessing FHR and uterine contractions passing a pressure-sensing catheter through the vagina and into the uterus after the membranes have ruptured. It is inserted into the uterine cavity and alongside the fetus

Question 51

What is scalp stimulation? How is it done?

Answer 51

if a fetus shows an unresponsive heartbeat during labor, vibroacoustic stimulation can be used the same as is done for nonstress tests during pregnancy to be certain a fetus is responding well to labor applying pressure with the fingers to the fetal scalp through the dilated cervix

Question 52

What is DIC? What labs are monitored? Contirbuting factors?

Answer 52

disseminated intravascular coagulopathy used up clotting factors in hemorrhage and unable to clot PTT INR platelets hematocrit HgB preeclampsia sepsis prexisting clotting disorder

Question 53

What are late decellerations caused by? What are interventions

Answer 53

placental insufficiency left side turn pitocin off oxygen

Question 54

What is the HELLP syndrome complication with preeclampsia? What S/S occur in addition to the high BP. edema and protienuria?

Answer 54

HELLP syndrome is a variation of the gestational hypertensive process named for the common symptoms that occur: Hemolysis leads to anemia. Elevated liver enzymes lead to epigastric pain. Low platelets lead to abnormal bleeding/clotting (Lisonkova et al., 2020). symptoms of nausea, epigastric pain, general malaise, and right upper quadrant tenderness from liver inflammation occur. L

Question 55

What occurs with mag sulfate toxicity?What to do?

Answer 55

low BP decrease in DTR decreased urine output drowsy decreased LOC turn mag off get lab level give calcium gluconate contact HCP

Question 56

What is normal volume of amniotic fluid levels? oligohydramnios? Polyhydramnios? Maternal reasons? Fetal?

Answer 56

800-1200 mL <300 mL alot, 2000 mL preeclampsia multiples heart conditions kidney GI tract functioning

Question 57

What is given with a maternal negative blood type? When?

Answer 57

Rhogan 28 weeks, within 72 hours of birth, any time invasive procedure where there is a potential of blood mixing

Question 58

What is a vasa privia?

Answer 58

cord between baby and cervix

Question 59

Which cesaerian incision is indicated for subsequent baginal births?

Answer 59

transverse