Maternity

Question 1

What are the phases of the menstrual cycle?

Answer 1

Preovulatory phase, luteal phase, menstrual phase, proliferative phase, secretory phase

Question 2

What occurs during the preovulatory phase?

Answer 2

Hypothalamus releases gonadotropin-releasing hormone to anterior pituitary
Anterior pituitary secretes FSH
Most follicles die, one matures into large Graafian follicle
Anterior pituitary stimulated by estrogen from follicle stimulants: secretes LH

Question 3

What indicates the start of the luteal phase?

Answer 3

Ovulation

Question 4

What happens during the luteal phase?

Answer 4

Body temp decreases 0.5-1degree
Corpus luteum formed from follicles in ovary after ovulation; secretes estrogen/progesterone during remaining 14 days of cycle
Corpus luteum degenerates if not fertilized, less estrogen/progesterone secretion so more FSH/LH secreted (new cycle start)

Question 5

What occurs during the menstrual phase?

Answer 5

4-6 days of bleeding - endometrium breakdown caused by decrease in Est/prog levels

Question 6

Proliferation phase

Answer 6

9 days
Estrogen stimulates growth of endometrium and suppresses FSH but increases LH secretion
LH stimulates ovulation/corpus luteum development
Ovulation between day 12/16
Estrogen high and progesterone low

Question 7

What occurs during the secretory phase?

Answer 7

12 days after ovulation
Response to increased LH
Graafian follicle replaced by corpus luteum
Progesterone prepares endometrium for pregnancy if fertilized ovum implanted

Question 8

How many days after ovulation is the zygote implanted ?

Answer 8

6-8 days

Question 9

How much amniotic fluid is there by the end of pregnancy?

Answer 9

800-1200ml

Question 10

How long does it take for the placenta to be complete?

Answer 10

12 weeks

Question 11

When is maternal immunoglobulin transferred

Answer 11

Third trimester

Question 12

What type of blood does the umbilical artery carry

Answer 12

Deoxygenated

Question 13

What type of blood does the umbilical vein carry?

Answer 13

Oxygenated

Question 14

What is the fetal heart rate I. The first trimester?

Answer 14

160-170bpm

Question 15

What is the fetal heart rate near/at term

Answer 15

110-160

Question 16

What bypasses the lungs in fetal circulation?

Answer 16

Ductus arteriosus- connects pulmonary artery to aorta

Foramen ovale- hole between left and right atria to bypass lungs

Question 17

What bypasses the liver in fetal circulation?

Answer 17

Ductus venosus - connects umbilical vein and ivc

Question 18

How long is gestation?

Answer 18

Time from fertilization to estimated date of delivery

280 days

Question 19

How do you calculate doc/nageles rule?

Answer 19

Subtract 3 months and add 7 days to first day of last menstrual period

Question 20

How long is term when using gtpal?

Answer 20

Longer than 37 weeks

Question 21

What are some presumptive signs of pregnancy?

Answer 21

Changes the woman notices-Amenorrhea, n/v, breast swelling, pronounced nipples, urinary frequency, fatigue, discoloration of the vaginal mucosa, quickening (1st perception of fetal movement- 16th to 20th week)

Question 22

Probable signs of pregnancy

Answer 22

Changes examiner notices-
hegars( softening of lower uterine segment - 6 weeks)
Goodells (softening of cervix - beginning of second month)
Chadwick’s (blue cervix, vagina, vulva- week 4)
Ballotment (rebounding of fetus against fingers on palpation)
Braxton hicks
Positive pregnancy test

Question 23

What are positive pregnancy signs?

Answer 23

Fetal heart rate - electronic device at 10-12 weeks and non electronic at 20 weeks
Active fetal movements
Ultrasound

Question 24

How do you determine gestation based on fundal height?

Answer 24

During 2nd and 3rd trimester- fundal height = fetal age in weeks +/- 2 cm

Question 25

When will the fundus be at the umbilicus level?

Answer 25

20-22 weeks

Question 26

Where will the fundus be at 16 weeks

Answer 26

Between symphysis pubis and umbilicus

Question 27

When will the uterus reach the xiphoid process?

Answer 27

36 weeks

Question 28

What does taking folic acid help prevent

Answer 28

Neural tube defects and orofacial clefts

Question 29

Why do we worry about rubella

Answer 29

Infection during first 8 weeks can lead to fetal infection

Question 30

Why do we worry about syphilis?

Answer 30

Can cross placenta- spontaneous abortion, mental subnormality and physical deformity

Question 31

What is Hpv called

Answer 31

Condyloma acuminatum

Question 32

Why do we worry about Hpv?

Answer 32

Transmission during vaginal birth | Infection causes epithelial tumors of mucous membrane in larynx

Question 33

Why do we worry about gonorrhea?

Answer 33

Fetus contaminated during delivery, cause postpartum infection- ophthalmia, neonatorum, pneumonia, sepsis

Question 34

Why do we worry about chlamydia?

Answer 34

Transmission during vaginal birth resulting in conjunctivitis or pneumonia Infection leads to premature rupture, labor and postpartum endometriosis

Question 35

Trichomoniasis

Answer 35

Associated with premature rupture and postpartum endometriosis

Question 36

How much does maternal blood volume increase by

Answer 36

40-50%

Question 37

What is physiological anemia?

Answer 37

Plasma increase exceeds red blood cell production

Question 38

What happens to vital signs during pregnancy

Answer 38

Pulse may increase 10-15 bpm, bp may slightly decrease during the second trimester, respiratory rate unchanged or slight increase

Question 39

What is chloasma

Answer 39

Mark of pregnancy- blotchy brown mark on face

Question 40

When do you give rhogam?

Answer 40

28 weeks gestation

Question 41

What should the hemoglobin/ hematocrit stay above?

Answer 41

10g/dl and 30% - anemia if below

Question 42

What color does the nitrazine strip turn if it is positive for amniotic fluid?

Answer 42

Blue - vagina has ph of 4.5-5.5 and fluid is 7-7.5

Question 43

What is the average expected weight gain?

Answer 43

25-30 lbs

Question 44

How many more calories should you eat when pregnant?

Answer 44

300/day- more in last two trimesters than first

Question 45

How many more calories must you consume when breast feeding ?

Answer 45

500/day

Question 46

When should you screen pregnant women for diabetes?

Answer 46

24-28 weeks

Question 47

What is dic

Answer 47

Disseminated intra vascular coagulation- forms clots in micro circulation

Question 48

What is characteristic of hydratiform mole?

Answer 48

Characteristic snowstorm pattern

Question 49

What are the two signs of preeclampsia

Answer 49

Hypertension and proteinuria

Question 50

What is HELLP

Answer 50

Hemolysis, elevated liver enzyme levels, low platelet count - severe preeclampsia

Question 51

What are some signs of magnesium toxicity?

Answer 51

Flushing, sweating, hypotension, depressed deep tendon reflex, CNS depression

Question 52

What is the antidote for magnesium

Answer 52

Calcium glauconate

Question 53

What do you use to treat incompetent cervix?

Answer 53

Cervical cerclage because it holds cervix shut

Question 54

What do you get from raw meat and kitty litter?

Answer 54

Toxoplasmosis

Question 55

Where are the ovarian hormones (FSH and LH) released from

Answer 55

Anterior pituitary gland

Question 56

What are the four ps of labor

Answer 56

``` Powers- uterine contractions Includes effacement dilation and pushing efforts Passageway Passenger- fetus membrane and placenta Psyche ```

Question 57

How long is an acceleration

Answer 57

At least 15 bpm more than baseline lasting at least 15 seconds

Question 58

When is a variable deceleration significant

Answer 58

When the fhr repeatedly declines to less than 70 bpm and stay there for at least a minute

Question 59

How long should the uterus relax between contractions

Answer 59

At least one minute

Question 60

What occurs during the first stage of labor?

Answer 60

Effacement/ dilation as well as latent active and transition phase

Question 61

How far apart are contractions during the latent phase

Answer 61

15-30 minutes apart and 15-30 seconds long

Question 62

How long are contractions in the active phase

Answer 62

Every 3-5 minutes 30-60 seconds long

Question 63

How long are contractions in transition phase

Answer 63

Every 2-3 minutes 45-90 seconds long

Question 64

What occurs during the second stage of labor

Answer 64

Pushing, expulsion of fetus

Question 65

What occurs during the third stage of labor

Answer 65

Separation of placenta, expulsion of placenta

Question 66

What is the fourth stage of labor

Answer 66

Physical recovery 1-4 hours after placenta delivery

Question 67

The fetus is distressed if the fhr is outside of what range?

Answer 67

110-160

Question 68

What are the normal newborn heart rates

Answer 68

Resting - 120-160 Sleeping - 80-100 Crying -180

Question 69

What are normal newborn respiration a

Answer 69

30-60

Question 70

What are the five areas of the pagan

Answer 70

Heart rate, respiratory rate/ effort, muscle tone, reflex irritability, skin color

Question 71

What do tocolytics do

Answer 71

Relax uterus

Question 72

What does Betamethasone and dexamethasone do

Answer 72

Corticosteroid to produce surfactant

Question 73

What do prostaglandins do?

Answer 73

Ripen cervix making it softer and begin to dilate and efface