Maternity and Newborn Health

Question 1

Normal lab values during third trimester

Answer 1

Hgb: >11g/dL (110g/L)
Hematocrit: > 33%
RBC: 5-6.25 x 10^6/mm^3 (5-6.25 x 10^12/L)
WBC: 5000-15000/mm^3
Plt: 150 000- 400 000/mm^3

Question 2

Contraindications for epidural

Answer 2

• uncorrected hypotension
• coagulopathies (extremely low plts, clotting disorders) -> risk for bleeding at epidural site -> hematoma formation -> spinal cord compression -> neurologic dysfunction
• infection at epidural site

Question 3

Info to collect if pt arrives at ER w/ ruptured membranes

Answer 3

• recent meds
• multiple gestations?
• color of amniotic fluid (meconium stained fluid may indicate fetal stress or hypoxia, could require newborn resuscitations)
• due date (<37 weeks -> risk for resp distress)

Question 4

Predictor of successful induction

Answer 4

Bishop score of 10

Question 5

Fundus height at 12 weeks

Answer 5

just above the symphysis pubis

Question 6

Chloasma s/s

Answer 6

benign
hormonally stimulate increase in pigmentation over the bridge of the nose and cheeks, usually appears in second trimester
fades postpartum

Question 7

Condylomata acuminata s/s

Answer 7

fleshy, nontender bumps on genital/anal areas aka anogenital warts, caused by HPV
tx = trichloroacetic acid

Question 8

Pruritic urticarial papules and plaques of pregnancy (PUPPP) s/s

Answer 8

pruritic, raised lesions form within abdominal striae, not umbilicus, and can spread to thighs, arms, legs, and back

Question 9

Intrahepatic cholestasis of pregnancy

Answer 9

intense, generalized itching, w/o rash

Question 10

Pica s/s

Answer 10

• compulsive craving for and consumption of substances normally not considered edible (ice, cornstarch, chalk, clay, dirt, and paper)
• not exclusive to pregnancy, but many women only experience it when pregnant
• often accompanied by iron deficiency anemia -> HCP will order hgb + htc levels

Question 11

Preeclampsia s/s

Answer 11

• proteinuria + htn
• headache, visual disturbances, and facial swelling
• complications = thrombocytopenia, liver dysfunction, renal insufficiency, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome

Question 12

Teaching for miscarriage

Answer 12

• no sex or tampons for 2 weeks
• report foul smelling vaginal discharge, heavy vaginal bleeding, + severe pains (s/s of infection or retained fetal tissue)
• continue prenatal vits w/ iron to prevent anemia + use ibuprofen for cramps

Question 13

Hyperemesis gravidarum (HG) s/s

Answer 13

• severe, persistent nausea and vomiting
• weight loss, poor skin turgor, dry mucous membranes, hypotension, tachycardia
• hypokalemia/hyponatremia, ketonuria, increased urine specific gravity, hemoconcentration, metabolic alkalosis

Question 14

Purpose of mag sulf in pregnancy

Answer 14

seizure prevention in preeclampsia

Question 15

Foods to prevent neural tube defects

Answer 15

foods with folic acid (e.g. fortified grain products), green leafy veggies

Question 16

Nagele’s rule

Answer 16

first day of last period - 3 months + 7 days + 1 year

Question 17

Initial interventions for morning sickness

Answer 17

• dry, high-carb foods + low fat proteins
• eat several small meals during the day
• drink fluids between rather than with meals
• foods w/ ginger
• foods high in vit B6

Question 18

Fetal tachycardia

Answer 18

• baseline HR >160 for >10 mins
• may be caused by fetal anemia, maternal fever, or infection

Question 19

Zika virus

Answer 19

• transmitted through mosquitoes, sexual contact, + infected bodily fluids
• causes microcephaly (small brain + head), developmental dysfunction, + encephalitis in babies born to Zika-infected women
• pregnant women should avoid travelling to Zika-affected places + women who live in Zika-affected areas should take precaution against mosquitos (DEET) + safe sex

Question 20

Magnesium sulfate toxicity s/s

Answer 20

mild: nausea, flushing, headache, hyporeflexia
mod: areflexia, hypocalcemia, somnolence
severe: resp paralysis, cardiac arrest
tx: stop mg + give IV calcium gluconate

Question 21

When can fetal HR be detected by Doppler

Answer 21

10-12 weeks

Question 22

Foods to avoid during pregnancy

Answer 22

• unpasteurized milk products
• unwashed fruits + veggies
• deli meat + hot dogs (unless heating until steaming hot)
• raw fish/meat
• fish high in mercury (e.g. shark, swordfish, king mackerel, tilefish)
• liver

Question 23

When to give narcotics during labor

Answer 23

peak of contractions to decrease sedation of fetus and risk of newborn resp depression

Question 24

Sinusoidal FHR

Answer 24

• repetitive, wave-like fluctuations w/ absent variability + no response to contractions
• ominous + requires immediate intervention
• suggests severe fetal anemia potentially due to fetomaternal hemorrhage (abdominal trauma) or some infections (parovirus B19)

Question 25

Early decelerations

Answer 25

- mirror contraction with an apparent, gradual decrease in FHR (>30 seconds from onset to nadir) - indicate fetal head compression - normal finding

Question 26

Variable decelrations

Answer 26

- abrupt decrease in FHR (<30 seconds from onset to nadir) + at least 15bpm below baseline for >15seconds-<2 mins - usually corrected w/ maternal position change to relieve umbilical cord compression - if recurrent/prolongs, can impair fetal oxygenation

Question 27

Late decelerations

Answer 27

- occur after onset of contractions and continue after its end - occur when fetal O2 is compromised - to correct: stop oxytocin, reposition to left/right side, administer O2, IV bolus

Question 28

Normal newborn weight loss

Answer 28

- 5-6% - weight loss usually ceases around 5 days + babies return to their birth weight by 7-14 days - weight loss of >7% needs further investigation

Question 29

Increased htc in newborns is associated w/

Answer 29

poorly controlled maternal diabetes

Question 30

Delayed meconium passage is associated w/

Answer 30

cystic fibrosis or Hirschsprung disease (portion of colon inhibits peristalsis)

Question 31

yawning, sneezing, high pitched cry, poor feeding, and loose stools are associated w/

Answer 31

neonatal abstinence syndrome

Question 32

smooth philtrum, thin upper lip, and short palpebral fissures associated w/

Answer 32

fetal alcohol syndrome

Question 33

Candida albicans infection s/s

Answer 33

- white patches on oral mucosa, palate, and tongue - infant may have trouble sucking or feeding due to associated pain

Question 34

What is vitamin K given to newborns for

Answer 34

to prevent newborn hemorrhagic disease

Question 35

Vaginal hematoma s/s

Answer 35

- persistent, severe vaginal pain or a feeling of fullness - uterus is firm and at the midline on palpation