Module 7 Flashcards
1
Q
CBC may be ordered when in pregnancy
A
1st prenatal visit
Repeated @ 28 weeks
2
Q
Why CBC is ordered again at 28 weeks:
A
this is the time that the blood is most hemodiluted and thus the pregnant woman is most likely to be anemic
3
Q
the average amount of oxygen-carrying hemoglobin inside a red blood cell
A
MCH (mean corpuscular hemoglobin)
4
Q
calculation of the average concentration of Hgb inside a red cell
A
MCHC (mean corpuscular hemoglobin concentration)
5
Q
macrocytic RBC= _____ MCH
A
high
6
Q
microcytic RBC= ______ MCH
A
low
7
Q
hypochromia which is seen in conditions where the Hgb is abnormally diluted inside the RBC, such as iron deficiency anemia and thalassemia = _____ MCHC
A
low
8
Q
hyperchromia which is seen in conditions where the Hgb is abnormally concentrated inside of cells, such as in burn patients = ______ MCHC
A
high
9
Q
a measurement of the average size of RBCs
A
MCV
10
Q
macrocytic RBCs as in vitamin B12 deficiency (pernicious anemia) = _____ MCV
A
high
11
Q
microcytic RBCs as in IDA or thalassemia= ______ MCV
A
low
12
Q
measures the amount of oxygen-carrying protein in the blood
A
Hgb
13
Q
measures the percentage of red blood cells in a given volume of whole blood
A
Hct
14
Q
maternal plasma volume increases _____% on average, achieving a maximum level at approximately _____ weeks gestation
A
45% @ 32 weeks
15
Q
Peak hemodilution occurs at ____-____ weeks
A
24 to 26
16
Q
describes the proportionately greater increase in plasma volume as compared to the rise in RBCs
A
physiologic anemia
17
Q
increased ____________ along with increase in _____________ ultimately expands the maternal blood volume by as much as 35 to 40%.
A
plasma volume; RBC mass
18
Q
________ and __________ anemias can occur in pregnancy
A
acquired and hereditary
19
Q
In ______________ anemia, the MCH, MCHC, and MCV are decreased
A
iron deficiency
20
Q
These are known as \_\_\_\_\_\_\_\_\_\_\_\_: Hgb- hemoglobin Hct- hematocrit MCH- mean corpuscular hemoglobin MCHC- mean cell hemoglobin concentration MCV- mean corpuscular volume
A
RBC indices
21
Q
reflect Hgb amount and characteristics
A
RBC indices
22
Q
a microscopic examination that screens for abnormalities in the size, shape, color, or structure of RBCs
A
stained red cell smear
23
Q
IDA causes ___________ and ___________ RBC which can be seen on a stained red cell smear
A
microcytic and hypochromic
24
Q
assesses the body’s ability to defend itself and helps to determine if the body is threatened by infections, inflammation, or hematopoietic and hemolytic disease
A
WBC
25
identifies the percentage of each type of white blood cell
differential smear
26
eosinophils and basophils may ________ slightly in pregnancy
decrease
27
neutrophils may _________ slightly in pregnancy
increase
28
increased neutrophils in pregnancy are more __________ cells and the differential smear will show a shift to the ______
immature; left
29
measures the number of platelets in a given volume of blood
platelet (Plt) count
30
during normal pregnancy Plt count usually ___________ progressively with gestation
decreases
31
decreased platelet count is due to an ___________utilization of platelets during pregnancy
increased
32
__________ count is associated with HELLP syndrome, immunologic thrombocytopenia purpura, disseminated intravascular coagulation (DIC), acquired hemolytic anemia, septicemia, and lupus erythematosus
low platelet
33
At 1st prenatal visit, most often an_____________ test is used for the initial antibody screen, since this test is sensitive to anti-Rh antibodies
indirect Coombs
34
Women who test indirect Coombs positive are then tested for the specific __________ and _________
antibody and titer
35
done at the first visit to detect antibodies to Rh positive blood
indirect Coombs
36
women at increased risk for Syphillis should undergo a repeat test @ ____ weeks and @ ___________
28 weeks and delivery
37
VDRL (Venereal Disease Research Laboratories) or the RPR (rapid plasma reagin) is used to test for:
Syphillis
38
if VDRL/RPR is positive, a ________ is also drawn
titer
39
______ titer indicates active Syphilitic disease
high (>1:16)
40
______ titer indicates false positive for Syphilis in 90% of cases or late or latent syphilis or early primary syphilis
low (<1:8)
41
Treatment of primary syphilis usually causes a progressive decline to a negative VDRL/RPR titer within ___ years
2
42
In secondary, late, or latent syphilis, low titers persist in about ____% of cases 2 years after treatment, despite a fall in titer
50%
43
does not indicate treatment failure or reinfection because these patients are likely to remain positive even if retreated.
low titers in secondary, late, or latent syphilis
44
_________ usually indicate relapse, reinfection, or treatment failure of syphilis
increasing titers
45
________________ can occur in women with acute and chronic illnesses such as TB, infectious mononucleosis, rheumatoid arthritis, collagen vascular diseases, chlamydia infection, and hepatitis
false positive VDRL/RPR
46
if ____________ is positive, either the fluorescent treponemal antibody-absorption test (FTA-ABS) or the microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA) is ordered
VDRL/RPR
47
tests that specifically determine if the individual has developed antibodies to the spirochete
treponemal antibody-absorption test (FTA-ABS)
| microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA)
48
A seropositive VDRL/RPR result indicates that the woman has been exposed to the spirochete and has developed ___________
antibodies
49
Since the syphillis antibody tests frequently remain positive even after successful treatment, clinicians use the ______of the VDRL or RPR to monitor treatment
titers
50
groups @ "high" risk for syphillis
women who live in area of high syphilis morbidity
| women who were not tested at 1st prenatal visit
51
a viral infection that produces a rash and fever in adults and children
rubella "German measles"
52
```
_________ has devastating fetal effects:
Eye lesions
Hearing defects
Heart disease
IUGR
spleen and liver enlargement
CNS disorders
```
Rubella
53
The incidence of congenital rubella is highest when the woman contracts it during:
first 1/2 of pregnancy or shortly before conception
54
The most frequently used test to detect rubella antibodies in serum
hemagglutination inhibition test (HAI or HI)
55
immunity is confirmed if the rubella titer is ____ or more
1:8
56
Women who have a rubella titer less than _____may be considered to be “equivocal” and should be considered susceptible to rubella unless there is evidence of adequate vaccination or a subsequent serologic test result indicating rubella immunity
1:8
57
when titer is less than _____, the woman and fetus are at risk for contracting rubella
1:8
58
If a rash occurs, repeat rubella titers are obtained __-__ weeks after the onset and again in ___ weeks
2-3; 2
59
significant ____________ in the titer level from the one test to the next indicates that the rash was due to Rubella. At this time there is no treatment. The woman should be counseled about the impact of rubella infection on the fetus
increase
60
women at risk for contracting rubella
women with negative tests
| women with titers < 1:8
61
women at risk for conracting rubella should be __________ shortly after delivery
vaccinated
62
```
S/S of ____________:
*may have no overt symptoms
nausea, vomiting
RUQ abdominal pain
enlarged and tender liver
fever
chills
general weakness
headache
```
Hep B
63
risk that the newborn will develop Hep B is ___-___% if the mother is positive for the Hep B surface antigen
10-20%
64
the risk for transmission of Hep B to newborns is as high as _____% if the mother is positive for Hep B surface antigen and also positive for the HbeAg
90%
65
Mothers with e antigen-positive blood are much _____ likely to transmit the Hep B surface antigen (HBsAg) to their children than those with HBsAgpositive, e antigen-negative blood
more
66
Hep B-Infected newborns usually become __________ and are at high risk for developing chronic liver disease.
Hep B carriers
67
test that screens for hepatitis B and is done routinely at the first prenatal visit
HBsAg
68
presence of _________ indicates that the patient either has a current acute Hep B infection or is a carrier
HBsAg
69
lab drawn to differentiate between Hep B infection and carrier state
HBeAg
70
presence in serum indicates Hep B acute infection
HBeAg
71
appears during acute or recent HBV infection and is present for about 6 months
(IgM) anti-HBc
72
becomes predominant late in normal recovery and, together with HBsAb, may persist in noncarriers for many years
(IgM) anti-HBc
73
a positive HBsAg test should be followed by a _______ test
HBeAg
74
```
Risk Factors for ___________:
current or past IV drug use
history of multiple STIs
being infected with HBV
being a prison inmate
being 22.5 years of age or older
having a sexual partner who abuses IV drugs
having 3 or more lifetime sexual partners.
```
Hep C
75
Vertical transmission rate of HCV
4%
76
Co-infection with HIV increases the chance of vertical HCV transmission by:
2-3x
77
chronic hepatitis may lead to this complication of pregnancy
preterm labor
78
useful test to detect hemoglobinopathies like Sickle cell anemia, thalassemia major, and hemoglobin C, which are common autosomal- recessive hemoglobinopathies
Hgb electrophoresis
79
If one parent carries the sickle cell trait and the other parent carries the trait for either thalassemia or hemoglobin C, an individual has a ____% chance of inheriting sickle-thalassemia or hemoglobin SC disease
25%
80
ethnicities at higher risk for hemoglobinopathies
African, Southeast Asian, and Mediterranean descent
81
low risk ethnicities for hemoglobinopathies
northern Europeans, Japanese, Native Americans, Inuit (Eskimo), and Koreans
82
________ individuals should be screened for hemoglobinopathies with a CBC, and _________ women should be screened with a CBC and hemoglobin electrophoresis
Non-African; Africa
83
test that is best used in cases where the immediate result is necessary for immediate patient care, not as a screening test because it does not yield enough information to assist with diagnosing a potential hemoglobinopathy
solubility test (i.e. Sickledex)
84
All women should be screened for Gestational Diabetes (GDM) in pregnancy between __________ weeks
24-28
85
Women at high risk (history of GDM, women with known impaired glucose metabolism, and women with a BMI > 30) should be screened for GDM at this time
first OB appt AND @ 24-28 weeks
86
amount of HIV infections in women caused by IV drug use
50%
87
amount of HIV infections in women caused by heterosexual sex
1/3
88
incubation period of HIV from infection to clinical disease
unknown but thought to be 2-3 months
89
HIV appears in plasma and circulating mononuclear cells _____-______ weeks after infection; HIV antibodies usually appear in ___-___ months
1-several weeks
| 1-3 months
90
_______ antibodies develop in all patients infected with HIV and are considered evidence of infection.
Anti-HIV
91
_________-positive patients can spread HIV
antibody
92
HIV Antibodies may appear by ____ days, but seroconversion may not occur for more than ____ months after infection
60 days; 12 months
93
perinatal transmission of HIV:
___% before 36 weeks
___% in the days before delivery
___% intrapartum
20%
50%
30%
94
Laboratory screening for HIV is highly specific. It usually consists of an _______ test, followed by a confirmatory test commonly the _________.
ELISA; Western blot
95
_____ restesting prior to 36 weeks is recommended for:
women who use illicit drugs
have STDs during pregnancy
have multiple sex partners during pregnancy
live in areas with high HIV prevalence
have HIV-infected partners
HIV
96
A false-positive result from the combination of the two tests is rare. More likely to occur is a __________ ELISA and an ___________ Western blot
positive; indeterminate or negative
97
The Western blot is a more complex test than the ELISA; it is less _________ but more __________ for HIV
less sensitive; more specific
98
An _____________ Western blot may be due to:
(1) recent HIV infection (usually positive within 6 weeks to 6 months)
(2) loss of antibodies in an AIDS patient with advanced immunodeficiency
indeterminate
99
alternative confirmatory test to the Western blot that detects HIV antibodies, but it is less expensive and easier to perform than the Western blot (HIV antibodies are detectable in at least 95 percent of patients within 3 months after infection)
immunofluorescent antibody (IFA) staining
100
_____ is now automatic routine testing in prenatal care but a woman can opt-out
HIV
101
The woman must understand that a positive HIV result does not necessarily mean a diagnosis of AIDS, but that a large percentage of seropositive individuals develop the disease within ___-____years
8-10
102
false positive rate of Western blot test
1-2%
103
chlamydia most common in women under age ____
25
104
chlamydia screening is recommended until age ___
30
105
```
Risk of ________:
antepartal bleeding
pelvic inflammatory disease
preterm labor
premature rupture of membranes
late postpartum infection
```
chlamydia
106
gonorrhea is damaging in _____ trimesters
all
107
```
Risk of ________:
spontaneous abortion
premature rupture of membranes
chorioamnionitis
premature delivery
intrauterine growth restriction
postpartum infection
```
gonorrhea
108
Newborns of ___________ infected mothers may develop: chlamydial conjunctivitis
pneumonia
nasopharyngeal infections
gonococcal neonatal opthalmia
chlamydia and gonorrhea
109
Tests for ________:
enzyme immunoassay tests
direct fluorescent antibody tests
DNA probe
chlamydia and gonorrhea
110
highly sensitive and specific test that has the ability to simultaneously identify Neisseria gonorrhoeae and Chlamydia trachomatis--clinically advantageous because both infections are present in about 40% of cases of gonorrhea and Chlamydia, and only one urogenital sample is required
DNA probe assay
111
CDC recommends diagnostic testing for C. trachomatis, at the _____ prenatal visit for all pregnant women
1st
112
Women < 25 years old and those who are at increased risk for chlamydia or gonorrhea should be:
retested in 3rd trimester
113
If a woman tests positive for chlamydia or gonorrhea and is treated, a repeat test (“test of cure”) should be completed within ___-____ months, preferably in the ____ trimester
3-6 months; 3rd
114
Women at risk for ______:
HIV positive women
Women in close contact with infected individuals
Foreign-born women from countries with high rates of this dx
Medically underserved women
Women who abuse alcohol and/or IV drugs
Women who are residents or employees of prisons
Women who are health care providers who give care to high-risk groups
TB
115
More than __% of childhood cases of tuberculosis occur in minority groups, most in children under 5 years of age
80
116
physical, chemical and microscopic evaluation of the urine used to screen for renal disease, UTI and metabolic disorders
urinalysis
117
Excess tissue fluid that accumulates during the day returns to the bloodstream and urine volume increases, thus producing __________ and ____________ in the morning.
nocturia; low specific gravity
118
common condition due to an increase in the glomerular filtration rate and sluggish tubular reabsorption of glucose
glucosuria
119
may occasionally appear, particularly after vigorous exercise and after the first void of the day...can also appear if a drop of vaginal discharge mixes with the urine
trace proteinuria
120
During a healthy, low-risk pregnancy, a complete urinalysis is usually performed generally at:
1st prenatal visit
121
Pregnancy-related anatomic, physiologic, and hormonal changes predispose a pregnant woman to __________, one of the most common medical problems of pregnancy.
pyelonephritis
122
Women with sickle cell trait or disease, high parity, and diabetes are more likely to develop:
bacteruria
123
a major risk factor for the development of pyelonephritis
asymptomatic bacteruria (ASB)
124
freshly voided, clean-catch, midstream specimen is required to screen for
symptomatic or asymptomatic bacteruria
125
diagnosis of ASB or symptomatic UTI is usually based on a colony count of ____________/ml of a particular organism, however, lower counts may also be significant
100,000
126
The pathogen responsible for 80-90% of infections is ______, followed by Klebsiella, Proteus, and the enterococci, Group B streptococcus and S. saprophyticus
E. coli
127
____________ for nitrites and leukocyte esterase is a less expensive way to screen for urinary tract infection
urine dipstick
128
this test alone is not sensitive enough to be used as a screening test for asymptomatic bacteruria
urine dipstick
129
by-products of bacterial growth that are frequently present and detected by dipstick with UTI
nitrites
130
the presence of this in urine is not necessarily positive for UTI because they can be due to vaginal contamination
leukocyte esterase
131
Patients at risk for UTI should have a urinalysis and a urine culture and sensitivity repeated at least ___________ or _____________
once or at least each trimester
132
Evidence supports that ___________ women do not need to have a urine dip stick routinely performed at each prenatal visit
asymptomatic
133
testing for asymptomatic bacteruria should be routinely conducted:
at 1st prenatal visit
134
GBS infection occurs in about 1 in every ________ babies born in the United States
3,000
135
percentage of women who carry GBS in pregnancy
10-30%
136
gestation for GBS screening
35-37 weeks
137
Women that do not need GBS screening as they automatically qualify for treatment during labor and birth
who had a previous baby with GBS infection GBS in their urine in the current pregnancy
138
GBS culture results are usually ready in _____ hours
24-48
139
__________ during labor recommended for these women:
Had a previous baby with GBS infection
Had GBS in their urine during the current pregnancy
Had a screening test in the current pregnancy that was positive for GBS
Go into labor before GBS test results are available and have any of the following risk factors:
--Preterm labor (<37 weeks)
--Membranes ruptured >18 hours before delivering the baby
--Fever of at least 100.4° F during labor
Antibiotic Treatment
140
if a woman tests positive for GBS in the ________ at 1st prenatal visit there is no need to test at 35-37 weeks because she will automatically receive intrapartum abx
urine
141
anytime there is more than __________ colonies of GBS in the urine, you should treat it
100,000
142
indicated screening only for women who have vaginal infection symptoms
wet prep
143
age to start pap smear screening
21
144
recommendation for frequency of pap smear screening for women 21-65 years
q 3 years
145
labs ordered at 1st prenatal visit
```
H+H/ CBC
ABO/ Rh/ antibody screen
GC/CT
RPR/VDRL
Hep B
Hep C
HIV
Rubella
pap smear (if indicated)
DMS (if indicated)
urine culture
```
146
labs ordered at 24-28 weeks
repeat H+H/ CBC
GDM screening
antibody screen
RPR/VDRL (only if risk factors)
147
labs ordered at 36 weeks
GC/CT (only if risk factors)
| GBS
148
labs ordered preconceptually if possible
Rubella
149
tests only ordered if there is indication (not routine)
```
hemoglobin electrophoresis
GC/CT in 3rd trimester
Early DMS
TB skin test
Thyroid studies
```
150
what to do if antibody screen (indirect Coombs) is positive at 1st prenatal visit
test for specific antibody and titer
151
value of 1hr GTT that indicates a 3 hr test
>130
152
HBsAg -- what does it mean?
Hep B surface antigen-- means infectious
153
anti-HBs -- what does it mean?
Hep B surface antibody-- means recovery+immunity OR successful immunization
154
anti-HBc -- what does it mean?
Hep B core antibody-- previous or ongoing Hep B infection> appears at onset of symptoms and persists for life
155
Hep B lab that midwife orders for routine prenatal labs and a positive result means the person is infectious
Hep B surface antigen (HBsAg)
156
platelets normal pregnancy value
150-400K
157
test that determines the degree of fetomaternal hemorrhage and will help you decide how many vials of RhoGAM are needed
Kleihauer Betke
158
Regular RhoGAM (300 µg) (1500 IU) will protect against exposure to up to _____ mL of Rh-positive red blood cells
15.0
159
Reasons to administer___________:
- Delivery of an Rh-positive baby to an Rh negative mom
- Antepartum prophylaxis at 26 to 28 weeks of gestation
- Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g., version) or abdominal trauma
- Actual or threatened pregnancy loss at any stage of gestation
- Ectopic pregnancy
RhoGAM
160
Administration of Rhogam at 28 weeks should occur even if the ___________ screen is not known to be negative at the time of Rhogam administration
antibody
161
When should women who are at high risk for chlamydia and gonorrhea be screened?
at 1st prenatal visit AND in 3rd trimester
162
abnormal Rubella titer value
<1:8
163
abnormal RBC value
< 3 or > 4.5
164
abnormal Hgb in 1st trimester
<11.0
165
abnormal Hgb in 2nd trimester
<10.5
166
abnormal Hgb in 3rd trimester
<11.0
167
abnormal Hct in 1st trimester
<33.0
168
abnormal Hct in 2nd trimester
<32.0
169
abnormal Hct in 3rd trimester
<33.0
170
abnormal MCV
<80
171
abnormal MCH
<27
172
abnormal MCHC
<33
