normal pregnancy/L&D (16%)

Question 1

when is serum hcg detectable? urine?

Answer 1

serum- 5 days s/p conception

urine- 14 days

Question 2

what is ladins sign

Answer 2

uterus softens s/p 6wks

Question 3

what is hegars sign

Answer 3

uterine isthmus softens s/p 6-8wks

Question 4

what is piskaceks sign

Answer 4

palpable lateral bulge/softening of uterine corpus 7-8wks

Question 5

what is goodell’s sign

Answer 5

cervical softening d/t inc vascularity s/p 4-5wks

Question 6

what is chadwick’s sign

Answer 6

bluish color of cervix + vulva 8-12wks

Question 7

timeline of cervical/uterine changes in 1st trimester

Answer 7

goodells (4-5wks)
ladins (6wks)
hegars (6--8wks)
piskaceks (7-8wks)
chadwicks (8-12wks)

Question 8

when can you first hear fetal heart tones? heart beat?

Answer 8

10-12wks (tones- doppler)

5-6wks (beat- US)

Question 9

what is a normal fetal HR

Answer 9

120-160

Question 10

when can fetus be seen on pelvic US

Answer 10

5-6wks

Question 11

when does mom start feeling fetal movement and what is this called

Answer 11

QUICKENING

16-20wks

Question 12

what is included in “para” (P)

Answer 12

# of pregnancies carried to 20wks
multiple gestations = 1

Question 13

fundal height measurements

Answer 13

12wks- above pubic symphysis
16wks- btw pubic symphysis + umbilicus
20wks- at umbilicus
38wks- 2-3cm below xiphoid

Question 14

naegele’s rule

Answer 14

EDD

1st day of LMP + 7D - 3mo

Question 15

freq of prenatal visits

Answer 15

<28wks- q4wks
28-36wks- q2wks
>36wks- q1wk

Question 16

routine tests during 1st prenatal visit

Answer 16

BP
blood type + Rh, CBC, random glucose
UA (glucose + protein)
HBsAg, HIV, syphilis, rubella titer
sickle cell + CF
pap smear

Question 17

3 markers for down syndrome in 1st trimester

Answer 17

free hcg- abnormally high/low
PAPP-A- usu low
nuchal translucency- US @ 10-13wks (inc thickness)

Question 18

when is chorionic villus sampling offered

Answer 18

10-13wks
if prior child w chromosomal abn
maternal age >35
abn 1st or 2nd trimester maternal screening tests
prior pregnancy losses

Question 19

what is triple screening and when is it done

Answer 19

wks 15-20
checks AFP, hcg, estradiol
screens for trisomy 21, trisomy 18, open neural tube defect/multiple gestation

Question 20

results of triple screen for trisomy 21

Answer 20

AFP- low
hcg- high
estradiol- low

Question 21

results of triple screen for trisomy 18

Answer 21

AFP- low
hcg- low
estradiol- low

Question 22

results of triple screen for neural tube defect/multiple gestation

Answer 22

AFP- high
hcg- n/a
estradiol- n/a

Question 23

what is inhibin-A and what can it indicate

Answer 23

high levels in 2nd trimester may indicate chromosome abn

Question 24

when can you do amniocentesis and what are the indications

Answer 24

15-18wks
prior child w chromosomal abnormality
mom >35yo
1st/2nd trimester abnormal screening
abnormal US
prior pregnancy losses

Question 25

when should you screen for gestational diabetes

Answer 25

24-28wks

Question 26

gestational diabetes values (GTT)

Answer 26

fasting <95 1hr <180 2hr <155 3hr <140

Question 27

what should be done in the 3rd trimester for unsensitized Rh negative moms

Answer 27

repeat antibody titers + rhogam @ 28wks + within 72h s/p birth

Question 28

when should you screen for GBS

Answer 28

32-37wks

Question 29

when should Hgb + Hct be checked

Answer 29

35wks

Question 30

5 variables of biophysical profile

Answer 30

``` fetal breathing fetal tones amniotic fluid levels NST gross fetal movements ```

Question 31

point values of biophysical profile

Answer 31

each category = 2pts, 10pt total

Question 32

what is a reactive NST vs nonreactive

Answer 32

reactive- 2+ accelerations in 20min; inc FHR >15bpm from baseline lasting >15sec nonreactive- no FHR accelerations or <15bpm from baseline lasting <15sec

Question 33

what does a reactive NST mean

Answer 33

fetal well being | repeat NST weekly/biweekly

Question 34

what does a nonreactive NST mean

Answer 34

sleeping, immature or compromised fetus | try vibratory stimulation or contraction stress test

Question 35

what is a contraction stress test

Answer 35

measure fetal response to stress @ times of contraction

Question 36

what is a negative contraction stress test

Answer 36

no late deceleration in presence of 3 contractions in 10min | fetal well being

Question 37

what is a positive contraction stress test

Answer 37

repetitive late decelerations in presence of 3 contractions in 10min worrisome, prompt delivery

Question 38

how much folic acid should pregnant woman take and when is it most effective

Answer 38

800mcg/day | 2mo prior to pregnancy + 1mo after conception

Question 39

what foods contain folic acid

Answer 39

green leafy veggies, oranges, cantaloupe, milk, banana, grains + organ meats

Question 40

what vitamins should be avoided in excess in pregnancy

Answer 40

fat-soluble (ADEK)

Question 41

how much caffeine should be max/day

Answer 41

500mg

Question 42

how many calories should pregnant women get

Answer 42

15%+ | 2200

Question 43

how much protein should pregnant women get

Answer 43

10-30g+ | 75g total

Question 44

how much iron should pregnant women get

Answer 44

30-60mg.day

Question 45

how much calcium should pregnant women get

Answer 45

1200mg/day

Question 46

average wt gain during pregnancy

Answer 46

25-35lbs

Question 47

maternal complications of multiple gestations

Answer 47

preterm labor spontaneous abortion preeclampsia anemia

Question 48

fetal complications of multiple gestations

Answer 48

``` IUGR placental abn breech umbilical cord prolapse preeclampsia ```

Question 49

what is lightening

Answer 49

fetal head descends into pelvis -> baby feels lighter to mom

Question 50

what are the cardinal movements of labor

Answer 50

engagement- fetal presenting part enters pelvic inlet flexion- flexion of head to allow smallest diameter to present into pelvis descent- passage of head into pelvis (lightening) internal rotation- fetal vertex moves from occiput transverse position to position where sagittal suture is parallel to anteroposterior diameter of pelvis extension- vertex extends as it passes beneath pubic symphysis external rotation- fetus externally rotates after head is delivered so shoulder can pass

Question 51

stages of labor

Answer 51

I- onset (True regular contractions) to full dilation of cervix II- full cervical dilation to delivery III- postpartum until placenta delivers IV- 1-2h s/p delivery when mom is assessed for complications

Question 52

what are the 2 phases of stage I of labor

Answer 52

latent- cervix effacement w gradual dilation | active- rapid cervical dilation (usu at 3-4cm)

Question 53

what are the 2 phases of stage II of labor

Answer 53

passive- complete dilation to active maternal expulsive efforts active- active maternal expulsive efforts to delivery of fetus

Question 54

what are the 3 signs of placental separation in stage III of labor

Answer 54

gush of blood lengthening of umbilical cord anterior-cephalad movement of uterine funds (becomes globular + firmer)

Question 55

what is considered a normal vs critical APGAR score

Answer 55

``` normal = 7+ critical = 3 or less ```

Question 56

what is the puerperium period

Answer 56

6wks s/p delivery

Question 57

effects on uterus in puerperium period

Answer 57

at level of umbilicus after delivery involution s/p 2days descends into pelvic cavity after 2wks normal size after 6wks

Question 58

what is loch serosa

Answer 58

pinkish/brown vaginal bleeding esp PP days 4-10 | usu resolves by 3-4wks PP

Question 59

when does breast milk come in

Answer 59

PP days 3-5 | bluish-white

Question 60

if mom is not breastfeeding when does menses return

Answer 60

6-8wks PP