OB Flashcards
1
Q
what are the criteria for preeclampsia?
A
-after 20th week
-140/90 on 2 occasions at least 8 hours apart
-one of more of the following: proteinuria, new onset headaches/visual disturbances, thrombocytopenia, impaired liver or kidney function, or pulmonary edema
2
Q
what is the cure for preeclampsia?
A
delivery is the only cure
3
Q
what is eclampsia?
A
severe preeclampsia in which seizures occur
4
Q
what are the effects of preeclampsia and eclampsia on fetus?
A
-long-standing HTN leads to placental insufficiency which impairs the nutrient and 02 to fetus which results in IUGR.
-placental abruption is also more frequent
5
Q
HELLP syndrome stands for?
A
- H = hemolysis
- EL = elevated liver enzymes
- LP = low platelet count
6
Q
when does HELLP syndrome occur?
A
-4-12% of all those with preeclampsia, most often in 27-37 weeks but also may develop postpartum
7
Q
how does the mother present with HELLP syndrome?
A
- often present with flu like symptoms including headache, nausea, vomiting, and visual disturbances
- pain in the upper right quadrant is related to liver dysfunction, but may be misdiagnosed as GI or gallbladder disease
8
Q
what is the treatment of HELLP syndrome?
A
platelet transfusions are given immediately before birth - 20,000/mm3 before vaginal delivery or 50,000/mm3 before C-section.
9
Q
HELLP syndrome treatment?
A
Immediate delivery of the fetus and platelet transfusion ideally prior to delivery
10
Q
does insulin cross the placenta?
A
No
11
Q
explain the effects of diabetes on a fetus/newborn
A
The fetus is exposed to elevated blood glucose levels which restrict fetal growth. at 20 weeks, the pancreas of the fetus be insipidus insulin the combination of elevated blood glucose from the mother, combined with elevated insulin from the newborn triggers rapid fetal growth increasing fat, and glucagon store at birth, sudden withdrawal of maternal glucose, combined with continued insulin production of the newborn results in hypoglycemia
12
Q
around how many weeks does the fetus start producing insulin?
A
20 weeks
13
Q
does glucose cross the placenta?
A
Yes
14
Q
what is sickle cell?
A
Recessive genetic disorder of chromosome 11, causing hemoglobin to be defective, so that red blood cells are sickle shaped and inflexible, as result accumulation in small vessels creates blockages and causes pain
15
Q
effects of sickle cell anemia on a pregnant woman
A
- Increase risk urinary and pulmonary infections, congestive heart failure, acute renal failure (all of which at any time can trigger crisis that puts the fetus at risk)
- Fetal mortality rates are about 18% due to sickling in the placenta
16
Q
Effects of sickle cell anemia on the fetus
A
- fetal death rates are about 18% due to the sickling of the placenta
- neonates are at increased risk for prematurity and IGUR
17
Q
cardiac disease in the mother puts baby at what risk? what is recommended?
A
5-10% of babies will have cardiac anomalies, fetal echocardiogram is recommended
18
Q
what is the recommended iron dosing for anemia?
A
60-120mg daily, avoid caffeine and dairy, take with a source of vitamin C
19
Q
foods high in folate
A
green leafy vegetables, liver, citrus fruits, legumes, nuts, and grains
20
Q
recommended supplementation of folate/folic acid
A
folate 600-1000mcg daily, folic acid 1-5mg daily
21
Q
naegele’s rule
A
first day of LMP minus 3 months plus 7 days = gestation age
22
Q
vasa previa
A
one or more of the fetal blood vessel lie across the cervical OS
23
Q
chorionic villus sampling
A
CVS; inserting a catheter into the ulterior to obtain placental villi for testing; preformed at 10-13 weeks gestation; chromosomal, DNA and enzymatic analysis is done to the tissue
24
Q
amniocentesis
A
15-20 week; US guided, needled is inserted into amniotic pocket; 15-20ml if amniotic fluid needed
25
name the 5 parameters of a BPP
fetal respiration, fetal movement, fetal tone, amniotic fluid volume, fetal HR (NST) (NST can be omitted)
26
cat I
normal; FHR baseline 110-160 bpm, moderate variability only, may have early decels but no late of variable decels
27
cat II
indeterminate (anything that isn’t cat I or III); variability may be minimal or marked; accelerations may be absent; decelerations may be prolonged, variability, or recurrent late with moderate variability.
28
cat III
no variability with recurrent late decelerations, recurrent variable decelerations; bradycardia; sinusoids pattern
29
early deceleration
caused by head compression; onset just before the start of the contractions, lowest level at the midpoint of the contraction (mirrors the contraction)
30
late deceleration
caused by compression of vessels and uteroplacental insufficiency; onset is late in the contraction and the lowest point is after the midpoint of the contraction
31
variable deceleration
caused by umbilical cord compression; maybe abrupt and not related to the contraction; maybe be variable and occur once or receptively; repetitively may indicate fetal distress
32
uterine hypertonus? what can cause it?
- uterus fails to relax between contractions
- hormonal imbalance, immature genitals, infections, cervical failure, fibroid tumors
33
uterine tachsystole
6 or more contractions in 10 mins or a series of 2 min or longer contractions; averaged over 30 mins
34
explain the hormonal changes that cause labor onset
progesterone inhibits contractions; progesterone levels fall and estrogen levels increase; this allow the uterine to contact in response to the pituitary gland’s release of oxytocin
35
fetal factors that initiate labor (4)
- prostaglandin levels rise; arachidonic acid is release from amniotic fluid, the cord placenta bed; arachidonic acid is converted into prostaglandin
- as the placenta ages, this tiggers contractions
- fetal cortisol from the fetal adrenal glands reduces progesterone formation
- the fetus secrets oxytocin equal to an infusion of 3mU/min
36
maternal factors in initiate labor (4)
- stretching of uterine muscles causes release of prostaglandin; prostaglandin prepares uterine tissue to respond to oxytocin
- decreased progesterone levels allows estrogen to excite the uterine muscle response
- cervical pressure stimulates nerve plexus; resulting in signals to the posterior pituitary gland to release oxytocin
- oxytocin release in the circulation raises dramatically all throughout labor; along with prostaglandin, oxytocin keeps muscles from binding calcium, this raises the calcium in the blood causing the contractions to be begin
37
first stage of labor
0 - 10cm; latent is 0-3cm; active is 3-7cm; transition is 7 - complete
38
2nd stage of labor
10 cm to birth
pushing
39
3rd stage of labor
birth of baby to birth of placenta
40
4th stage of labor
birth of placenta to women is stabilized
41
1st degree tear
perineal skin + mucous membranes of the vagina are torn
42
2nd degree tear
perineal skin plus vaginal mucous membranes as well as the fascia and muscles of the perineum
43
3rd degree tear
perineal skin, vaginal mucous membranes, and fascia and muscle of the perineum are torn and extends to the rectal sphincter
44
4th degree tear
tear extends into the rectal sphincter
45
vacuum assisted birth rules
- suction 50-60mmHg
-traction is applied with contraction
-traction should be limited to 20-30mins
- only 3 “pop offs” allowed
-increased risk for mother and newborn
46
marginal placenta previa
comes within 3cm of the cervix - is type is the most likely to resolve, this is because as the pregnancy grows the uterine grows and where the placenta implants moves upwards away from the cervix
47
partial placenta previa
within 3c of the cervical
48
the most irregular fetal heart rhythm is…
premature atrial contraction (PAC); usually resolve without interventions
49
most common effect of COVID on a fetus, and what is the recommendations from the CDC
preterm birth; there is a risk of stillborn; pregnant women are at a greater risk of being hospitalized and ventilation; CDC recommends women receive COVID vaccinations, including boosters
50
describe how sickle cell disease (SCD) is passed down
SCD is autosomal recessive disorder; in order to develop the disease, the child has to inherit the treat from both parents. if both parents have SCD 25% will have the disease, 50% will be a carrier; and 25% will have neither.
51
what medications is safe for women that have influenza
oseltamivir (tamiflu)
52
what is the difference between physiologic and pathological jaundice?
- pathological jaundice appears within the first 24 hours of life; physiologic appears after 24 hours (24-28 but may be later)
53
blue / black cohosh herb and pregnancy
not considered safe; stimulates contractions; also associated with maternal cardiovascular abnormalities and fetal hypoxia
54
when should a pregnant woman start antiviral?
only zanamivir or oseltamivir; within 48 hours of symtpoms
55
what is the difference between open and closed glottis pushing; which is recommended and why?
- closed-glottis pushing = holding breathe and bearing down hard without the urge to push
- open glottis pushing = women is advise to hold her breath for no more then 5-6 seconds when feeling the urge to push and take several breathes between pushes
- closed glottis pushing is no longer recommended because of the risk of fetal hypoxia
56
treatment for suspected necrotizing entercolitis in order of importance
- stop feeding; place NG to decompress stomach/intestines, IV fluid resuscitation and TPN to prevent dehydration and malnutrition; abx as indicated; surgical intervention if perforation as occured
- preterm infants that are formula fed are at highest risk for necrotizing enterocolitis
57
uterus descend post delivery
- by day 2 after delivery the uterus should normal descend by 1cm per day; usually the fondus can no longer by palpated by day 14
- post delivery the uterus is approx 1000g/2.2lbs and by 6 weeks PP it is 60g/2oz
58
during a ctx, the usual response to maternal cardiovascular system is…and why?
- increase BP, decrease HR
- because during a ctx the blood flow to the placenta slows temporarily causing maternal blood volume to increase 10-25%, this causes the BP to increase and the HR to decrease
59
what weeks should an amniocentesis be done and why?
- amniocentesis should be done at 16-20 weeks when adequate amniotic fluid volumes and fetal cells in the fluid are present
- earlier then 13-14 weeks is associated with increase fetal foot deformities; done between 15-16 weeks have a increased risk of resp problems
60
what are the 3 phases of a contraction?
increment, peak/acme, decrement
61
what is the increment phase of the contraction?
the contraction begins at the fundus and spreads downwards towards the uterus
62
what is the peak/acme of the contraction?
the point in which the contraction is the strongest and most intense
63
what is the decrement of the contraction?
the uterus begins to relax and the contraction decreases in intensity
64
BH contractions begin at h how many weeks?
16 weeks
65
what is the proteinuria level for preclampsia?
greater the 0.3g (300mg) in 24 urine; +1 dipstick
66
lochia rubia
- days 1 - 3 PP
- dark red with small clots
- abnormal: large clots; foul odor
67
lochia serosa
- 4 - 10 days PP
- serosanguinous drainage
- abnormal: persistent red drainage; excessive drainage; clots; foul odor
68
lochia alba
- 10 days to 6 weeks PP
- light yellow to white discharge, decreasing in volume
- abnormal: return to red or serosanguineous drainage; clots; foul smelling
69
3 primary causes of thromboembolic disorders in PP
- venous stasis; compression of vessels, prolong standing or inactivity, blood vessel dilate promoting thrombus formation
- hypercoagulation; coagulation factors increased; this is thought to help protect women from hemorrhage
- blood vessel trauma; may occur during c-section resulting in pelvic vein thrombosis
70
how long after miso can you start oxytocin?
3-4 hours after last dose of miso
71
how long after cervidil can you start oxytocin?
30-60 mins post removal of cervidil
72
how long after deinoprostone gel can you start oxytocin?
6-12 hours
73
contraindications of external cephalic version (ECV); what about Rh-negative?
- 37 weeks or more, anything that doesn’t allow for vaginal delivery (placenta previa, active gential herpes), non reactive NST, multiple gestation, amniotic fluid abnormality, pervious uterine surgery/ c-section.
- Rh negative is not a contraindication but RhoGAM should be given after the procedure
74
what is nocturia and why is normal is 2nd and 3rd trimester?
- nocturia = voiding at night
- when a patient is reclining in bed the pressure on the pelvic vessels lessens and the blood flow to the kidneys increases
75
what hormone is primarily responsible for maintaining the pregnancy? which hormone is primarily responsible for fetal growth?
- progesterone maintains the pregnancy; estrogen is primarily responsible for growth
- estrogen and progestestrone are are produced by the placenta at about 12 weeks
76
why do you monitor urine output when patient is on magnesium?
magnesium should be held if urine output is less then 30ml/hr because urine output must be adequate for magnesium to clear the system; to avoid magnesium toxicity which can result in resp depression.
77
what medication do you use to treat magnesium toxicity?
calcium gluconate
78
evaporative heat loss
heat loss that occurs when fluid is on newborns skin (amniotic fluid) is converted to vapor
79
convection heat loss
heat is lost to cool air passing over the infants skin, such as a draft or cold hair in room; cloth newborn and keep room warm
80
convection heat loss
heat is loss via radiation; when you place a infant by a nearby cool surface such as windows or isolette walls (NOT direct contact)
81
conduction heat loss
heat is loss through direct contact with cool surface, such as cool hands, stethoscope, cold blankets; skin to skin contact helps prevent conductive heat loss
82
reassuring fetal movements
4 fetal movements in 1 hour; or 10 movements in 2 hours
83
untreated hypothyroidism in pregnancy is more likely to cause what abnormalities in fetus:
significantly associated with brain development and can lead to fetal death
84
what is the selling maneuver and why is used in emergent C sections
gentle cricoid pressure against the trachea to effectively block the esophagus, reducing GI reflex and risk for aspiration. This is used in C-sections because the patient may not be NPO
85
what is a uterine artery embolization? what is used for?
-a procedure done by a interventional radiologist where tiny particles (about the size of grains of sand) are injected into the blood vessels that lead the uterus, decreasing the blood flow to the uterus, resulting in decreased blood loss
- used to avoid hysterectomy or to treat uterine fibroids
86
contraindications for uterine artery embolization?
infection of urinary or vaginal tract, hemodynamically unstable, cancer, rental failure, hyperthyroidism, and hx of radiation to pelvis
87
massive transfusion protocols: ratio to PRBCs, FFP, and platelets is….
1:1:1 = approximately makes whole blood
88
HIV exposed infants should receive what antiviral after delivery
- if mother took antiretroviral during pregnancy: zidovudine; as soon as possible following delivery (within 6-12 hours) and continue for usually 6 weeks; dose is determined by weight and gestation age at birth
- if mother didn’t take antiretrovirals, neonate should receive both zidovudine and nevirapine
89
what is considered anemia in a term infant
hematocrit below 45%
90
during birth, at what stage does the mother frequently experience chills?
stage 4; 1- 4 hours post delivery; unknown why but thought to be the result of circulatory changes post delivery
91
why do you give a tocolytic prior to external cephalic version?
tocolytic is administered to relax the uterus during the procedure
92
why does diarrhea pose a greater risk of dehydration for a neonate then an older child?
the intestines are relatively longer and have more surface area; this normal increases the absorption but with diarrhea it also increases the rate of fluid loss
93
when is the fundus palatable at the umbilicus?
20 weeks
94
when is the fundus palatable at the mid point between the symphysis pubis and the umbilicus?
16 weeks
95
where is the fundus at 12 weeks?
level with the symphysis pubis
96
how to measure fundal height after 22-24 weeks
gestational age is approx to centimeters; example 26 cm = 26 weeks
97
what is chloasma?
dark blotchy pigmentation of the face that occurs with pregnancy; melasma gravidarum
98
one of the most common pregnancy complications with patient with systemic lupus erthematosus?
preeclampsia; risk being 16-30%; also SGA is common, occurring in 10-30% of lupus pregnancies
99
TXA dosing and timeline
- 1g in 100ml IV min over 10 mins, a 2nd dose 30 mins after 1st if bleeding persists
- must be given within 3 hours of onset of bleeding/birth; shown no effectiveness if given later
100
maternal hyperthyroidism may cause __(4)_____ in fetus?
fetal tachycardia, preterm birth, stillborn, and SGA
101
frank breech
legs are completely extended towards the shoulders/head and the buttocks is the presenting part
102
full/complete breech
the fetus is in a flexed position with legs flexed against the abd/chest, head is in the superior position
103
footling breech
one or both legs are extended and presenting
104
what is polycythemia?
- hematocrit greater the 65%; results from fetal hypoxia or intrauterine transfusion = placental insufficiency, poorly controlled GDM, delayed cord clamping, twin to twin transfusion, maternal tobacco use, and certain chromosomal disorders
- treatment is partial exchange transfusion
105
what is a safe platelet count that a women can deliver at?
must be a over 50,000; gestational thrombocytopenia is common and characterized by platelet counts of 130,000-150,000.
106
the drug most commonly associated with abruptio placenta?
cocaine; cocaine is rapidly absorbed in the fetus, placenta and mother; all experience vasoconstriction which may be the direct cause of the abruption
107
cocaine use is associated with…..(5)
abruptio placentae, placenta previa, IUGR, precipitous delivery and preterm labor
108
during the uterine ctx, the contraction force is in the ________ section of the uterus
upper two thirds of the uterus
109
how many extra calories should a pregnant women eat?
300 calories per day
110
to prevent damage to the fetus, a pregnant women should be treated for syphilis before ______ weeks?
16 weeks; if left untreated the neonate may develop congenital syphilis with wide range physical and mental impairments
111
S/S of amniotic fluid embolism (AFE)
resp distress, cardiovascular collapse (hypotension), mental status change, seizures, DIC; many patient’s die within 1 hour of onset; treatment is supportive, including respiratory and hemodynamic support, and treatment of cogulopathy
112
A1C levels in GDM
above 6.5% x2; remember that there is a faster turnover rate of red blood cells in pregnant women, so can be tested more frequently in pregnant women
113
what is the earliest indications of maternal hemorrhage?
fetal brady/tachycardia; maternal BP often remains normal even with extensive blood loss due to the increased maternal blood volume
114
“HELPERR” for shoulder dystocia
- H = call for help
- E = consider episiotomy
- L = legs into the knee-chest position (McRoberts)
- P = superapublic pressure
- E = “enter” - provider inserts hand in the vagina and attempts to rotate the shoulder into a more deliverable position
- R = remove posterior arm
- R = roll patient to hands and knees
115
expected weight gains in singleton and twin/triplets
- singleton = 25-35 lbs
- twins/trips = 35-45 lbs
116
definition of precipitous delivery
onset of labor to birth is less then 3 hours
117
incomplete breech
one leg is flexed and the other leg is extended towards head, buttocks presentation
118
oligohydramnios
AFI l of 5cm or less - linked with urinary/kidney problems; fetus is threatened by adhesions that can cause amputations and pressure that can cause deformities; cord compressions causing fetal distress
119
polyhydramnios
AFI over 24cm - often caused by fetal anomalies of CNS or GI systems; GDM, or multiple gestational
120
5 parameters for bishops score
cervical dilation, cervical effacement, fetal station, cervical consistency, and cervical position
121
explain prostaglandin for cervical ripening
soften the cervix, relax cervical muscle and induces contractions; allows the uterus to respond more readily to pitocin
122
return to ovulation for breastfeeding vs non breastfeeding
breastfeeding: 2-18months
non breastfeeding: 7-9 weeks
123
definition of PPH
1000ml loss or greater with s/s of hypovolemia in the first 24 hours
124
how does TXA work>
inhibits plasminogen activation, inhibits the breakdown of fibrinogen and fir in clots = decreased bleeding
125
contraindications for the methergine
HTN
126
hemabate contraindications
asthma
127
succenturiate placenta
placenta has one more accessory lobes apart from the main placenta body which vessels of the fetal origin
128
battledore placenta
the umbilical cord is inserted at or near the placenta margin rather than in the center
129
podalic version
rarely used today; vaginal birth of second twin if not cephalic, provider reaches into the uterus and grabs the fetus by the feet and is delivery breech while applying downward pressure externally to the abd and pulling the feet through the cervix and vagina
130
when is an US most accurate
6-10 weeks using crown to rump length with accuracy of plus or minus 3-5 days
131
a infant born to a mother with hep B should….
be given the hep B vaccine and hep B immune globulin within 12 hours of birth
132
when is a PP mother most at risk for DVT?
3 days post delivery
133
why is brow presentation concerning?
generally require a C section - because the average diameter is 13.5 cm compared to a normal presentation being 9.5cm
134
a fetus in breech position is especially at risk for….
fetal abnormalities; 3 times that of a fetuses in cephalic position; additionally at risk for cord prolapse
135
risk factors for placenta previa
previous c section, older then 35 years, more then 5 pregnancies, prior uterine surgery and previous hx of placenta previa
136
correct maternal position for NST
semi fowlers with pillow under right hip to displace uterus to the left
137
narcotics have what effect on fetal HR?
decreased variability and and decreased accelerations
138
uterine atony
soft or weak uterus after birth (uterine tone)
139
after prostaglandin cervical gel, what position should the patient lay in?
dorsal recumbent; 30- 60 mins of lying on back with pillow under right hip into order to tip uterus to the left
140
left lateral sims position
lying on left side, the left hip and lower extremely are straight with right hip and knee bent; support upper leg with pillows; this position helps reduce the need for episiotomy; slows the fetal descent and reduces risk of aspiration
141
velamentous cord
cord doesn’t attach directly to the placenta, instead it goes into the amnion sack/layers and then attaches itself to the placenta; can also be a previa
142
different word for polyhydramnios
hydramnios; drop the poly
143
____ mothers are risk for polyhydramnios
DM
144
a fundal height more then 4cm greater then the number of weeks gestation is….
macrosomia; fetal weight more then 90%
145
contraindications to inductions
multiple gestation, abnormal fetal heart tones, breech, uncertain presentation, polyhydramnios, maternal HTN, maternal heart disease, active herpes, and history of myomectomy (fibroid surgery), placenta previa, prolapsed cord; should be at least 39 weeks
146
What does APGAR stand for?
- Appearance (skin color)
- Pulse
- Grimace
- Activity (tone)
- Respiratory (rate and effort)
147
caput succedaneum
swelling; abnormal molding of neonatal skull with a collection of fluid that crosses the suture lines; fluid is above the periosteum; caused by pressure such as labor or vacuum assisted deliveries
148
cephalohematoma
blood collections between the periosteum and skull; does not cross the suture lines
149
subgaleal hemorrhage
accumulation of blood between the skull and the skin of the head; crosses the suture lines; life threatening; 20-40% of blood volume is in the skull; treatment is blood and FFP transfusion, requires NICU care
150
absents of blinking reflex is concerning for….
cerebral palsy; lack of blinking reflex is a sign of brain damage
151
when is Rhogam be given
at 26-28 weeks and 72 hours post deliver
152
1st trimester US used for what fetal birth defects and estimate gestational age accuracy
- brain and spine
- age accuracy +/- 1-2 weeks
153
2nd trimester US used for what fetal birth defects and estimate gestational age accuracy
- size/position of placenta, umbilical cord, major birth defects including cardiovascular and neutral tube defects
- age accuracy +/- 2 weeks
154
3rd trimester US used for what fetal birth defects and estimate gestational age accuracy
- fetal viability, BPP, size/ position of placenta, size/position of fetus, umbilical cord, and estimated AFI
155
describe maternal gential herpes and newborn treatment
- if a neonate is asymptomatic at birth and maternal lesions are not present: obtain skin and mucus specimens and cultures 24 hours after birth, if positive, then newborn starts acyclovir.
- if active lesions are present at the time of delivery, neonate should immediately begin IV acyclovir
156
HPV/genital warts delivery and newborn transmission
HPV/gential warts are rarely transferred during vaginal delivery; c section is not a routinely done due to infection; in rare instances HPV infection/warts do develop in newborns mouth and throat
157
preferred vaginal yeast infection treatment
vaginal cream or suppository such as Movistar (miconazole)
158
preferred treatment for substance use disorders for pregnant women
- buprenorphine is better then methadone, neonates are less likely to experience NAS
159
how long do PP blues last
usually happens 5 or less days post delivery; usually last 2-3 days, but for sure less then 2 weeks, caused by hormonal changes; if lasts longer may be PP depression and should seek how help
160
neonatal thrombocytopenia
less then 150,000/mm3
161
most common cause of e. coli infection in neonates
maternal GI tract; usually obtained during delivery
162
24-26 weeks skin appearance
translucent; red; many visible blood vessels, and scant vernix
163
35-40 weeks skin appearance
deep cracks, no visible blood vessels, and this vernix
164
42-44 weeks skin appearance
dry, wrinkled, peeling, no vernix, and loss of subcutaneous fat
165
vernix in weeks
production begins at week 20, top lay of skin develops during weeks 20-24 and thickens to form a water barrier by week 32; near term the vernix washes aware and the skin becomes increasing wrinkled and peels
166
what is the ritgen maneuver?
as the head is delivered, the provider applies pressure to the perineum, this causes the fetal head to extend during birth which helps protect from perineal lacs
167
s/s of uterine rupture
sudden onset; severe abd pain, sudden pause in ctx, fetal distress, vaginal bleeding, hemodynamic unstable mother
168
s/s of abruptio placentae
sudden onset, mild to moderate pain, vaginal bleeding, hypertonic ctx (rigid uterus), uterine tenderness, fetal distress
169
low birth weight is defined as:
2500g or less
170
choanal atresia
nasal passage ways are occluded by soft tissue; resp distress and cyanosis occur when mouth is closed; BIG SIGN, when neonate cries = resp status improves; neonate may require intubation until surgery can be provided
171
best medication for anxiety during pregnancy?
SSRIs - such a citalopram or sertraline
172
absence of the moro reflex on one side indicates….? bilateral absence indicates….?
- fractured clavicle
- cerebral palsy
173
multiparous woman, induction successful bishops score?
5
174
nulliparous woman, induction successful bishops score?
9
175
most common cervical laceration positions (clock)
3 and 9 o’clock
176
normal fetal pulse ox when intrauterine
30-65%
177
+ scarfs sign indicates?
preterm infant
178
what is idiopathic cardiomyopathy and when does it develop in pregnant women?
- cardiac disorder associated with abnormalities of the ventricular wall thickness, size of the ventricular cavity, contraction, relaxation, conduction and rhythm
- develops in the last month of pregnancy or soon after birth without preexisting cardiac disease
179
grade 1 placental abruption
10-20% of the placenta is detached but the mother and the fetus are not in distress; uterus may be tender and mild tetany evident
180
grade 2 placenta abruption
20-50% of the placental surface is detached with or without enteral bleeding; uterine bleeding and tetany are evident; mother is not in shock but fetus shows signs of distress
181
grade 3 placenta abruption
over 50% of placenta surface is detached with severe uterine tetany, maternal shock and frequently coagulopathy; fetal distress
182
another name or cordocentesis and what week is it preformed
- percutaneous umbilical cord blood sampling (PUBS)
- after 18 weeks
183
what is PUBS used for?
done after 18 weeks, used for identify fetal abnormalities, infections, anemia, congenital alloimmune thrombocytopenia
184
vascular spiders are most common on what part of the body?
face, arms, and upper torso
185
fundal height is no longer accurate at how many weeks?
36
186
common dental problem for pregnant women and why?
gingivitis - increased estrogen levels and increase vascular levels cause swelling of mouth and gums; resolves after deliver
187
normal vaginal ph
4.5-5.5
188
normal vaginal ph is amniotic fluid is present
7.0-7.2; presents of blood and semen is create a similar ph
189
pregnant women on dialysis should received hemodialysis how often a week compared to non pregnant?
x6 weekly compared to non pregnant
190
3 signs of placental seperation
uterus rises, blood gushes, and cord lengthens
191
what is protracted labor
slow labor; abnormally slow cervical dilation and fetal descent during active labor
192
protracted labor for multipara
less then 2cm per hour
193
protracted labor for nullipara
less then 1 cm per hour
194
MVUs needed fro normal labor progression
200
195
how to calculate MVUs
subtracting the baseline terrine pressure from the peak pressure of each contraction in a 10 min period
196
how long is cervidil (dinoprostone) left in the vagina?
12 hours
197
erythema toxicum
red spot by area with whit or yellow papules in the center of the back and chest of the neonate 24-48 hours after birth, sometimes up to 2 weeks; usually disappears within a few hours or days
198
nexus flammeus
port-wine stain; permanent pink to dark red to purple birthmark; can occur throughout the body
199
nevus vascularis
strawberry hemangioma - raised dark red rough surfaced lesion, usually on the scalp; growth appears around 5-6 months but recedes by school age without treatment
200
what is the antiviral drug of choice someone pregnant or trying to get pregnant with HIV
dolutegravir
201
hydrotherapy water temps
36-38 C / 96.8 / 100.4 F
202
maternal positioning for c section
supine with wedge under right hip
203
normal crea level for pregnant women
less then 1.0 mg/dL - (non pregnant is less then 1.5) - this value falls because of the increased blood volume and increased perfusion of the kidneys
204
how long does it take for the uterus to go back to pre pregnancy size?
4 weeks
205
arrest of labor is defined as (nullipara/multipara)
more then 3 hours of pushing for nullipara and more then 2 hours of pushing for multipara
206
bishop score that indicates “ripe” cervix
9 ; anything less then 4 has a high likelihood of failure
207
advantage of spinal epidural analgesia over epidural?
more immediate pain relief ; regular epidurals take 20-30 mins for effect
208
how long do you hold PO iron if patient is getting an iron infusion
48 hours
209
adverse effects of iron infusions
GI upset, back pain, muscle pain, dizziness, headache, hypotension, peripheral edema, arthralgia (joint pain), localized pain at IV site
210
BPP: fetal movement that is considered normal
3 or more separate movements in 30 mins
211
long term risk associated with episiotomy
fecal incontinence;
212
how long do afterpains last for multipara? what about nullipara?
3 days; nullipara usually don’t experience afterpains because the uterus stays somewhat contractions, may experience if multi gestational; afterpains may increase with intensity with the number of pregnancies
213
NST maternal positioning
semi fowlers with support under right hip
214
high AFP, normal HCG, normal uE3, normal INH-A
neutral tube defects
215
low AFP, high HCG, low uE3, high INH-A
Trisomy 21
216
low AFP, low HCG, low uE3, low INH-A
trisomy 18
217
high AFP, high HCG, normal uE3, normal INH-A
multiple gestation
218
cardiac condition with the highest risk for maternal death
marfan syndrome with aortic root dilation ; risk for the aorta with rupture with pregnancy esp if dilation exceeds 4cm; risk for the fetus to get the genetic anomaly is 50%
219
idiopathic cardiomyopathy of pregnancy is charactized by:
EF less then 45%, heart enlargement, and left ventricular systolic function: dyspnea, orthopedic, cough palpitations, and chest pain
220
choosing not to breastfeed, how long does swelling and breast discomfort last?
10 days
221
most common site of pregnancy associated DVT?
left leg; approx 90% of all cases
222
gestational thrombocytopenia is defined as a platelet count of…..
less then 100,000 mm3; occurs because of blood dilation due to increased blood volume
223
fundal height at 36 week? what happens after 36 weeks?
at the xiphoid process; after 36 weeks it slowly descents, fetus drops down and engages into the pelvis
224
C vs U hold for breastfeeding
C hold is only used for the football hold, all other breastfeeding positions use U hold
225
when does fetal growth slow down or plateau
37 weeks
226
affected of maternal chickenpox infection on fetus
varicella; depends on time of exposure; eye abnormalities, malformation of limns, hypoplasia of digits, restricted growth, microcephalus, brain and nervous system abnormalities, developmental/intellectual disabilities
mortality rates are high, over 50% for those with severe defects
227
goal MVUs during pit induction/augmentation?
200-300 MVUs
228
symptoms of sacral nerve injury?
fecal incontinence, urinary incontinence and loss of sensation to the perineum
229
methylerine route of admin station?
PO or IM
230
methylerine route of admin station?
PO or IM
231
what weeks do you give mag sulf for neuro protection?
32 weeks or less
232
when should heparin be stopped prior to epidural?
12-24 hrs ; this prevents hematoma forming at needle insertion site which can cause temporary or permanent paralysis on the spinal cord
233
arrest of labor
no cervical dilation for the more then 4 hours with adequate uterine contraction or more then 6 hours with inadequate contractions
234
what is the bacterial name for syphilis
spirochete treponema pallidum
235
what to hormones are thought to contribute to n/v in pregnancy?
HCG and estrogen
236
what drug can women take while pregnant with lupus?
hydroxychloroquine
237
PUPP
prurtitic urticaria papules of pregnancy - rash that usually starts on the the abd and spread but spares below the belly button and pubic region - spreads to the extremities but involve the face, palms of hands and soles of feet; treatment is topical steroids; can occur in 2nd trimester but most often in 3rd
238
how did Synthroid dosing change once pregnant?
Increase the dose of levothyroxine by 30%
239
how did Synthroid dosing change once pregnant?
Increase the dose of levothyroxine by 30%
240
What is the target TSH level for first trimester?
0.1 - 2.5 mlU/L
241
treatment choice for embolism in pregnancy?
low grade molecular weight heparin; should be discontinued to least 24 hours prior to delivery and postpartum treatment; should be restarted as soon as he moved out dynamically stable; should continue for at least six weeks postpartum. The goal treatment is a period of 3 to 6 months. 
242
treatment for neonate born to a mom active genital herpes
IV Aciclovir
243
which has a higher pH: amniotic fluid or vaginal fluid?
Amniotic fluid
244
what is the normal pH for amniotic fluid?
7.1 to 7.3
245
what is a normal pH for vaginal secretions?
4.5 to 6.0
246
good rate and time of contractions in a 10 min period
3 - 5 contractions in 10 mins, each lasting 30-40 secs
247
HIV viral load greater then 1000 or unknown at time of delivery
scheduled c section @ 38 weeks and IV zidovudine infusion prior to c section in addition to PO antiretroviral medication
248
HIV viral load less then 1000 plan of care
scheduled c section @ 39 weeks
249
another name for hemabate
carboprost tromethamine
250
what is the organism that is caused by cats and eating raw meat
toxoplasmosis gondii
251
where should the fundus be immediately following birth?
@ the U
252
what affect does oxytocin have on the body that needs to monitored
antidiuretic - mother needs to be monitored for water intoxication
253
what does taking NSAIDs cause in pregancy
significant cardiac defects
254
what is the contridication for hemabate
asthma
255
what is the contraindication for the methergine
hypertension
256
How long is the vibrioacoustic simulation done on baby?
usually 1-2 secs repeating up to three times extending to 3 secs if needed
257
successful Bishop score for multiparous woman vs nulliparous
5 for multi, 9 for null
258
vascular spiders appear where
face, arms, upper torso
259
fetal decent causes the bladder to move…
ascend
260
normal fetal breathing movement during BPP
1 fetal breathing movement 30 secs in 30 mins
261
vanishing twin in first trimester is considered….
normal
262
another name for battledore placenta
marginal core insertion; a condition where the umbilical cord is inserted at or near the placenta margin rather than the center
263
a cordocentesis can be performed after how many weeks gestation?
18 weeks
264
velamentous insertion of the umbilical cord is commonly asso
placenta previa
265
battledore placenta, the greatest maternal risks are for
preterm labor and bleeding
266
if the mother is Rh- and the father is rh+, what are the odds that the fetus will be rh+?
100%
267
another name for subutex
buprenorphine
268
how many hours before buprenorphine administration should the patient abstain from drug use?
12-24
269
High levels of alpha fatoprotein
indicate a possible
neutral tube defect
270
Neonate blood gas findings that indicate respiratory acidosis
decreased pH, increase pco2, increase p02, base WNL
271
New ballard score assessment for gestational age, a zero indicates how many weeks gestation?
24
272
appendicitis pain in pregnant vs non pregnant women
appendicitis is normally felt in the RLQ but can be misdiagnosed as the uterus enlarges moving the appendicitis to the RUQ, moving as much as 8 inches up
273
klumpke paralysis
injury to the lower nerves of the brachial plexus; affects the hand
