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Flashcards in OB and Pregnancy Deck (70):
1

Fetal heart tones can be detected by:

10 - 12 weeks

2

When is the fundus at the symphysis pubis?

12 weeks

3

Where is the fundus at 20 weeks?

at the umbilicus

4

What are Leopold maneuvers? when are they possible?

systematic palpation to determine fetal positioning possible after 20 weeks

5

During which trimester is fetal movement typically felt?

second trimester

6

What is lightening and when does it typically occur?

lightening is when the baby settles lower into the pelvis usually 2-4 weeks before labor

7

What weeks are the second trimester?

14 to 26 weeks

8

What are two indications for amniocentesis?

family history of chromosomal abnormalities

advanced maternal age

9

When is amniocentesis typically performed?

15 - 20 weeks

10

When is triple or quad screen (aka multiple marker test) performed?

15 - 20 weeks

11

What tests are included with triple or quad screens?

hCG

estriol

alpha-fetoprotein

 

inhibin-A

12

What types of disorders are the triple/quad screen looking for?

chromosomal abnormalies and neural tube defects

13

When is the ORAL GLUCOSE TOLERANCE TEST typically performed? When might it be performed early?

28 weeks (which is early in the 3rd trimester)

can be done at 20 weeks if family history of diabetes or in obese mother ( > 200 pounds)

14

When is RhoGAM given?

28 weeks

15

When is hgb/hct measured?

28-36 weeks depending on previous levels

16

When is an elevated alpha-fetoprotein NOT a concern?

In multiple births, an elevated value is expected.

17

What weeks are the every-two-week visits?

28 to 36 weeks

prior the visits are every 4 weeks

after the visits are every week

18

How is the due date calculated?

Naegele's rule LMP - 3 months + 7 days =

19

Typical bleeding in ectopic pregnancy?

dark brown to tarry

20

What named SIGN may be found in ectopic pregnancy?

Hegar's sign softening of cervico-uterine junction

21

What four diagnostic tests are performed by the NP in ectopic pregnancy and what is the motivation?

hCG

CBC

blood type

Ultrasound 

 

Preparing for surgery

22

Where do 95% of ectopic pregnancies occur?

the fallopian tubes

23

Approximately what percentage of pregnancies will result in spontaneous abortion (miscarriage)?

15%

24

What is the cause of the majority of losses in the first trimester?

random chromosomal abnormalities

25

What are some causes of fetal loss in the second trimester? (3)

o infection

o cervical incompetence

o uterine abnormalities

26

Fetal age of viability

24 weeks

27

Medications used for medical abortion

o mifepristone (blocks progesterone)

AND

o misoprostol (prostaglandin that relaxes uterus)

28

What is another use for misoprostol?

it is used to prevent NSAID related ulcers (it is a prostaglandin)

29

What is the definition of PREGNANCY INDUCED HYPERTENSION?

BP > 140/90

OR systolic rise > 30 mm/Hg or diastolic rise > 15 mm/Hg

at least 2 readings, a minimum of 6 hours apart

30

What are the five risk factors for PREGNANCY INDUCED HYPERTENSION?

o youngest and oldest moms

o newest and most experienced moms (1st, 5th+)

o personal or family history of PIH, HTN, renal, CV

o diabetes

o autoimmune (like lupus)

31

How is a patient with PIH monitored for progression to HELLP syndrome?

Liver Function Tests

32

How is a patient with PIH monitored for progression to pre-eclampsia?

24 urine for protein

33

Why might an ultrasound be done on a patient with PIH?

to monitor for lag in fetal growth as a result of PIH

34

If rest at home is unsuccessful in patient with PIH, and condition worsens, what bedrest position will be used?

left lateral recumbent

35

What is a common initial sign of PRE-ECLAMPSIA?

sudden weight gain - can't get rings OFF or shoes ON

36

Define PRE-ECLAMPSIA

PIH + PROTEINURIA + generalized EDEMA after 20 weeks gestation

37

Parameters for weight gain in PRE-ECLAMPSIA

greater than 2 lbs / wk or 6 lbs / mo

38

What effect does pre-eclampsia have on DTRs and what is the significance?

WNL progressing to 3-4+ this indicates a pre-seizure state (which would signal progression to eclampsia)

39

What are four means of monitoring the health of the baby in PRE-ECLAMPSIA?

  • weekly non-stress tests
  • biophysical profile 
  • kick counts 
  • ultrasound - fetal growth and placental condition

40

What may be given to stimulate lung maturity as maternal condition worsens? Up to what gestational age? How many doses?

B-methasone x 2 doses given to those under 34 weeks gestation

41

Define ECLAMPSIA

PIH + Pre-eclampsia + SEIZURE

42

What three prodromal symptoms may occur before seizure in ECLAMPSIA?

  • severe, unrelenting headache 
  • vision changes  
  • worsening RUQ or epigastric pain

43

What is the usual blood pressure in ECLAMPSIA?

consistently 160/90 (stage 2 HTN)

44

What is the anticipated testing for eclampsia?

systems of concern? (3)

specific tests (6)

 Examination of liver, coagulation, and kidney status:

  • CBC
  • LFTs with full chem profile
  • coagulation profile
  • 24 hour urine for protein
  • creatinine clearance
  • uric acid

45

What is used to "break" a seizure in a paitent with eclampsia?

Magnesium sulfate 

second line: valium

46

What does HELLP stand for?

H EL LP

Hemolysis,

Elevated

Liver enzymes & 

Low

Platelets

47

What does a person with HELLP sydrome look like?

"a person with liver failure that might bleed.. and that's exactly what they are."

- Barkley

48

Signs and symptoms of HELLP (4)

nausea, maybe vomiting

jaundice

extreme fatigue

ill-feeling

49

What are typical LFTs in HELLP?

very elevated

normal AST and ALT = 35 - 40

in HELLP, will be in the 100s

50

Which is PAINFUL - 

previa or abruption?

Abruption is painFUL

 

Previa is painLESS

51

When does previa often occur?

Late second, early third trimester

Often after intercourse

52

Increased incidence of previa is seen in patients with one or more of these three very uterine-focused factors:

  • previous C section or previa
  • multiparity
  • malpresentation (breech or transverse)

53

How great is the risk to the fetus in placenta previa?

often little risk

except if bleeding is severe

or other cause of distress exists

54

What diagnostic and monitoring tools are used for placenta previa?

  • ultrasound
  • external fetal monitor
  • CBC if bleeding is continuous or severe

55

What is the vaginal management of placenta previa?

Vaginal rest

NO bimanual exam

Speculum only to determine extent of bleeding

 

56

Is hospitalization expected when bleeding from placenta previa?

yes

57

How is the health of the fetus monitored during bleeding with placenta previa

non-stress test

biophysical profile

 

58

When does placental abruption usually occur?

second or third trimester

59

Is abruption an obstetrical emergency?

YES

risks both to mother and fetus

including the risk of death

60

What syndrome might uncontrolled hemorrhage

caused by abruption result in?

disseminated intravascular coagulation (DIC)

61

What are four contributing factors to abruption?

 

think of the abruption picture

 

 

  • trauma
  • hypertension
  • cocaine, alcohol, cigarette use
  • uterine tumor or structural abnormality

(think crack head with uterine tumor who gets hit in the belly...and already had HTN...how could she not have an abruption??)

62

Is placental abruption painful?

yes, very

63

Is heavy, bright red bleeding always

apparent in placental abruption? 

No, if it is concealed there may be

minimal to moderate bleeding

but then the uterus will be rigid

 

64

Is there usually fetal compromise

associated with abruption?

very much so

fetal heart tones may be absent

fetal death is very likely unless mom was already hospitalized at the time

65

Can an abruption be diagnosed by ultrasound alone?

No

66

What bloodwork would be ordered for placental abruption?

  • CBC
  • type
  • Rh
  • coagulation profiles 

preparing for surgery and transfusion

67

What is the time frame associated with premature labor?

21 - 36 weeks gestation

68

Risk factors for premature labor?

the long list that can result in premature labor

several in common with abruption risk factors

  • history of preterm labor
  • UTI / STD
  • multiple gestation
  • low income
  • poor weight gain / poor nutrition
  • cocaine, smoking
  • uterine structural abnormalities
  • cervical trauma
  • adolescent or advanced maternal age (like PIH)

69

Are cervical changes associated with the contractions of premature labor?

yes 

diliation and/or effacement

70

What tocolytic therapy may be utilized in premature labor?

terbutaline 

which is a beta agonist