OB and Pregnancy

Question 1

Fetal heart tones can be detected by:

Answer 1

10 - 12 weeks

Question 2

When is the fundus at the symphysis pubis?

Answer 2

12 weeks

Question 3

Where is the fundus at 20 weeks?

Answer 3

at the umbilicus

Question 4

What are Leopold maneuvers? when are they possible?

Answer 4

systematic palpation to determine fetal positioning possible after 20 weeks

Question 5

During which trimester is fetal movement typically felt?

Answer 5

second trimester

Question 6

What is lightening and when does it typically occur?

Answer 6

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

Question 7

What weeks are the second trimester?

Answer 7

14 to 26 weeks

Question 8

What are two indications for amniocentesis?

Answer 8

family history of chromosomal abnormalities

advanced maternal age

Question 9

When is amniocentesis typically performed?

Answer 9

15 - 20 weeks

Question 10

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

Answer 10

15 - 20 weeks

Question 11

What tests are included with triple or quad screens?

Answer 11

hCG

estriol

alpha-fetoprotein

inhibin-A

Question 12

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

Answer 12

chromosomal abnormalies and neural tube defects

Question 13

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

Answer 13

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)

Question 14

When is RhoGAM given?

Answer 14

28 weeks

Question 15

When is hgb/hct measured?

Answer 15

28-36 weeks depending on previous levels

Question 16

When is an elevated alpha-fetoprotein NOT a concern?

Answer 16

In multiple births, an elevated value is expected.

Question 17

What weeks are the every-two-week visits?

Answer 17

28 to 36 weeks

prior the visits are every 4 weeks

after the visits are every week

Question 18

How is the due date calculated?

Answer 18

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

Question 19

Typical bleeding in ectopic pregnancy?

Answer 19

dark brown to tarry

Question 20

What named SIGN may be found in ectopic pregnancy?

Answer 20

Hegar’s sign softening of cervico-uterine junction

Question 21

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

Answer 21

hCG

CBC

blood type

Ultrasound

Preparing for surgery

Question 22

Where do 95% of ectopic pregnancies occur?

Answer 22

the fallopian tubes

Question 23

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

Answer 23

15%

Question 24

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

Answer 24

random chromosomal abnormalities

Question 25

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

Answer 25

o infection o cervical incompetence o uterine abnormalities

Question 26

Fetal age of viability

Answer 26

24 weeks

Question 27

Medications used for medical abortion

Answer 27

o mifepristone (blocks progesterone) AND o misoprostol (prostaglandin that relaxes uterus)

Question 28

What is another use for misoprostol?

Answer 28

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

Question 29

What is the definition of PREGNANCY INDUCED HYPERTENSION?

Answer 29

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

Question 30

What are the five risk factors for PREGNANCY INDUCED HYPERTENSION?

Answer 30

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)

Question 31

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

Answer 31

Liver Function Tests

Question 32

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

Answer 32

24 urine for protein

Question 33

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

Answer 33

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

Question 34

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

Answer 34

left lateral recumbent

Question 35

What is a common **initial sign** of **PRE-ECLAMPSIA**?

Answer 35

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

Question 36

Define PRE-ECLAMPSIA

Answer 36

PIH + PROTEINURIA + generalized EDEMA after 20 weeks gestation

Question 37

Parameters for weight gain in PRE-ECLAMPSIA

Answer 37

greater than 2 lbs / wk or 6 lbs / mo

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

Define ECLAMPSIA

Answer 41

PIH + Pre-eclampsia + SEIZURE

Question 42

What three prodromal symptoms may occur before seizure in ECLAMPSIA?

Answer 42

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

Question 43

What is the usual blood pressure in ECLAMPSIA?

Answer 43

consistently 160/90 (stage 2 HTN)

Question 44

What is the **anticipated testing for eclampsia**? systems of concern? (3) specific tests (6)

Answer 44

Examination of **liver, coagulation, and kidney status:** * **CBC** * **LFTs** with full chem profile * **coagulation** profile * 24 hour **urine for protein** * **creatinine** clearance * **uric acid**

Question 45

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

Answer 45

Magnesium sulfate second line: valium

Question 46

What does HELLP stand for?

Answer 46

**H EL LP** ## Footnote Hemolysis, Elevated Liver enzymes & Low Platelets

Question 47

What does a person with HELLP sydrome look like?

Answer 47

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

Question 48

Signs and symptoms of HELLP (4)

Answer 48

nausea, maybe vomiting jaundice extreme fatigue ill-feeling

Question 49

What are typical LFTs in HELLP?

Answer 49

very elevated normal AST and ALT = 35 - 40 in HELLP, will be in the 100s

Question 50

Which is PAINFUL - previa or abruption?

Answer 50

Abruption is painFUL Previa is painLESS

Question 51

When does previa often occur?

Answer 51

Late second, early third trimester Often after intercourse

Question 52

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

Answer 52

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

Question 53

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

Answer 53

often little risk except if bleeding is severe or other cause of distress exists

Question 54

What **diagnostic and monitoring tools** are used for **placenta previa?**

Answer 54

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

Question 55

What is the vaginal **management** of **placenta previa?**

Answer 55

Vaginal rest NO bimanual exam Speculum only to determine extent of bleeding

Question 56

Is hospitalization expected when bleeding from placenta previa?

Answer 56

yes

Question 57

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

Answer 57

non-stress test biophysical profile

Question 58

When does placental abruption usually occur?

Answer 58

second or third trimester

Question 59

Is abruption an obstetrical emergency?

Answer 59

YES risks both to mother and fetus including the risk of death

Question 60

What syndrome might uncontrolled hemorrhage caused by abruption result in?

Answer 60

disseminated intravascular coagulation (DIC)

Question 61

What are four **contributing factors** to abruption? think of the abruption picture

Answer 61

* **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**??)

Question 62

Is placental abruption painful?

Answer 62

yes, very

Question 63

Is heavy, bright red bleeding always apparent in placental abruption?

Answer 63

No, if it is concealed there may be minimal to moderate bleeding but then the uterus will be rigid

Question 64

Is there usually **fetal compromise** associated with **abruption?**

Answer 64

very much so fetal heart tones may be absent fetal death is very likely unless mom was already hospitalized at the time

Question 65

Can an abruption be diagnosed by ultrasound alone?

Answer 65

No

Question 66

What bloodwork would be ordered for placental abruption?

Answer 66

* CBC * type * Rh * coagulation profiles preparing for surgery and transfusion

Question 67

What is the time frame associated with premature labor?

Answer 67

21 - 36 weeks gestation

Question 68

Risk factors for premature labor? the **long list** that can result in premature labor several in common with **abruption** risk factors

Answer 68

* 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)

Question 69

Are cervical changes associated with the contractions of premature labor?

Answer 69

yes diliation and/or effacement

Question 70

What tocolytic therapy may be utilized in premature labor?

Answer 70

**terbutaline ** which is a **beta agonist **