Part 3 - TBN: Mother Baby

Question 1

A non-invasive way to assess fetal wellbeing, specifically their heart rate and movements

Answer 1

Nonstress Test (NST)

Question 2

What is considered as reactive in NST?

Answer 2

2 accelerations in 20 minutes

Question 3

What does a reactive NST indicate?

Answer 3

• Indicates fetal well being
• Accelerations have been noted and are associated with movement

Question 4

What are the reasons for nonreactive NST?

Answer 4

• The fetus is sleeping
• Certain medications (Example: narcotics)
• Maternal smoking
• Fetal malformations

Question 5

Also called oxytocin challenge test (OCT).
A test to assess the fetal responses to contractions.

Answer 5

Contraction Stress Test (CST)

Question 6

What does negative (negative for decelerations) mean in CST?

Answer 6

3 contractions in 10 minutes

Question 7

What does positive (positive for decelerations) mean in CST?

Answer 7

Repetitive decelerations occurring for at least 50% of contractions, EVEN if < 3 occur in 10 min span

Question 8

What happens if there is unsatisfactory or suspicious result during CST?

Answer 8

Test must be repeated within 24 hours

Question 9

A noninvasive test that combines a nonstress test (NST) and a fetal ultrasound to assess fetal movements, fetal breathing movements, muscle tone, amniotic fluid index, and nonstress test?

Answer 9

Biophysical Profile (BPP)

Question 10

What is the normal score for biophysical profile (BPP)?

Answer 10

8-10

Question 11

What does the <8 score indicate in biophysical profile (BPP)?

Answer 11

Fetal Hypoxia

Question 12

Fetal movements:
> 3 body/limb movement in 30 minutes

Answer 12

Score = 2

Question 13

Fetal breathing movements (FBM):
> 1 episode of breathing movements of >30 seconds

Answer 13

Score = 2

Question 14

Muscle tone: > 1 extension/fl exion

Answer 14

Score = 2

Question 15

Amniotic fluid index (AFI): AFI > 5 cm or Pocket of fluid > 2 cm

Answer 15

Score = 2

Question 16

Fetal movements:
< 3 body/limb movement in 30 minutes

Answer 16

Score = 0

Question 17

Fetal breathing movements (FBM): No breathing movements or < 30 seconds of sustained breathing movements

Answer 17

Score = 0

Question 18

Muscle tone: No movement, extension or flexion

Answer 18

Score = 0

Question 19

Amniotic fluid index (AFI): AFI < 5 cm or No pockets of fluid > 2 cm

Answer 19

Score = 0

Question 20

A needle is inserted through the abdomen into the uterus under direct visualization through ultrasonography. Amniotic fluid is withdrawn from the uterus (amniotic fluid contains fetal cells).

Answer 20

Amniocentesis

Question 21

When is amniocentesis done?

Answer 21

After 14 weeks

Question 22

Why is amniocentesis done?

Answer 22

• Testing for genetic disorders/congenital anomalies (Example: neural tube defects)
• Assessment of fetal lung maturity (for amniocentesis)

Question 23

A needle is inserted (transcervical or transabdominal) to obtain a tissue sample from the fetus.

Answer 23

Chorionic Villus Sampling (CVS)

Question 24

When is chorionic villus sampling (CVS) done?

Answer 24

10-13 weeks

Question 25

Why is chorionic villus sampling (CVS) done?

Answer 25

Only done if there is a genetic concern.

Question 26

Pathology: During pregnancy, the baby's blood does not typically enter the mother's circulatory system and does not mix with her blood.

Answer 26

Rh Incompatibility during pregnancy

Question 27

Pathology: A rare condition where there is a benign proliferation of trophoblasts. Trophoblasts are normally what develops into the placenta.

Answer 27

Hydatidiform Mole (Molar Pregnancy)

Question 28

A molar pregnancy that: - Comes from a fertilized egg, but the nucleus was lost or inactivated. - Has no fetal parts, amniotic sac, or membranes

Answer 28

Complete Mole

Question 29

A type of molar pregnancy that: - Comes from one normal ovum that is fertilized. - Has fetal parts & an amniotic sac

Answer 29

Partial Mole

Question 30

Early sign of Molar Pregnancy

Answer 30

Asymptomatic

Question 31

Later signs of molar pregnancy

Answer 31

* Vaginal bleeding * Excessive nausea & vomiting (due to increased hCG) * Anemia (from blood loss) * Abdominal cramping * Preeclampsia

Question 32

Placenta attaches too deep into the uterine wall (A little penetration of the myometrium).

Answer 32

Placenta Accreta

Question 33

Myometrium is Invaded (Deep penetration of the myometrium).

Answer 33

Placenta Increta

Question 34

Myometrium is penetrated. Placenta grows through uterine wall & may attach to anything on the other side (bladder/intestines) (Perforation of the uterus) .

Answer 34

Placenta Percreta

Question 35

Abruptio Placenta characteristics

Answer 35

- Detachment issue - Dark red blood - May be concealed bleeding - Abdominal pain & uterine tenderness - Fetal distress (placenta has come off the uterine wall)

Question 36

Placenta Previa Characteristics

Answer 36

- Attachment issue (the placenta attaches low in the uterus) - Bright red blood - Visible bleeding - Painless and nontender uterus - Typically will have a normal fetal heart rate

Question 37

Pathology: Hypertension & proteinuria after 20 weeks gestation in a pregnant woman who previously had a normal blood pressure.

Answer 37

Preeclampsia

Question 38

Triad signs of preeclampsia

Answer 38

Proteinuria Rising BP Edema

Question 39

Signs and symptoms of proteinuria

Answer 39

* Severe headache * RUQ or epigastric pain * Visual disturbances * ↓ Urine output * Clonus (hyperactive reflexes) * Rapid weight gain

Question 40

Medication to prevent eclampsia (seizures)

Answer 40

Magnesium sulfate

Question 41

Risk factors for developing preeclampsia

Answer 41

- History of: Preeclampsia in previous pregnancies Family that had preeclampsia - 1st pregnancy - Obesity - Younger (< 18) & older (> 35) - Medical conditions (Chronic HTN, renal disease, diabetes, autoimmune disease)

Question 42

What is the cure for preeclampsia?

Answer 42

Preeclampsia will resolve after the placenta has been expelled.

Question 43

Signs of False Labor

Answer 43

- Contractions are IRREGULAR - Stops with walking/position change (Stops with comfort measure) - Felt in the the abdomen above the umbilicus - No significant changes in: Effacement, Dilation - In posterior position: baby's head facing mom's front of belly

Question 44

Signs of True Labor

Answer 44

- Contractions are REGULAR (they get stronger, longer & closer together as time goes on) - More intense with walking (Continues despite the use of comfort measures) - Felt in lower back - Significant changes in: * Effacement * Dilation * Can cause bloody show - In anterior position: baby's head facing mom's back