Part VIII

Question 1

What is important to remember about Rubella?

Answer 1

· Antibody check in pregnancy (we want a positive Rubella Titer) but can’t vaccinate until delivery

· Congenital rubella syndrome (CRS)-Can have overwhelming fetal consequences

· Deafness, congenital heart disease, bone abnormalities, intellectual disabilities, small head, death

Question 2

What is important to know about the Herpes Simplex Virus?

Answer 2

· 30-50% risk of infection with vaginal birth-symptoms can take up to 4 weeks (If active disease, C-section only)

· Symptoms: vesicular skin lesions, resp. distress, temp. abnormalities, seizures, poor feeds

· Babies are treated with acyclovir

Question 3

What is important to remember about Group B Streptococcus?

Answer 3

(Approx. 50% of women are carriers as normal flora, but it can make the baby septic when exposed during birth)

· Women screened at 35-37 weeks’

· Leading cause of infectious neonatal sepsis and mortality

· Flora is killed by Penicillin G q. 4 hours IV thru labor or clindamycin if marked PCN allergy.

Question 4

In a diabetic pt, Insulin needs typically _________ as pregnancy progresses

Answer 4

increase

Question 5

What are some Maternal Risks with Diabetes Mellitus?

Answer 5

Polyhydramnios (hydramnios) - too much fluid

· Preeclampsia

· Hypo or hyperglycemia

· Difficult labor

· UTI’s and vaginitis

Question 6

What are some Fetal/Neonatal Risks with Diabetes Mellitus?

Answer 6

· Congenital anomalies (heart, CNS, & skeletal)

· Macrosomia (Excessive fat but delayed organ development) with chronic diabetes

· Birth injury from the macrosomia

· Cord prolapse

· Hypoglycemia after birth

· Respiratory distress syndrome (low surfactant)

· High insulin levels reduce fetal enzymes needed for surfactant production

· Polycythemia=hyperbilirubinemia

Question 7

What is the Screening done to check for Gestational Diabetes?

Answer 7

· Assess for increased risks of gestation diabetes at first visit ( Those with normal risks are screened 24-28 weeks’ gestation)

· First: 2 Hour Glucose Tolerance Test-75 gram oral glucose load without regard to fasting; glucose is measured 2 hours later. A level above 120mg/dL is abnormal (if you fail this, the do the 3 hr glucose tolerance test)

· Second: 3 Hour Glucose Tolerance Test-100 gram oral glucose load following fasting and glucose taken 3 times do determine Gestation Diabetes.

Question 8

What is important to know about Substance Addiction and Pregnancy?

Answer 8

· ALL patients should be screened

· Be alert for clues of substance abuse in patient history or red flags (for example, mother “not from around here” or friends come in that could be giving them drugs)

· Be matter of fact and nonjudgmental when interviewing

· Ask direct questions starting with less threatening

· “Cold Turkey” detoxification not advisable because of fetal risks

· Careful planning for L&D with intensive fetal care and referrals

· Coordination with community agencies for safety and best outcomes

Question 9

If mom’s blood type is 0+ and Baby is B-, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 9

*ABO concern; no Rh concern (no RhoGAM needed)

Question 10

If mom’s blood type is AB- and Baby is B-, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 10

*No ABO concern; no Rh concern

Question 11

If mom’s blood type is 0- and Baby is 0+, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 11

*No ABO concern; Rh concern (RhoGAM needed)

Question 12

If mom’s blood type is B- and Baby is A+, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 12

*No ABO concern (because mom is not O); Rh concern (RhoGAM needed)

Question 13

If mom’s blood type is A- and Baby is A+, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 13

*No ABO concern; Rh concern (RhoGAM needed)

Question 14

If mom’s blood type is AB+ and Baby is AB-, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 14

*No ABO concern; no Rh concern

Question 15

If mom’s blood type is 0- and Baby is AB-, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 15

*ABO concern; no Rh concern

Question 16

If mom’s blood type is B- and Baby is A+, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 16

*No ABO concern; Rh concern (RhoGAM needed)

Question 17

If mom’s blood type is A- and Baby is B-, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 17

*No ABO concern; no Rh concern

Question 18

If mom’s blood type is 0+ and Baby is A+, is there an ABO concern or Rh concern? Do they need RhoGAM?

Answer 18

*ABO concern; no Rh concern