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theresa maurer Flashcards

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1
Q

habitual abortion

A

spontaneous abortion that has terminated the course of 3 or more consecutive pregnancies

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2
Q

first trimester bleeding and pain

A

ectopic pregnancy should always be suspected

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3
Q

Threatened abortion
s/s
Rx
diagnosis

A

bleeding in first half pregnancy
fresh or old brown blood
may or may not having cramping and low backache
Rx: pelvic rest, bed rest, no sex, notify midwife if there is fever, a gush, increased bleed or increase low back pain.
Rx: heavy bleeding/febrile, no bleeding but ctx and abnormal ultrasound-immediate physician eval
slight bleeding and no other abnormal findings, reiterate Rx regular RTC
gentle spec exam, screen vaginitis cervicitis
gentle bimanual exam, uterine size, effacement, dilation, membrane status

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4
Q

febrile

A

signs of fever

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5
Q

inevitable abortion
s/s

eval

treatment

follow up

A

combo of bleeding ctx, ROM, dilation
assess gestational age, amount bleeding, ab pain, emotional status, previous or stat hematocrit, dilation, vital signs
choices: if bleeding is not excessive, pain not excessive and emotional status good, hematocrit 30%
1. go to physician for induced abortion D&C
2. go home await spontaneous abortion
take temp every 4 hours
call midwife if a pad is soaked in less than 1 hr
clots larger than 2.5 cm
fever of 100 +
when aborted call midwife
followup: counsel, support, sex 2-4weeks, genetic counseling.

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6
Q

incomplete abortion

A

placenta is not expelled with fetus
can cause bleeding or infection
D&C

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7
Q 
missed abortion
s/s
diagnosis
plan
follow up
A

vag spotting bleeding, low ab back pain
fundal height ceases to increase, uterus decreases
regressed mammary changes
loses weight
persistent amenorrhea
no fetal heart tones
diagnosis: ultrasound
severe coagulation problems may occur from carrying non viable fetus
order coagulation serums, prothrombin,fibronogen, platelets, partial prothrombin, endocrinologic workup, uterine abnormalities screen
followup: counsel, support, sex 2-4weeks, genetic counseling.

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8
Q

incompetent cervix
s/s
predisposed

A

rare in primigravidas
evidence in 2nd trimester
painless dilation, ROM, expulsion of fetus, vag discharge free from infection s/s (itching, odor etc)
previous fetal loss, cervical surgery

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9
Q

cerclage

reason for

follow up

A

Classic shirodkar-permanent suture stays until birth, csection delivery
Modified Shirodkar- purse string suture each pregnancy removed at delivery
Mcdonalds- purse string suture each pregnancy removed at delivery

can be done if cervix is 4 cm
vaginal exam every 2 weeks
counseling
client to report any s/s of bleeding, ROM, foul odor, fever.

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10
Q

suspicious history of incompetent cervix- assesment

A

History- s/s previous loss, infections in relation, discharge etc.
gestational age, genetic abnormalities, previous suction abortios, cervical traumas
Pelvic ex- consis, length, dilation (internal, ext) membranes, position station present part

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11
Q

history of cervical trauma without fetal loss

plan

A

vaginal exam every two weeks starting at 2nd trimester until fetal viability or

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12
Q

history of fetal loss but no current signs of cervical incompetence

A

vaginal exams every 1-2 weeks starting in 2nd trimester until viability or dilation

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13
Q

cerclage is removed in these cases

A

infection, suture not intact, or laceration cervix
after ROM, impending labor or 38 weeks, labor start
all unless it is a Classic Shirodkar suture

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14
Q

hydadtiform mole

complete/partial

A

chorionic villi are clear vessels with pedicles hanging like grapes, mass of cyst clear vesicles
complete- all vesicles
partial- vesicles with non viable fetus and sac
some are benign with potential to be malignant & proceed choriocarcinoma

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15
Q

benign

A

not harmful

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16
Q

malignant

A

infectious volatile

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17
Q

hydadtiform mole
likelyhood
s/s

A

10 times higher in women over 45 years
persistent nausea and vomiting, uterine bleeding evident at 12 weeks, brown blood, intermittent, anemia, large for dates baby, shortness of breath, tender ovaries, not fht, parts or palpation.
PIH, preeclampsia, eclampsia, before 24 weeks!
very high Hcg levels

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18
Q

ectopic pregnancy
predisposed
types
diagnosis

A

pelvic infections, IUD, precious ectopic & tubal preg

types: cervical, tubal, ovarian, abdominal
order quantitative Hcg & ultrasound

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19
Q

cervical ectopic pregnancy

s/s

A

rare,not lasting after 20 wks
painless bleeding at implantation
cervical mass, distention, thinning of cervical wal, dilation of ex os, enlarged fundus

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20
Q

tubal ectopic pregnancy
s/s

differential diagnosis

labs

A

most common 95% or more cases
classic case of tubal cases knowing or unknowing suspected pregnancy but spotting has substituted menses.
s/s sharp stabbing pain, tearing, low ab pain
hypotension, shock, tenderness, painful exam, tender boggy mass to one side of uterus

pain in the neck or shoulder* especially inhaling
displaced uterus
low Hcg or neg pregnancy tests

differential: salpingitis, threatened/inc abortion, twisted ovarian cyst, ruptured corpus luteum follicular cyst

CBC with differential and quantitative beta Hcg
ultrasound

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21
Q

abdominal ectopic pregnancy

s/s

A

s/s sharp stabbing pain, tearing, low ab pain
hypotension, shock, tenderness, painful exam, tender boggy mass to one side of uterus, displaced uterus

pain in the neck or shoulder* especially inhaling
gastrointestinal upset, transverse lie, painful fetal movement, very audible heart tones, small parts outside of uterus, cervical displace, dilation no effacement.

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22
Q

hyperemesis gravidarum
s/s
plan

A

s/s: excessive nausea and vomiting, extends past 1st trimester, poor appetite and intake, weight loss, dehydration,electrolyte imbalance, extreme response to psycho social events, acidosis (starvation), alkalosis (no hydrochloric acid), hypokolemia(low potassium)
labs: BUN and electrolytes
urine dipstick for acetone and glucose
blood gases, serum pH,
spilling glucose and acetone- immediate eval, glucose to assess for diabetes
dehydration IV fluids
continues after IV fluids admit to hospital

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23
Q 
Tuberculosis mycobacterium
s/s
history
labs
treatment
A

initial lesion develops on lung, exudate inflammed, necrosis of lung tissue-airborne droplets
s/s- fever, night sweats, weight loss, persistent colds and cough, chronic cough with yellow green mucous
pleurisy(chest pain, inflammation) rales

previously infected, exposure to, history, environmental, poverty, drug use, socioeconomic

Mantoux test, PPD test, not if active infection!
chest xray and sputum test
BCG vaccine can cause positive test- xrays everty 2 years. scar on arm from vaxx

treatment: INH (isoniazid chemotherapy) for women under age 35 during pregnancy with positive PPD neg xray and post PPD and post xray. If not in pregnancy then after pregnancy, treatment continued if pregnancy occurs mid treatment.
reportable disease.

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24
Q

A Sickle Cell screen should be offered to which group of clients?

A

african descent

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25
``` cultures prone to certain disease african mediterranean french canadian jewish ```
Sickle cell anemia is found primarily in 1/375 birth of African-Americans. Thalasemia is predominantly found in those of Mediterranean descent; TaySachs disease is found in those of French Canadian descent Ashkenazi Jewish descent.
26
hepatitis most common in US rare forms
``` inflammation of the liver via an infection hep A and hep B hep D is secondary to B -mediterranean D & E rare- Asia, south america reportable diseases ```
27
``` Hep A (infectious hepatitis) route of transmission ``` s/s
most common worldwide- impoverished pop, poor hygienic fecal oral route is transmission - contaminated food and water s/s- flu, fatigue, malaise, weak, nausea, low fever, upper right pain, rapid onset, 10-15 days acute to resolve 2 months no risks to newborn,no transmission vaccine for at risk or close contact ISG (immune serum globin) routine screen
28
``` Hep B (serum hepatitis) route of transmission s/s transmission treatment labs ```
transmission through blood, blood products, needles , saliva, vag secretions, semen. 1-6 months incubation may lead to chronic carrier, active hep, liver disease, cirrhosis. s/s rash fever, fatigue, weak, nausea, vomit, low fever, upper right pain, tender enlarged liver, headache vertical transmission to the baby is common, any route of delivery, postnatal close contact infects all body fluids but breast milk!!! breastfeeding contraindicated if cracked sore nipples 90% change of transmission, 90% become carriers, transmitted to offspring, 25% die of cirrhosis, liver carcinoma babies receive hep b vax at birth within 1 hour 90-95% protection, hep b vax is given to mothers who havent been vaxxed prior IgM- active antibody IgG- antigen routine screen
29
Hepatitis C
40-50% of hep cases in US low incidence of vertical transmission to baby blood test positive for hepc antibody
30
rubella (German measles) risks to newborn s/s labs treatment
1st trimester infection- 20% chance of congenital malformations 1st month- 50% malformations glaucoma, cardiac defects, deafness, brain and deafness, SA, eyes, heart, brain CNS s/s low fever, drowsy, sore throat, rash, spreads rapid, swollen glands, lasts 3-5 days routine screen- rubella titres 1:10 or above immunity below 1:10- lack of immunity offer vaxx POSTPARTUM 1:64 or higher ACTIVE infection- consult -series of titers consult live vaxx not in pregnancy! 1st trimester- option to abort avoid pregnancy 3 months after vax
31
cytomegalovirus s/s transmission
common viral infection-various strains most asymptomatic: fever sore throat, swollen glands, fatigue transmission is effective in fetal period (10-40 weeks) not seen until birth risks: microcephaly, hydrocephaly, small eyes, seizures, blindness, encephalitis. IUGR, oligiohydraminos no vaxx and no treatment test babies saliva, urine, blood high concentrations
32
toxoplasmosis s/s transmission testing
parasitic protozoa, infected meats, raw or undercooked, cat feces, soil. raw milk s/s fatigue, malaise, muscle pain, swollen lymph death, preterm, CNS, anecephalus, hyrdocephalus, eye and brain defects. hydrops the earlier the infection the more severe disease. 1st and 2nd trimester most transmission. 3rd transmission always congenital anomalies preconception, skin test 48-72 hrs ELISA lab, high titers recent infection, rising titers current infection, low titers immunity IgG antibodies from previous infection protects baby consult with virologist, routine screen Spiraymicin cordocentesis can check baby for infection
33
varicella (herpes zoster=shingles) s/s risks treatment
highly contagious viral infection form of HSV 25-40% of babies have congenital varicella syndrome infection in 1st 20 weeks of pregnancy greatest risk incubation 10-21 days contagious 2 days before lesions and 7-10 days after lesions are crusted fever chills, malaise, lesions head neck to trunk, pneumonia, chest pain, cough, fever risks: cataracts, chorioretinitis, limb hypoplasia, dydronepherosis, micorcephaly, maternal pneumonia 40% maternal death varicella contracted at the very end of pregnancy , no antibodies, 5% babies die treatment VZIG- exposed first 20 weeks and 6 days before delivery 2 days after delivery routine testing serological for antibodies, vax prior to pregnancy no conception atleast 3 months!
34
why are pregnant women more susceptible to UTI
normal hydronephrosis may cause urine stasis
35
preventing UTI
drink 8 glasses of water, empty bladder, cranberry, good hygeine
36
presence of bacteria significant in clean catch
50,000 bacteria of same species per mililitre
37
100,000 of nonpatho, or 100,000 mixed
contaminated specimen
38
bacteria reported in urinalysis
coliforms, e coli, enterococci, klebsiella.
39
s/s of UTI risks treatment
urinary frequency, dysuria, pain, suprapubic pain preterm labor and birth, low birth weight, pyelonephritis, inflamed kidneys amoxicillin, ampicillin repeat culture 2 weeks, if doesn't work 2nd round of diff antibiotics, suppressive therapy if doesn't work
40
recurring UTI factors
diabetes, sickle cell trait, history of UTI
41
cystitis s/s labs
inflammation of the bladder, bacterial infection s/s urgency, frequency, dysuria, low ab pain, hematuria culture- nitrates, high WBC, high bact, rbc in urine, blood in urine treatment same
42
``` acute pyelonephritis cause s/s risks treatment ```
inflammation of both kidneys, bacterial 2% freq in pregnant women compression of ureters by uterus dilation and decreased tone of ureters from progesterone urine stasis- decreased bladder tone, urine stasis s/s fever, chills, hematuria,nause vomit, hx of UTI, frequency CVA tenderness (right side kidney), low abpain risks- septic shock, respiratory distress, anemai, pretern labor/delivery treatment: refer to physician IV therapy, electrolytes, IV antibiotics.suppression therapy
43
why is hemoglobin lowered in pregnancy
hemodilution results in blood expansion and increase in plasma but not rbc's, ration of rbc's to plasma is disproportionate.
44
why does a women need increased iron in pregnancy
because of the increase in rbc's
45
factors that effect hemoglobin
race, sex, elevation, smoking meds, Africans have a hemoglobin 1 gdl higher women who smoke or live higher altitudes have a higher low
46
anemia levels and definition
decrease in # of rbc or decrease in the concentration less than 12 in nonpregnant less than 10 in pregnant
47
s/s of anemia
fatigue, dizzy, malaise, headache, sore tongue, skin pallor, hx of heavy menses, close pregnancies, pale nails, hx anemia, nause vomit no appetite, PICA
48
initial lab test of rbc size
microcytic-decreased rbc size, iron deficient, thallasemia, lead disease normocytic- blood loss, sicke cell, G6PD, med side effects macrocytic-vitamin B 12 deficient, folic acid deficient
49
high iron foods
green leafy veggies, liver, egg yolk, raisins, fortified
50
treatment anemia | true anemia= hypochromic*
start on iron, folic acid and vita C supplements
51
hemoglobin below 9 after supplementing
hx, reeval, do labs, consult | CBC, reticulocyte count, serum iron, serum ferritin, TIBS (binding), platelet count, hemog electrophoresis
52
MCV levels
high Mean Corpuscular Value = folate, b12 deficient | low MCV= iron deficiency
53
hemoglobin electrophoresis
``` AA = normal AS= sickle cell trait carrier SS= sickle cell disease (genetic disorder) africans ```
54
women with sickle cell trait have higher incidence of these conditions
asymptomatic bacteriuria, pyelonephritis close monitoring is needed
55
G6PD
x linked genetic disease affects enzyme G6PD, associated with rbc's prevalent in Mediterranean, African americans
56
hemolysis
destruction of rbc
57
treatment of G6PD clients
obtain status if not sure avoid fava beans, sulfa drugs, oxidant drugs, surgeries, diagnose any and treat infections prompt such as UTI to reduce hemolysis risk notify physician immediately in case of csection
58
normal pregnancy increase cardiac output by %? | when does increase occur?
40% | occurs early pregancy peaks at 20 weeks to 24 weeks
59
cardiac output increases, when, %?
during pregnancy and during birth 50% during contractions, highest immediate postpartum
60
heart disease/congestive failure | s/s
persistent rales in lungs, decreased physical activity, dysnpea, cyanosis, edema lower extremities pregnancy can progress disease rheumatic fever, heart failure, heart murmurs, dysrythmia, cardia enlargement, clubbed hands
61
treatment and s/s of heart disease
collaborative care, iron folic acid, close monitor 20-24 weeks, counseling
62
normal blood pressure in pregnancy rise and falls | how to take
drop in second trimester, rise in third trimester sitting up with arm at heart level at rest, no crossed legs left side supine,
63
hypotension pressure
90/60 mm Hg indicate low blood pressure, or hypotension
64
hypertension
140/90 mm Hg in pregnancy indicate high blood pressure, or hypertension
65
asthma
1 in 4 pregnant women risks: perinatal mortality, hyperemisis gravidarum, preterm, chronic hypertension, preeclampsia, hemorrhage, low birth weight
66
OTC drugs that induce asthma attacks
aspirin and ibuprofen aleve,
67
medications contraindicated in pregnant women with asthma
demoral, morphine and hembate
68
type 1 diabetes
true insulin dependent | occurs before age 40
69
type 2
occurs after age 40 | obesity can be controlled with diet, exercise, oral hypoglycemic agents
70
gestational diabetes s/s risks
abnormal carbohydrate metabolism glucose monitor, diet exercise diabetes mellitus cannot be diagnosed until postpartum routine screen all women at 28 weeks s/s polyuria, polydipsia (excessive thirst), weight loss, poor healing, polyhydraminos shoulder dystocia, macrosomia, hypoglycemia, respiratory distress
71
screen for women with history of diabetes, previous large baby, recurring candida, glycosuria
initial screen, 28 weeks, 34-36 weeks
72
secondary risk factors to diabetes
preeclampsia, polyhydraminos, large for dates babies | screen at first signs and again at 34-36 weeks
73
most efficacious diabetic screening
fasting blood sugar, 1 - 2hr postglucose challenge
74
glucose challenge test
dont eat since midnight before test. drink entire glucose(100 g glucose) mixture and draw blood at 1 or 2 hr mark
75
abnormal testing values for glucose challenge and fasting plasma, GTT
fasting plasma of > 105mg per 100 ml 1 -hr 50g glucose challenge of >135 mg 2-hr 75g glucose challenge of > 120 mg
76
does a woman with known or obivous diabetic get a GTT
no
77
3-hr 100g GTT diagnostic for diabetes if
fasting 90mg 1 hr 165mg 2 hr 145 mg 3 hr 125 mg
78
normal fast blood sugar, abnormal 1-2 hr, and abnormal GTT is gestational diabetic T or F
true
79
values for plasma are 15% higher then whole blood values in glucose testing T or F
true
80
any post and neg combo of fasting and 1 /2hr do GTT | T or F?
tue
81
dietary guidelines for diabetes
30 calories per kg, 50% carb, 20 protein, 30 fat
82
mulitple gestation | s/s
large for dates, rapid growth in 2nd trimester, palpation of multiple small parts, more then one fetal heart tone
83
antepartum management of multips
early signs of preterm labor, s/s preeclampsia monitor fetal growth, nutrition calories and protein added for each baby, weekly appointments for weight gain, fetal growth and preeclampsia, weekly from 34 weeks for cervical changes
84
rh - mom and rh- dad =
negative baby no worries
85
rh - mom | labs
screened initial ABO blood type if Rh- then: 28 weeks & 36 weeks for titers below 1:16 rhogam is offered prophylactic at 28 weeks is last about 12 weeks. a positive titer from rhogam should be no higher then 1:4 If mom is sensitized with postive Coombs check titers at 26 to 28 weeks, 32-36 weeks, and 38 weeks indirect Coombs test if antibodies are present a titer is obtained and a
86
reasons for giving Rhogam to Rh- neg mother
uterine bleeding, trauma, hemorrhage, invasive procedures, SA, miscarriage, ectopic pregnancy, transfusion, postpartum in 72 hrs, prophylactic at 28 weeks Rh- is the most sensitizing antibody! NO rhogam if antibodies present and mother sensitized
87
HDFN
hemolytic disease of the fetus newborn
88
% of mothers sensitized in first pregnancy
13% of rh- mothers will be sensitized in first pregnancy
89
risk of having a subsequently affected baby if not receiving Rhogam in previous postpartum?
90-100% risk of affecting next baby
90
kernicterus
brain damage from extreme jaundice, sensitization, bilirubin fills the brain
91
hydrops fetalis
extreme hemolysis form of Rh incompatibility, shifted edema
92
how do antibodies attack baby in Rh- incompatibility
IgG antibodies cross the placenta and attack the baby
93
Rhogam class C category
thimerosal= toxic mercury based 50-300ug given deep Im- side of muscle atlease 72 hours before antibodies can be produced
94
labs for baby of rh- mother
blood typing from cord bilirubin test hemoglobin and cbc
95
hydraminos predisposed factors risks plan/labs
factors : multip, diabetes, erythroblastosis, fetal malform risks: cord prolapse, hemorrhage! fetal malpresentation abruptio placenta uterine dysfunction s/s: uterine enlarged, tense uterine wall, hard to get fht, uterine fluid thrill, dyspnea, vulvar edema, pressur pains, nausea vomit, frequent change in baby lie plan: screen diabetes, screen ABO/Rh disease ultrasound consult physician
96
``` oligohydraminos predisposed s/s risks plan ```
congenital anomalies, IUGR, PROM, postmature syndrome s/s- molding contour of fetus, not ballotable, lagging fundal height. risks: variable decels, less fluid for cord cushion, poor tolerance for labor, cord compression, plan: hydration, bed rest, nutrition, ultrasound, AFI check, NST's, kick counts, fetal monitor
97
Amniotic fluid production in pregnancy
increases in preg until it reaches about 1000 ml by third trimester, gradually decreases around 34 weeks to about 800 ml
98
signs of fetal demise | risks
ceased: fht, uterine growth, movement, retrogressed breast changes, fetal skull collapse with exam, Spaldings sign- excessive overlap of bones exaggerated curvature of spine Birth 2/3 weeks of demise risks: deseminated intravascular coagulation DIC, test prothrombin, platelet and fibrogen. drop in platelets fibro consult, incrase in prothrombin consult induce labor. encouraged to view, touch and hold infant dont try to diagnose death, most have no cause even after autopsy
99
hypertensive disorders of pregnancy
``` preeclampsia eclampsia chronic hypertensive PIH proteinuria, edema ```
100
hypertension
140/90 or higher! or 30 rise in top, 15 rise on bottom from base
101
MAP
= D x 2 + S _________ 3 2 readings 6 hours apart
102
proteinuria
more than .3 g in 24 hr spec/ 1-2+ on stick | 2 or more occasions when 6 hours apart
103
edema
sudden weight gain, unquestionable in hands and feet
104
hypotension | predisposed factors
hydadtiform mole trophoblastic disease, multips, chronic hypertensive vascular disease (20%), chronic renal disease, diabetes, fetal hydrops, age 35+, previous hx of preeclampsia
105
preeclampsia s/s labs Rx
headaches, blurred vision, upper edema, proteinuria increased weight and BP labs: hemoglobin & hematocrit, platelet, liver function, kidney profile(BUN), urine protein, coagulation profile leaning towards: bed rest, 2 hr in am and pm on left sideprotein, high protein high calorie before 36 weeks ultrasound for IUGR, introuterineplacental insufficiency NST, fetal kick count, liver & kidney function tests
106
progressive severe eclampsia
hyperflexia, headaches, visual disturbances, epigastric pain, oliguria, elevating BP, 160/100 severe, increasing proteinuria 3+ 4+
107
HELLP
may develop from preeclampsia, | hemolysis, elevated liver enzymes, low platelets,
108
eclampsia
when preeclampsia progresses to convulsions most common prior to delivery can happy 10 days postpartum magnesium sulfate to prevent future seizure
109
placenta previa | predisposed
more common in women: multiparity, 35+, multip, large placenta ( erythroblastosis), previous c section, smoking hx of IUD
110
signs of placenta previa
PAINLESS bleeding sudden onset ultrasound repeat for vag bleeding 5-10% also have placenta accreta
111
complete placenta previa
hospitalization with labs: Rh, indirect Coombs, platelets, DIC. NST, fetal kick risk of hemorrhage, fetal distress, maternal distress
112
marginal and partial previa delivery
can be vaginally , presenting part is like tampon
113
placenta accreta
2 or more cesections
114
abruptio placenta | predisposing factors
hypertension, preeclampsia, folic acid deficient, ab trauma, short cord, malnutrition, sudden uterine decrease, ROM in polyhydraminos, difficult external version, cocaine usage
115
abruptio placenta | s/s
painful LOCALIZED tenderness, hypertonic boardlike uterus, decreased fetal movements, fetal distress, uterine enlargement, maternal shock. back pain, colicky uterus,
116
abruption placenta management
period of observation and obtain findings management is delivery, vaginal if no distress. emergent csection and immediate transfer start IV, trendelburg position, vital signs, heart tones, oxygen, warm blankets
117
trendelburg postion
supine with feet at 15-30 degree elevation
118
size dates discrepancy definition
woman is sure of her dates and LMP, EDD is determined an uterus is smaller or larger for dates ultrasound and complete intake
119
common reasons for size date descrp
3rd trimester- large baby inaccurate dates 1st 2nd trimester- anomalies, disease, infection. small
120
differential diagnosis of size dates discrepancy
multip, IUGR, diabetes, thyroid (smaller), malnutrition, polyhydraminos, oligohydraminos, fetal lie, anomalies, station, hypertension preeclampsia, psychosocial, infections, drugs. placenta previa( larger longitudinal, smaller for tranverse, myomata (larger)
121
myomata
fibroids
122
IUG, SGA
intrauterine growth restriction small for gestational age most SGA is because of IUGR SGA can also be malnutrion, or genetically predisposed smaller babies
123
symetrical
compromised growth of body length head and weight
124
assymetrical
compromised growth of body length and weight but head is normal
125
IUGR risk factors
preeclampsia renal disease, poor nutrition, poor weight gain,infection,amomalies, multip, previous IUGR, drug use, pre-pregancy less then 90 lbs, anemia, diabetes, alcohol, hypoglycemia,
126
postmaturity syndrome
post dates plus oligiohydraminos, mec stained fluid, Newborn with: lost of subcutaneous fat, long fingernails, peeling wrinkled skin, alert facies, no lanugo, no vernix

NARM Antepartal complications (1 decks)

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