ACNM Review Session Flashcards by Betsy McCanse

Pyrosis is caused by

Reflux of the acidic secretions into lower esophagus

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a function of progesterone in pregnancy is to

suppress maternal immunologic response to fetal antigens

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the softness and compressibility of the uterine isthmus is called

Heagar’s sign

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the disproportion of erythrocytes to plasma results in which type of anemia

physiologic anemia

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the end of the eight postferilization week also marks the end of which period

embryonic period

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oxygenated blood enters the placental intervillous space by way of the

spiral arteries

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this pelvis type has an inlet which is characteristically oval with an AP diameter much larger then the transverse diameter

anthropoid

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Naegele’s rule is calculated by

first day of LMP minus 3 months,plus 7 days

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CVS testing screens for all the following EXCEPT

neutral tube defects

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women who do a lot of gardening are at an increased risk for

toxoplasmosis

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Auscultation with a fetoscope should be possible at which gestion

18-20 weeks

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exercise in pregnancy may help to prevent/treat which condition

gestational diabetes

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when is the fetus seen as a separate object it’s own identity

third trimester

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a 25 yo G2P0101 at 8 weeks gestation reports her first baby was born at 33 weeks after going into spontaneous labor. what should she be offered

progesterone injections

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a 36 yo at 36 weeks gestation reports having young some moderate bright red vaginal bleeding. Which is the best method to asses the bleeding

sterile speculum exam to evaluate at cervical os

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a 33 yo G2P1001 at 34 weeks gestation is at her routine prenatal visit. her internal history to date has been bening. today her fundal height is measuring 31 cm. which is the best action at this visit

order an an abdominal ultrasound

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what best describes growth of the uterus in the 2nd half of pregnancy

hypertrophy results in increased oxygen receptors and expression of those receptors

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which medications will relax the uterus

calcium channel blockers, beta agonists, magnesium suflate

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terutaline

is contraindicated beyond 48-72 hours of use for treatment of PTL

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what is true concerning induction of labor

safety issues are a concern with elective induction prior to 39 completed weeks

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what hormone initiates labor

prostaglandins

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what may prevent a successful IOL for jennifer

nulliparity and unfavorable cervix

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what is your treatment approach for GBS in this situation

obtain a GBS culture. start antibiotics. if the culture is negative, you may discontinue antibiotic prophylaxis

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what is the appropriate treatment regimen

start vancomycin 1 g IV q 12 hours until delivery

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engagement in cephalic presentation

involves the widest portion of the presenting part

what is the result of flexion

the presenting diameter changes from occipitofrontal to sboccipiotbregmatic

how would you appropriately monitor this patient

intermittent auscultation is acceptable

how frequently and when will you auscultation Cindy's FHR

Q 15-30 minutes, before and after interventions

what is true about electronic teal monitoring (EFM) and FHR patterns in a low-risk labor

reassuring FHR patterns indicate normal fetal acid-base balance

how would you classify the FHR

category ll

what management is needed for category ll

continued monitoring and further assesment

what describes a normal LOA position

longitudinal lie, attitude = flexed, denominator = occipit

in the same position (LOA), where is the ceohalic prominence

on the opposite side of the back

in the same position as (LOA), where is the cephalic prominence

on the same side of the back

how will you asses or diagnose he r progress

according to the friedman curve, this is a 1st stage protraction disorter

the patient is 9/100/+1 and you palpate the posterior fontanelle roughly in the 2:00 position. you cannot palpate the anterior fontanelle

the head is in LOA

Jeanine, a 41 y.o. G5 P4004 at 39.4 weeks is in active labor. BP upon admission was 120/70 and is consistent with her prenatal course. The nurse is concerned about her current readings: 130/75, 134/74. What do you tell the nurse?

A slight elevation is normal, especially duing contractions. Let's make sure she's as comfortable as possible.

What other changes in vital signs will you anticipate wit ha normal course of labor?

Slight elevation of pulse, temp and respiratory rate.

In LOA, during internal rotation:

the occiput rotates right toward the midline, the sagittal suture from the oblique to the AP diameter

Internal rotation

May be delayed with epidural anesthesia, fetopelvic disproportion, rigid perineum or maternal exhaustion

concerning uterine rupture:

Risk increases with use of pitocin FHR abnormalitites are a positive sign Risk increases with prior uterine surgery

what's the most common sign of uterine rupture?

fetal distress

considered a later maneuver in management for shoulder dystocia

Wood's Screw, Rubin

If effective, McRobert's maneuver:

flattens out sacrum and rotates symphysis pubis superiorly

Associated factors for shoulder dystocia

Large baby Length of 2nd stage Post-dates induction

What might be done to predict and prevent SD?

highly unpredictable and unpreventable

Most common cause of postpartum hemorrhage

uterine atony

Contributes to uterine atony

Myometrium Smooth muscle uterine fibers

Lidocaine is effective...

peaks at 5 minutes | duration 30 min- 2hr

After infiltration of the perineum, which signs or symptom is most concerning and why?

Metallic taste in mouth & dizziness. | Hypotension - rapid systemic effects

what complication may be encountered if a placenta is deliverd by the Duncan mechanism

increased bleeding

Involutional changes

``` Uterus: immediately after delivery is between symphisis and umbilicus At 12 hours rises to umbilicus Decreases height by 1 cm/day 3 days pp = U/3 7 days pp = U/3-5 2 weeks pp = pelvic organ ```

placental eschar passage

10-14 days pp is NORMAL not a period will have small clots may last 2-3 days

process of involution takes place over which of the following pp time frames

first 6 weeks

endometrium regenerates in...

3 weeks

placental site regenerates in...

6 weeks

hematological changes: interstitial fluid

3-4 days mobilizes, increases plasma volume

H/H & plasma protein end of 2nd week pp

decreased. | Normal by 6-8 weeks pp WITH or WITHOUT iron supplementation (unless already low and taking iron)

Hemodynamic changes during initial pp period include:

elevated cardiac output for up to 48 hours after birth BP is stable increase in WBC during first 72 hrs pp (then falls to 6-10K...normal by 6 days pp)

Hgb v blood loss

q 500 ml blood loss = 1 g reduction Hgb

Hgb first 24 hrs

slight decrease, plateaus for 4 days, slowly increases; normal by day 14

increased thromboembolism risk pp due to

changes in diameter and velocity of deep veins

Diuresis pp

most begins by days 2-5

systolic murmur

20% of all women will have persistent SM beyond 4 weeks pp

Pregnancy-associated proteinuria should be resolved by...

6 weeks | pre-e/eclampsia/HELLP

Pre-e pp

check pre-e labs daily postpartum to be sure stabilizing before d/c

fluid and electrolytes normal by...

21 days pp

temp pp

may have slight increase to 99.6 immediately pp; resolves spontaneously within 24 hours. May also elevate slightly with engorgement

Rubella <1:10 ratio

non-immune

infant with negative coombs/direct autoagglutination test

administer Rhogam

300 mg Rhogam covers...

30 ml fetal cells in maternal system

ex: 150 Kleinhauer -Betke from auto accident + major bleed= how many doses Rhogam?

5 doses at 300 mg each

how many women will have some fetal-maternal transplacental exchange of blood during pregnancy or at delivery?

75%

timing of Rhogam at end of pregnancy

does not have to be given pp if given within 3 weeks prior to delivery

rubella vaccine contraindicated if..

mom allergic to neomycin

reliable contraception for how long after administering Rubella vax?

1 month

pp hemorrhage

blood loss in excess of 500 ml or more after the 3rd stage of labor

risk factors for pp hemorrhage

hx of pp hemorrhage overdistention prolonged, induced or augmented labor uterine or placental abnormalities (previa, fibroids)

early pp hemorrhage

>500 ml in 1st 24 hrs, or a 10% drop in Hct from admission

Late pp hemorrhage

>500 ml between 1st 24 hrs and 6 wks pp

reasons for late pp hemorrhage

lacerations, infection, placental fragments | Most often occurs in 2nd week when placental eschar sloughs off

s/s late pp hemorrhage

persistent lochia, subinvolution, painless bright red bleeding

early pp hemorrhage rx tx

oxytocin 10 U/500 ml IV Methergine 0.2 mg IM (contraindicated with HTN, preeclampsia, eclampsia) Hemabate 250 mcg IM (C/I with PID, renal/cardiac/hepatic dz or asthma) Cytotec 800 mcg per rectum (not FDA approved)

Late pp hemorrhage rx tx

Methergine 0.2 mg PO q 4 hr x 24-48 hrs | may require abx if infxn is causative agent