ACNM Review Session Flashcards
Pyrosis is caused by
Reflux of the acidic secretions into lower esophagus
a function of progesterone in pregnancy is to
suppress maternal immunologic response to fetal antigens
the softness and compressibility of the uterine isthmus is called
Heagar’s sign
the disproportion of erythrocytes to plasma results in which type of anemia
physiologic anemia
the end of the eight postferilization week also marks the end of which period
embryonic period
oxygenated blood enters the placental intervillous space by way of the
spiral arteries
this pelvis type has an inlet which is characteristically oval with an AP diameter much larger then the transverse diameter
anthropoid
Naegele’s rule is calculated by
first day of LMP minus 3 months,plus 7 days
CVS testing screens for all the following EXCEPT
neutral tube defects
women who do a lot of gardening are at an increased risk for
toxoplasmosis
Auscultation with a fetoscope should be possible at which gestion
18-20 weeks
exercise in pregnancy may help to prevent/treat which condition
gestational diabetes
when is the fetus seen as a separate object it’s own identity
third trimester
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
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
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
what best describes growth of the uterus in the 2nd half of pregnancy
hypertrophy results in increased oxygen receptors and expression of those receptors
which medications will relax the uterus
calcium channel blockers, beta agonists, magnesium suflate
terutaline
is contraindicated beyond 48-72 hours of use for treatment of PTL
what is true concerning induction of labor
safety issues are a concern with elective induction prior to 39 completed weeks
what hormone initiates labor
prostaglandins
what may prevent a successful IOL for jennifer
nulliparity and unfavorable cervix
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
what is the appropriate treatment regimen
start vancomycin 1 g IV q 12 hours until delivery
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
