CNM Purple Big Book: Pregnancy

Question 1

Indomethacin for polyhydramnios

Answer 1

Impairs production of lung liquid, increases fluid movement through fetal membranes or decreases fetal urine production

Question 2

etiology of polyhodramnios

Answer 2

CNS or GI tract anomalies (anencephaly, atresia)

Question 3

probable signs of pregnancy

Answer 3

Enlargement of abdomen
Enlargement of uterus
Palpation of fetal outline
Ballottement
change in the shape of the uterus
Piskacek's sign
Hegar's sign
Goodell's sign
Palpation of Braxton Hicks
\+pregnancy test

Question 4

Accuracy of USG by trimester

Answer 4

3-5 days in first trimester
7-10 days in second trimester
14-21 days in third trimester

Question 5

why can pregnancy be considered a hypercoagulable state?

Answer 5

Because fibrinogen (Factor I) and Factors VII-X increase during pregnancy

Question 6

diagonal conjugate

Answer 6

should be more than 11.5

Question 7

interspinous diameter

Answer 7

distance between ischial spines, normally 10 cm; is midplane

Question 8

intertuberous diameter

Answer 8

11 cm

Question 9

Morning sickness rx

Answer 9

Pyridoxine (vit B6): 25 mg PO BID or TID
Doxylamine 12.5 mg PO BID or QID w B6
Metoclopramide 5-10 mg PO q6-8 hr
Promethazine 25 mg q4h per rectal suppository

Question 10

indications for NST

Answer 10

decreased fetal movement
postdates
DM, HTN, IUGR

Question 11

Contraction Stress Test

Answer 11

acceptable: 3 ctxn lasting 40-60 sec & palpable
Results: Negative: no late or variable decels (good)
Equivocal/suspictious: non-repetitive or nonnpersistect decels, or long-term variability is absent
Positive: persistent late decels with 50%+ of ctxns

Question 12

c/i to CST

Answer 12

Absolute: previous classical c/s or myomectomy, placenta previa, at risk for preterm labor
Relative: GA <37 wks, multiple gestation

Question 13

BPP scoring

Answer 13

Breathing movement (1/+ episodes in 30 min)
Body movement (3/+ episodes in 30 min)
Tone (1/+ extension/flexion in 30 min)
Qualitative AFV: at lest one pocket of fluid at least 2 cm in 2 perpendicular planes
Reactivity (reactive NST)
8-10 is normal if absence of oligo
6 is equivocal; repeat testing
4 or less considered abnormal

Question 14

L/S ratio for lung maturity

Answer 14

ratio of 2:1 or greater is indicative of fetal lung maturity except in diabetes

Question 15

phosphatidylglyceral (PG)

Answer 15

appears after 35 wks when lungs are mature; along with favorable L/S ratio, confirms lung maturity;
If PG present even with L/S ratio <2, risk of RDS is minimal

Question 16

Shake test

Answer 16

Amniotic fluid shaken in tube with saline and 95% ethanol for 15 sec. complete ring of bubbles on surface = fetal lung maturity
Low false positive rate
High false negative rate

Question 17

Sensitized pregnancy: Rh neg mother with posiitve antibody titer

Answer 17

> 1:4

Question 18

Tx of residual iron depletion after blood loss (Hbg 7 or higher)

Answer 18

oral iron x 3 months as long as woman is afebrile and able to ambulate