CNM Varney's Review Book Part B Flashcards
Measurement of abdominal girth in a woman of average size is a helpful adjunct to fundal heaight in dx of what?
polyhydramnios
in a face presentation, which of the following will be the cephalic prominence that is palpable during the fourth leopold’s maneuver?
occiput
which is the cephalic prominence that is palpable during the fourth Leopold’s maneuver in well-flexed cephalic presentation
sinciput (front of skull from forehead to crown)
if you feel cephalic prominence on same side as fetal parts, is indicative of ?
vertex presentation
if both hands simultaneously encounter a hard mass that is equally prominent on both sides, indicates what?
sinciput/military presentation
pelvis is comprised of how many bones?
four (innominate x 2, sacrum, coccyx)
which diameter of pelvic inlet can be measured clinically?
diagonal conjugate
what is the plane of least dimensions?
midplane
minimal measurement of the angle of the pubic arch that determines adequacy of pelvic outlet
90 degrees
pelvimetry reveals:
inlet: oval with forepelvis more narrow than posterior pelvis; A–P diameter much larger than transverse diameter
sacrum: flat, long and posteriorly inclined
sacrosciatic notch: wide
sidewalls: somewhat convergent
ischial spines: prominent but not encroaching
pubic arch: slightly narrow:
The book says anthropoid, but I swear it’s supposed to be android.
least common pelvic shape among women?
platypelloid
anthropoid pelvises are most associated with what labor problem?
posterior position of the fetus
what is the shortest A-P diameter of the pelvis?
obstetrical conjugate
woman at 39 wks GA, 5’3”, now weighs 138 lb. Prepregnancy 115 lb. How do you categorize total pregnancy weight gain?
insufficient
weight gain advised with BMI <18.5
28-40 lb
2.2-6.6 lbs first trimester
1 lb/wk in second & third trimesters
weight gain advised BMI 18.6-24.9
25-35 lb
2.2-6.6 lb first trimester
1 lb/wk in second & third trimesters
weight gain advised BMI 25-29.9
15-25 lb
- 2-6.6 lbs first trimester
- 6 lb/wk in second & third trimesters
weight gain advised BMI >30
11-20 lb
- 1-4.4 lb in first trimester
- 5 lb/wk in second and third trimesters
mitosis
form of nuclear division of cells which already have a set arrangement of chromosomes
meiosis
rearrangement of the sets of chromosomes before division
convert kg to lb
1 kg = 2.2 lb
which is the least likely to affect a newborn’s birth weight?
maternal parity, maternal prepreg weight, maternal height, GA
maternal height
head-sparing IUGR is most likely due to what?
uteroplacental insufficiency
what is the optimal birth weight range in grams?
3500-3999 gm
RDA for calories and protein for pregnant women?
2500 calories, 60 gm protein
RDA calcium during pregnancy?
1200 mg
appropriate amt of vit C supplementation during pregnancy?
250 mg
which is a source of complete protein?
tofu, green peas, peanut butter, lentils
tofu (cited by Livestrong.com)
lentils (when sprouted)
at what GA is it important to reevaluate a client’s nutrition to ensure adequat diet during the peak in cellular growth of the fetal brain?
28 weeks
The Higgins Intervention Methodology for determineng weight requirements uses what to determine calorie and protein intake?
ideal body weight and individual activity level
Using the Higgins Intervention Methodology, what is the daily caloric and protein additional allowance at 20 wks GA?
adding 500 calories and 25 g protein to the woman’s nonpregnant requirements
which of the following has the highest iron content?
beef liver, soy beans, spinach, roast beef
soy beans
which comprises the majority of dietary iron
nonheme iron
for which of the following in pregnancy is exercise an absolute contraindication?
hx of IUGR, multiple gestation, vitral valve prolapse, presence of infection/fever
presence of infxn/fever
What should be used as criteria to identify candidates for complete genetic evaluation?
age, personal and famiy hx, screening tests
what can affect the normative levels of alpha-fetoprotein?
age, weight, race
NOT parity
a triple screen test with a positive result of a serum level of AFP elevated above cutoff value of 2.5 multiples of the mean alert you to an increased risk of what?
spina bifida
what result on a triple screen would alert you to an inccreased possiblity of Down syndrome?
low maternal serum AFP, low estriol levels, high hCG levels
triple screen looks for what?
AFP (produced by fetus)
hCG (produced within placenta)
estriol (produced by fetus and placenta)
what do high levels of AFP signify in triple screen?
baby may have neural tube defect (spina bifida/anencephaly)
The most common reason for elevated AFP levels is inaccurate dating of pregnancy
Low levels of AFP, abnormal levels of hCG/estriol may indicate what?
baby may have Trisomy 21 (Down syndrome) or
Trisomy 18 (Edwards syndrome) or
other chromosomal abnormality
What is looked at in quad screen?
AFP (produced by fetus)
hCG (produced by placenta)
estriol (produced by fetal liver and placenta)
Inhibin A (produced by placenta)
When is Quad screen done?
between 15-20 weeks
second trimester
when is a nuchal translucency test done?
between 11-14 weeks (10-13?)
what is done in a first-trimester combined test/first trimester screen?
nuchal translucency test (u/s)
PAPP-A (blood test)
B-hCG (serum)
When is CVS done?
between 11-12 or up to 14 wks
When is amniocentesis done?
between 16-22 wks
First trimester screen looks for risk of what?
Down syndrome Trisomy 21, Trisomy 18
what is first trimester screen usually combined with?
nuchal translucency
when is first trimester screen done?
between 11-13 weeks
what is looked at in BPP?
fetal breathin fetal movement fetal tone (open/close hand) AFI plus NST
reactive NST
blood flow to fetus is adequate
nonreactive NST
requires additional testing to see if truly due to poor oxygenation or due to other things (baby sleeping, maternal medicines)
Turner’s syndrome
chromosomal condition that exclusively affects females. TS occurs when one of the two X chromosomes is missing or incomplete. (only monosomy compatible with life)
~1% of fetus with TS come to term (also read up to 33% liveborn)
~10% SAB due to TS
Dx of TS is by karyotyping
Maternal age does NOT affect risk of TS
s/s Turner syndrome
short stature broad chest with widely spaced nipples congenital lymphedema with swollen fingers and toes low hairline webbed posterior neck bone and cartilage abnormalitites cardiac defects ovarian dysgenesis (require HRT) narrow, high arched palate renal abnormalitites HTN conductive and sensorial hearing loss mild malformation or low set ears speech problems strabismus, amblyopia, ptosis obesity nonverbal, verbal-spatial processing learning disabilities
FHR Category I
110-160 bpm FHR variability moderate Lack of late or variable decels Early decels present or absent Accels present or absent
FHR Category II
Not predictive of fetal acid-base status (indeterminate)
Not enough evidence to place in Cat I or II
Required surveillance and reevaluation
Interpreted in the context of entire clinical situation
Bradycardia without absent baseline variability
Tachycardia
Minimal baseline variability
Absent baseline variability without recurrent decels
Marked baseline variability
Absence of accels after fetal stimulation
Recurrent variables with minimal/moderate baseline variability
Prolonged decels >2 min <10 min
Recurrent late decels with moderate variability
Variable decels with overshoots/shoulders
FHR Category III
Recurrent late decels
Recurrent variable decels
Bradycardia
Sinusoidal pattern
BPP 8/10 or 10/10
normal/reassuring
BPP 6/10
requires intervention
Reactive NST defined as 10x10 for what GA?
<32 wks GA
a reactive NST is reassuring, meaning what for how long?
It indicates a <1% chance of fetal death within 1 week of the reactive NST
Bishop score of 8 or more
likely to achieve successful induction or go into labor spontaneously
Bishop score 6
<6 usually indicate the need for cervical ripening
to reduce the risk of limb reduction defects related to CVS, the procedure should be performed after what GA?
after 10 wks GA
Which is NOT a test for fetal lung maturity?
lecithin/sphingomyelin ratios (L/S)
phsphatidylglycerol (PG) tests
optical density assessment of bilirubin in amniotic fluid
the “shake” and “tap” test
Optical density assessment is NOT for fetal lung maturity.
What can be done through cordocentesis?
fetal blood transfusions or to medicate the fetus
What things diminish maternal perception of fetal movement?
Polyhydramnios
Oligohydramnios
anterior placenta
(also activity, position, meds, obesity)
36 wk GA, uncomplicated preg presents with c/o decreased fetal movement. NST is reactive. What is appropriate regarding further NSTs?
There is no need for serial NSTs at this point
Pt calls day after reactive NST to say very decreased fetal movement. Repeat NST is NOT reactive. What is best management now?
Consult with physician
Schedule her for immediate BPP/AFV
What is a complete cessation of fetal movement associated with?
impending fetal death
Auscultated acceleration tests have been propposed as an alternative to what method of fetal assessment?
NST
Fetal heart rate reactivity is usually reached in what range of GA?
28-32 wks
what is the minimum frequency of serial NSTs?
at least once/wk
What is the frequency for serial NSTs for women at particularly high risk for poor outcome r/t uteroplacental insufficency?
twice per week
34 wks, NST d/t mother is gestational diabetic. Previous NST reactive. This one not reactive after 20 minutes. What is the next step?
Continue NST for another 20-30 minutes
What method of fetal assessment is the most accurate predictor of uteroplacental insufficiency?
Contraction Stress Test
Which method of fetal assessment is a woman with placenta previa NOT a good candidate for?
Contraction Stress Test
A contraction stress test is known to have about a 30% false-positive rate. What does this mean?
One third of women with positive CST have a fetus that is actually normal. d
what are the components of the modified BPP?
NST and AFV
tachysystole
6 or more contractions in a 10 minute window, averaged over 30 minutes
normal uterine contractions
5 or fewer contractions in a 10 minute window;
last 40-60 seconds each
Waht is the AFI if these are the findings:
quadrant 1: 1 cm, 2 cm, 4.5 cm pockets of fluid
quad 2: 2.5 cm pocket
quad 3: 3 cm, 5 cm pockets
quad 4: 1.5 cm, 5 cm pockets
17 cm
the deepest pocket is measured in each quadrant, one number from each quadrant is added to find total
What is the normal range of AFI?
5-25 cm
what are minimum components of limited obsterical u/s in second and third trimesters
fetal number, lie and cardiac activity
G3P1021 at 9 wks GA calls at 3:30 am because she noticed some dime-sized spots of blood on her underwear when she went to the bathroom. She denies abdominal or back pain, no symptoms of UTI. Her temp is 99.1. She has had a few more spots since the initial ones. What is the best course of action?
Recommend pelvic rest,
teach her the sx that need to be reported immediately
have her come into the office the next day
Pt with hx of SAB comes in for vaginal spotting at 9 wks. PE: speculum exam reveals no vaginitis or cervicitis, +bright red blood pooled in posterior fornix, VS wnl, bimanual wnl. Denies cramping or pain. What do you do?
Obtain u/s eval in next 24 hours.
for how long should sexual intercourse be avoided after 1st trimester SAB?
2-4 wks
Why should a woman wait a few weeks to resume sexual intercourse after SAB?
d/t increased risk of infection at this time
A woman is said to suffer from habitual abortions when spontaneous abortion has terminated the course of how many pregnancies?
three or more consecutive
when is pregnancy loss most likely to occur due to an incompetent cervix?
second trimester
iwhat are some risk factors for incompetent cervix?
previous cervical cone biopsy
hx of cervical laceration during previous childbirth
hx of 3 or more ABs using suction
22 wk GA has cerclage. PE: ROM without labor What steps do you take regarding sutures?
remove them
What are some usual sites for ectopic pregnancy?
cervix
ovaries
fallopian tube
LMP 6 wks ago. 5 days of vaginal spotting. Now significant pain in lower right abdomen. What should you do first?
Pelvic exam for uterine sizing/adnexal masses and qualitative hCG.
Following dx of ectopic pregnancy, what is most appropriate management step?
Refer immediately to physician for management
What are soem predisposing risk factors for an ectopic pregnancy?
IUD
BTL
pelvic infections
Initial visit. LMP 15 wks ago. Some bloody d/c intermittent x 1 wk. Daily n/v. Denies abdominal pain/cramping. S>D uterus, no FHR found. Speculum exam: brownish bloody d/c. Bimanual: andexal tenderness. Cervix: long, closed, posterior.
What is your dx?
Hydatidiform mole
What exam/lab would be most useful in confirming dx of hydatidiform mole?
single serum quantitative hCG level and sonogram
What is diagnostic for TB?
Postiive chest xray
Woman from Jamaica received BCG vax as child, had neg chest xray 4 years ago. What is appropriate management of this client?
repeat chest xray
??? while pregnant???? I guess so, with lead apron
Migrant farm worker at 16 wk GA, from El Salvador. Comes in 4 days after PPD administered, to have results read. 12mm swelling noted. 2 yrs earlier was neg. No s/s. What is the most accurate interpretation of this test result?
It can be evaluated and is considered positive because she has risk factors for TB. A positive result usually remains visible for about a week.
Migrant worker just dx with +PPD test. Best next step to take in the management of this pt?
Order a chest xray
What should woman do who becomes pregnant while taking isoniazid (INH) for TB?
Most clinicians recommend continuation of INH tx or prophylaxis if woman becomes pregnant during tx course to avoid drug resistance.
Heb B is present in all of an infected woman’s body fluids except…?
breastmilk (at least it has not been assoc with MTCT) The concern would be over cracked nipples exposing baby to other maternal fluids like blood.
A +HBsAg screening test indicates what?
active Hep B (acute or chronic) only
What is the mgmt of newborn infants of Heb B-infected mothers?
Immediate bath, immunization with Heb B immune globulin(HBIG), and vax with Heb B vax.
A woman becomes pregnant several years after being infected with Hep C. How will this affect her care?
She will be monitored for signs of abnormal liver dz that may affect her nutritional status
IN which stage of pregnancy is maternal infection with rubella MOST likely to cause congential malformations?
in the first month
What are the rash characteristics of rubella infection?
Pale or bright red, spreading rapidly from fact to entire body, and then fading rapidly
