CNM Varney's Review Book Part C Flashcards
A woman come sto see you because she received a rubella vax 2 wks ago and has just found out that she is approximately 4 wks preg. What is your response?
Explain there is theoretical risk from the vax but that there is no demonstrated evidence of teratogenicity from the vax.
What are ways to avoid toxoplasmosis?
avoid contact with cat feces, wear gloves while gardening, and avoid eating raw or undercooked meat.
In which stage of pregnancy is maternal infection with varicella most likely to cause congenital varicella syndrome in the fetus?
the first 20 weeks
What is the most common cause of maternal mortality r/t varicella?
varicella pneumonia
G1P0 at 39 wks GA exposed to varicella two weeks ago (not immune). You administered 1 dose varicella zoster immune globulin (VZIG) at that time. She calls today c/o fever, chills, muscle pain x 2 days. Appt to see you later today. What is best course of action?
have her come into your office after ovvice hours for PE and counseling/education.
About 16 days after being exposed to varicella (and not being priorly immune), a G1P0 at 39 wks develops vesicular rash on head and neck with occasional vesicle on abdomen. Goes into labor on foruth day after eruption of the vesicles and delivers 7 lb 12 oz male with no signs of distress or varicella infection. How do you manage woman and infant?
Give VZIG to infant immediately and consider isolation of infant from mother.
What physiological change of pregnancy makes pregnant women more susceptible to UTIs?
Hydronephrosis, which causes urinary stasis
A black woman with recurrent UTIs should first be screened for what?
sickle cell trait/dz
G3P1 at 29 wks with hx of recurrent UTIs in previous pregnancy leading to PTL/PTB at 30 wks had a repeat urine culture at 28 wks = +. Gave 10-day course ampicillin. TOC is positive. What is best course of action?
obtain careful hx of compliance with tx regime and prescribe another course of tx with different drug based on sensitivity testing.
When would it be most appropriate to initiate suppressive therapy for asymptomatic bacteriuria?
when 2 complete courses of tx have been completed without a cure
Who should nOT receive nitrofuantoin to tx asymptomatic bacteriuria?
Woman with G6PD deficiency
What are some expected findings from microsopic u/a of woman with cystitis?
bacteriuria, hematuria, pyuria
What is the most common cause of true anemia during pregnancy?
iron deficiency
What is hemodilution of pregnancy?
normal increase in plasma volume that outpaces increase in erythrocyte production
What is the generally accepted, working definitiaon of anemia in pregnant women?
Hgb <10 g/dL
G1P0 at 8 wks has Hgb 10g/dL. Bulimia age 14. Currently asympotmatic for anemia; denies any bingeing and purging . Nl weight for height. What is best management option for her?
Iron, folic acid, PNV, nutrition counseling
Iron supplements causing G1P0 to become constipated. Solution?
continue iron supplementation, provide advice on relief measures for constipation, reevaluate Hgb level at 28 wks.
What is daily recommended amt of elemental iron supplementation in pregnancy?
30 ml
Anemia labs results at 20 wk GA: Hgb 9.8 low reticulocyte count MCV of 98 What kind of anemia does this suggest?
Macrocytic anemia
Hgb electrophoresis reveals woman has Hb AS. What does this result mean?
Shows that she has sickle cell trait
Woman with sickle cell dz wants to know how pregnancy will affect course of dz.
Pregnancy increases both intensity and frequency of sickle cell crises
Which group of women is most likely to have G6PD?
Woman of Turkish descent
When does cardiac output peak in pregnancy, making it most likely for a woman with cardiac dz to decompensate?
20-24 wks
How will pregnancy affect asthma?
The clinical course of asthma in pregnancy cannot be predicted.
What pregnancy complications/outcomes is asthma associated with?
hyperemesis gravidarum
preeclampsia
LBW
Why should a fasting blood sugar not be used as the sole screening crieteria in pregnancy
because the fasting bs in gestational diabetics may be normal
3hr GTT results: fasting: 100 1 hr: 200 2 hr: 150 3 hr: 130 What is the best interpretation and management?
This client is gestational diabetic. Refer to nutritionist; comanage with MD. ADA/ACOG cutoff values: fasting: 95 1 hr: 180 2 hr: 155 3 hr: 140
50g, 1-hour glucose screen value which indicates need for the 3hr GTT
130-140mg/dL
when is a glucose challenge test not necessary for the dx of DM?
fasting plasma glucose >126 mg/dL
casual plasma glucose >200 mg/dL on 2 separate days
what is a casual plasma glucose?
randomly taken during the day.
Normally functioning system does not have wide glucose range throughout day.
HgbA1c levels
Normal in non-diabetic: 4.5-6
5.7-6.4 = prediabetes
>6.5 on two separate occasions = diabetes
If dx with previous DM, target is ve been taught?)
Tocolytic of choice to treat preterm labor in multiple prenancy
magnesium sulfate
What are some things associated with development of oligohydramnios?
congenital anomalies
IUGR
postmature syndrome
describe the normal changes in amniotic fluid volume during pregnancy
gradual increase through 33-35 weeks, then a decrease until term
what are some complications associated with polyhydramnios?
cord prolapse
placental abruption
pp hemorrhage
what is a known cause of polyhydramnios?
DM
Following IUFD, onset of labor usually occurs within 2-3 week due to?
cessation of placental function
what is a risk of expectant management of iufd?
DIC
IUFD at 34 wks. Mother asks you reason.
even after a thorough autopsy, most intrauterine deaths have no known cause
In the absence of a baseline blood pressure, which would be considered HTN? 130/80 135/88 128/90 138/78
128/90
What is an accurate definition of proteinuria?
protein in the urine in excess of 1 g/dL
what things predispose a woman to develop preeclampsia?
trophoblastic dz
maternal age >35
multiple pregnancy
If a woman develops preeclapsia before 36 wks gestation, midwife should monitor for development of which associated condition?
IUGR
Eclamptic seizures are usually which type of sz?
tonic-clonic
You admit pt to hosptial for preeclampsia, to initiate magnesium sulfate therapy, but she begins seizing before you can start an IV. What is MOST appropriate action at this time?
Call for help!
notify the physician
try to stop the sz with mag (apparently port was in)
what is your top priority following an eclamptic sz?
maintain patent airway and administer O2
G4P2 at 28 wk GA present with vaginal bleeding without contractions. U/S reveals total placenta previa. birth hx: 1 c/s for fetal distress, 2 VBAC. What is most appropriate course of action now?
Admit to hospital for maternal blood studies and fetal assessment.
A woman with placenta previa and prior c/s is at increased risk for what?
placenta accreta
highest with pp&c/s, but generally is increased just with hx of c/s
placenta accreta
placenta attached to myometrium
placenta increta
placenta extends into myometrium
placenta percreta
placenta extends through entire myometrium and uterine serosa
what is the most common cause for S>D?
large fetus
what are some other causes of S>D?
GDM
Myomata
trophoblastic dz
What would be most helpful in confirming a clinical suspicion of IUGR in a pregnancy that is high risk based on hx of previous IUGR or complications arising this pregnancy?
two U/S measurements of abdomoinal circumference at least four weeks apart
birthweight for LGA
4000 gm or more
ACOG birthweight for macrosomia
4500 gm
what percentage of pregnancies labeled postdates are ACTUALLY postdates?
50%
When should you initiate and how often should you conduct NST in a postdates pregnancy when there are normal fetal movement coutns?
initiate at 41-42 weeks and twice weekly thereafter
When in pregnancy do BH contractions begin?
approximately 6 weeks at the earliest
(so my thought is: if frequent flyer comes in repeatedly for BH preterm, and it is likely due to a sub-level infection which the body is trying to get rid of by getting rid of the pregnancy…is that why they can start as soon as 6 weeks, bc there is underlying infection?)
Waht percentage of women at or near term will start labor spontaneously within 24 hours of PROM?
80%
