Exam 1 - High Risk Pregnancy Flashcards
1
Q
_______ risk factors originate within the mother or fetus
A
biophysical
2
Q
________ risk factors are maternal behaviors or adverse life events
A
psychosocial
3
Q
________ risk factors are the type of family the mother comes from or where the mother lives
A
sociodemographic
4
Q
_______ risk factors are those in the mothers workplace or overall surroundings
A
environmental
5
Q
antepartum testing usually begins at ___ weeks and continues until birth
A
32
6
Q
when tracking the daily fetal movement or kick counts, she should feel ___ fetal movements every 2 hours
A
10
7
Q
fetal alarm signal is when the mother doesn’t feel the fetus move for over ____ hours and it is not a good sign
A
12
8
Q
decreased fetal movement often indicates fetal _______
A
hypoxemia
9
Q
ectopic pregnancy can be detected by US in the _____ trimester
A
1st
10
Q
the EDD can be determined by US during the ___ trimester
A
1st
11
Q
the placenta location can be determined via US during the ___ trimester
A
2nd
12
Q
2 uses for transvaginal US
A
- mother has a high BMI
- fetus is still small
13
Q
a _____ US is used for a specific cause like assessing fetal presentation during labor
A
limited
14
Q
a ______ US is used to further assess or evaluate abnormalities
A
specialized
15
Q
test done to analyze how much blood the placenta is getting from the mother and how much blood the baby is getting from the placenta
A
doppler blood flow analysis
16
Q
if there is severe restriction to the umbilical artery blood flow it can cause _____ _____ _____
A
fetal growth restriction
17
Q
decreased amniotic fluid
A
oligohydramnios
18
Q
in oligohydramnios the maximum vertical pocket is less than __ cm
A
2
19
Q
in oligohydramnios, the fundal height is often _____ than normal
A
lower
20
Q
increased amniotic fluid volume
A
polyhydramnios
21
Q
in polyhydramnios the maximum vertical pocket is greater than ___ cm
A
8
22
Q
if the total AFI is less than ___ cm it is oligo
A
5
23
Q
if the total AFI is greater than ___ cm it is poly
A
25
24
Q
_________ assessments determine chromosomal abnormalities and fetal risk
A
biochemical
25
for biochemical assessments, Rh negative women should have ______ after procedures
Rhogam
26
test done to obtain a sample of amniotic fluid because it contains fetal cells for testing
amniocentesis
27
an amniocentesis is done between ___ and ___ weeks
15 and 18
28
test done where they remove part of the placental tissue (chorion) to test fetal genetic tissue
chorionic villus sampling
29
chorionic villus sampling is done between ___ and ___ weeks
10 and 13
30
test where a needle is inserted in the umbilical vein under US to gather a fetal blood sample or for a fetal blood transfusion
Percutaneous Umbilical Blood Sampling (PUBS)
31
PUBS has been replaced by _____ _____ ______ in a lot of places because it is safer and easier
chorionic villus sampling
32
testing that consists of multiple screening in each trimester for those who are genetically higher risk
Non-invasive prenatal testing (NIPT)
33
in the first trimester, the NIPT screens for _____ and _____ hormones and uses US
PAPP-A and HCG
34
NIPT screening that is used in the 2nd trimester
quad screening
35
the quad screening is used for trisomy ____ and ____
21 and 18
36
NIPT where they take blood from the mother and separate the fetal blood from it to identify chromosomal abnormalities
cell-free DNA screening
37
cell-free DNA screening screens fro trisomy ___, ___, and ____
13, 18, 21
38
cell-free DNA screening is done at ___ weeks
15
39
screening tool that looks for Rh alloimmunization
Coombs Test
40
if the values of the Coombs test are greater than 1:8 to 1:32, then the fetus has a significant risk for _____ ____
hydrops fetalis
41
in a reactive NST, there will at least ____ accelerations that last longer than 15 seconds and go 15 bpm above the fetal baseline and no decels
2
42
if the fetus is less than 32 weeks, an acceleration is considered ____ seconds and ____ bpm above baseline
10, 10
43
a nonreactive NST is if there are not ___ qualifying accelerations in the 20-minute window and/or decels
2
44
a ________ stress test provides an earlier and more accurate warning of fetal compromise than the NST
contraction
45
2 types of contraction stress test
nipple stimulation test
oxytocin challenge test
46
the nipple stimulation test should be stopped when there is a uterine contraction lasting longer than ___ seconds OR ___ or more contractions in 10 minutes
90, 5
47
the oxytocin challenge test is when you administer Pitocin until ___ moderate contractions last 40-60 seconds
4
48
a ______ contraction stress test is when there at least 3 uterine contractions in a 10 minute period with no late or variable decelerations
negative
49
a ______ contraction test is when late decelerations occur with 50% or more of the contractions in 10 minutes
positive
50
variable decels with or without contractions are caused by _____ ____
cord compression
51
early decels are caused by ______ _____ and are normal and shouldn't worry too much
head compression
52
late decels are caused by ______ ______
placental insufficiency
53
early decels lowest point is the same as the _____ of the contraction
peak
54
_______ diabetes is people who have diabetes before getting pregnant
pregestational
55
most patients with pregestational diabetes are _____ dependent during their pregnancy
insulin
56
for those with pregestational diabetes, pregnancy can accelerate _______ complications
vascular
57
_______ diabetes is a carbohydrate intolerance that develops during pregnancy
gestational
58
GDM usually develops in the ___ or ___ trimester
2nd or 3rd
59
3 things diabetic patients are at higher risk for in pregnancy
- polyhydramnios
- infections
- ketoacidosis
60
ketoacidosis occurs from hyperglycemia that creates ketones in the blood and then causes the body to go into _____ _____
metabolic acidosis
61
DKA occurs most often in the ___ and ___ trimester
2nd and 3rd
62
DKA can occur in pregnant women when their BS is only ____, whereas in non pregnant people it is usually 300 or more
200
63
hypoglycemia happens more often in _____ pregnancy
early
64
_______ can cross the placenta, so the mother's levels and the fetuses levels will be proportionate
glucose
65
in the 1st trimester, the rising estrogen and progesterone stimulate the pancreas beta cells to create more _____
insulin
66
during the 1st trimester more glucose is stored and less is produced, causing _____
hypoglycemia
67
insulin-dependent mothers are more prone to ________ during the 1st trimester and may need to decrease their insulin
hypoglycemia
68
in the 2nd/3rd trimester hormone changes cause ______ tolerance to glucose, _____ insulin resistance, ______ glycogen stores, and _____ production of glucose
decreased, increased, decreased, increased
69
from 18 to 36 weeks, maternal insulin requirements ______
increase
70
the mother becomes more insulin resistant to ensure enough ______ for the fetus
glucose
71
in a non-breastfeeding mother, insulin-carb balance returns to normal in ___ to ___ days after birth
7-10 days
72
in a breastfeeding mother, the carb-insulin balance will return after _______
weaning
73
GDM patients should not go more than ___ hours without food
4
74
hyperglycemia in the ___ trimester is associated with more birth defects
1st
75
poor glycemic control in later stages of pregnancy are associated with ______ making it harder for the baby to move down the birth canal and increasing the chance of a C-section
macrosomia
76
the optimal time for birth for pt. with GDM
39 weeks
77
since your RBC turnover rate is faster in pregnancy, the A1c only shows the past ___ to __ weeks instead of 3 months
2 to 6 weeks
78
pregnant women with diabetes fasting blood sugar before breakfast should be ___ to ___
60 to 95
79
pregnant women with diabetes blood sugar before lunch, dinner, or bedtime snack should be between ___ and ___
60 and 105
80
pregnant women with diabetes blood sugar an hour after meals should be less than ____
140
81
pregnant women with diabetes blood sugar 2 hours after eating should be less than ____
120
82
Pregnant women with diabetes blood sugar between 2AM and 6AM should be less than ____
60
83
in pregestational diabetes, if it was previously regulated by oral hypoglycemic you will usually be switched to ______ for better control
insulin
84
in the 1st trimester, you will give ___units/kg of inuslin
0.6
85
GDm patients will do a combo of ______ and _____ acting insulin before breakfast and dinner
intermediate, rapid
86
GDM patients have a higher risk for PP ________
hemorrhage
87
insulin requirements in breastfeeding women ______ because glucose goes into milk
decrease
88
2 step glucose test is done during the 2nd trimester at ___ to ____ weeks
24-28
89
the 1st step in the 2 step approach for GDM you administer ____ g of glucose and test BS one hour later
50
90
in the 1st step of the two-step approach for GDM, the test is positive if the BS is ____ or higher
130
91
in the 2nd step of GDM screening you will take a fasting BS and then administer _____g of carbs and then take BS every hour for 3 hours
100
92
if ____ or more values are met or exceeded in the 2nd step of the glucose screening then it is positive for GDM
2
93
values for 2nd step of GDM screening
- fasting: 95-105
- 1 hour: 180-190
- 2 hour: 155-165
- 3 hour: 140-145
94
in pt. with GDM, fetal surveillance will start at ___ weeks
32
95
during the intrapartum phase in pt. with GDM, BS should be monitored hourly and BS should be between ____ and ____
80 and 110
96
patients with GDM will do a __ hour, ___ gram glucose test 4-12 weeks pp
2, 75
97
3 increased risks with hyperthyroidism
- miscarriage
- preterm birth
- goiter
98
do not use _____ ______ in diagnosis or treatment of hyperthyroidism because it is harmful to the fetal thyroid
radioactive iodine
99
medication for hyperthyroidism only used in 1st trimester
Propylthiouracil (PTU)
100
Propylthiouracil (PTU) can cause severe ______ toxicity
hepatic
101
using methimazole (MMI) to treat hyperthyroidism in the ____ trimester can cause fetal deformities
1st
102
hypothyroidism is associated with ________
infertility
103
CHF that occurs in the last month of pregnancy and up to 5 months PP
peripartum cardiomyopathy
104
3 s/s and peripartum cardiomyopathy
dyspnea
fatigue
edema
105
iron deficiency anemia is treated with ______ ______ 325 mg BID
ferrous sulfate
106
if the pt. has iron deficiency anemia, their serum ferritin will be less than ___ and their Hgb will be low
12
107
megaloblastic anemia is caused by low ____ ____ or vitamin ____
folic acid, B12
108
anemia can result in increased CO and put you at risk for _______
preeclampsia
109
2 medications to avoid in patients with asthma because they cause bronchospasm
hemabate and methergine
110
skin condition of pregnancy where there is pruritis without a rash
pruritus gravidarum
111
skin condition of pregnancy where there is a rash and pruritus on thighs and abdomen sometimes seen with weight gain
polymorphic eruption of pregnancy
112
common liver disease of pregnancy that causes pruritus in the 3rd trimester and is often worse at night
Intrahepatic cholestasis of pregnancy
113
2 anticonvulsants that can be taken during pregnancy because they have a lower risk of fetal deformities
Lamictal and Keppra
114
when taking anticonvulsants you need to increase intake of folic acid to __ mg a day because they resist folic acid
4mg
115
in a mother with substance use disorder, they will take _____ while pregnant to decrease neonatal abstinence syndrome
suboxone
116
triad of preeclampsia
hypertension
proteinuria
lower extremity edema
117
preeclampsia usually develops after ____ weeks
20
118
if there is no proteinuria then preeclampsia is described as HTN with either of these 5 things
- thrombocytopenia
- impaired LFT
- RUG pain
- renal insufficiency
- cerebral sx
119
chronic HTN with superimposed preeclampsia is based of off one of the two findings
- sudden increase in well controlled BP
- proteinuria
120
to prevent preeclampsia, start on ___ mg of aspirin at __ weeks
81, 12
121
4 s/s of severe preeclampsia
- severe HA
- epigastric pain
- RUQ pain
- visual disturbances
122
in preeclampsia, a 24 hour urine will have over ____ mg of protein
300
123
in preeclampsia there will be hyperactive reflexes known as ______
clonus
124
preeclampsia without severe features should deliver at ___ weeks
37
125
preeclampsia with severe features should deliver at ___ weeks
34
126
if the preeclampsia has severe features they are admitted and placed on ______ _____ IV infusion to prevent seizures
magnesium sulfate
127
3 medications to regulate BP in severe preeclampsia
labetalol, nifedipine, hydralazine
128
2 steroids given to enhance babies lungs for early delivery
betamethasone
dexamethasone
129
s/s of placental abrutpion
rigid, tender, tense abdomen
130
bolus/loading dose of magnesium sulfate
4-6g over 15-20 mins
131
maintenance dose of magnesium sulfate
40g in 1000 ml of LR
132
magnesium therapeutic range to maintain
4-7
133
magnesium toxicity s/s
- absent deep tendon reflexes
- decreased RR
- decreased LOC
134
magnesium sulfate antidote
calcium gluconate
135
HELLP syndrome diagnostic lab findings
- hemolysis
- elevated liver enzymes
- low platelets
136
passive painless dilation of the cervix that can lead to preterm birth in the 2nd trimester
cervical insufficiency
137
cervical insufficiency is if the cervix is less than ___ mm
25
138
medication to treat cervical insufficiency
progesterone
139
you can get a _____ placed too for cervical insufficiency
cerclage
140
blood test that determines if Rhogam is needed during pregnancy to prevent alloisoimmunixation
Kleihaur-Betke
141
s/s of an ectopic pregnancy
abdominal pain
delayed menses
abnormal vaginal bleeding
142
if the ectopic pregnancy ruptures there will be referred pain in the _____
shoulder
143
signs of shock with ruptured ectopic pregnancy
faint, dizzy, cullen sign (blue around belly button)
144
if the HCG is lower than _____ and there is a baby seen on ultrasound then it is ectopic
1500
145
if the ectopic pregnancy is caught early you can give ______ to expel the baby
methotrexate
146
a ______ molar pregnancy is when an egg without a nucleus is fertilized by sperm
complete
147
a _____ molar pregnancy is when 1 egg is fertilized by more than 1 sperm
partial
148
molar pregnancy is diagnosed by US and a ______ than normal HCG
higher
149
placenta _____ is when the placenta is in the lower part of the uterus and partially or fully covers the cervical os
previa
150
bleeding with placenta previa
painless and bright red
151
most of the time placenta previa clears by __ weeks
32
152
s/s of placenta abruption
intense localized uterine pain with or without bleeding
153
in placental abruption, _____ fundal height cna indicate concealed bleeding
increased
154
with placental abruption if the HR increased and BP drops it is a sign of _____ ____
hypovolemic shock
155
widespread intravascular activation of clotting that results from another event
Disseminated intravascular coagulation (DIC)
156
DIC causes widespread clot formation and _______
hemorrhage
157
