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Family > Exam 1 - High Risk Pregnancy > Flashcards

Exam 1 - High Risk Pregnancy Flashcards

1
Q

_______ risk factors originate within the mother or fetus

A

biophysical

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2
Q

________ risk factors are maternal behaviors or adverse life events

A

psychosocial

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3
Q

________ risk factors are the type of family the mother comes from or where the mother lives

A

sociodemographic

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4
Q

_______ risk factors are those in the mothers workplace or overall surroundings

A

environmental

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5
Q

antepartum testing usually begins at ___ weeks and continues until birth

A

32

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6
Q

when tracking the daily fetal movement or kick counts, she should feel ___ fetal movements every 2 hours

A

10

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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

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8
Q

decreased fetal movement often indicates fetal _______

A

hypoxemia

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9
Q

ectopic pregnancy can be detected by US in the _____ trimester

A

1st

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10
Q

the EDD can be determined by US during the ___ trimester

A

1st

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11
Q

the placenta location can be determined via US during the ___ trimester

A

2nd

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12
Q

2 uses for transvaginal US

A
  • mother has a high BMI
  • fetus is still small
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13
Q

a _____ US is used for a specific cause like assessing fetal presentation during labor

A

limited

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14
Q

a ______ US is used to further assess or evaluate abnormalities

A

specialized

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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

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16
Q

if there is severe restriction to the umbilical artery blood flow it can cause _____ _____ _____

A

fetal growth restriction

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17
Q

decreased amniotic fluid

A

oligohydramnios

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18
Q

in oligohydramnios the maximum vertical pocket is less than __ cm

A

2

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19
Q

in oligohydramnios, the fundal height is often _____ than normal

A

lower

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20
Q

increased amniotic fluid volume

A

polyhydramnios

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21
Q

in polyhydramnios the maximum vertical pocket is greater than ___ cm

A

8

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22
Q

if the total AFI is less than ___ cm it is oligo

A

5

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23
Q

if the total AFI is greater than ___ cm it is poly

A

25

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24
Q

_________ assessments determine chromosomal abnormalities and fetal risk

A

biochemical

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25
Q

for biochemical assessments, Rh negative women should have ______ after procedures

A

Rhogam

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26
Q

test done to obtain a sample of amniotic fluid because it contains fetal cells for testing

A

amniocentesis

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27
Q

an amniocentesis is done between ___ and ___ weeks

A

15 and 18

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28
Q

test done where they remove part of the placental tissue (chorion) to test fetal genetic tissue

A

chorionic villus sampling

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29
Q

chorionic villus sampling is done between ___ and ___ weeks

A

10 and 13

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30
Q

test where a needle is inserted in the umbilical vein under US to gather a fetal blood sample or for a fetal blood transfusion

A

Percutaneous Umbilical Blood Sampling (PUBS)

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31
Q

PUBS has been replaced by _____ _____ ______ in a lot of places because it is safer and easier

A

chorionic villus sampling

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32
Q

testing that consists of multiple screening in each trimester for those who are genetically higher risk

A

Non-invasive prenatal testing (NIPT)

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33
Q

in the first trimester, the NIPT screens for _____ and _____ hormones and uses US

A

PAPP-A and HCG

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34
Q

NIPT screening that is used in the 2nd trimester

A

quad screening

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35
Q

the quad screening is used for trisomy ____ and ____

A

21 and 18

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36
Q

NIPT where they take blood from the mother and separate the fetal blood from it to identify chromosomal abnormalities

A

cell-free DNA screening

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37
Q

cell-free DNA screening screens fro trisomy ___, ___, and ____

A

13, 18, 21

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38
Q

cell-free DNA screening is done at ___ weeks

A

15

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39
Q

screening tool that looks for Rh alloimmunization

A

Coombs Test

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40
Q

if the values of the Coombs test are greater than 1:8 to 1:32, then the fetus has a significant risk for _____ ____

A

hydrops fetalis

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41
Q

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

A

2

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42
Q

if the fetus is less than 32 weeks, an acceleration is considered ____ seconds and ____ bpm above baseline

A

10, 10

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43
Q

a nonreactive NST is if there are not ___ qualifying accelerations in the 20-minute window and/or decels

A

2

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44
Q

a ________ stress test provides an earlier and more accurate warning of fetal compromise than the NST

A

contraction

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45
Q

2 types of contraction stress test

A

nipple stimulation test
oxytocin challenge test

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46
Q

the nipple stimulation test should be stopped when there is a uterine contraction lasting longer than ___ seconds OR ___ or more contractions in 10 minutes

A

90, 5

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47
Q

the oxytocin challenge test is when you administer Pitocin until ___ moderate contractions last 40-60 seconds

A

4

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48
Q

a ______ contraction stress test is when there at least 3 uterine contractions in a 10 minute period with no late or variable decelerations

A

negative

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49
Q

a ______ contraction test is when late decelerations occur with 50% or more of the contractions in 10 minutes

A

positive

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50
Q

variable decels with or without contractions are caused by _____ ____

A

cord compression

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51
Q

early decels are caused by ______ _____ and are normal and shouldn’t worry too much

A

head compression

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52
Q

late decels are caused by ______ ______

A

placental insufficiency

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53
Q

early decels lowest point is the same as the _____ of the contraction

A

peak

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54
Q

_______ diabetes is people who have diabetes before getting pregnant

A

pregestational

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55
Q

most patients with pregestational diabetes are _____ dependent during their pregnancy

A

insulin

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56
Q

for those with pregestational diabetes, pregnancy can accelerate _______ complications

A

vascular

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57
Q

_______ diabetes is a carbohydrate intolerance that develops during pregnancy

A

gestational

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58
Q

GDM usually develops in the ___ or ___ trimester

A

2nd or 3rd

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59
Q

3 things diabetic patients are at higher risk for in pregnancy

A
  • polyhydramnios
  • infections
  • ketoacidosis
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60
Q

ketoacidosis occurs from hyperglycemia that creates ketones in the blood and then causes the body to go into _____ _____

A

metabolic acidosis

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61
Q

DKA occurs most often in the ___ and ___ trimester

A

2nd and 3rd

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62
Q

DKA can occur in pregnant women when their BS is only ____, whereas in non pregnant people it is usually 300 or more

A

200

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63
Q

hypoglycemia happens more often in _____ pregnancy

A

early

64
Q

_______ can cross the placenta, so the mother’s levels and the fetuses levels will be proportionate

A

glucose

65
Q

in the 1st trimester, the rising estrogen and progesterone stimulate the pancreas beta cells to create more _____

A

insulin

66
Q

during the 1st trimester more glucose is stored and less is produced, causing _____

A

hypoglycemia

67
Q

insulin-dependent mothers are more prone to ________ during the 1st trimester and may need to decrease their insulin

A

hypoglycemia

68
Q

in the 2nd/3rd trimester hormone changes cause ______ tolerance to glucose, _____ insulin resistance, ______ glycogen stores, and _____ production of glucose

A

decreased, increased, decreased, increased

69
Q

from 18 to 36 weeks, maternal insulin requirements ______

A

increase

70
Q

the mother becomes more insulin resistant to ensure enough ______ for the fetus

A

glucose

71
Q

in a non-breastfeeding mother, insulin-carb balance returns to normal in ___ to ___ days after birth

A

7-10 days

72
Q

in a breastfeeding mother, the carb-insulin balance will return after _______

A

weaning

73
Q

GDM patients should not go more than ___ hours without food

A

4

74
Q

hyperglycemia in the ___ trimester is associated with more birth defects

A

1st

75
Q

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

A

macrosomia

76
Q

the optimal time for birth for pt. with GDM

A

39 weeks

77
Q

since your RBC turnover rate is faster in pregnancy, the A1c only shows the past ___ to __ weeks instead of 3 months

A

2 to 6 weeks

78
Q

pregnant women with diabetes fasting blood sugar before breakfast should be ___ to ___

A

60 to 95

79
Q

pregnant women with diabetes blood sugar before lunch, dinner, or bedtime snack should be between ___ and ___

A

60 and 105

80
Q

pregnant women with diabetes blood sugar an hour after meals should be less than ____

A

140

81
Q

pregnant women with diabetes blood sugar 2 hours after eating should be less than ____

A

120

82
Q

Pregnant women with diabetes blood sugar between 2AM and 6AM should be less than ____

A

60

83
Q

in pregestational diabetes, if it was previously regulated by oral hypoglycemic you will usually be switched to ______ for better control

A

insulin

84
Q

in the 1st trimester, you will give ___units/kg of inuslin

A

0.6

85
Q

GDm patients will do a combo of ______ and _____ acting insulin before breakfast and dinner

A

intermediate, rapid

86
Q

GDM patients have a higher risk for PP ________

A

hemorrhage

87
Q

insulin requirements in breastfeeding women ______ because glucose goes into milk

A

decrease

88
Q

2 step glucose test is done during the 2nd trimester at ___ to ____ weeks

A

24-28

89
Q

the 1st step in the 2 step approach for GDM you administer ____ g of glucose and test BS one hour later

A

50

90
Q

in the 1st step of the two-step approach for GDM, the test is positive if the BS is ____ or higher

A

130

91
Q

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

A

100

92
Q

if ____ or more values are met or exceeded in the 2nd step of the glucose screening then it is positive for GDM

A

2

93
Q

values for 2nd step of GDM screening

A
  • fasting: 95-105
  • 1 hour: 180-190
  • 2 hour: 155-165
  • 3 hour: 140-145
94
Q

in pt. with GDM, fetal surveillance will start at ___ weeks

A

32

95
Q

during the intrapartum phase in pt. with GDM, BS should be monitored hourly and BS should be between ____ and ____

A

80 and 110

96
Q

patients with GDM will do a __ hour, ___ gram glucose test 4-12 weeks pp

A

2, 75

97
Q

3 increased risks with hyperthyroidism

A
  • miscarriage
  • preterm birth
  • goiter
98
Q

do not use _____ ______ in diagnosis or treatment of hyperthyroidism because it is harmful to the fetal thyroid

A

radioactive iodine

99
Q

medication for hyperthyroidism only used in 1st trimester

A

Propylthiouracil (PTU)

100
Q

Propylthiouracil (PTU) can cause severe ______ toxicity

A

hepatic

101
Q

using methimazole (MMI) to treat hyperthyroidism in the ____ trimester can cause fetal deformities

A

1st

102
Q

hypothyroidism is associated with ________

A

infertility

103
Q

CHF that occurs in the last month of pregnancy and up to 5 months PP

A

peripartum cardiomyopathy

104
Q

3 s/s and peripartum cardiomyopathy

A

dyspnea
fatigue
edema

105
Q

iron deficiency anemia is treated with ______ ______ 325 mg BID

A

ferrous sulfate

106
Q

if the pt. has iron deficiency anemia, their serum ferritin will be less than ___ and their Hgb will be low

A

12

107
Q

megaloblastic anemia is caused by low ____ ____ or vitamin ____

A

folic acid, B12

108
Q

anemia can result in increased CO and put you at risk for _______

A

preeclampsia

109
Q

2 medications to avoid in patients with asthma because they cause bronchospasm

A

hemabate and methergine

110
Q

skin condition of pregnancy where there is pruritis without a rash

A

pruritus gravidarum

111
Q

skin condition of pregnancy where there is a rash and pruritus on thighs and abdomen sometimes seen with weight gain

A

polymorphic eruption of pregnancy

112
Q

common liver disease of pregnancy that causes pruritus in the 3rd trimester and is often worse at night

A

Intrahepatic cholestasis of pregnancy

113
Q

2 anticonvulsants that can be taken during pregnancy because they have a lower risk of fetal deformities

A

Lamictal and Keppra

114
Q

when taking anticonvulsants you need to increase intake of folic acid to __ mg a day because they resist folic acid

A

4mg

115
Q

in a mother with substance use disorder, they will take _____ while pregnant to decrease neonatal abstinence syndrome

A

suboxone

116
Q

triad of preeclampsia

A

hypertension
proteinuria
lower extremity edema

117
Q

preeclampsia usually develops after ____ weeks

A

20

118
Q

if there is no proteinuria then preeclampsia is described as HTN with either of these 5 things

A
  • thrombocytopenia
  • impaired LFT
  • RUG pain
  • renal insufficiency
  • cerebral sx
119
Q

chronic HTN with superimposed preeclampsia is based of off one of the two findings

A
  • sudden increase in well controlled BP
  • proteinuria
120
Q

to prevent preeclampsia, start on ___ mg of aspirin at __ weeks

A

81, 12

121
Q

4 s/s of severe preeclampsia

A
  • severe HA
  • epigastric pain
  • RUQ pain
  • visual disturbances
122
Q

in preeclampsia, a 24 hour urine will have over ____ mg of protein

A

300

123
Q

in preeclampsia there will be hyperactive reflexes known as ______

A

clonus

124
Q

preeclampsia without severe features should deliver at ___ weeks

A

37

125
Q

preeclampsia with severe features should deliver at ___ weeks

A

34

126
Q

if the preeclampsia has severe features they are admitted and placed on ______ _____ IV infusion to prevent seizures

A

magnesium sulfate

127
Q

3 medications to regulate BP in severe preeclampsia

A

labetalol, nifedipine, hydralazine

128
Q

2 steroids given to enhance babies lungs for early delivery

A

betamethasone
dexamethasone

129
Q

s/s of placental abrutpion

A

rigid, tender, tense abdomen

130
Q

bolus/loading dose of magnesium sulfate

A

4-6g over 15-20 mins

131
Q

maintenance dose of magnesium sulfate

A

40g in 1000 ml of LR

132
Q

magnesium therapeutic range to maintain

A

4-7

133
Q

magnesium toxicity s/s

A
  • absent deep tendon reflexes
  • decreased RR
  • decreased LOC
134
Q

magnesium sulfate antidote

A

calcium gluconate

135
Q

HELLP syndrome diagnostic lab findings

A
  • hemolysis
  • elevated liver enzymes
  • low platelets
136
Q

passive painless dilation of the cervix that can lead to preterm birth in the 2nd trimester

A

cervical insufficiency

137
Q

cervical insufficiency is if the cervix is less than ___ mm

A

25

138
Q

medication to treat cervical insufficiency

A

progesterone

139
Q

you can get a _____ placed too for cervical insufficiency

A

cerclage

140
Q

blood test that determines if Rhogam is needed during pregnancy to prevent alloisoimmunixation

A

Kleihaur-Betke

141
Q

s/s of an ectopic pregnancy

A

abdominal pain
delayed menses
abnormal vaginal bleeding

142
Q

if the ectopic pregnancy ruptures there will be referred pain in the _____

A

shoulder

143
Q

signs of shock with ruptured ectopic pregnancy

A

faint, dizzy, cullen sign (blue around belly button)

144
Q

if the HCG is lower than _____ and there is a baby seen on ultrasound then it is ectopic

A

1500

145
Q

if the ectopic pregnancy is caught early you can give ______ to expel the baby

A

methotrexate

146
Q

a ______ molar pregnancy is when an egg without a nucleus is fertilized by sperm

A

complete

147
Q

a _____ molar pregnancy is when 1 egg is fertilized by more than 1 sperm

A

partial

148
Q

molar pregnancy is diagnosed by US and a ______ than normal HCG

A

higher

149
Q

placenta _____ is when the placenta is in the lower part of the uterus and partially or fully covers the cervical os

A

previa

150
Q

bleeding with placenta previa

A

painless and bright red

151
Q

most of the time placenta previa clears by __ weeks

A

32

152
Q

s/s of placenta abruption

A

intense localized uterine pain with or without bleeding

153
Q

in placental abruption, _____ fundal height cna indicate concealed bleeding

A

increased

154
Q

with placental abruption if the HR increased and BP drops it is a sign of _____ ____

A

hypovolemic shock

155
Q

widespread intravascular activation of clotting that results from another event

A

Disseminated intravascular coagulation (DIC)

156
Q

DIC causes widespread clot formation and _______

A

hemorrhage

157
Q
A

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