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OB > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

most common reason for doing prenatal testing is

A

advanced maternal age (35 years or older)

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2
Q

advanced paternal age is more than

A

55 years

after that there is an increase in certain chromosomal abnormalities

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3
Q

Reasons for prenatal testing (7)

A
  • Maternal age > 35 years
  • Birth of previous infant with chromosomal abnormalities or neural tube defect
  • Chromosomal abnormality in family member
  • Gender if mom is carrier of X-linked disorder
  • Pregnancy after 3 or more spontaneous abortions
  • Maternal Rh sensitization
  • Elevated levels of maternal serum AFP
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4
Q

the point of genetic counseling is to

A

help the family make some decisions and prepare them for the potential effects that may present in their baby

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5
Q

it’s quite common for down syndrome babies to also have

A

cardiac anomalies

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6
Q

multifactorial disorders

A

more than 1 gene is involved

also, environmental factors or sex of child may affect if it is expressed

Cardiac anomalies
Cleft lip and palate
Neural tube defects

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7
Q

Teratogens

A

any factor that adversely affects the fertilized ovum, embryo, or fetus

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8
Q

Causative agents

A 
Maternal infectious agents
Drugs, Rubella and Vaccine
Pollutants
Ionizing radiation
Maternal hyperthermia
Maternal co-morbidities
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9
Q

1 factor that influences the teratogen’s effect on the pregnancy

A

maternal genome and fetal genotype

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10
Q

Top 3 factors that influences the teratogen’s effect on the pregnancy

A
  1. maternal genome and fetal genotype
  2. stage of development when exposure occurs
  3. dose and duration of the exposure of the agent
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11
Q

___ mcg of folic acid daily before conception is recommended to prevent ____

A

400

neural tube defects

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12
Q

Women with epilepsy may be treated wth ___, which is a known tetratogen

A

Dilantin

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13
Q

CVS, PUBS, and Amniocentesis are done at what times?

A

CVS: towards the end of the first trimester (10-13 wks)

A: Between 15 and 20 weeks
PUBS: after 16 wks - not until the woman is definitely into the second trimester

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14
Q

Ultrasound can be done when?

A

anytime during the pregnancy

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15
Q

In the third trimester, how can fetal wellbeing be assessed?

A

Nonstress Test

Biophysical Profile

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16
Q

What is Amniocentesis and when is it done?

A
  • Invasive test to identify chromosomal or biochemical abnormalities
  • done Between 15 and 20 weeks
  • there is a Risk of spontaneous abortion infection, ruptured membranes
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17
Q

Why would Amniocentesis be done in the 3rd trimester (after 28 weeks)?

A

to assess:

  • Fetal lung maturity
  • Detects fetal hydrous and erythroblastosis fetalis
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18
Q

CVS stands for what? What is it and when is it done? What are some risks?

A

Chorionic Villus Sampling

10-13 wks
Karyotyping to identify chromosomal abnormalities
Results in 48 hrs

Risks: 0.5% to 2.0% chance of spontaneous abortion and limb abnormalities

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19
Q

PUBS stands for what? What is it and when is it done? What are some risks?

A

Percutaneous Umbilical Blood Sampling

after 16 wks
Blood gas, CBC, coag, Rh
Results in hrs

Risks: cord laceration, thromboembolic, infection, spontaneous ab, PROM (premature rupture of membranes)

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20
Q

PTO, PROM

A

pre-term labor

premature rupture of membranes

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21
Q

Women who have a high risk factor will start having NSTs at about

A

30-32 weeks gestation

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22
Q

What is the optimal type of NST?

A
  • At least 2 FHR acceleration within 20 minute period
  • At least 15 beats above baseline
  • Lasting at least 15 seconds

baby is awake/moving around

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23
Q

What is an NST and what is the purpose? When is it done?

A

Assess fetal well-being – uteroplacental function
Noninvasive
After 28 wks

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24
Q

Accelerations in FHR read during NST are indicative of

A
  • Adequate O2 of CNS
  • Healthy neural pathway from fetal CNS to FH
  • Ability of FH to respond to stimuli
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25
Q

Biophysical Profile (BPP) is the ultrasound evaluation of 5 parameters in fetus:

A
  1. Breathing movement
  2. Movement of limbs or body
  3. Tone – extension/flexion of extremities
  4. Amniotic fluid index (AFI)
  5. Reactive FHR with activity (NST)
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26
Q

When is BPP done?

A

Usually in 3rd trimester but may be done after 24 wks

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27
Q

8 to 10 on BPP =

A

normal (10 is highest grade possible)

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28
Q

4 to 6 on BPP =

A

possible compromise

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29
Q

0 to 2 on BPP =

A

high perinatal mortality

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30
Q

Indications for BPP

A
  • Maternal diabetes mellitus
  • Maternal heart disease
  • Maternal chronic hypertension
  • Maternal sickle cell anemia
  • Maternal renal disease
  • Hx previous stillbirths
  • Rh sensitization
  • Maternal preeclampsia or eclampsia
  • Suspected post maturity
  • Intrauterine growth restriction
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31
Q

Maternal Co-Morbidities

A

Acute and chronic illnesses:

  • present before pregnancy
  • develop during pregnancy
  • affect fetal health and outcome

most affect fetal OXYGENATION at some level

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32
Q

What are some key Maternal Co-Morbidities that can affect fetal health and outcome? (12)

A

asthma
cystic fibrosis

cardiac anomalies

sickle cell
Thalassemia

diabetes
thyroid conditions

multiple sclerosis
Systemic Lupus Erythematosis

Developmental Disabilities
Physical Disabilities
Cancer

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33
Q

Signs of Psychosocial Distress

A
  • Increasing Anxiety
  • Inability to establish communication
  • Inappropriate responses or actions
  • Denial of pregnancy
  • Inability to cope with stress
  • Intense preoccupation with the sex of the baby
  • Failure to acknowledge quickening
  • Failure to plan and prepare for the baby (e.g. living arrangements, clothing, feeding supplies)
  • Indications of substance abuse
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34
Q

There is a correlation between chronic behavioral/mental health disorders in the mother and ___

A

prematurity

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35
Q

Nursing Interventions for women with chronic behavioral/mental health disorders

A

Provide strategies to:

  • help decrease anxiety
  • keep her oriented to reality
  • promote optimal functioning during pregnancy and while in labor
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36
Q

Smoking during pregnancy has serious health risks including:

A
  • Bleeding complications
  • Miscarriage
  • Stillbirth
  • Prematurity
  • Placenta previa
  • Placental abruption
  • Low birth weight (LBW)
  • Sudden infant death syndrome
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37
Q

When do organs complete formation and therefore teratogens have their greatest impact at this time?

A

9-12 weeks

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38
Q

Potential perinatal STIs

A

Chlamydia, Gonorrhea, Syphilis, HPV, HIV and AIDS

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39
Q

___ and ____ are particularly dire/toxic if the mother develops during the first trimester

A

Rubella and Toxoplasmosis

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40
Q

TORCH

A 
Toxoplasmosis
Other: Varicella, Hepatitis B
Rubella
Cytomegalovirus
Herpes Simplex
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41
Q

Nursing Diagnoses for mom that’s been exposed to Perinatal Infection

A

Ineffective Health Maintenance
Grieving
Readiness for Enhanced Knowledge
Ineffective Coping

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42
Q

Pre gestational DM means

A

Diabetes Mellitus existing before pregnancy
Type 1 diabetes
Type 2 diabetes

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43
Q

Gestational diabetes mellitus (GDM) is

A

any degree of glucose intolerance with onset or recognition during pregnancy (2nd or 3rd trim)

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44
Q

Pre diabetes is

A

impaired fasting glucose (IFG)

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45
Q

How does pregnancy impact insulin production?

A

Placenta produces hormones such as estrogen, cortisol and human placental lactogen –> these hormones INHIBIT the functioning of insulin, so the blood glucose level is INCREASED

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46
Q

First trimester, insulin need is

A

reduced

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47
Q

Second trimester, insulin need is

A

increased

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48
Q

Third trimester, insulin need is

A

gradually increasing up to 36 weeks

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49
Q

During delivery, insulin need

A

Maternal insulin requirement drops drastically to pre pregnancy level

intervention: frequent BS during labor

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50
Q

When breastfeeding, insulin need

A

mother maintains lower insulin requirement

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51
Q

Weaning breastfeeding, insulin need is

A

returned to prepregnancy level

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52
Q

Recommendations for ADA for patients with type 1 diabetes as soon as menstruation begins

A

patients are counseled on high risk of being pregnant to themselves and to baby

high risk of neonatal morbidity and mortality

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53
Q

The normal number of chromosomes in body cells other than reproductive cells is ____

A

46, or diploid.

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54
Q

Trisomy and monosomy are what?

Most common trisomy is what?

A

numerical abnormalities of single chromosomes.

The most common trisomy is Down syndrome, or trisomy 21, in which three copies of chromosome 21 are in each somatic cell.

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55
Q

polyploidy

A

refers to abnormalities involving full sets of chromosomes.

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56
Q

monosomy – which is the only one compatible with postnatal life?

A

A monosomy exists when each body cell has a missing
chromosome, with a total number of 45.

The only monosomy compatible with postnatal life is Turner syndrome, or monosomy X (this person is always female)

most are lost in spontaneous abortion

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57
Q

According to ADA Guidelines for Preconception Care, what should the A1C levels be maintained at before attempting conception?

A

less than 6.5

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58
Q

What types of drugs might be contraindicated in pregnancy for type 1 diabetic patients?

A

Statins, ACEs, ARBs

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59
Q

Gestational diabetes is considered similar to type 2 diabetes in that

A

the patient has hyperglycemia but has hypo insulin production

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60
Q

About ___% of patients with gestational diabetes go on to develop type 2 diabetes later in life

A

20-25

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61
Q

Low Risk for gestational diabetes includes:

A
  • Normal weight before pregnancy
  • Under age 25
  • No hx unexplained stillbirth
  • No diabetes in immediate family
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62
Q

High Risk for gestational diabetes includes:

A
  • Ethnicity: Af Am, Hisp, Native Am
  • HTN
  • Hypercholesterolemia
  • GD or LGA in previous pregnancy
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63
Q

Symptoms warranting OGTT

A
  • Persistent glycosuria on 2 visits
  • Proteinuria
  • Urinary frequency after first trimester
  • Excessive thirst or hunger
  • Recurrent monilial infections
  • Polyhydramnios, suspected large fetal size, or increased fundal height for date
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64
Q

Does the nurse in the prenatal clinic develop the same care plan for Type 1, Type 2 and GDM?

A

YES - all about education and adherence

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65
Q

What is the treatment for Type 1, Type 2 and GDM mothers?

A

1 is Diet

If not managed well on diet, add meds

Drugs for Type 1:
- Insulin - may be admitted during 2nd trimester to regulate

Drugs for Type 2 and GDM:

  • Oral hypoglycemic (Glyburide & Metformin) may be effective – Prescribed, though not approved by FDA (Category B / C)
  • Insulin, if diet and oral hypoglycemics not effective
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66
Q

Any treatment for babies of Type 1, Type 2 and GDM mothers occurs when?

A

AFTER delivery

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67
Q

Danger signs for first trimester

A

abdominal pain and bleeding

also persistent vomiting and symptoms of infection

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68
Q

Hydatiform Molar Pregnancy (aka Gestational Trophoblastic Disease) – symptoms, risks, treatment

A

Proliferation and degeneration of trophoblastic villi

no actual pregnancy

Symptoms:

  • Vaginal bleeding, uterus growing rapidly which leads to size/date discrepancy
  • excessive nausea/vomiting, abdominal pain

Risks:

  • choriocarcinoma (cells become malignant)
    • repeat mole

Tx: remove uterine contents (D+C) – necessary

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69
Q

Ectopic Pregnancy

A

implantation of fertilized embryo occurs somewhere outside the uterus

the pregnancy cannot continue since the embryo cannot survive without supportive environment of uterus

most do occur in the fallopian tubes

first symptom is pain associated with the fact that embryo is growing where it shouldn’t

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70
Q

causes of ectopic pregnancy

A

could be result of pelvic inflammatory disease

scarring or fibrosis in the tube
(can come from endometriosis or previous pelvic or tubal surgery)

IUD use

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71
Q

if ectopic pregnancy, patient presents with

A

amennorhea, nausea, vomiting

positive pregnancy test

sharp 1-sided abdominal pain with referred shoulder pain

vaginal spotting

low serum progesterone and low HCG levels

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72
Q

ectopic pregnancy diagnosis is made with what tool?

A

transvaginal ultrasound (woman inserts in her vagina and technician then manipulates)

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73
Q

Treatment of ectopic pregnancy in Fallopian Tubes (medical, surgical, emotional)

A

Medical:
If tube not ruptured, Methotrexate IM to dissolve embryo

Surgical:

  • If tube not ruptured, laparoscopic salpingostomy to remove products of conception and salvage the tube
  • If tube is ruptured, laparoscopic salpingectomy

Counseling

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74
Q

When does Spontaneous Abortion occur, and what are the signs?

A
  • Before 20 weeks of gestation
  • bleeding, cramping, abdominal pain, decreased symptoms of pregnancy
  • most common in first trimester
  • D & C if necessary
  • Emotional support
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75
Q

Incompetent Cervix
 aka Cervical Insufficiency

A
  • Painless dilation and cervical effacement
  • Before second trimester
  • Bedrest until cerclage
  • Cerclage:
    McDonald
    Shirodkar
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76
Q

haploid

A

The total number of chromosomes is a multiple of the haploid number of 23 (69 or 92 total chromosomes)

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77
Q

After 20 weeks vs. before 20 weeks

A

before 20 weeks: abortion

20 weeks: pre-term delivery

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78
Q

Another structural abnormality occurs when all or part of a chromosome is attached to another – this is called

A

translocation

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79
Q

Most common cause of Spontaneous Abortion

A

chromosomal anomalies

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80
Q

Teratogens

A

are agents in the fetal environment that either cause or

increase the likelihood that a birth defect will occur.

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81
Q

D+C

A

Dilatation and curettage

(stretching the cervical os to permit suctioning or scraping the
uterine walls)

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82
Q

3 types of spontaneous abortions:

A

threatened abortion
inevitable abortion
incomplete abortion

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83
Q

threatened abortion

A

vaginal bleeding occurs

cervix is still intact, as are the membranes

for this, when there has been bleeding, the treatment is bedrest, no sex

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84
Q

inevitable abortion

A

cervix has dilated, bleeding will continue, membranes have ruptured - eventually, the contents of the uterus will be expressed

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85
Q

incomplete abortion

A

all of the products of conception have not been expelled from the uterus - even more bleeding because placenta is still there

for this, they treat with D+C to make sure they removed all the contents

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86
Q

chorionic villus sampling (CVS)

A

a procedure to obtain a sample of chorionic villi for analysis of fetal cells.

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87
Q

placenta previa

A

abnormal implantation of placenta in the lower uterus

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88
Q

alpha-fetoprotein (MSAFP)

A

plasma protein produced by the fetus

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89
Q

neural tube defects

A

failure of the bony encasement of spinal cord or skull to close

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90
Q

Cerclage

A

treatment for Incompetent Cervix
 aka Cervical Insufficiency where they put in basically a suture that just closes the cervix around the 12-14 week

may be left in until around 36 week or later

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91
Q

Hyperemesis Gravidarum

A

Excessive vomiting
Unable to retain fluids, which can lead to:

Dehydration
Electrolyte imbalance
Acid-Base imbalance
Starvation Ketosis
Weight Loss
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92
Q

Treatment for Hyperemesis Gravidarum

A 
1. NPO + IVF
    Emotional Support
2. Slowly add food
    Monitor weight
    Continue support
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93
Q

Danger signs during second trimester

A 
vaginal bleeding
leaking amniotic fluid
glycosuria
abdominal pain
HTN/proteinuria
fundal height
absence of fetal movement
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94
Q

Rh Incompatibility

A

Rh- mom plus Rh+ dad

AKA

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95
Q

Rh Isoimmunization

A

antibodies (which can cross the placenta) destroy the baby’s RBCs resulting in massive hemolysis

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96
Q

RhoGAM is administered to every Rh- mother when?

A

28 -34 wks (prenatal dose)

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97
Q

RhoGAM is administered 24 to 72 hours post partum if

A

baby is Rh+

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98
Q

After delivery, if baby is Rh-, is RhoGAM needed?

A

no

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99
Q

Indirect Coombs

A

“antibody screen”

Measures number of Rh+ antibodies in mother’s blood

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100
Q

Direct Coombs

A

Detects antibody coated Rh+ cells in infant’s blood

Done after delivery on baby’s cord blood - this is done on all babies as part of their type and screen

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101
Q

Negative indirect coombs means

A

Mother given RhoGAM

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102
Q

Positive indirect coombs “sensitized” means

A

Fetus monitored for hemolytic disease of the newborn (erythroblastosis fetalis)

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103
Q

Low levels of MSAFP suggest ____. Elevated MSAFP levels are associated with ____

A

low = chromosomal abnormalities such as trisomy 21

elevated = open NTDs and
body wall defects.

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104
Q

The lecithin/sphingomyelin (L/S) ratio is a test for

A

estimating fetal lung maturity.

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105
Q

phosphatidylglycerol (PG) and phosphatidylinositol (PI)

A

two other components of
surfactant

The presence of PG and PI
phospholipids supports the likelihood that the fetal lungs are mature

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106
Q

ΔOD450 (delta OD450)

test

A

measure the optical density (OD) of the amniotic fluid stained
by bilirubin if the mother is Rh-negative and was sensitized after being exposed to Rh-positive blood.

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107
Q

karyotype

A

display imaged chromosomes from largest pair to smallest pair

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108
Q

PUBS

A

also called cordocentesis, involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy

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109
Q

late decelerations

A

decreases in the

FHR persisting after the contraction ends

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110
Q

amniotic fluid index (AFI)

A

A method that adds
the depths of amniotic fluid in four uterine quadrants

volume sums greater than 10 cm are considered reassuring

volume sums less than 5 cm are considered oligohydramnios

higher than 18 to 20 cm suggests excess amniotic fluid volume, or hydramnios

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111
Q

perinatologist

A

medical specialist in high-risk pregnancy care from about 20 weeks of gestation through 4 weeks postpartum

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112
Q

cervical dilation and evacuation (D&E)

A

removal of fetal

tissue, followed by vacuum or surgical curettage.

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113
Q

maceration of the fetus

A

discoloration, softening, and eventual tissue degeneration

– of the fetus

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114
Q

bicornuate uterus

A

uterus with 2 horns

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115
Q

cerclage procedure

A

suturing of the cervix to prevent early dilation

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116
Q

salpingectomy

A

removal of the tube

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117
Q

gestational trophoblastic disease

A

occurs when trophoblasts (peripheral cells that attach the fertilized ovum to the uterine wall) develop abnormally.

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118
Q

After 20 weeks of pregnancy, the two major causes of hemorrhage are

A

placenta previa and abrupto placentae (Separation of a normally implanted placenta before the fetus is born)

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119
Q

Preeclampsia

A

A systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater occurring after 20 weeks of pregnancy that is accompanied by significant
proteinuria (≥0.3 g in a 24-hour urine collection, which usually correlates with a random urine dipstick evaluation of ≥1+).

Edema, although common in preeclampsia, is now considered to be nonspecific because it occurs in many pregnancies not complicated by hypertension.

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120
Q

postictal

A

the unresponsive state after a seizure

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121
Q

ABO incompatibility

A

occurs when the mother is blood type O and the fetus is blood type A, B, or AB. Types A, B, and AB blood contain a protein component (antigen) that is not present in type O blood.

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122
Q

Treatment of preeclampsia includes

A

reduced activity, reduction of environmental stimuli, and administration of medications to prevent generalized seizures.

and magnesium sulfate, but this can have serious CNS depression side effects

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123
Q

polydipsia

A

thirst

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124
Q

osmotic diuresis in diabetes

A

The kidneys attempt to excrete large volumes
of fluid in the vascular bed and the heavy solute load of glucose

produces the second hallmark of diabetes, polyuria and glycosuria

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125
Q

ketosis

A

accumulation of acids in the

body

126
Q

glycosuria

A

glucose in urine

127
Q

Without glucose the cells starve,
so weight loss occurs, even though the person ingests large amounts
of food, which is called ____.

A

polyphagia

128
Q

gluconeogenesis

A

formation of glycogen from noncarbohydrate sources such as proteins and fat

129
Q

macrosomia

A

fetus that weighs more than 8.8 lb

[4000 g]

130
Q

shoulder dystocia

A

delayed or difficult birth of fetal shoulders after the head is born

131
Q

caudal regression syndrome

A

failure of sacrum, lumbar spine, and lower extremities to develop

132
Q

In addition to having an increased risk for congenital anomalies,
the infant of a mother with preexisting diabetes has an increased
risk for

A

hypoglycemia, hypocalcemia, hyperbilirubinemia, and

respiratory distress syndrome

133
Q

Viral infections that occur during pregnancy can be transmitted to the fetus in two ways:

A

across the placental barrier or by exposure to organisms during birth

134
Q

Dystocia is

A

a general term that describes any difficult

labor or birth.

135
Q

hydramnios

A

excess volume of amniotic fluid

136
Q

Hypotonic labor dysfunction

A

or secondary arrest, usually occurs

during the active phase of labor, when progress normally quickens.

137
Q

abruptio placentae

A

premature separation of placenta

138
Q

Hypertonic labor dysfunction

A

is less common than hypotonic dysfunction and more often affects women in early labor with their first baby.

Contractions are uncoordinated and erratic in their frequency, duration, and intensity. The contractions are painful but ineffective.

Hypertonic dysfunction usually occurs during
the latent phase of labor.

139
Q

Tocolytic drugs

A

drugs that inhibit uterine contractions

140
Q

cephalopelvic disproportion

A

The head or shoulders may not be

able to adapt to the pelvis if they are too large

141
Q

uterine rupture

A

tear in uterine wall

142
Q

Precipitate labor

A

one in which birth occurs within 3 hours of its
onset.

Intense contractions often begin abruptly rather than gradually increasing in frequency, duration, and intensity, as is typical of most labors.

143
Q

Precipitate birth

A

occurs after a labor of any length, in or out of the hospital or birth center, when a trained attendant is not present to assist.

144
Q

Chorioamnionitis

A

(intraamniotic infection), or inflammation of
the membranes, which may be associated with group B streptococci, Neisseria gonorrhoeae, Listeria monocytogenes, or species from
the general Mycoplasma, Bacteroides, and Ureaplasma in the amniotic fluid

145
Q

oligohydramnios

A

loss of the amniotic fluid cushion for the fetus.

146
Q

Preterm labor

A

begins after the 20th week but before the end of the 37th week of pregnancy.

147
Q

Amniocentesis

A

transabdominal puncture of amniotic sac

may be done to obtain amniotic fluid for culture if chorioamnionitis is suspected because this infection would contraindicate stopping preterm labor.

148
Q

placenta accreta

A

an abnormally adherent placenta

sometimes associated with Placenta previa (abnormal implantation of the placenta in lower uterus)

149
Q

Occult (hidden) prolapse

A

The cord is compressed between the fetal presenting part and pelvis but cannot be seen or felt during vaginal examination.

the cord slips alongside the
fetal head or shoulders.

The prolapse cannot be palpated or seen but
is suspected because of changes in the FHR, such as sustained bradycardia or variable decelerations.

150
Q

Cord prolapsed in front of the fetal head

A

The cord cannot be seen but can probably be felt as a pulsating mass during vaginal examination.

151
Q

Complete cord prolapse

A

The cord can be seen protruding from the vagina.

152
Q

Uterine Inversion

A

An inversion occurs when the uterus completely or partly turns inside
out, usually during the third stage of labor. Such an event is uncommon but potentially fatal.

153
Q 
anaphylactoid syndrome, often called amniotic 
fluid embolism (AFE), occurs when
A

amniotic fluid is drawn into the

maternal circulation and carried to the woman’s lungs.

154
Q

Nursing care for the woman at risk for a preterm birth before 34 weeks of gestation focuses on

A

helping her delay birth long enough to provide time for fetal lung maturation with corticosteroids,

allow transfer to a facility that has neonatal intensive care,

or reach a gestation at which the infant’s problems with immaturity are less.

155
Q

The main risk in prolonged pregnancy is

A

reduced placental function.

This may compromise the fetus during labor and result in meconium aspiration in the neonate.

156
Q

The key intervention for umbilical cord prolapse is to

A

relieve pressure on the umbilical cord and to expedite delivery.

157
Q

S+S of uterine rupture

A

signs of shock, abdominal pain, a sense of
tearing, chest pain, pain between the scapulae, abnormal fetal heart rate patterns, cessation of contractions, and palpation of the fetus
outside the uterus.

158
Q

Anaphylactoid syndrome (formerly amniotic fluid embolism) is more likely to occur when

A

labor is intense and the membranes have

ruptured.

159
Q

Amniotomy

A

artificial rupture of the amniotic sac

160
Q

chorioamnionitis

A

inflammation of the amniotic sac, usually caused by bacterial and viral infections

161
Q

Vasa previa

A

in which fetal umbilical cord vessels branch over the amniotic sac rather than inserting into the placenta; fetal hemorrhage is a possibility if the membranes rupture

162
Q

cephalopelvic disproportion

A

fetal head that is too large to fit through the mother’s pelvis

163
Q

umbilical cord around the fetal body or neck

A

nuchal cord

164
Q

chignon

A

Temporary caput or scalp edema

is common at the location of the vacuum extractor cup.

165
Q

Infants born between 34 and 37 weeks of gestation are called

A

late preterm infants (LPIs) because they have many needs that are similar to those of preterm infants.

166
Q

Preterm infants

A

born before the

beginning of the 38th week of gestation

167
Q

Low birth weight (LBW)

A

infants weighing 5 lb, 8 oz (2500 g) or less at birth and of any gestational age

168
Q

Extremely-low-birth-weight (ELBW)

A

weigh 2 lb, 3 oz (1000 g) or less at birth.

169
Q

Very-low-birth-weight (VLBW)

A

weigh 3 lb, 5 oz (1500 g) or less at birth.

170
Q

Periodic breathing

A

the cessation of breathing for 5 to 10 seconds without other changes followed by 10 to 15 seconds of rapid respirations

Changes in color or heart rate do not occur.

171
Q

Apneic spells

A

involve absence of breathing lasting more than 20 seconds or less if accompanied by cyanosis, pallor, bradycardia, or hypotonia

172
Q

Signs of Inadequate Thermoregulation

A 
Axillary temperature 98.4°F (36.9°C)
Abdominal skin temperature 97.7°F (36.5°C)
Poor feeding or feeding intolerance
Irritability followed by lethargy
Weak cry or suck
Decreased muscle tone
Cool skin temperature
Mottled, pale, or acrocyanotic skin
Signs of hypoglycemia
Signs of respiratory difficulty
Poor weight gain, if chronic
173
Q

urine specific gravity in dehydration and over hydration in newborn

A

dehydration - USG > 1.01

over hydration -

174
Q

Containment

A

simulates the enclosed space of the uterus,
prevents excessive and disorganized motor activity, and is comforting
to infants. It involves keeping the extremities in a flexed position with
swaddling, positioning devices, or with the nurse’s hands.

175
Q

Corrected or developmental age is

A

the chronologic age minus the number of weeks the infant was born early

176
Q

compliant vs noncompliant lungs

A

compliant = elastic

noncompliant = stiff

177
Q

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease, is

A

a chronic condition in which damage to the infant’s lungs requires prolonged dependence on supplemental oxygen. It occurs most often in infants less than 32 weeks’ gestational age and in one third of VLBW infants.

178
Q

Intraventricular hemorrhage (IVH) is also called germinal matrix hemorrhage and periventricular-intraventricular hemorrhage. It is

A

bleeding into and around the ventricles of the brain.

The first few days of life are the
most common times for hemorrhage to occur.

It may also occur in term infants from asphyxia or trauma

179
Q

Retinopathy of prematurity (ROP) is

A

a condition where injury to the blood vessels in the eye may result in visual impairment or blindness in preterm infants.

It occurs more often in preterm infants weighing less than 1000 g and less than 29 weeks of gestational age

180
Q

Necrotizing enterocolitis (NEC) is

A

a serious inflammatory condition

of the intestinal tract that may lead to cellular death of areas of intestinal mucosa.

181
Q

Short bowel syndrome (SBS) is

A

a condition caused by a bowel that is
shorter than normal.

It is caused by congenital malformations of the GI tract or surgical resection that decreases the length of the small intestines.

182
Q

Postterm infants are those who are born after

A

the 42nd week of gestation.

183
Q

If placental insufficiency is present, decreased amniotic fluid volume (oligohydramnios) and compression of the umbilical cord may occur. The fetus may not receive the appropriate amount of oxygen and nutrients and may be small for gestational age. This condition results in hypoxia and malnourishment in
the fetus and is called

A

postmaturity syndrome

184
Q

Small-for-gestational-age (SGA) infants are those who fall below the
____ percentile in size on growth charts.

A

tenth

185
Q

LARGE-for-gestational-age (LGA) infants are those who fall above the
____ percentile in size on growth charts.

A

90

186
Q

Late preterm infants, born between 34 and 36 weeks, are at risk for

A

respiratory, thermoregulation, and feeding problems as well as hypoglycemia, hyperbilirubinemia, acidosis, and sepsis.

187
Q

Preterm infants differ in appearance from full-term infants. Some differences include:

A

small size, limp posture, red skin, abundant

vernix and lanugo, and immature ears and genitals.

188
Q

The ____ position is used for preterm infants because it decreases breathing effort and increases oxygenation.

A

prone

189
Q

Common complications of preterm birth are (6):

A 
respiratory distress syndrome
bronchopulmonary dysplasia
intraventricular hemorrhage
retinopathy of prematurity
necrotizing enterocolitis
short bowel syndrome
190
Q

Infants with postmaturity syndrome may appear:

A

thin with loose skin folds
cracked and peeling skin
meconium staining

They may have respiratory difficulties at birth and suffer from hypoglycemia and inadequate temperature regulation.

191
Q

In symmetric growth restriction, the infant is proportionally small; in asymmetric growth restriction, the head and length are _____ and the body is ____.

A

normal

thin

192
Q

Asphyxia is

A

insufficient oxygen and excess carbon dioxide in the blood and tissues.

193
Q

transient tachypnea of the newborn (TTN)

A

develop rapid respirations soon after birth from inadequate absorption of fetal lung fluid.

Although the condition usually resolves within 24 to 48 hours, it is the most common respiratory cause of admission to NICU

194
Q

Meconium aspiration syndrome (MAS) is

A

a condition in which there is obstruction, chemical pneumonitis, and air trapping caused by meconium in the lungs.

195
Q

Persistent pulmonary hypertension of the newborn (PPHN) is a

A

a condition in which pulmonary vascular resistance remains high after birth and right-to-left shunting of blood occurs, causing severe respiratory difficulty.

196
Q

bilirubin encephalopathy

A

the acute manifestation of bilirubin toxicity

can lead to kernicterus

197
Q

kernicterus

A

the chronic and permanent result of bilirubin toxicity.

In this condition, bilirubin deposits cause yellowish staining of the brain, especially
the basal ganglia, cerebellum, brainstem, and hippocampus.

198
Q

erythroblastosis fetalis

A

agglutination and hemolysis of fetal erythrocytes from maternal-fetal blood incompatibility

199
Q

hydrops fetalis

A

a severe anemia that results in heart failure and generalized edema.

200
Q

Phenylketonuria (PKU) is

A

a genetic disorder that causes CNS injury

from toxic levels of the amino acid phenylalanine in blood.

201
Q

Gastroschisis

A

a defect to the side of the abdomen, through which the intestines protrude.

They are not covered by peritoneum or skin and float freely in the amniotic fluid.

202
Q

esophageal atresia (EA)

A

the esophagus is most commonly divided into two unconnected segments (atresia) with a blind pouch at the proximal end.

The cause is a failure of normal development during the fourth week of
pregnancy.

203
Q

tracheoesophageal fistula

A

If the distal end is of the esophagus is connected to the trachea

The cause is a failure of normal development during the fourth week of
pregnancy.

204
Q

omphalocele

A

the intestines protrude into the base of the umbilical cord.

205
Q

Spina bifida is

A

failure of the vertebral arch to close.

It is seen by a dimple on the back, which may have a tuft of hair over it.

206
Q

Meningocele is

A

protrusion of meninges and spinal fluid through the spina bifida, covered by skin or a thin membrane.

Because the spinal cord is not
involved, paralysis does not occur.

207
Q

Myelomeningocele

A

protrusion of a membrane-covered sac through the spina bifida.

The sac contains meninges, nerve roots, the spinal cord, and spinal fluid.

The degree of paralysis depends on the location of the defect.

The infant may also have hydrocephalus, or it may develop after surgery.

208
Q

Ventricular septal defect

A

is the most common type of
congenital heart defect.

It occurs alone or with other defects.

The opening in the septum ranges from the size of a pin to very large.

209
Q

Patent ductus arteriosus is

A

a failure of the ductus arteriosus

to close after birth.

210
Q

In coarctation of the aorta,

A

blood flow is impeded through a constricted area of the aorta near the ductus arteriosus, increasing pressure behind the defect.

The blood pressure is higher in the upper extremities than in the lower extremities.

211
Q

Tetralogy of Fallot has four characteristics:

A
  1. a ventricular septal defect
  2. aorta positioned over the ventricular defect
  3. pulmonary stenosis
  4. hypertrophy of the right ventricle.
212
Q

In transposition of the great arteries, the positions of the ____ and the _____ are reversed.

A

the aorta and the pulmonary artery

213
Q

ACyanotic Heart Defects example

A

Patent ductus arteriosus

214
Q

Cyanotic Heart Defects example

A

transposition of the great vessels

215
Q

Left-to-Right Shunting Defects examples

A

ventricular septal defects and

patent foramen ovale.

216
Q

Defects with Obstruction of Blood Outflow examples

A

Coarctation of the aorta and

stenosis of the pulmonary or aortic valves

217
Q

Defects with Decreased Pulmonary Blood Flow example

A

tetralogy of Fallot

218
Q

Cyanotic Defects with Increased Pulmonary Blood Flow example

A

transposition of the great vessels

219
Q

Asphyxia before or during birth may cause

A

apnea, acidosis, pulmonary hypertension, and possible death.

Neonatal resuscitation must
be initiated immediately.

220
Q

In transient tachypnea of the newborn, respiratory difficulty in infants is caused by

A

failure of fetal lung fluid to be absorbed completely.

It usually resolves spontaneously with supportive care.

221
Q

Nonphysiologic jaundice appears ____.

Bilirubin levels rise ____ and than in physiologic jaundice. If untreated it may result in injury to the brain.

A

in the first 24 hours of life.

faster

222
Q

Infants with polycythemia have increased viscosity of blood that may cause

A

thromboemboli, stroke, hyperbilirubinemia, and other complications.

223
Q

Infants with phenylketonuria must be on a ____ diet to prevent severe intellectual disability.

A

low phenylalanine

224
Q

How do we determine if it’s amniotic fluid in PROM

A

Nitrazine paper to test the pH

or send to the lab and see that the fluid has the appearance of ferns under the microscope i.e. ferning

225
Q

About 50% of the time when there’s PROM but no contractions,

A

the mom will go into labor in about 24 hours

the next 25% will go within 48 hrs

226
Q

Criteria influencing the treatment plan for PROM

A

Establish gestational age

Ultrasound to assess fetus

227
Q

If LMP July 16, 2011, what is EDC?

A

May 1, 2012

228
Q

polyhydramnios

A

excessive amniotic fluid

229
Q

twin-to-twin transfusion

A

a serious disorder that occurs in identical twins and higher order multiples who share a placenta.

This occurs when the blood vessels of the babies’ shared placenta are connected.

This results in one baby (this twin is referred to as the recipient) receiving more blood flow, while the other baby (this twin is referred to as the donor) receives too little.

230
Q

Generally speaking, if a pregnancy is triplets or more, they will be delivered at what kind of center?

A

Level 3 perinatal center with associated NICU

231
Q

Preterm Labor “PTL” - weeks, contractions, effacement and dilation

A

Gestation 20-37 wks
Persistent uterine contractions - more than 6 in an hour- (4 every 20 mins or 8 per hour)
Cervical effacement at least 80%
Cervical dilation of more than 1 cm

232
Q

Risk factors for preterm labor

A 
Lack of prenatal care
Stress
Uterine anomalies
Multiple gestation
Polyhydramnios
Hx or current UTI
233
Q

Tocolysis

A

medication to inhibit labor

234
Q

Treatment for Preterm Labor If fetus viable:

A

-> hydrate

if contractions subside:
home on bedrest
no work
no sex
no distress
stress reduction
235
Q

General notes for treatment of preterm labor

A

Careful maternal monitoring and FHR monitoring

Identify and report symptoms of fetal hypoxia

236
Q

Treatment for Preterm Labor If fetus viable and labor is progressing

A

-> hydration

-> tocolysis
Nifedipine
MgSO4
Propranolol

-> corticosteroids (every 12 hrs for a couple days)
Dexamethasone
Betamethasone

237
Q

tocolysis meds for PTL patients

A

Nifedipine
MgSO4 (magnesium sulfate)
Propranolol

238
Q

3 types of hypertension that occur during pregnancy

A
  1. Chronic hypertension – not a function of pregnancy
    Present before pregnancy (therefore, in first trimester also)
    Possibly undiagnosed before prenatal visits
  2. Gestational/Transient [aka Pregnancy-induced hypertension]
    Develops in 2nd trimester
    Hypertension with NO OTHER SYMPTOMS
  3. Preeclampsia –> eclampsia
    Hypertension
    Proteinuria
239
Q

chronic hypertension

A

Present before pregnancy (therefore, in first trimester also)

Possibly undiagnosed before prenatal visits

240
Q

Gestational/Transient [aka Pregnancy-induced hypertension]

A

Develops in 2nd trimester
Hypertension with no other symptoms

treated with anti-hypertensive

241
Q

If patient is in first trimester and has hypertension diagnosed, is it a function of pregnancy?

A

No

242
Q

Preeclampsia –> eclampsia

A

Hypertension

Proteinuria

243
Q

What is the Second leading cause of maternal death - about 1/10-15 pregnancies?

A

Preeclampsia

244
Q

Certain populations more at risk for pre-eclampsia

A

Age 35
Race – higher in African Americans
Socioeconomic status – lower asso. W/poor diets, increase in smoking
Primagravida 6-8 times more likely to develop PIH

Genetic predisposition , oxidative stress, and the release of immune factors cause placental dysfunction

Eclampsia is grand mal seizures as a result of the progression of preeclampsia
Eclampsia does not have a B/P correlation, or proteinuria, etc.
Mild pre can cause eclampsia

245
Q

Symptoms of preeclampsia

A

B/P > 140/90 @ 20 wks or more
Proteinuria
Sometimes: pitting pedal edema, facial edema

246
Q

Medical Management of preeclampsia - goals and meds

A
  • > stabilize blood pressure

  • > prevent eclampsia

nifedipine, hydralazine, labetolol

247
Q

eclampsia

A

seizures and coma

248
Q

Signs of mild preeclampsia (systolic, diastolic, proteinuria)

A

Systolic 140-160
Diastolic 90-110
Proteinuria 3-5 gm in 24˚

249
Q

Signs of severe preeclampsia (systolic, diastolic, proteinuria)

A

Systolic > 160
Diastolic > 110
Proteinuria > 5 gm in 24˚

250
Q

Medical Management to prevent eclampsia in patients with uncontrolled or high HTN

A
  • Bedrest
  • EFM
  • IVF (NPO in case of c/s)
  • Antihypertensive therapy:
    labetalol, hydralazine
    Magnesium Sulfate to prevent seizures
  • Fetal gestation >34 wks –> deliver
  • Corticosteroids
251
Q

purpose of Magnesium Sulfate is to prevent

A

seizures

252
Q

What is the focused assessment for a pt being tx with MgSO4?

A
  • Vital signs -> blood pressure, temperature, FHR
  • Neuro -> level of consciousness (A&Ox4), confusion, deep tendon reflexes, visual disturbances
  • Pain -> headache, epigastric pain from liver
  • Respiratory -> respirations and sPO2, coughing, SOB, dyspnea, rales/rhonchi
  • Uterus/Placenta -> uterine rigidity, vaginal bleeding
  • Urine -> output, protein, specific gravity
    Weight (daily), pedal edema
  • Labs
  • P/S -> emotional state, knowledge -> teaching
253
Q

key nursing intervention on MgSO4 is to assess

A

deep tendon reflexes

if they become diminished, it’s a clear indicator that MgSO4 is reaching toxic levels and should be discontinued

254
Q

If patient develops any signs of MgSO4 toxicity, the first step is always

A

stopping the infusion

255
Q

For Magnesium Sulfate induced
Respiratory Depression or Respiratory Arrest,
institute Emergency Treatment (5 steps):

A
  • STOP infusion immediately.
  • Oxygen at 10LPM via face mask
  • GIVE Calcium Gluconate 1 Gram slow IVP
    (in Pre-eclampsia tray or Crash cart)
  • Continuous Pulse Oximetry and ECG monitors
  • Contact anesthesia for airway management (Rapid Response)
256
Q

Antidote for Magnesium Sulfate

A

Calcium Gluconate

257
Q

HELLP Syndrome - what is it and what are symptoms, what can it lead to and how do you treat?

A

Hemolysis, Elevated Liver enzymes and Low Platelets

Variant or Complication of Preeclampsia

Flu-like symptoms
Epigastric pain from distended liver
Jaundice

Multiple system organ failure

FFP or platelet transfusion
Delivery ASAP

258
Q

What is the best treatment for HELLP

A

Delivery ASAP

259
Q

Danger signs - 3rd trimester

A

Vaginal bleeding
Abdominal pain
Fundal height
Leaking amniotic fluid Absence of fetal movement
Glycosuria
HTN/Proteinuria
Abnormal fetal heart rate

260
Q

All pregnant women are screened for GBS between ___ wks gestation via vaginal swab. If culture is positive, IV antibiotics are administered when?

A

35-37

at delivery

261
Q

When is HIV retesting done during pregnancy?

A

34-36 wks

262
Q

Chorioamnionitis can progress to

A

Septicemia (affecting both mom and baby)

263
Q

How is Placenta Previa diagnosed?

A

prenatal ultrasound

264
Q

Hemorrhagic Disorders: Placenta Previa

A

Painless bright red vaginal bleeding in third trimester
Presenting part – not engaged
Possibly transverse lie

Medical Management
No vaginal examinations!

  • > c/s
  • > NSVD possible for high partial
265
Q

marginal/low-lying placenta previa

A

not covering cerivical os

potential for vaginal delivery

266
Q

partial placenta previa

A

partially covering cervical os

risk of injury to placenta with vaginal exam

267
Q

complete placenta previa

A

covers the cervical os completely

268
Q

Hemorrhagic Disorders: Abruptio Placenta

A

Separation of the placenta from the uterine wall
Dx – ultrasound, clinical presentation

Severe pain and dark vaginal bleeding in third trimester
Not in labor or
Labor could be progressing normally
Classic symptom - “board-like” pressure

269
Q

NSVD possible for Abruptio Placenta patient IF:

A 
If in labor
If minimal bleeding
If hemodynamically stable
No uterine tenderness
No fetal distress
270
Q

Moms at increased risk for Abruptio Placenta

A
  • smoker
  • hypertension
  • other causes of reduced oxygenation in the placenta
  • cocaine – causes infarcs in the placenta
271
Q

3 types of Abruptio Placenta

A

Marginal
Concealed
Complete

272
Q

Precipitous Delivery

A

Rapid intense contractions
Labor less than 3 hrs

potential complication: trauma to the cervix as result of insufficient time for it to dilate (if baby is descending too fast)

273
Q

Main nursing intervention with Precipitous Delivery

A

helping mom to control/avoid pushing with breathing techniques until cervix is dilated more

274
Q

Dystocia

A

Long, difficult, or abnormal labor

As a result of
Powers
Passenger
Passageway

275
Q

Dysfunctional Labor Pattern: Hypertonic

A

Strong, painful, ineffective contractions
Contributing factor: maternal anxiety
Occiput-posterior malposition of fetus

release of catecholamines which lead to myometrial dysfunction

***prolonged labor phase
fetal distress could occur early

276
Q

Dysfunctional Labor Pattern: Hypotonic

A

Contractions decrease in frequency, intensity

Maternal and fetal factors that produce excessive uterine stretching

most common: too many drugs/pain meds

treatment: trying to stimulate contractions (enema, nipple stimulation, walking)

277
Q

Structural dystocia

A

Shoulder Dystocia –> McRoberts Maneuver
Cephalo-Pelvic Disproportion (CPD)
Fetal Anomalies
IDM or LGA

all of these are indicates for a c section

278
Q

Cephalo-Pelvic Disproportion (CPD)

A

baby’s head is too big to fit through pelvis

279
Q

Obstetric emergency if Uterine rupture comes with what kind of pain?

A

Sharp referred pain -> between scapula

280
Q

Uterine inversion

A

uterus follows the placenta out

requires Surgical repair

281
Q

Does Umbilical cord prolapse require c section?

A

yes

282
Q

Chorioamnionitis “chorio”

A
  • Maternal fever (100.4 F)

Plus

  • WBC > 15,000
  • Maternal tachycardia (> 100 bpm)
  • Fetal tachycardia (> 160 bpm)
  • Foul or strong-smelling amniotic fluid
  • Tender uterus
283
Q

____ are contraindicated in the presence of symptomatic Amniotic Fluid Infection.

A

Tocolytics

284
Q

Tachycardia in FHR

A

> 160 bpm

285
Q

Bradycardia in FHR

A
286
Q

Baseline FHR is

A

FHR between contractions i.e. when nothing is happening

287
Q

Closer to term, the ___ the resting heart rate can be

A

lower

normal could be 110-120 for a healthy full term baby

288
Q

Accelerations

A

jump of 15

indicate good CNS and responsiveness

289
Q

Variable decelerations are the result of

A

cord compression

onset varies with contractions

290
Q

Late deceleration caused by

A

utero-placental insufficiency (lack of oxygenation to the baby)

occurs at peak of contraction

291
Q

Early decelerations caused by

A

head compression

occurs at the beginning of the increment and peak of the contraction

292
Q

At the peak of the contraction, is there oxygen flowing to the baby?

A

no

293
Q

VEAL CHOP

A

Variable - cord compression

Early - head

Accelerations - OK

Late - placenta

294
Q

Are there interventions for early decelerations?

A

No

295
Q

What are the interventions for repeated variable or late decelerations?

A 
Discontinue oxytocin
Lateral position change
Increase IVF rate
Oxygen per face mask
Palpate for hyperstimulation
Notify HCP
296
Q

Post term Pregnancy

A

extends beyond 42 wks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction

297
Q

Indications for induction

A

Post term pregnancy
Premature Rupture of Membranes (PROM)
Chorioamnionitis
HTN: Chronic, Gestational, or Preeclampsia (mild)

Maternal co-morbidities:
Diabetes
Cardiac or Respiratory
Psychosocial (including hx precipitous or rapid labor and distance to hospital )

Fetal compromise:
Intrauterine growth restriction (IUGR)
Oligohydramnios
Isoimmunization
Fetal demise
298
Q

Bishop score

A

Determines how successful an induction of labor will be

299
Q

Mechanical induction

A

Amniotomy = AROM

Membrane Stripping

300
Q

Medication induction

A

Cervical Ripening:
dinoprostone insert or gel
misoprostol (off-label)
laminaria

Synthetic Oxytocin IV

301
Q

2 ways that labor is augmented (when cervix is not dilating)

A

Mechanical:
AROM
Membrane Stripping

Medication:
Synthetic Oxytocin IV

302
Q

Indications for Cesarean Section - STAT

A
  • Fetal distress (prolonged deceleration without recovery)
  • Umbilical cord prolapse
  • Placenta Abruptio
  • Uterine rupture
  • Hemorrhage
303
Q

Indications for Cesarean Section - Scheduled

A

Repeat
Multiples
Infection: HIV, active herpes lesions
Previous 4th degree perineal laceration

Scheduled during last weeks
Placenta Previa
Presentation: Breech, Transverse

304
Q

Indications for Cesarean Section - Non emergent

A

Failure to progress – prolonged labor
Failed labor induction
Macrosomia / CPD

Complications:
Preeclampsia and HELLP
Preterm labor (if progressing and 22-28 wks)

305
Q

Major risks of c section

A

Respiratory Depression
Anesthetic gases or medications (epi/spinal)
Maternal or Newborn respiratory depression

Infection
-> Pre-operative prevention
Surgical Care Improvement Project Measure

306
Q

General Anesthesia for c/s Preferred if

A
  • Platelet count is less than 100,000
  • Epidural/spinal is not effective
  • “STAT” emergency section for fetal or maternal distress
307
Q

Apnea of Prematurity

A

Apnea – not breathing >15 to 20 secs accompanied by pallor, hypotonia, cyanosis, and bradycardia

308
Q

severe vs moderate prematurity

A

Severe prematurity
22 to 26 weeks

Moderate prematurity
26 to 30 weeks

309
Q

GFR =

A

Grunting Flaring Retractions

310
Q

Treatment for Meconium Aspiration Syndrome

A

Suctioning before first breath to prevent aspiration pneumonia

311
Q

Symptoms of Sepsis

A 
Temperature Instability
Feeding 
Poor suck
Feeding intolerance 
Hypoglycemia
Respiratory - “GFR”
Hypotonia
312
Q

EMTALA

A

Emergency Medical Treatment and Labor Act
Federal law

Patients must be treated for all emergency conditions (including admission) regardless of ability to pay and can only be transported to another facility for a higher level of care.

OB (7 decks)

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