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Midwifery > High Risk Pregnancy Care > Flashcards

High Risk Pregnancy Care Flashcards

1
Q

Maternal complications from the effects of alcohol and nicotine use during pregnancy include what?

A

pre e, placental abruption, placenta previa, spontaneous abortion, ectopic pregnancy and PROM

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2
Q

What is the highest prevalence of women who smoke during pregnancy?

A

non-hispanic American Indian or Alaska native women

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3
Q

Up to how many days after birth can an infant show signs of NAS?

A

up to 14 days after birth

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4
Q

Birth defects, low birth weight, premature birth, small head circumference and SIDS are general effects of infants that were exposed to what in utero?

A

Opiods (prescription or heroin), barbs or benzos

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5
Q

What does TORCH stand for?

A

Toxoplasmosis, other (syphilis, varicella-zoster, parvo B19), rubella, cytomegalovirus and herpes

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6
Q

Fully cooking meat, avoiding unpasteurized milk/cheese, avoid handling kitty litter, avoid drinking untreated water and good handwashing following gardening are all prevention education that should be given in order to avoid which infection?

A

Toxoplasmosis

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7
Q

The greatest risk for congenital varicella syndrome occurs when the mother is infected in the first or last 20 weeks of pregnancy?

A

First

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8
Q

Maternal infection occurring from ____ days before to ____ days after delivery can be passed to newborn causing serious infection

A

6 days

2 days

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9
Q

A maculo-papular rash that becomes vesicles and then crusts by 1 week is c/w which virus?

A

Varicella

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10
Q

What antiviral agent can be given to mothers who have a severe varicella infection?

A

IV acyclovir

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11
Q

What do you give if a pregnant woman has been exposed and is susceptible to varicella?

A

varicella-zoster immunoglobulin (VZIG)

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12
Q

Disease transmission to fetus and likelihood of severe complications are highest in which trimester for parvovirus B19?

A

second trimester

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13
Q

What are 2 complications that can occur to the fetus if the mother has parvovirus B19?

A

Severe fetal anemia and hydrops fetalis

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14
Q

A discrete pinkish-red maculo-papular rash that appears first on the face then on the trunk and extremities with symptoms lasting 3 days is c/w which virus?

A

Rubella

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15
Q

What is the most common congenital infection?

A

cytomegalovirus (CMV)

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16
Q

Mononucleosis-like syndrome consisting of fever, chills, malaise, myalgia, leukocytosis and lymphadenopathy is c/w which virus?

A

CMV

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17
Q

Most cases worldwide are HIV 1 or HIV 2?

A

HIV 1

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18
Q

Which screening test is used for HIV?

A

enzyme immunoassay (EIA or ELISA)

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19
Q

Which cells are a type of white blood cell that plays a vital role in the immune system?

A

CD4

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20
Q

What is the strongest predictor for vertical transmission and at what point should you offer a cesarean?

A

Viral load

Consider a cesarean at 38 weeks if viral load is >1000 copies/mL

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21
Q

Which IV highly active antiretroviral therapy (HAART) is indicated during labor for the HIV positive woman?

A

zidovudine

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22
Q

What two things is an infant at risk for if their mother was infected with Zika during pregnancy?

A

Microcephaly and severe brain damage

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23
Q

A prenatal diagnosis that is based on u/s measurements used to describe impaired or restricted intrauterine growth and considered a pathologic process is what?

A

IUGR

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24
Q

A neonatal diagnosis that describes an infant who falls <10th %tile is what?

A

SGA

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25
Q

Occurs early in pregnancy and is likely caused by congenital infections, chromosomal abnormalities and maternal drug use (tobacco, alcohol, dilantin, cocaine, heroin) is which growth restriction (symmetric or asymmetric)?

A

Symmetric

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26
Q

Appears later in pregnancy and is r/t either reduced nutrition to fetus causing decreased abdominal circumference or abnormalities in utero-placental perfusion causing a head sparing appearance is which growth restriction (symmetric or asymmetric)?

A

Asymmetric

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27
Q

Newborns weighing over _____ or are > ____ %tile are considered LGA/macrosomic?

A

4000g (4500g in some studies) or 90th %tile

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28
Q

Which term refers to placentation of twins and is most reliable when assessed in the first trimester?

A

Chronicity

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29
Q

Use of fertility drugs increases the chance of which zygosity in twins?

A

Dizygotic (DZ) (fraternal)

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30
Q

What three things must happen for Rh isoimmunization to occur?

A

Fetus must be D+ and mother D-
Mother must be sensitized
Sufficient quantities of fetal cells must gain access to the mothers blood stream

31
Q

How long is Rho (D) immunoglobulin (Rhogam) protective for?

A

12 weeks

32
Q

What condition is the #1 reason for hospitalization in the first trimester?

A

Hyperemesis gravidarum (HG)

33
Q

What are some of the typical criteria for HG?

A

severe/intractable vomiting with unknown etiology, weight loss of >5% pre pregnancy weight, ketouria, electrolyte imbalance, thyroid/liver lab abnormalities

34
Q

What are four different medications that can aid with HG?

A

Pyridoxine, diclegis, metoclopramide and promethazine

35
Q

Cough with minimal sputum production, low grade fever, hemoptysis and weight loss and c/w which infection?

A

Tuberculosis

36
Q

What medication do you treat a woman with during pregnancy if she has latent TB infection?

A

Isoniazid (INH)

37
Q

Serum hCG is positive ___ to ____ days after fertilization?

A

8-9 days

38
Q

Appearance of signs and symptoms of possible loss of fetus (vaginal bleeding with or without intermittent pain) is which type of abortion?

A

Threatened

39
Q

When the cervix is dilating, that is considered which type of abortion?

A

Inevitable

40
Q

An abortion where part of the products of conception has been retained is considered what?

A

Incomplete abortion

41
Q

You should be able to visualize an IUP trans-abdominally at an hCG level of ____ and trans-vaginally at an hCG level of ____.

A

6500

2000

42
Q

A _____ abortion is when all the productions of conception have been expelled.

A

Complete

43
Q

Hcg levels higher than _____ are highly suggestive of _____.

A

> 100,000

Hydatidiform mole

44
Q

Three or more consecutive abortions is termed _____ pregnancy loss.

A

Recurrent

45
Q

Severe abdominal pain (often unilateral), CMT and serum b-hCG usually <6500 is c/w which diagnosis?

A

Ectopic pregnancy

46
Q

Hcg levels higher than _____ are highly suggestive of _____.

A

> 100,000

Hydatidiform mole

47
Q

An abruption that occurs between the placenta and amniotic fluid is a _______ abruption.

A

Preplacental

48
Q

Previous mid trimester loss, cervical surgery and DES are risk factors for what and what can you do?

A

Cervical insufficiency

Cervical cerclage after 12-14 weeks

49
Q

A partial abruption that is between the placenta and membranes is called what?

A

Subchorionic

50
Q

A partial abruption that is between the placenta and myometrium is called what?

A

Retro-placental and has a worse prognosis than sub-chorionic hemorrhage

51
Q

Normal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall is called what?

A

Placenta accreta

52
Q

Seizure frequency and severity is likely to increase or decrease during pregnancy with a diagnosis of epilepsy?

A

Increase

53
Q

Which seizure medications should be avoided during pregnancy?

A

Valproate and Phynetoin

54
Q

What is the safest anti-epileptic drug to take in pregnancy?

A

Carbamazepine (Tegretol)

55
Q

What is the definition of thrombocytopenia in pregnancy?

A

<150,000 platelet count

56
Q

What is the most common etiology of thrombocytopenia?

A

Gestational thrombocytopenia (GT)

57
Q

Which ethnicity is affected the most by stillbirth?

A

Non-hispanic black women

58
Q

Which medication can be used for treatment or prophylaxis of VTE in pregnancy because it does not cross the placenta?

A

Unfractionated/low-molecular weight (LMW) Heparin

59
Q

Blood pressure >140/90 diagnosed before pregnancy, before 20 weeks gestation or after 12 weeks postpartum is which diagnosis?

A

Chronic hypertension

60
Q

New onset blood pressure after 20 weeks gestation without proteinuria is which diagnosis?

A

Gestational hypertension

61
Q

Two blood pressures > ___/___ on two occasions at least 4 hours apart after ____ weeks gestation is preeclampsia.

A

> 140/90

> 20 weeks gestation

62
Q

What does HELLP stand for?

A

Hemolytic anemia, elevated liver enzymes and low platelet count that can occur AP or PP

63
Q

What are 3 first line antihypertensives for women who require pharmacologic therapy for chronic hypertension?

A

Labetolol, nifedipine and methyldopa

64
Q

What are the five severe features that, even when proteinuria is not present, can be paired with a new onset of HTN >20 weeks in pregnancy to warrant a diagnosis of preeclampsia?

A

Thrombocytopenia (platelets <100,000), renal insufficiency (serum creatinine >1.1mg/dL), impaired liver function, pulmonary edema, cerebral or visual symptoms

65
Q

What is are three known insulin antagonist that contribute to GDM?

A

hPL, progesterone, and estrogen

66
Q

In a two step appraoach to diagnose GDM, a BSG level of ______ on 1 hour screening warrants further testing with the 3hr gtt.

A

130 mg/dL

67
Q

What are the abnormal values used to diagnose GDM in the 2hr gtt, or one step approach?

A

Fasting: 95mg/dL or greater
1 hour: 180mg/dL or greater
2 hour: 155mg/dL or greater

68
Q

What is the first line therapy recommended for medical management of GDM and why?

A

Insulin

Does not cross the placenta

69
Q

When should antenatal testing (NST, BPP) begin if poorly controlled GDM or requiring medication therapy without other comorbidities?

A

32 weeks

70
Q

What screening should be performed and when in the PP period if a woman was diagnosed with GDM?

A

75g 2 hour OGTT at 6-12 weeks PP

71
Q

A diagnosis of anemia can be made with hgb levels of

A

<11.0

<10.5

72
Q

At what hCG level should you be able to see a FHR on u/s?

A

5,000-6,000

73
Q

For a 3 hour gtt, what is the NDDG criteria?

A

Fasting: >105
1 hour PP: >190
2 hour PP: >165
3 hour PP >145

74
Q

For a 3 hour gtt, what is the carpenter/coustan criteria?

A

Fasting: >95
1 hour PP: >180
2 hour PP: >155
3 hour PP >140

Midwifery (10 decks)

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