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NM 702 Prenatal Care > Module 7 > Flashcards

Module 7 Flashcards

1
Q

CBC may be ordered when in pregnancy

A

1st prenatal visit

Repeated @ 28 weeks

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2
Q

Why CBC is ordered again at 28 weeks:

A

this is the time that the blood is most hemodiluted and thus the pregnant woman is most likely to be anemic

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3
Q

the average amount of oxygen-carrying hemoglobin inside a red blood cell

A

MCH (mean corpuscular hemoglobin)

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4
Q

calculation of the average concentration of Hgb inside a red cell

A

MCHC (mean corpuscular hemoglobin concentration)

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5
Q

macrocytic RBC= _____ MCH

A

high

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6
Q

microcytic RBC= ______ MCH

A

low

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7
Q

hypochromia which is seen in conditions where the Hgb is abnormally diluted inside the RBC, such as iron deficiency anemia and thalassemia = _____ MCHC

A

low

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8
Q

hyperchromia which is seen in conditions where the Hgb is abnormally concentrated inside of cells, such as in burn patients = ______ MCHC

A

high

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9
Q

a measurement of the average size of RBCs

A

MCV

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10
Q

macrocytic RBCs as in vitamin B12 deficiency (pernicious anemia) = _____ MCV

A

high

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11
Q

microcytic RBCs as in IDA or thalassemia= ______ MCV

A

low

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12
Q

measures the amount of oxygen-carrying protein in the blood

A

Hgb

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13
Q

measures the percentage of red blood cells in a given volume of whole blood

A

Hct

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14
Q

maternal plasma volume increases _____% on average, achieving a maximum level at approximately _____ weeks gestation

A

45% @ 32 weeks

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15
Q

Peak hemodilution occurs at ____-____ weeks

A

24 to 26

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16
Q

describes the proportionately greater increase in plasma volume as compared to the rise in RBCs

A

physiologic anemia

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17
Q

increased ____________ along with increase in _____________ ultimately expands the maternal blood volume by as much as 35 to 40%.

A

plasma volume; RBC mass

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18
Q

________ and __________ anemias can occur in pregnancy

A

acquired and hereditary

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19
Q

In ______________ anemia, the MCH, MCHC, and MCV are decreased

A

iron deficiency

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20
Q 
These are known as \_\_\_\_\_\_\_\_\_\_\_\_:
Hgb- hemoglobin
Hct- hematocrit
MCH- mean corpuscular hemoglobin
MCHC- mean cell hemoglobin concentration
MCV- mean corpuscular volume
A

RBC indices

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21
Q

reflect Hgb amount and characteristics

A

RBC indices

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22
Q

a microscopic examination that screens for abnormalities in the size, shape, color, or structure of RBCs

A

stained red cell smear

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23
Q

IDA causes ___________ and ___________ RBC which can be seen on a stained red cell smear

A

microcytic and hypochromic

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24
Q

assesses the body’s ability to defend itself and helps to determine if the body is threatened by infections, inflammation, or hematopoietic and hemolytic disease

A

WBC

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25
Q

identifies the percentage of each type of white blood cell

A

differential smear

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26
Q

eosinophils and basophils may ________ slightly in pregnancy

A

decrease

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27
Q

neutrophils may _________ slightly in pregnancy

A

increase

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28
Q

increased neutrophils in pregnancy are more __________ cells and the differential smear will show a shift to the ______

A

immature; left

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29
Q

measures the number of platelets in a given volume of blood

A

platelet (Plt) count

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30
Q

during normal pregnancy Plt count usually ___________ progressively with gestation

A

decreases

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31
Q

decreased platelet count is due to an ___________utilization of platelets during pregnancy

A

increased

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32
Q

__________ count is associated with HELLP syndrome, immunologic thrombocytopenia purpura, disseminated intravascular coagulation (DIC), acquired hemolytic anemia, septicemia, and lupus erythematosus

A

low platelet

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33
Q

At 1st prenatal visit, most often an_____________ test is used for the initial antibody screen, since this test is sensitive to anti-Rh antibodies

A

indirect Coombs

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34
Q

Women who test indirect Coombs positive are then tested for the specific __________ and _________

A

antibody and titer

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35
Q

done at the first visit to detect antibodies to Rh positive blood

A

indirect Coombs

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36
Q

women at increased risk for Syphillis should undergo a repeat test @ ____ weeks and @ ___________

A

28 weeks and delivery

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37
Q

VDRL (Venereal Disease Research Laboratories) or the RPR (rapid plasma reagin) is used to test for:

A

Syphillis

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38
Q

if VDRL/RPR is positive, a ________ is also drawn

A

titer

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39
Q

______ titer indicates active Syphilitic disease

A

high (>1:16)

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40
Q

______ titer indicates false positive for Syphilis in 90% of cases or late or latent syphilis or early primary syphilis

A

low (<1:8)

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41
Q

Treatment of primary syphilis usually causes a progressive decline to a negative VDRL/RPR titer within ___ years

A

2

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42
Q

In secondary, late, or latent syphilis, low titers persist in about ____% of cases 2 years after treatment, despite a fall in titer

A

50%

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43
Q

does not indicate treatment failure or reinfection because these patients are likely to remain positive even if retreated.

A

low titers in secondary, late, or latent syphilis

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44
Q

_________ usually indicate relapse, reinfection, or treatment failure of syphilis

A

increasing titers

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45
Q

________________ can occur in women with acute and chronic illnesses such as TB, infectious mononucleosis, rheumatoid arthritis, collagen vascular diseases, chlamydia infection, and hepatitis

A

false positive VDRL/RPR

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46
Q

if ____________ is positive, either the fluorescent treponemal antibody-absorption test (FTA-ABS) or the microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA) is ordered

A

VDRL/RPR

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47
Q

tests that specifically determine if the individual has developed antibodies to the spirochete

A

treponemal antibody-absorption test (FTA-ABS)

microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA)

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48
Q

A seropositive VDRL/RPR result indicates that the woman has been exposed to the spirochete and has developed ___________

A

antibodies

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49
Q

Since the syphillis antibody tests frequently remain positive even after successful treatment, clinicians use the ______of the VDRL or RPR to monitor treatment

A

titers

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50
Q

groups @ “high” risk for syphillis

A

women who live in area of high syphilis morbidity

women who were not tested at 1st prenatal visit

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51
Q

a viral infection that produces a rash and fever in adults and children

A

rubella “German measles”

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52
Q 
\_\_\_\_\_\_\_\_\_ has devastating fetal effects: 
Eye lesions
Hearing defects
Heart disease
IUGR
spleen and liver enlargement
CNS disorders
A

Rubella

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53
Q

The incidence of congenital rubella is highest when the woman contracts it during:

A

first 1/2 of pregnancy or shortly before conception

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54
Q

The most frequently used test to detect rubella antibodies in serum

A

hemagglutination inhibition test (HAI or HI)

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55
Q

immunity is confirmed if the rubella titer is ____ or more

A

1:8

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56
Q

Women who have a rubella titer less than _____may be considered to be “equivocal” and should be considered susceptible to rubella unless there is evidence of adequate vaccination or a subsequent serologic test result indicating rubella immunity

A

1:8

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57
Q

when titer is less than _____, the woman and fetus are at risk for contracting rubella

A

1:8

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58
Q

If a rash occurs, repeat rubella titers are obtained __-__ weeks after the onset and again in ___ weeks

A

2-3; 2

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59
Q

significant ____________ in the titer level from the one test to the next indicates that the rash was due to Rubella. At this time there is no treatment. The woman should be counseled about the impact of rubella infection on the fetus

A

increase

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60
Q

women at risk for contracting rubella

A

women with negative tests

women with titers < 1:8

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61
Q

women at risk for conracting rubella should be __________ shortly after delivery

A

vaccinated

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62
Q 
S/S of \_\_\_\_\_\_\_\_\_\_\_\_:
*may have no overt symptoms
nausea, vomiting
RUQ abdominal pain
enlarged and tender liver
fever
chills
general weakness
headache
A

Hep B

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63
Q

risk that the newborn will develop Hep B is ___-___% if the mother is positive for the Hep B surface antigen

A

10-20%

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64
Q

the risk for transmission of Hep B to newborns is as high as _____% if the mother is positive for Hep B surface antigen and also positive for the HbeAg

A

90%

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65
Q

Mothers with e antigen-positive blood are much _____ likely to transmit the Hep B surface antigen (HBsAg) to their children than those with HBsAgpositive, e antigen-negative blood

A

more

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66
Q

Hep B-Infected newborns usually become __________ and are at high risk for developing chronic liver disease.

A

Hep B carriers

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67
Q

test that screens for hepatitis B and is done routinely at the first prenatal visit

A

HBsAg

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68
Q

presence of _________ indicates that the patient either has a current acute Hep B infection or is a carrier

A

HBsAg

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69
Q

lab drawn to differentiate between Hep B infection and carrier state

A

HBeAg

70
Q

presence in serum indicates Hep B acute infection

A

HBeAg

71
Q

appears during acute or recent HBV infection and is present for about 6 months

A

(IgM) anti-HBc

72
Q

becomes predominant late in normal recovery and, together with HBsAb, may persist in noncarriers for many years

A

(IgM) anti-HBc

73
Q

a positive HBsAg test should be followed by a _______ test

A

HBeAg

74
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_\_:
current or past IV drug use
history of multiple STIs
being infected with HBV
being a prison inmate
being 22.5 years of age or older
having a sexual partner who abuses IV drugs
having 3 or more lifetime sexual partners.
A

Hep C

75
Q

Vertical transmission rate of HCV

A

4%

76
Q

Co-infection with HIV increases the chance of vertical HCV transmission by:

A

2-3x

77
Q

chronic hepatitis may lead to this complication of pregnancy

A

preterm labor

78
Q

useful test to detect hemoglobinopathies like Sickle cell anemia, thalassemia major, and hemoglobin C, which are common autosomal- recessive hemoglobinopathies

A

Hgb electrophoresis

79
Q

If one parent carries the sickle cell trait and the other parent carries the trait for either thalassemia or hemoglobin C, an individual has a ____% chance of inheriting sickle-thalassemia or hemoglobin SC disease

A

25%

80
Q

ethnicities at higher risk for hemoglobinopathies

A

African, Southeast Asian, and Mediterranean descent

81
Q

low risk ethnicities for hemoglobinopathies

A

northern Europeans, Japanese, Native Americans, Inuit (Eskimo), and Koreans

82
Q

________ individuals should be screened for hemoglobinopathies with a CBC, and _________ women should be screened with a CBC and hemoglobin electrophoresis

A

Non-African; Africa

83
Q

test that is best used in cases where the immediate result is necessary for immediate patient care, not as a screening test because it does not yield enough information to assist with diagnosing a potential hemoglobinopathy

A

solubility test (i.e. Sickledex)

84
Q

All women should be screened for Gestational Diabetes (GDM) in pregnancy between __________ weeks

A

24-28

85
Q

Women at high risk (history of GDM, women with known impaired glucose metabolism, and women with a BMI > 30) should be screened for GDM at this time

A

first OB appt AND @ 24-28 weeks

86
Q

amount of HIV infections in women caused by IV drug use

A

50%

87
Q

amount of HIV infections in women caused by heterosexual sex

A

1/3

88
Q

incubation period of HIV from infection to clinical disease

A

unknown but thought to be 2-3 months

89
Q

HIV appears in plasma and circulating mononuclear cells _____-______ weeks after infection; HIV antibodies usually appear in ___-___ months

A

1-several weeks

1-3 months

90
Q

_______ antibodies develop in all patients infected with HIV and are considered evidence of infection.

A

Anti-HIV

91
Q

_________-positive patients can spread HIV

A

antibody

92
Q

HIV Antibodies may appear by ____ days, but seroconversion may not occur for more than ____ months after infection

A

60 days; 12 months

93
Q

perinatal transmission of HIV:
___% before 36 weeks
___% in the days before delivery
___% intrapartum

A

20%
50%
30%

94
Q

Laboratory screening for HIV is highly specific. It usually consists of an _______ test, followed by a confirmatory test commonly the _________.

A

ELISA; Western blot

95
Q

_____ restesting prior to 36 weeks is recommended for:
women who use illicit drugs
have STDs during pregnancy
have multiple sex partners during pregnancy
live in areas with high HIV prevalence
have HIV-infected partners

A

HIV

96
Q

A false-positive result from the combination of the two tests is rare. More likely to occur is a __________ ELISA and an ___________ Western blot

A

positive; indeterminate or negative

97
Q

The Western blot is a more complex test than the ELISA; it is less _________ but more __________ for HIV

A

less sensitive; more specific

98
Q

An _____________ Western blot may be due to:

(1) recent HIV infection (usually positive within 6 weeks to 6 months)
(2) loss of antibodies in an AIDS patient with advanced immunodeficiency

A

indeterminate

99
Q

alternative confirmatory test to the Western blot that detects HIV antibodies, but it is less expensive and easier to perform than the Western blot (HIV antibodies are detectable in at least 95 percent of patients within 3 months after infection)

A

immunofluorescent antibody (IFA) staining

100
Q

_____ is now automatic routine testing in prenatal care but a woman can opt-out

A

HIV

101
Q

The woman must understand that a positive HIV result does not necessarily mean a diagnosis of AIDS, but that a large percentage of seropositive individuals develop the disease within ___-____years

A

8-10

102
Q

false positive rate of Western blot test

A

1-2%

103
Q

chlamydia most common in women under age ____

A

25

104
Q

chlamydia screening is recommended until age ___

A

30

105
Q 
Risk of \_\_\_\_\_\_\_\_:
antepartal bleeding
pelvic inflammatory disease
preterm labor
premature rupture of membranes
late postpartum infection
A

chlamydia

106
Q

gonorrhea is damaging in _____ trimesters

A

all

107
Q 
Risk of \_\_\_\_\_\_\_\_:
spontaneous abortion
premature rupture of membranes
chorioamnionitis
premature delivery
intrauterine growth restriction
postpartum infection
A

gonorrhea

108
Q

Newborns of ___________ infected mothers may develop: chlamydial conjunctivitis
pneumonia
nasopharyngeal infections
gonococcal neonatal opthalmia

A

chlamydia and gonorrhea

109
Q

Tests for ________:
enzyme immunoassay tests
direct fluorescent antibody tests
DNA probe

A

chlamydia and gonorrhea

110
Q

highly sensitive and specific test that has the ability to simultaneously identify Neisseria gonorrhoeae and Chlamydia trachomatis–clinically advantageous because both infections are present in about 40% of cases of gonorrhea and Chlamydia, and only one urogenital sample is required

A

DNA probe assay

111
Q

CDC recommends diagnostic testing for C. trachomatis, at the _____ prenatal visit for all pregnant women

A

1st

112
Q

Women < 25 years old and those who are at increased risk for chlamydia or gonorrhea should be:

A

retested in 3rd trimester

113
Q

If a woman tests positive for chlamydia or gonorrhea and is treated, a repeat test (“test of cure”) should be completed within ___-____ months, preferably in the ____ trimester

A

3-6 months; 3rd

114
Q

Women at risk for ______:
HIV positive women
Women in close contact with infected individuals
Foreign-born women from countries with high rates of this dx
Medically underserved women
Women who abuse alcohol and/or IV drugs
Women who are residents or employees of prisons
Women who are health care providers who give care to high-risk groups

A

TB

115
Q

More than __% of childhood cases of tuberculosis occur in minority groups, most in children under 5 years of age

A

80

116
Q

physical, chemical and microscopic evaluation of the urine used to screen for renal disease, UTI and metabolic disorders

A

urinalysis

117
Q

Excess tissue fluid that accumulates during the day returns to the bloodstream and urine volume increases, thus producing __________ and ____________ in the morning.

A

nocturia; low specific gravity

118
Q

common condition due to an increase in the glomerular filtration rate and sluggish tubular reabsorption of glucose

A

glucosuria

119
Q

may occasionally appear, particularly after vigorous exercise and after the first void of the day…can also appear if a drop of vaginal discharge mixes with the urine

A

trace proteinuria

120
Q

During a healthy, low-risk pregnancy, a complete urinalysis is usually performed generally at:

A

1st prenatal visit

121
Q

Pregnancy-related anatomic, physiologic, and hormonal changes predispose a pregnant woman to __________, one of the most common medical problems of pregnancy.

A

pyelonephritis

122
Q

Women with sickle cell trait or disease, high parity, and diabetes are more likely to develop:

A

bacteruria

123
Q

a major risk factor for the development of pyelonephritis

A

asymptomatic bacteruria (ASB)

124
Q

freshly voided, clean-catch, midstream specimen is required to screen for

A

symptomatic or asymptomatic bacteruria

125
Q

diagnosis of ASB or symptomatic UTI is usually based on a colony count of ____________/ml of a particular organism, however, lower counts may also be significant

A

100,000

126
Q

The pathogen responsible for 80-90% of infections is ______, followed by Klebsiella, Proteus, and the enterococci, Group B streptococcus and S. saprophyticus

A

E. coli

127
Q

____________ for nitrites and leukocyte esterase is a less expensive way to screen for urinary tract infection

A

urine dipstick

128
Q

this test alone is not sensitive enough to be used as a screening test for asymptomatic bacteruria

A

urine dipstick

129
Q

by-products of bacterial growth that are frequently present and detected by dipstick with UTI

A

nitrites

130
Q

the presence of this in urine is not necessarily positive for UTI because they can be due to vaginal contamination

A

leukocyte esterase

131
Q

Patients at risk for UTI should have a urinalysis and a urine culture and sensitivity repeated at least ___________ or _____________

A

once or at least each trimester

132
Q

Evidence supports that ___________ women do not need to have a urine dip stick routinely performed at each prenatal visit

A

asymptomatic

133
Q

testing for asymptomatic bacteruria should be routinely conducted:

A

at 1st prenatal visit

134
Q

GBS infection occurs in about 1 in every ________ babies born in the United States

A

3,000

135
Q

percentage of women who carry GBS in pregnancy

A

10-30%

136
Q

gestation for GBS screening

A

35-37 weeks

137
Q

Women that do not need GBS screening as they automatically qualify for treatment during labor and birth

A

who had a previous baby with GBS infection GBS in their urine in the current pregnancy

138
Q

GBS culture results are usually ready in _____ hours

A

24-48

139
Q

__________ during labor recommended for these women:
Had a previous baby with GBS infection
Had GBS in their urine during the current pregnancy
Had a screening test in the current pregnancy that was positive for GBS
Go into labor before GBS test results are available and have any of the following risk factors:
–Preterm labor (<37 weeks)
–Membranes ruptured >18 hours before delivering the baby
–Fever of at least 100.4° F during labor

A

Antibiotic Treatment

140
Q

if a woman tests positive for GBS in the ________ at 1st prenatal visit there is no need to test at 35-37 weeks because she will automatically receive intrapartum abx

A

urine

141
Q

anytime there is more than __________ colonies of GBS in the urine, you should treat it

A

100,000

142
Q

indicated screening only for women who have vaginal infection symptoms

A

wet prep

143
Q

age to start pap smear screening

A

21

144
Q

recommendation for frequency of pap smear screening for women 21-65 years

A

q 3 years

145
Q

labs ordered at 1st prenatal visit

A 
H+H/ CBC
ABO/ Rh/ antibody screen
GC/CT
RPR/VDRL
Hep B
Hep C
HIV
Rubella
pap smear (if indicated)
DMS (if indicated)
urine culture
146
Q

labs ordered at 24-28 weeks

A

repeat H+H/ CBC
GDM screening
antibody screen
RPR/VDRL (only if risk factors)

147
Q

labs ordered at 36 weeks

A

GC/CT (only if risk factors)

GBS

148
Q

labs ordered preconceptually if possible

A

Rubella

149
Q

tests only ordered if there is indication (not routine)

A 
hemoglobin electrophoresis
GC/CT in 3rd trimester
Early DMS
TB skin test
Thyroid studies
150
Q

what to do if antibody screen (indirect Coombs) is positive at 1st prenatal visit

A

test for specific antibody and titer

151
Q

value of 1hr GTT that indicates a 3 hr test

A

> 130

152
Q

HBsAg – what does it mean?

A

Hep B surface antigen– means infectious

153
Q

anti-HBs – what does it mean?

A

Hep B surface antibody– means recovery+immunity OR successful immunization

154
Q

anti-HBc – what does it mean?

A

Hep B core antibody– previous or ongoing Hep B infection> appears at onset of symptoms and persists for life

155
Q

Hep B lab that midwife orders for routine prenatal labs and a positive result means the person is infectious

A

Hep B surface antigen (HBsAg)

156
Q

platelets normal pregnancy value

A

150-400K

157
Q

test that determines the degree of fetomaternal hemorrhage and will help you decide how many vials of RhoGAM are needed

A

Kleihauer Betke

158
Q

Regular RhoGAM (300 µg) (1500 IU) will protect against exposure to up to _____ mL of Rh-positive red blood cells

A

15.0

159
Q

Reasons to administer___________:

  • Delivery of an Rh-positive baby to an Rh negative mom
  • Antepartum prophylaxis at 26 to 28 weeks of gestation
  • Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g., version) or abdominal trauma
  • Actual or threatened pregnancy loss at any stage of gestation
  • Ectopic pregnancy
A

RhoGAM

160
Q

Administration of Rhogam at 28 weeks should occur even if the ___________ screen is not known to be negative at the time of Rhogam administration

A

antibody

161
Q

When should women who are at high risk for chlamydia and gonorrhea be screened?

A

at 1st prenatal visit AND in 3rd trimester

162
Q

abnormal Rubella titer value

A

<1:8

163
Q

abnormal RBC value

A

< 3 or > 4.5

164
Q

abnormal Hgb in 1st trimester

A

<11.0

165
Q

abnormal Hgb in 2nd trimester

A

<10.5

166
Q

abnormal Hgb in 3rd trimester

A

<11.0

167
Q

abnormal Hct in 1st trimester

A

<33.0

168
Q

abnormal Hct in 2nd trimester

A

<32.0

169
Q

abnormal Hct in 3rd trimester

A

<33.0

170
Q

abnormal MCV

A

<80

171
Q

abnormal MCH

A

<27

172
Q

abnormal MCHC

A

<33

NM 702 Prenatal Care (8 decks)

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