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NM702-Antepartum > Module 9 & 10 - Fetal Well-Being; Nutrition & Exercise > Flashcards

Module 9 & 10 - Fetal Well-Being; Nutrition & Exercise Flashcards

1
Q

T/F - Etiology is usually apparent in 1st trimester bleeding.

A

False - etiology is often unknown

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2
Q

T/F- Goal during dx with 1st trimester bleeding is one of exclusion.

A

True

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3
Q

All of the following are ___________ ________ of 1st trimester bleeding:
Polyps, cervivitis, vaginal infection, STI, implantation spotting (which is most often ____, ___ to ____
days after conception, lasting only a day or two; a
minority of pregnant women have this kind of
spotting), increased vascularization of the cervix in
pregnancy = increased friability, post-coital spotting due to increased friability

A

Normal etiologies;

scant, 7-11 days;

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4
Q

It is important to assess bleeding _________, __________, associated __________ & ___________, ___________ and __________.

A

severity, amount, associated signs and symptoms, pain, and cramping.

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5
Q 
Pertinent past history for 1st trimester bleeding includes:
previous \_\_\_\_\_\_\_\_
prior \_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ disorders
\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_
A 
ectopic
SABs
medical
risk factors
fibroids
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6
Q

Physical exam for 1st trimester bleeding includes:(4)

A

Physical exam
• Vital signs
• Abdominal exam – pain, maybe FHT,s
• Speculum exam – observe internal and external
• Bimanual exam – CMT, adnexal masses, uterine
enlargement

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7
Q

_____________ _____________ is the most common early pregnancy complication.

A

Spontaneous abortion

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8
Q

_____% of SABs are in the 1st 12 weeks.

A

80%

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9
Q

____________ _____________ are the most common reason for SABs.

A

Chromosomal errors

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10
Q

SAB rate is ___ to ____ % of all conceptions.

A

25-30%

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11
Q

Risk factors for SAB include: (7)

A 
Risk factors
• Smoking
• Alcohol
• Immune factors (recurrent loss)
• Inherited blood dyscrasias (recurrent loss)
• Excessive caffeine, >500 mg daily
• Environmental exposures
• Pesticides, arsenic, lead, formaldehyde, benzene
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12
Q

(A) Inevitable (B) Missed (C) Incomplete (D) Threatened (E) Complete

_____ closed cervix, uterus appropriately sized,
_____ cervix dilated, increased bleeding with
cramps/ctx, products of conception can be at os
_____ small contracted uterus, open cervix,
scant bleeding/cramping
____ placental tissue remaining, cervix open,
POC can be at os, uterus smaller than expected for
gestational but not well contracted, variable
bleeding/cramping
____ in utero death of embryo prior to 20th wk with
retention of pregnancy for prolonged period of time.
Cervix closed, +/- bleeding

A 
D) Threatened
A) Inevitable
E) Complete
C) Incomplete
B) Missed
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13
Q

_________ is key to diagnosis of SAB
• May see abnormal ____ ____, slow or absent____,or
___________

_______ ____ is adjunct to determine viability
• _________every 2-3 days
• Max levels at __ - ___ weeks, then declines
• Serial measures

A

Ultrasound;
yolk sac; FHT; hematoma

Serial b-hCG;
Doubles; 8-10 weeks;

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14
Q

Ectopic pregnancy occurs in about ___ % of pregnancies, clinical manifestations usually occur in the ___ to ___wk of pregnancy, but can occur later.

A

2%; 6-8 weeks

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15
Q

T/F - All women with an ectopic will be symptomatic when you see them.

A

False - many are asymptomatic

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16
Q 
\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_:
• Tubal ligation
• Tubal pathology/surgery
• Prior ectopic
• IUD – especially Mirena
\_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_\_:
• Infertility
• Assisted reproduction technology
• Prior hx of genital tract infection (Chlamydia, GC, salpingitis)
• Multiple sex parters (secondary to increased risk for PID)
• Smoking – risk is dose dependent
\_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_:
• Prior cesarean
• Douching
A

High; ectopic
Moderate; ectopic
Lower; ectopic

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17
Q

Signs/sx of ectopic may include ___________, ________________/____________, and _____________ (profuse if cervical pregnancy).

A

abdominal pain, amenorrhea/+preg test, bleeding

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18
Q

T/F- Women with an ectopic may experience normal pregnancy signs, like breast tenderness, nausea, etc.

A

True

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19
Q

Signs of a ruptured ectopic may include ___________ _________ (from blood irritating the diaphragm) and _________ to ___________ (from blood pooling in the cul de sac).

A

shoulder pain; urge to defacate

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20
Q

T/F - A pregnancy test should be done on all women of childbearing age who present with abdominal pain.

A

True

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21
Q

Evaluation for suspected ectopic should include:

• _______ exam for _______ mass
• Assess ________ _______ _______ (sometimes your
first clue on routine 1st visit exam)
• ___________ (may or may not see __________sac)
• Serial _______ (may see _____ rise, may be normal)

A

pelvic; adnexal
cervical motion tenderness
Ultrasound; extrauterine
B-hCG; slower

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22
Q

Midwifery management of ectopic is to ____________.

A

refer!

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23
Q

MD may proceed with medical mgt (_________) rather than surgery, if _________ and hCG

A

Methotrexate; unruptured;

24
Q

A complete hydatidiform mole has ____ ____ _____. A partial mole has _______ _________ _________.

A

no fetal tissue; some fetal tissue.

25
Q

Risk factors for molar pregnancy include _________ maternal _____, _________ maternal ______, and _____ _______ pregnancy.

A

younger maternal age, older maternal age, and previous molar pregnancy.

26
Q

Multiparas begin feeling FM between ___ to ___ weeks; pimiparas begin feeling FM between ___ to ___ weeks.

A

16-18; 18-22

27
Q

FM maximize around ___ weeks, then become ___ frequent.

A

34; less

28
Q

FHT can usually be obtained with a doppler starting between ___ to ___ wks gestation.

A

10 to 12

29
Q

Fingerbreadths are used to assess FH between __ to __ wks gestation. After__ wks a tape measure is used and normal is +/- __ cm of wks of gestational age

A

12 to 20; 20; 2cm

30
Q

A _________ ________correlates with fetal survival for one week or more in 99% of cases.

A

reactive NST

31
Q

A non-reactive NST correlates with poor fetal outcome in __% of cases.

A

20%

32
Q

Normal AFI is __to __cm.

A

8 to 24;

33
Q

A CST uses pitocin or nipple stim to create ___ contractions in a ____minute window. If the fetus has a negative fetal response (positive test) __________ is contraindicated.

A

3; 10; induction

34
Q

Doppler velicometry is used in conjunction with other fetal well being tests to assess wellbeing of fetus with _________ ____________ __________

A

fetal growth restriction

35
Q

Protein requirements are ___ to ___ gm/day in __ to ___ servings

A

70-75; 2-4

36
Q

_________ __________ required increased protein.

_________ _________ and ___________ often have inadequate protein.

A

Bariatric patients

Low income and vegeterians

37
Q

Carbohydrates: Daily serving: ___ - ___servings (___ gms/day and ___% of caloric intake) ___ oz is one serving.
Average intake is _________.

A

6-9; 175gm/day; 60%; 1oz is one serving

excessive

38
Q

T/F - Adequate carbohydrate intake helps prevent ketosis.

A

True

39
Q

_______ are good for body energy stores.

A

Fats

40
Q

Fats should be limited to ___% or less of total caloric intake

A

30%

41
Q

Omega-3 fatty acids (DHA)
May reduce the incidences of _________ ______ and _________.
__________ is a good source of DHA

A

preterm birth and preeclampsia;

salmon

42
Q

True/False - Omega -3 fatty acids (DHA) important to neural and retinal membranes promoting increased infant cognitive ability, verbal IQ, and attention spans

A

True

43
Q

Omega-3 fatty acids (DHA) cont.

Recommendations are to consume approx ____ -____mg/day = __ servings/week especially in 2nd & 3rd trimesters

A

200-300mg/day = 2servings/week

44
Q

High doses (>__________ IU/day) of Vitamin ___ can cause teratogenic effects.

A

25,000; A

45
Q

T/F - You should not eat foods high in vitamin A.

A

False - needed for eye and neuro development; previtamin A is food source and is safe

46
Q

Vitamin ___ is folate/folic acid.

A

B

47
Q

Folic Acid _____mcg/day prior to preg; ____mcg/day during preg; ______mcg day if hx of NTD to start _______ mos prior to conception.

A

400; 600; 4000; 6months

48
Q

Need approx ___ mg/day of iron.

A

30mg/day

49
Q

Calcium: need ___________mg/day; ____to ______servings (teens need ____ to ____ servings; _____mg/day)

A

1000; 3 to 4; 4 to 5;1300

50
Q

Calcium needs increase around ___ wks due to fetal bone growth.

A

12

51
Q

________________ is needed for the absorption of calcium. RDA is ______ mg

A

Vitamin D; 600

52
Q

Water: ___ liters/day

A

3

53
Q 
Grains: \_\_\_oz per day
Vegetables: \_\_ -\_\_\_cups/day;
Fruits: \_\_\_cups/day;
Dairy: \_\_\_-\_\_\_cups/day; 
Protein: \_\_\_-\_\_\_oz/day; 
Oils: \_\_\_tsp/day
A 
Grains: 6oz/day
Vegetables: 2-3cups/day
Fruits: 2cups/day
Dairy: 3-4cups/day
Protein: 5-6oz/day
Oils: 6tsp/day
54
Q

________ should be eaten twice per wk as protein source due to benefits of DHA, which are fetal ________ and ________ development

A

Fish; brain and eye development

55
Q

Recommended wt gain:
____ to ____;_____ in 1st; __-___ in 2nd/3rd
for the following:
BMI 30

A

30: 11-20; 0-1; 1/2

56
Q

NTD is twofold the risk in __________ women.

A

overweight

57
Q

Obese women have 3x increased risk of __________ and 5x increased risk of ____________.

A

3x - stillbirth; 5x - preeclampsia

NM702-Antepartum (3 decks)

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