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OB 1 Flashcards

1
Q

What is the goal of genetic counseling?

A

To identify risk

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2
Q

What’s the earliest genetic testing available?

A

Chorionic Villus Sampling; at 10-13 weeks

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3
Q

How is Chorionic Villi Sampling done?

A

Abdominal or vaginal; tissue sample of placenta

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4
Q

What does the patient need to do before Chorionic Villi Sampling?

A

Drink water and make bladder full

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5
Q

What are some risks of Chorionic Villi Sampling?

A

Spontaneous abortion, Fetal limb loss (especially prior to 9 weeks gestation), chorioamnionitis, rupture of membranes

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6
Q

What’s Amniocentesis?

A

Taking a sample of amniotic fluid to check genetic risk. Need enough fluid to test. Great for information purpose, but very high risk

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7
Q

When can amniocentesis be done?

A

15 weeks - birth

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8
Q

What are some risks of amniocentesis?

A

Infection, miscarriage, bleeding, rupture of membrane, fetal damage/death, bladder damage

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9
Q

What is Alpha-Fetoprotein (AFP) test?

A

Maternal blood testing; screening tool used to detect neural tube defects

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10
Q

When can AFP test be done?

A

15-18 weeks

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11
Q

What does low AFP level indicate?

A

Risk for Down Syndrome

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12
Q

What does high AFP level indicate?

A

Risk for neural tube defects or open abdominal defect

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13
Q

What is placenta previa?

A

When placenta implants in the lower segment of the uterus; may cover all or part of cervical opening

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14
Q

What happens if the cervical opening is covered by the placenta?

A

No vaginal delivery, no matter how much the placenta is covering the cervical opening

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15
Q

Why does painless vaginal bleeding occur in 3rd trimester with placenta previa?

A

As the cervix begin to dilate, placenta tears, which causes bleeding

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16
Q

What are some expected findings of placenta previa?

A

Painless, bright red vaginal bleeding during 2nd - 3rd trimester, higher than expected fundal height

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17
Q

Why is pelvic/vaginal exam contraindicated in placenta previa?

A

You don’t know where the placenta is before the ultrasound; we don’t want to perforate or separate the placenta because placenta = baby’s O2 supply.
we also don’t want to cause more bleeding

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18
Q

Can placenta previa patients ambulate how many times as they want closer to labor?

A

No. Strict bedrest

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19
Q

What’s placental abruption?

A

Premature separation of the placenta from the uterus; meaning that baby has lost their O2 supply

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20
Q

When does placental abruption occur?

A

After 20 weeks of gestation

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21
Q

What’s the leading cause of maternal death?

A

Placental abruption

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22
Q

What’s the biggest difference between placenta previa and placental abruption?

A

Placenta previa causes painless vaginal bleeding while placental abruption causes painful vaginal bleeding

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23
Q

What are some expected findings in placental abruption?

A

Sudden onset of intense localized uterine pain, profusely bleeding dark red blood, “board-like” abdomen, uterine tenderness, contractions with hypertonicity, fetal distress

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24
Q

What do contractions with hypertonicity mean and why is it bad for the fetus?

A

Uterine muscle squeezing constantly and not relaxing. More stress to the baby & decreased O2 and blood flow

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25
Q

What’s the biggest and most important nursing assessment with placental abruption?

A

FHR monitoring, make sure baby is okay

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26
Q

What’s the only management for placental abruption?

A

Delivery. Therefore prepare for emergency C-section but may deliver vaginally; but it will be a very rapid labor

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27
Q

What’s ectopic pregnancy?

A

Abnormal implantation of the ovum outside of the uterine cavity. very dangerous

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28
Q

What are some expected findings of ectopic pregnancy?

A

Unilateral stabbing pain & referred shoulder pain, tenderness in lower quadrant, scant dark red or brown vaginal spotting

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29
Q

What’s the treatment for ectopic pregnancy if it’s ruptured?

A

Laparoscopic salpingectomy. it has to be rapid because it’s fatal to mom

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30
Q

What’s the treatment for ectopic pregnancy if it’s not ruptured?

A

Methotrexate to dissolve pregnancy and/or salpingostomy

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31
Q

What are some preSUmptive signs of pregnancy?

A

Amenorrhea, fatigue, n/v, quickening, urinary frequency, breast changes, uterine enlargement

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32
Q

What are some prOBable signs of pregnancy?

A

Pregnancy test, abdominal enlargement, Braxton Hicks contractions, fetal outline felt by examiner, Hegar’s sign, Chadwick’s sign, Goodell’s sign

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33
Q

What’s Hegar’s sign?

A

Softening and compressibility of lower uterus

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34
Q

What’s Chadwick’s sign?

A

Deepened violet-bluish color of cervix and vaginal mucosa (indication of uterus becoming vascular)

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35
Q

What’s Goodell’s sign?

A

Softening of cervical tip

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36
Q

What are the positive signs of pregnancy?

A

Auscultation of fetal heart sounds, fetal movements felt by examiner, visualization of the embryo or fetus by ultrasound

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37
Q

What’s a nonstress test?

A

Hook to the monitor and see if the baby is moving for 20-30 minutes. Mom pushes the button when movement felt

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38
Q

What does the “reactive” result of a nonstress test indicate?

A

Baby is moving within normal range; > 2 accelerations within a 20-minute period

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39
Q

What does “nonreactive” result of a nonstress test indicate?

A

Baby not moving within normal range; fewer than 2 accelerations in a 40-minute period. Further investigation needed

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40
Q

What’s a contraction stress test?

A

Assessing fetal response to contractions; determine how fetus will tolerate the stress of labor

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41
Q

Why is a contraction stress test risky?

A

When contractions occur, placental blood flow is decreased and oxygen is restricted

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42
Q

Why is oxytocin-stimulated contraction stress test much more risky than nipple-stimulated?

A

It’s performed when nipple-stimulated test fails; it requires IV administration of oxytocin to induce uterine contractions. Once that contraction starts, there’s no going back. High risk of preterm labor

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43
Q

When is a biophysical profile ordered?

A

With nonreactive stress test, suspected oligohydramnios or polyhydramnios, suspected fetal hypoxemia or hypoxia

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44
Q

What does the biophysical profile consist of?

A

FHR (110-160)
Fetal breathing (are they trying to breathe?)
Body movements (good moving?)
Fetal tone (flaccid vs moving)
Amount of amniotic fluid

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45
Q

What’s considered embryonic stage?

A

Day 15 - 8 weeks

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46
Q

Which fetal development stage is the most critical time in development of organ systems?

A

Embryonic stage; by the end of 8 weeks, all organs are present but not fully developed

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47
Q

When do moms need to be extra cautious about environmental teratogens?

A

During embryonic stage, when organs are forming

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48
Q

When is fetal stage?

A

9 weeks - end

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49
Q

What’s quickening?

A

Fetal movement felt by mother

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50
Q

When is quickening felt?

A

At about 20 weeks

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51
Q

What’s monozygotic?

A

“identical” twin; from 1 ovum and 1 sperm. Same genetic makeup therefore same sex and genotype
Usually shares placenta

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52
Q

What are some risks associated with monozygotic?

A

One can be bigger than another, getting all the nutrients.

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53
Q

What’s dizygotic?

A

“fraternal” from 2 ova and 2 sperm. 2 different genetic makeup. 2 placentas, 2 chorions, and 2 amnions

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54
Q

Describe the menstrual cycle

A

1st day of period to the 1st day of the next period; about 28 days on average

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55
Q

What are the phases of the menstrual cycle?

A

Menstrual (Day 1-6), Proliferative (Day 7-14), Secretory (Day 15-26)

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56
Q

When does uterine bleeding usually begins?

A

14 days after ovulation

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57
Q

When is the fertile period?

A

Ovum is only fertile for 24 hours after ovulation

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58
Q

How long does it take for an egg to implant?

A

About 6-10 days after fertilization

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59
Q

What are the 2 structures of blastocyst?

A

Embryoblast, which become embryo, and Trophoblast, which becomes placenta

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60
Q

Why does the placenta have same DNA as baby?

A

Because both the placenta and the embryo are made from the blastocyst

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61
Q

How does hormone impact the menstrual cycle?

A

After ovulation, estrogen and progesterone are secreted. If not pregnancy, both levels drop, leading endometrium to not being nourished anymore. This comes out as menstrual bleeding.

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62
Q

What’s estrogen’s role in pregnancy?

A

Crucial for maturing egg follicle

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63
Q

What’s progesterone’s role in pregnancy?

A

Thickens endometrium, relaxes uterus to maintain pregnancy
Therefore, if not enough progesterone, miscarriage

64
Q

Which hormone helps release egg in ovulation and increase labor contractions and opening of cervix for birth?

A

Prostaglandins

65
Q

What area is most likely damaged during childbirth?

A

Perineal body

66
Q

What are the placenta functions?

A

Transfer oxygen & nutrients to fetus, remove waste products and CO2 away from fetus and into maternal blood, makes hormones, and transfers antibodies from mother to fetus

67
Q

What’s the role of placental barrier?

A

Prevent direct contact between fetal & maternal blood

68
Q

What hormones are produced during pregnancy by the placenta?

A

chorionic gonadotropin (HCG), Prolactin, Estrogen, Progesterone, Relaxin

69
Q

What are the danger signs during pregnancy?

A

s/s of HTN or preeclampsia, burning during urination, severe vomiting, diarrhea, fever and chills, abdominal cramping, vaginal bleeding, changes in fetal activity, s/s hyper/hypo glycemia

70
Q

Why do we worry about fever and chills during pregnancy?

A

Bacterial/viral infection that can cross placenta barrier and harm the baby

71
Q

How to calculate due date using Nagele’s rule

A

1st day of LMP - 3 months + 7 days + 1 year (as needed)

72
Q

What is supine hypotension?

A

Baby compresses inferior vena cava, leading to decreased venous return vausing hypotension

73
Q

How is supine hypotension alleviated?

A

By lying on the side, especially left, for better blood flow to uterus or sit up semi-fowler’s

74
Q

When does gestational HTN begin?

A

After 20 weeks of gestation

75
Q

What’s the major difference between gestational HTN and preeclampsia?

A

Presence of proteinuria

76
Q

What is preeclampsia?

A

Gestational HTN + possible headaches & visual disturbances, edema, and proteinuria

77
Q

What’s severe preeclampsia?

A

Preeclampsia + BP >160/110, >3+ proteinuria, hyperreflexia, extensive peripheral edema, epigastric and RUQ pain

78
Q

What’s eclampsia?

A

Severe preeclampsia + new onset of seizure activity or coma

79
Q

When can eclamptic seizures occur?

A

Before or during labor, or postpartum (48 hours after delivery) Therefore keep eclamptic patients in the hospital for more than 48 hours after birth

80
Q

What is HELLP syndrome?

A

Severe preeclampsia + Hemolysis, Elevated Liver enzymes, and Low platelet count

81
Q

What’s polyhydramnios?

A

Too much amniotic fluid; usually associated with gestational diabetes

82
Q

What’s oligohydramnios?

A

Low amniotic fluid

83
Q

What is hyperemesis gravidarium?

A

Morning sickness on steroids

84
Q

What are some expected findings of hyperemesis gravidarium?

A

Electrolyte imbalance, dehydration, nutritional deficiencies, urine ketone might be present due to breakdown of proteins and fats

85
Q

What are the treatments for hyperemesis gravidarium?

A

Give fluids and hope they grow out of it. Lactated ringers, vitamin B6 to help combat nausea, and antiemetics

86
Q

What are some remedies that can help with nausea?

A

Always keep something light in stomach. sour candies, ginger, alcohol pads

87
Q

What can be used in severe case of hyperemesis gravidarum?

A

Feeding tube or TPN might be used

88
Q

What are the symptoms of threatened abortion?

A

Possible mild cramps, slight spotting, no tissue passing, closed cervix
Pregnancy may continue

89
Q

What do you see when someone is having inevitable abortion?

A

Mild-moderate cramping, moderate bleeding, no tissue passing usually dilated cervix

90
Q

What happens during incomplete abortion?

A

Severe cramps, heavy, profuse bleeding, some tissue passing, cervix dilated with tissue in cervical canal or passage of tissue

91
Q

In what type of abortion is at high risk of infection and D&C or D&E needs to be performed?

A

Incomplete abortion

92
Q

What does complete abortion look like?

A

Mild cramps, minimal bleeding, all tissue passing, cervix closed after passage

93
Q

What’s the type of abortion that mother doesn’t know about it until their 1st ultrasound appointment?

A

Missed; no cramps, spotting, or tissue passing. closed cervix.
Died in utero

94
Q

What’s a significant finding with septic abortion?

A

Malodorous discharge; severe infection after an abortion

95
Q

Abortion treatment includes:

A

D&E or D&C, or prostaglandins and oxytocin to start labor and pass naturally

96
Q

What is gestational diabetes?

A

Impaired glucose tolerance that is first recognized or begins during pregnancy

97
Q

What’s 1-hour GTT for gestational diabetes diagnosis?

A

At 24-28 weeks; 50g oral load, check BG after 1 hour. If 130-140, need 3-hour GTT

98
Q

What’s 3-hour GTT?

A

When 1-hour GTT is abnormal; check fasting glucose, 100g oral load, check BG 1, 2, and 3 hours post load. If 2 or more of the values elevated = diabetic

99
Q

What does class A1 diabetes indicate?

A

No meds needed; diet controlled. usually hard for mothers due to pregnancy cravings

100
Q

What does Class A1 diet look like?

A

3 meals/2 snacks, encourage bedtime snacks to prevent hypoglycemia at night, never skip meals, < 50% of calories from carbs

101
Q

What does class A2 diabetes indicate?

A

Need meds; oral: glyburide and metformin. SubQ or pump insulin may be needed or not

102
Q

What’s magnesium sulfate used for?

A

Prevent seizures in eclamptic patients

103
Q

What does magnesium sulfate do?

A

Relaxes smooth muscle & vasodilates

104
Q

What are the signs of magnesium sulfate toxicity?

A

RR <12/min, cardiac dysrhythmias, decreased LOC, low urine output, low BP, absence of DTR

105
Q

What do you need to monitor (baby-wise) when giving magnesium sulfate?

A

Continous FHR monitoring, perform NST & kick counts to make sure baby is perfusing

106
Q

What’s the antidote for magnesium sulfate?

A

Calcium gluconate

107
Q

What’s cerclage?

A

Sewing cervix shut to prevent preterm labor on patients with cervical insufficiency

108
Q

When is cerclage removed?

A

at 36-38 weeks; removal does not mean immediate labor

109
Q

When should cerclage patient come to the hospital?

A

If feeling anything labor-like; if labor starts, cervix will dilate, and that stitch will be ripping the cervix if left unseen. Since uterus and cervix is very vascular, bleeding will be a problem

110
Q

How does pregnancy affect BP?

A

Systolic: slight or no increase from baseline
Diastolic: slight decrease around 24-32 weeks, but will gradually return to baseline by the end of pregnancy

111
Q

What pregnancy category medications are considered safe?

A

Category A, but consult provider before taking any medications

112
Q

What are neural tube defects?

A

Birth defects of brain, spine, and spinal cord due to low folic acid level

113
Q

How can neural tube defects be prevented?

A

Start taking folic acid even before trying to get pregnant

114
Q

What is fundal height?

A

Measured in cm from symphysis pubis to top of the fundus

115
Q

How do we know if fundal height is on track?

A

At 20 weeks, which is the half-way mark, fundal height should be at umbilicus
Textbook - 20cm at 20 weeks, 21cm at 21 weeks, etc.

116
Q

What can cause fundal height to be bigger than expected?

A

polyhydramnios, placenta previa, molar pregnancy

117
Q

What can cause fundal height to be measured small?

A

Nicotine use, HTN

118
Q

What is urinary frequency during pregnancy?

A

Pregnancy hormones and increased blood volume increase filtration, increasing the amount of urine production
Happy kidneys
Also because uterus is compressing bladder

119
Q

What is a fetal demise?

A

Fetal death after 20 weeks; stillbirth.

120
Q

What is fetal demise associated with?

A

Hyperglycemia and ketoacidosis, congenital anomalies, infections, postdates, etc.

121
Q

Explain fetal circulation

A

Umbilical vein -> ductus venosus (liver to heart) -> Foramen ovale (r. atrium to l. atrium) -> ductus arteriosus (from heart to down) -> umbilical artery
Lung bypass because fetus is in amniotic fluid therefore alveoli filled with fluid

122
Q

What are some skin changes during pregnancy?

A

Chlosama/melasma, linea nigra, striae gravidarum

123
Q

Where does chorionic villi develop out of?

A

Trophoblast; extended into the endometrium. within placenta

124
Q

What’s the function of amniotic fluid?

A

It’s like sterile urine; it cushions against impacts to the maternal abdomen, maintains a stable temperature, allows symmetric development, prevents membranes from adhering to developing fetal parts, barrier to infection

125
Q

What’s the inner fetal membrane called?

A

Amnion

126
Q

What’s the outer fetal membrane called?

A

Chorion

127
Q

How many arteries & veins are in the umbilical cord?

A

2 arteries and 1 vein

128
Q

Why do we worry about blood clots, especially during postpartum?

A

Because of increased clotting factors during pregnancy; it’s a normal change

129
Q

What can help with leg cramps due to expanding uterus partially obstructing blood return from veins in legs?

A

Calcium

130
Q

What’s the desired outcome for “Count to Ten” method of fetal movement testing?

A

10 distinct movements in 1-2 hours

131
Q

What kind of vaccine do we not give to pregnant people?

A

Live virus vaccine since it can cross placenta barrier

132
Q

How can sex lead to preterm labor?

A

Semen has prostaglandins and oxytocin; those can start labor

133
Q

Why do we need emergency Birth Pack easily accessible at bedside with patients with preeclampsia?

A

Cure for preeclampsia is to deliver the baby, and sometimes they can get into labor very fast

134
Q

What is hydatidiform Mole (molar pregnancy)?

A

Bening proliferative growth of the placental trophoblast. Chorionic villi develop into cysts in a grape-like cluster; embryo fails to develop

135
Q

Prune-like vaginal bleeding with uterus size larger than gestational weeks indicates

A

Molar pregnancy

136
Q

What’s the treatment for molar pregnancy?

A

Suction & curettage to evacuate tissue. if not removed completely, it will keep coming back. Avoid pregnancy until cleared

137
Q

Can UTI lead to preterm labor?

A

Yes, the cramps can lead to it

138
Q

Why are you prone to hypoglycemia in the first trimester?

A

Fasting glucose decreases by 10% during first trimester; trying to adapt to baby’s portion of energy too

139
Q

What can iron deficiency anemia cause in relation to birth?

A

Preterm birth and low birth weight

140
Q

What is the primary mechanism to stop hemorrhage from the uterine arteries after childbirth?

A

Contraction of the uterine smooth muscle that compresses arteries - massage the fundus so muscles can contract

141
Q

Signs of ovulation include:

A

Basal body temperature drops slightly, then spikes 1/2 a degree, positive test for spike in luteinizing hormone

142
Q

In which stage of fetal development is most vulnerable to medications and chemicals?

A

Embryonic stage, because that’s when organ formation occurs

143
Q

Amniotic fluid embolus frequently leads to

A

DIC; monitor bleeding

144
Q

For diabetic patients, educate to

A

Check fetal kick counts daily to make sure they are perfusing

145
Q

What are some common discomforts of pregnancy?

A

Breast tenderness, urinary frequency, epistaxis

146
Q

Why is dysuria a complication of pregnancy?

A

Could be UTI with cramps or other kidney - bladder infection (ex. pyelonephritis, etc.) that can also cause cramping and lead to preterm labor

147
Q

Is it normal to feel whether you are happy with pregnancy or not during first few months of pregnancy?

A

Yes

148
Q

What kind of foods are good calcium source if patient does not like milk?

A

Dark green leafy vegetables

149
Q

Why does the nurse use an acoustic vibration device during the nonstress test?

A

To awaken sleeping fetus

150
Q

What can cause development of placenta abruption?

A

Blunt abdominal trauma, cocaine use, cigarette smoking.

Fetal position and maternal age is not a risk factor

151
Q

What medication is used to mature fetus’s lungs?

A

Betamethasone (corticosteroid)

152
Q

What are some risk factors for hyperemesis gravidarum?

A

diabetes, multifetal pregnancy, gestational trophoblastic disease

153
Q

What are some risk factors of preterm labor?

A

UTI, multifetal pregnancy, hydramnios, DM, uterine abnormalities

154
Q

What are some contraindications for magnesium sulfate use?

A

Fetal distress, vaginal bleeding, cervical dilation greater than 6 cm

155
Q

When there’s any kind of problem during pregnancy, educate mom to

A

check kick count daily

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