OB Exam 1 Flashcards
What is the goal to genetic testing?
Identify risk
Your client wants to know how to tell if she is ovulating. Select all that apply:
A. Cervical mucus is thick, sticky, and opaque white
B. Basal body temp drops slightly, then spikes 1/2 a degree
C.menstural period is just starting, spotting
D.positive test for spike in LH
E. Levels of progesterone are decreasing
B,D
How long is an egg fertile for after ovulation?
12-24 hours
Where does fertilization occur?
Outer 1/3 of fallopian tube
how long does it take a zygote to travel to the uterus?
3-4 days
Morula
“Solid ball of cells”, gives rise to blastocyst= embryoblast(embryo) and trophoblast (placenta)
when does blastocyst implant into endometrium?
6-10 days after conception, usually into fundus
How long does the sperm remain viable in female reproductive tract?
At least 2-3 days
(possibly 3-5 days)
Which is counted as the first day of the menstrual cycle?
A. First day of bleeding during menses
B. Day of ovulation
C. Last day of bleeding during menses
D. Day before the menstrual bleeding starts
The first day of bleeding during menses
How long after intercourse could she get pregnant?
Sperm can reach site of fertilization in 5 minutes; conception likely up to a week after intercourse (sperm viable 3-5 days in female tract) and implantation (pregnancy) 2-3 weeks after
How long after ovulation could she get pregnant?
five days before ovulation, the day of ovulation, and one day after ovulation (sperm can live 3-5 days, ova fertile for 24 hours)
What is included in genetic counseling?
Information, education, and support
How many pregnancy genetic tests are there?
4
What is the first (earliest) genetic test that can be done in pregnancy?
CVS (chorionic villus sampling)
When can a CVS be done?
10-13 weeks
What is a CVS?
Chorionic villus sampling: tissue sample of the placenta
Indicated: risk for giving brith to neonate with genetic chromosomal abnormality (cannot determine spina bidifida or anencephaly)
Full bladder necessary for testing
What are the four pregnancy genetic tests?
Chorionic villus sampling, amniocentesis, alpha-fetoprotein, and level 2 ultrasound/targeted ultrasound
What is an amniocentesis?
Sample of amniotic fluid, empty bladder needed (avoid puncture)
When is an amniocentesis done?
15-20 weeks
What is an AFP test?
Alpha-fetoprotein test of maternal blood
When is an alpha-fetoprotein test done?
15-18 weeks
When is a level 2 ultrasound (targeted ultrasound) done?
After 18 weeks
What is a level 2/targeted ultrasound?
Complete scan of fetal anatomy
What area is more likely to be damaged during childbirth?
Perineum
What is the pear shaped organ?
Uterus
Organ made of hollow smooth muscle with constant rhythmic contractions, lined with cells responsive to hormones
Uterus
What is a gynecoid pelvis?
Perfect shape and angle that is most optimum condition for vaginal delivery
Presumptive signs of pregnancy
Amenorrhea, fatigue, N/V, urinary frequency, breast changes, quickening(Could be gas), uterine enlargement
What is quickening?
The mother feels the movement of the baby
Probable signs of pregnancy
Abd enlargement, Hegar’s sign, Chadwick’s sign, Goodell’s sign, Braxton Hicks contractions, positive pregnancy test, fetal outline felt by examiner(could be tumor, anatomy)
Confirmation of pregnancy: positive indicators
Auscultation FHR, fetal movements felt by examiner, visualization of embryo/fetus by ultrasound
Risk for CVS
Spontaneous abortion, risk for fetal limb loss (greatest risk=prior to 9 weeks), miscarriage, chorioamnionitis and rupture of membranes
Risk for amniocentesis
Amniotic fluid emboli, maternal/fetal hemorrhage,maternal/fetal infection ,inadvertent fetal damage/anomalies involving limbs, fetal death, inadvertent maternal intestinal/bladder damage,miscarriage/preterm labor,premature rupture of membranes,leakage of amniotic fluid
key points for amniocentesis
Empty bladder prior to procedure
Baseline vitals and FHR prior to
Monitor vs, FHR, uterine contractions throughout and 30 min following
Client rest for 30 min
Administer Rho(D) immune globulin to client if they are Rh-Negative
Risk for AFP test
Low AFP= Down syndrome
High AFP= neural tube defects
Placenta previa vs placental abruption
Placenta implants in lower segment of uterus covering cervical opening vs premature separation of placenta from uterus
Presentation for placenta previa
Painless, bright red vaginal bleeding during 2nd and 3rd trimester; higher than expected fundal height; fetus may be breech, oblique, or transverse
Risk factors for placenta previa
Previous previa, uterine scarring, advanced maternal age (>35), multi fetal pregnancy, multiple gestations, smoking
Presentation for placental abruption
Partial or complete detachment of placenta after 20 weeks; sudden onset of intense localized uterine pain, dark red vaginal bleeding, “board-like” with palpation, contractions with hypertonicity, fetal distress
Risk factors for abruptio placentae
Maternal HTN, trauma (MVA=biggest), cocaine(substance abuse), history of abruption, smoking, PROM(premature rupture of membranes), Multifetal pregnancy
Tx plans for placenta previa
Assess bleeding, leakage, or contractions; fundal height; NO vaginal exams; prepare to give IVF, blood products, betamethasone, prepare for c section, bed rest, nothing inserted into vagina
Tx plans for placental abruption
Palpate uterus for tenderness, serial monitoring for fundal height, FHR monitoring, emotional support, Delivery is only management for abruption
Ectopic pregnancy
Abnormal implantation of ovum outside of uterine cavity; second most frequent cause of bleeding in early pregnancy
expected findings for ectopic pregnancy
Unilateral stabbing pain, tenderness in lower quadrant, scant dark red or brown vaginal spotting
If ruptured, bleeding is red
Tx for ectopic pregnancy-ruptured
Methotrexate (dissolves pregnancy) and laparoscopic salpingectomy
Tx for ectopic pregnancy-non ruptured
Methotrexate and salpingostomy to salvage fallopian tube
Hegar’s sign
softening and compressibility of lower uterus
Chadwick’s sign
Deepened violet-bluish color of cervix and vaginal mucosa
Goodell’s sign
Softening of cervical tip
Non-stress test
Monitors FHR in response to fetal movement; client pushes button when she feels fetal movement
Reactive vs non reactive
Positive non-stress test
Reactive= two or more accelerations within a 20 min period
Negative nonstress test
Non reactive= fewer than two accelerations in 40 min period
Contraction stress test
Nipple stimulated and oxytocin stimulated
(Contractions must be started)
Analysis of FHR response to contractions, determines how fetus will tolerate labor stress
What should be avoided with contraction stress test?
Hyperstimulation of uterus (contraction longer than 90 seconds or five or more contractions in 10 min)
When is oxytocin stimulated contraction stress test used?
If nipple stimulation doesnt work. More difficult to stop… can lead to preterm labor
Contraindications for oxytocin-stimulated contraction stress test
Placenta previa, vasa previa, preterm labor, multiple gestations,previous classic incision from c section, reduced cervical competence(insufficiency)
Quad marker screening
Blood test to provide info about likelihood of fetal birth defects- DOES NOT DX
Can be used instead of maternal AFP blood level, yields more reliable results
What does quad marker screening test for?
Human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP), estriol, inhibin A
Low levels of AFP indicate
Risk for Down syndrome
high levels of AFP indicate
Risk for Neural tube defects
Higher than expected levels of hCG and inhibin A indicate…
Risk for Down syndrome
lower levels than expected for estriol can indicate…
Risk for Down syndrome
Positive and negative contraction stress test
reactive and nonreactive
When is a BPP ordered?
Non reactive stress test, suspected oligohydramnios or polyhydramnios, suspected fetal hypoxemia or hypoxia
What is a BPP?
Biophysical profile ; uses ultrasound to visualize physical and physiological characteristics of fetus, observes for fetal response to stimuli, combo of FHR and fetal ultrasound monitoring
What is the BPP assessing?
FHR, fetal breathing, body movements, fetal tone (flexed?), amount of amniotic fluid
BPP scoring
8-10=normal, low risk of chronic fetal asphyxia
4-6= abnormal, suspect chronic fetal asphyxia
Less than 4= strongly suspect chronic fetal asphyxia—>possible delivery
each category=0-2
If quad marker screening tool shows abnormalities…
Diagnostic tools (depending on gestation) needed for Dx (amino or CVS)
Maternal alpha-fetoprotein results
High levels indicate neural tube defect/open abdominal defect
Low levels can indicate Down syndrome
ONLY A SCREENING TOOL
Stages of fetal development
Two stages: embryonic and fetal
embryonic stage
Day 15-8 weeks gestation
Most critical time in development of organ systems
Most vulnerable to malformations caused by environmental teratogens
what stage is the most critical time in development of organ systems?
Embryonic: All organ systems are present by end of 8 weeks
What stage is most vulnerable to malformations caused by environmental teratogens?
Embryonic
During embryonic stage, the amniotic fluid…
Cushions against impact to maternal abdomen
Maintains stable temp
Allows symmetric development(neutral position for fetus to develop properly, defies gravity)
Prevents membranes from adhering to fetal parts
Allows room and buoyancy for fetal movement
Hormones produced by placenta
Chorionic gonadotropin
Prolactin
Estrogen
Progesterone
Relaxin
When is quickening felt?
Subsequent=18-19 weeks
First-time moms= 20-22 weeks
Monozygotic twins
“Identical”
1ovum/1sperm->2 babies
Dizygotic twins
“Fraternal”
2 ova/2 sperm->2 babies
Risks for monozygotic twins
TTTS (twin to twin transfusion syndrome), sFGR (selective fetal growth restriction), low birth weight, preterm birth, umbilical issues (tangled/compressed), oligo/polyhydramnios, heart defects, brain defects, neural tube defects, postpartum hemorrhage (large placenta/(s) )
Risks for dizygotic twins
least amount of risk associated
umbilical cord issues (tangled/compressed), fetal growth restriction (limited room), low birth weight, preterm birth, placenta issues (placenta previa, abruptio placentae,etc)
When is the fertile period for the menstrual cycle?
12-14 days before new menstrual cycle; five days leading up to ovulation, day of ovulation, and day after ovulation (abt 7 day window)
Describe the menstrual cycle
Three phases: menstrual, proliferative, and secretory ; two cycles: ovarian and endometrial ; average of 28 days
whole body effects of ovulation
Temp drops before ovulation, then spikes 1/2 degree after ovulation
Cervical mucus changes from thick to thin-> clear and stretches like egg white
spinnbarkeit
Sign of ovulation: cervical mucus changes from thick, sticky, and white to thin, clear, and stretches like egg white
How long does it take for an egg to implant?
6-10 days after conception
How do hormones impact menstrual cycle and how they change
regulate menstrual cycle
GnRH released and triggers release of
FSH(inc size and number of follicle cells) and LH(inc antral fluid to burst follicle to ovulate) to stimulate ovarian follicle to ovulate and release estrogen(rebuilding endometrium) and progesterone(maintaining uterine lining for implanting)
if no implanting-> levels of estrogen and progesterone drop-> menstruate, prostaglandins cause contractions of myometrium to release the endometrial lining
Estrogen function-menstrual cycle
Maturing of egg follicle
Progesterone function- menstrual cycle
Thickens endometrium to ready for zygote
Progesterone function- after implantation (pregnancy)
Relaxes uterus to maintain the pregnancy
Prostaglandins function-menstrual cycle
Help release of egg in ovulation
Prostaglandins function- pregnancy
Increases labor contractions and opening of cervix for birth
what hormone(s) decrease to trigger the shedding of the endometrium?
Estrogen and progesterone
What happens when estrogen drops (before progesterone begins)
Ovulation
Placenta functions
- Transfers oxygen and nutrients to fetus
- Removes waste products and CO2 into maternal blood
- Makes hormones
- Transfers antibodies from mother to fetus
Placenta….
Prevents direct contact between fetal and maternal blood (placental barrier)
What roles does placenta play
Transfers oxygen and nutrients, removes waste, makes hormones, transfers antibodies form mother to fetus and serves as a direct contact barrier between fetal and maternal blood
hormones produced by placenta
Chorionic gonadotropin, prolactin, estrogen, progesterone, relaxin
Progesterone promotes growth…
Of the lobes, lobules, and alveoli in the lungs
During pregnancy… renal filtration is… and urinary production…
Increased filtration, urine production amount is the same
Describe umbilical cord
Two arteries, one vein-> vessels surrounded by Wharton’s jelly
“AVA”
Lifeline
Cholasma
Inc of pigmentation on the face (pregnancy mask) Lightens and goes away
Linea Nigra
Dark line of pigmentation form umbilicus to pubic area, lightens and goes away
Striae gravidarum
Stretch marks, dont go away, but lighten
Umbilical arteries…
Carry deoxygenated blood away from the fetus to placenta (mother)
Umbilical vein…
Brings oxygenated blood from mother to fetus “main vein”
describe embryo at 5 weeks
Marked C-shaped body and rudimentary tail
Describe embryo at 7 weeks
Head is rounded and nearly erect. Eyes shifted forward and closer together, eyelids begin to form
describe embryo at 8 weeks
Every organ system present, HR detectable by Doppler, eyes ears nose and mouth recognizable
At about 20 weeks gestation…
Quickening, primitive breathing movements (alveoli filled with fluid), vernix caseosa, lanugo
The more premature… the …. Vernix caseosa is present
MORE
The further along the baby is developed… the… lanugo is present
Less
fetal stage
9 weeks-pregnancy ends
Amniotic fluid first from diffusion from maternal blood then fetus’ urine, volume inc weekly to about a quart
What is amniotic fluid
First from diffusion from maternal blood then fetus’ urine
Regulates temp, cushions, allows movement, allows symmetrical development, barrier to infection
Amniotic fluid function
Regulates temperature, cushions, allows movement, barrier to infection
What hormone is produced during pregnancy
Human chorionic gonadotropin (hCG)
Danger signs during middle pregnancy-report!
Facial edema, blurred vision, seeing floaters, edema in hands, severe headaches, epigastric pain-> HTN condition or preeclampsia (middle of pregnancy)
Danger signs during pregancy-beginning-report!
Burning during urination
Severe vomiting
Diarrhea
Fever/chills
Abd cramping, vaginal bleeding(early vs late means diff things)
Gush of fluid from vagina(27 weeks)
Naegele’s rule
Take LMP date (beginning) and subtract 3 months and add 7 days and one year (if applicable)= due date
How to calculate GTPAL
G= how many pregnancies(total)
T=term deliveries (after 37 weeks)
P=preterm(before 37 weeks)
A=abortion
L=living children
Supine hypotension
Weight of baby and uterus compresses on IVC and SVC and causes hypotension
Relaxin effects musculoskeletal system
Causes pelvic joints to relax and gait to change
How is supine hypotension alleviated?
Have mother lay on her left side(best side bc vena cava runs on right side=optimal blood flow but right works too)
Progression of HTN
GHTN—>preeclampsia->severe preeclampsia-> eclampsia
Gestational HTN
Begins after 20 weeks
140/90 or greater (about twice, 4-6 hrs apart within a week)
NO proteinuria
BP return to baseline postpartum
Preeclampsia
Gestational HTN with proteinuria > or = to 1+. Report transient headaches might occur with episodes of irritability . Edema can be present
BP higher than 140/90
Tx= bed rest and increase circulation to kidneys and uterus
Severe preeclampsia
BP=160/110 or greater, proteinuria greater than 3+, oliguria, creatinine higher than 1.1
-headaches, blurred vision, hyperreflexia(clonus), extensive peripheral edema, epigastric pain, RUQ pain(enlarged liver, inc ALT and AST), thrombocytopenia
Eclampsia
Severe preeclampsia with onset of seizures and/or coma. Preceded by headache, severe epigastric pain, hyperreflexia, hemoconcentrations (possible warning manifestations of convulsions)
After 20 weeks, up to 6 weeks postpartum
HELLP syndrome
Variant of GHTN=hematologic conditions coexist with severe preeclampsia and hepatic dysfunction. Dx by laboratory not clinically
Components of HELLP syndrome
H: hemolysis->anemia and jaundice
EL:elevated liver enzymes (ALT,AST, epigastric pain, N/V)
LP: low platelets (thrombocytopenia, abornmal bleeding and clotting time, bleeding gums, Petechiae, possible DIC)
Difference between polyhydramnios and oligohydramnios
Oligo=low fluid
Poly=too much fluid
Hyperemesis gravidarium
Continuous and excessive vomiting causing weight loss, dehydration, electrolyte imbalances, and malnutrition; high hCG levels
assessment for hyperemesis gravidarum
S/s dehydration, fluid/electrolyte imbalance
Weight loss
Tx for hyperemesis gravidarium
-LR
-vitamin B6 (pyridoxine) and other supplements as needed
-antiemetic (metoclopramide)
NPO diet
Nausea medicine-ondansetron
Gradually reintroduce food
What are the different types of abortions?
Spontaneous vs. elective
spontaneous abortion
Natural causes that end pregnancy
First trimester- before 20 weeks
types of spontaneous abortions
Threatened, inevitable, incomplete, complete, missed, septic, and recurrent
Threatened abortion
Possible mild cramps, slight spotting, no tissue passed and cervical opening closed; pregnancy still safe
mild to moderate cramps, moderate bleeding, May or may not have tissue passed and dilated cervical opening; case of “when” it happens
Inevitable spontaneous abortion
severe cramps, heavy/profuse bleeding, tissue is passed, dilated with tissue in cervical canal or passage of tissue; some tissue remains
Incomplete spontaneous abortion
Complete spontaneous abortion
Mild cramps, minimal bleeding, tissue passed, and no cervical opening (closed after tissue passed)
Missed spontaneous abortion
No cramps, minimal to no bleeding(spotting), retention of tissue (none passed), closed cervical opening; usually feel no changes, typically found in US with no FHR; no signs of distress
Various cramp intensities, possible malodorous discharge, various amounts of tissue passed, cervical opening usually dilated
Septic spontaneous abortion
Recurrent spontaneous abortion
Cramps and bleeding varies, tissue has passed, cervix usually dilated
Tx for each abortion
-Ultrasound=priority(is placenta intact?)-?fetus viable?
-Cervical exam (if threatened->avoid!)
-D&C or D&E
-Prostaglandins (stimulate labor to let body take care of it naturally i.e. missed spontaneous abortion)
nursing care for spontaneous abortions
-Perform pregnancy test
-Observe color and amt of bleeding (count pads)
-Maintain client on bed rest (esp if threatened abortion)
-avoid vaginal exams
-determine how much tissue passed and save for examination (genetic issue?)
-assist with termination of pregnancy(if missed/incomplete)
-client education and support
Education for clients-spontaneous abortion
-Notify provider if heavy,bright red vaginal bleeding, elevated temp, foul-smelling vaginal discharge
-small amt of discharge normal for 1-2 weeks
-take prescribed abx
-refrain from bath tubs, sexual intercourse, placing anything into vagina for 2 weeks
-discuss grief and loss with provider before attempting another pregnancy
Risk factors for spontaneous abortions
Chromosome abnormalities
Maternal illness
Advanced maternal age
Premature dilation
Chronic maternal infections
Maternal malnutrition
Trauma (MVA, DV)
Substance use
What is gestational diabetes
Impaired glucose tolerance, first recognized or begins during pregnancy; pregnancy hormones—>insulin insensitivity
Two classes: A1-no meds and A2-meds
How is GDM diagnosed?
1 hr Oral glucose test(blood taken 1 hr after 50 g oral glucose) if elevated(>130-140), then a 3 hour glucose tolerance test administered(fasting, 100g oral glucose, sugar taken before and after glucose); if two or more out of the four BGL are elevated, Dx of GDM
GDM and the fetus
Macrosomia(big baby), birth trauma(shoulder dislocation), electrolyte imbalance, hypoglycemia (dec sugar after cord cut after birth from moms sugar, risk at 24-48 hr)
How is GDM treated?
Manage sugar with insulin and lifestyle changes
Magnesium sulfate
anticonvulsant used to prevent seizures for eclampsia pts
What is magnesium sulfate used for
Anticonvulsant, prophylaxis/tx to depress CNS and prevent seizures (eclampsia and severe eclampsia)
Magnesium sulfate toxicity
BURP
BP dec
Urine output dec
RR <12
Patella reflex absent
What do you monitor for a pt on magnesium sulfate?
VS, I&O, headache, visual disturbances, contractions, FHR and activity
What are signs of magnesium sulfate toxicity
Absence of deep tendon reflexes
Urine output <30mL/hr
RR <12/min
Dec LOC
Cardiac dysrhythmias
Hot flashes
Double vision
Slurred speech
Magnesium sulfate antidote
Calcium Gluconate
D/C infusion, administer antidote
Cerclage
Stitch in cervix to keep it closed until time for delivery
What is cerclage used for
Tx for cervical insufficiency(besides progesterone if she’s low)(no signs of labor, but feels pressure and cervix opens, preterm delivery due to weakness)
What s/s do pt need to report with cerclage
S/s infection, abnormal discharge, foul odor, pain, contractions, “pressure” pink-stained discharge or bleeding, rupture of membranes
How does pregnancy affect BP?
inc cardiac output, blood volume, HR, heart muscle enlargens for circulation for two; begins around/after 20 weeks
What pregnancy category medications are safe?(BP)
Methyldopa (antihypertensive)
Nifedipine (CCB and antihypertensive)
Hydralazine (vasodilator)
Labetalol (BB)
what medications are not safe for pregnant HTN pts?
ACEs and ARBs!
(-pril and -sartan)
How do we advise pts about BP meds?
do not take anything ending in -pril or -sartan; do not take antihypertensive if BP systolic 100 or below
Take BP and HR before BB- hold if les than 60 or systolic 100
Orthostatic hypotension- move positions slowly
Report SOB with BB
What are neural tube defects?
severe birth defects that affect the brain, spinal cord, or spine (Spina Bifida, anencephaly, encephaloceles, chiari malformation)
Spina bifida
spinal column doesn’t close completely, which can cause nerve damage and paralysis of the legs
Chiari malformation
Brain tissue extends into the spinal canal
Anencephaly
Most of the brain and skull don’t develop, and babies are usually stillborn or die shortly after birth
Encephaloleces
Portions of the brain and meninges protrude due to defects in the cranium
How can neural tube defects be prevented?
tale 400 mcg folic acid daily, avoid hot temperatures while pregnant (saunas hot tubs etc), control diabetes, avoid opioids, avoid anticonvulsants and other medications that may cause them
What is fundal height?
Measured in cm from symphasis pubis to top of uterus. Cm should match weeks in pregnancy ex: 36cm=36 weeks; helps gauge how baby is growing
How is Fundal height measured, and how do we know it is on track?
Fingers above and below umbilical cord, tape measure from pubis symphasis to fundus
What is urinary frequency during pregnancy?
The uterus sits behind bladder, first trimester it pushes on the bladder
When does urinary frequency during pregnancy get better or end?
When uterus gets big enough to rise above the bladder
What is a fetal demise?
When a baby dies in the womb after 20 weeks, or stillborn
How is fetal demise diagnosed?
Death of a baby after 20 weeks (before=miscarriage)
-vaginal bleeding, a uterus that is smaller than expected, or a lack of fetal movement, no FHR, non reactive stress test
Which physiological change is common in the cardiovascular system during pregnancy?
-inc lung capacity
-inc cardiac output
-dec blood volume
-dec HR
-inc iron absorption
Inc cardiac output
Which sign refers to the deepened violet-bluish color of the cervix and vaginal mucosa during pregnancy?
-Braxton hicks contractions
-Hegar’s sign
-Goodell’s sign
-Chadwick’s sign
Chadwick’s sign
Which of the following is a presumptive sign of pregnancy?
-Hegar’s sign
-Quickening
-fetal heart sounds
-visualization of the embryo
Quickening
What is a common discomfort of pregnancy related to the musculoskeletal system?
-heartburn
-leg cramps
-round ligament pain
-N/V
-headache
Round ligament pain
What’s physiological change occurs in the uterus during pregnancy?
-dec in uterine weight
-thickening of the uterine wall
-inc in uterine muscle tone
-reduced uterine blood flow
Thickening of the uterine wall
What is an indicator of potential preeclampsia during pregnancy?
-mild back ache
-facial edema and severe headaches
-constipation
-round ligament pain
Facial edema and severe headaches
What does BPP assess?
-fetal heart rate
-maternal blood pressure
-fetal breathing, body movements, tone
-maternal weight gain
Fetal breathing, body movements, tone
What is the main benefit of conducting a nonstress test (NST)?
-determines the gestational age of fetus
-assesses the response of fetal heart rate to fetal movements
-it measures the amount of amniotic fluid
-it evaluates the size of the uterus
It assesses the response of fetal heart rate to fetal movements
Which of the following is NOT a contraindication for an oxytocin-stimulated contraction stress test?
-placenta previa
-multiple gestations
-previous vaginal birth
-reduced cervical competence
Previous vaginal birth
In a contraction stress test, which condition should be avoided?
-hyperstimulation of the uterus
-fetal movement
-maternal position changes
-continuous FHR monitoring
Hyperstimulation of the uterus
At what gestational age is chorionic villus sampling (CVS) ideally performed?
10-13 weeks
In a quad marker screening, which combination of results suggests an increased risk for Down syndrome?
Low AFP, high hCG, high inhibin A, low estriol
What is the second most frequent cause of bleeding in early pregnancy?
Ectopic pregnancy
Which medication is used for medical management of an unruptured ectopic pregnancy?
Methotrexate
What is the primary characteristic of bleeding associated with placenta previa?
Painless and bright red blood
Which of the following is NOT a risk actor for placenta previa?
-previous previa
-advanced maternal age (>35)
-first pregnancy
-multiple gestations
First pregnancy
Which statement about abruptio placentae is correct?
-it typically occurs before 20 weeks gestation
-it is characterized by painless vaginal bleeding
-the uterus may feel “board-like) on palpation
-vaginal examinations are recommended for diagnosis
The uterus may feel “board-like” on palpation
What is the only definitive management for abruptio placentae?
Delivery
