Perinatal Flashcards
After a normal pregnancy a male infant is born by normal vaginal delivery to a 17 year old primigravida. One minute after birth the infant has a heart rate of 80 beats per minute, gives irregular gasps, has blue hands and feet but a pink tongue. The infant has some muscle tone but does not respond to stimulation. At 5 minutes the infant’s heart rate is 120 beats per minute and is breathing well. The tongue is pink but the hands and feet are still blue. The infant moves actively and cries well.
The Apgar score at 1 minute is: (Choose the correct answer.)
a. 2
b. 4
c. 3
d. 5
e. 6
b. 4
After a normal pregnancy a male infant is born by normal vaginal delivery to a 17 year old primigravida. One minute after birth the infant has a heart rate of 80 beats per minute, gives irregular gasps, has blue hands and feet but a pink tongue. The infant has some muscle tone but does not respond to stimulation. At 5 minutes the infant’s heart rate is 120 beats per minute and is breathing well. The tongue is pink but the hands and feet are still blue. The infant moves actively and cries well.
After one minute the attending midwife should do the following: (Choose the most appropriate answer.)
a. Give chest compressions
b. Give the infant face mask ventilation
c. Suction the infant vigorously
d. Give the infant Narcan
e. Intubate and ventilate the infant
b. Give the infant face mask ventilation
After a normal pregnancy a male infant is born by normal vaginal delivery to a 17 year old primigravida. One minute after birth the infant has a heart rate of 80 beats per minute, gives irregular gasps, has blue hands and feet but a pink tongue. The infant has some muscle tone but does not respond to stimulation. At 5 minutes the infant’s heart rate is 120 beats per minute and is breathing well. The tongue is pink but the hands and feet are still blue. The infant moves actively and cries well.
After 5 minutes the infant should be: (Choose the most appropriate answer.)
a. Given a glucose water feed
b. Taken to the nursery for observation
c. Taken to the nursery for bathing
d. Given intravenous fluids
e. Put on the mother’s chest
e. Put on the mother’s chest
The male infant described in the previous three questions has a gestational age of 40 weeks and weighs 2800 g. Three days after birth he weighs 2500g. His mother is complaining of painful nipples and sore breasts.
Which of the following represents the most appropriate response?
a. The infant has lost too much weight and should be formula fed
b. The infant should be admitted to the nursery so that his mother can get some rest
c. The infant needs intravenous fluids
d. His mother needs breastfeeding advice and support
e. It is likely he is not feeding well because he is too small
d. His mother needs breastfeeding advice and support
Which of the following statements is part of the “Ten steps to successful breasfeeding”?
Choose one correct response only.
a. Give newborn infants formula if there is weight loss.
b. Mothers should breastfeed for the first time after their infant has been bathed
c. Discourage breastfeeding on demand.
d. Encourage the use of dummies, teats and nipple shields.
e. Allow mothers and their infants to remain together all the time from delivery to discharge.
e. Allow mothers and their infants to remain together all the time from delivery to discharge.
Which one of the following women are at the most increased risk of transmiting HIV to their fetus:
a. A woman who is pregnant for the first time
b. A woman who becomes infected with HIV during pregnancy.
c. A woman who was infected with HIV before she fell pregnant
d. A woman who has had a previous pregnancy
e. A woman who has Tuberculosis
b. A woman who becomes infected with HIV during pregnancy.
Which one of the following options is most appropriate for the HIV positive mother who wishes to reduce the chance of her infant becoming infected:
a. Exclusively formula feed
b. Feed the infant breast milk in the nursery but convert to formula at home
c. Give clear feeds fro the first 48 hours.
d. Practice safe sex
e. Breast feed but give formula while mother is at work
a. Exclusively formula feed
An infant is born at 40 weeks and weighs 2800 g. — Choose match
Post term infant Low birth weight Small for gestational age Term, appropriate birth weight Preterm infant Infant of a diabetic mother Inappropriate for gestational age Wasted infant IUGR
Small for gestational age
An infant is born to a 35 year old G3 P2 mother. She was noted at antenatal clinic on two occasions to have glycosuria. The infant’s birthweight at term is 4600g — Choose match
Post term infant Low birth weight Small for gestational age Term, appropriate birth weight Preterm infant Infant of a diabetic mother Inappropriate for gestational age Wasted infant IUGR
Infant of a diabetic mother
An infant with a birthweight of 2600 g has a gestational age of 36 weeks. — Choose match
Post term infant Low birth weight Small for gestational age Term, appropriate birth weight Preterm infant Infant of a diabetic mother Inappropriate for gestational age Wasted infant IUGR
Appropriate birth weight
A woman who defaults from the antenatal clinic in the last month of pregnancy delivers vaginally at 42,5 weeks. There is some meconium staining of the liquor. The infant is actively suctioned before delivery of the shoulders. He does not need resuscitation. He is noted to have long finger nails. He has a birth weight between the 10th and 90th centiles. — Choose match
Post term infant Low birth weight Small for gestational age Term, appropriate birth weight Preterm infant Infant of a diabetic mother Inappropriate for gestational age Wasted infant IUGR
Post term infant
An infant is born at 39 weeks gestation and weighs 2400g. His head circumference and length plots on the 50th centile for gestational age. His skin is dry and his legs appear thin. — Choose match
Post term infant Low birth weight Small for gestational age Term, appropriate birth weight Preterm infant Infant of a diabetic mother Inappropriate for gestational age Wasted infant IUGR
Wasted infant
A young couple consult you about pregnancy. They are healthy, have a normal sex life and are not using contraception. They hope to become parents and ask you when the best time is to book for antenatal care. When would you advise her from the list below?
A. When she is 3 months pregnant (12 to 14 weeks)
B. When she misses a period
C. When she has missed her second period
D. When she first feels fetal movements
C. When she has missed her second period
The abdominal examination gives the best assessment of the duration of pregnancy when carried out at which one of the opt1111ions below? A. From 8 to 12 weeks B. From 14 to 18 weeks C. From 28 to 32 weeks D. From 32 to 38 weeks
B. From 14 to 18 weeks
A patient has been in the antenatal ward for a week with hypertension and proteinuria. She had a Caesarean Section for her only previous delivery. Control of her blood pressure has been reasonably good with antihypertensive agents and has reached 34 weeks gestation. She now presents with continuous abdominal pain and dark red vaginal bleeding. Her blood pressure is 160/100.
Which of the diagnoses below is the most likely? A. Show B. Abruption C. Placenta praevia D. Ruptured uterus
Memo: C. Placenta praevia
Might be: B. Abruption
A woman is admitted for delivery because she is thought to be post-term by sure dates and her BP has risen from 130/80 to 140/100. The evening prior to induction she has her cervix assessed and the Bishop score is found to be 3. She is given prostaglandin gel to ripen her cervix. That night she experiences strong contractions and notes blood and mucus on her pad.
Which of the diagnoses below is the most likely? A. Abruption B. Placenta praevia C. Show D. Ruptured uterus
C. Show
A 41 year old woman books in her first pregnancy at 16 weeks gestation. She wishes to avoid any procedure which may carry harm to her fetus but wants information about the risk of her infant being a Down Syndrome.
What would be your recommendation from the selection below?
A. Chorion villus sampling
B. Maternal serum triple testing
C. Book for amniocentesis
D. Tell her it is too late to do anything
C. Book for amniocentesis
An 18 year old primigravid woman presents at 36 weeks gestational age complaining of swelling of her ankles and fingers but no other symptoms. On examination, she has a blood pressure of 160 / 100 mm Hg with evidence of oedema affecting both legs to the level of the knee. Her urine shows 1 + proteinuria. Her pregnancy prior to this presentation had been normal.
Which of the options below is the most likely diagnosis? A. Chronic hypertension B. Imminent eclampsia C. HELLP syndrome D. Pre-eclampsia
D. Pre-eclampsia
An unbooked patient is referred to hospital from an obstetric midwife unit where she presented complaining of severe epigastric pain and vomiting. On arrival in hospital she is slightly jaundiced, her blood pressure is mildly elevated at 140 / 90 mm Hg and she is passing dark coloured urine through her Foley’s catheter. Abdominal examination reveals a 32 week pregnancy.
Which of the options below is the most likely diagnosis? A. Pre-eclampsia B. HELLP syndrome C. Chronic hypertension D. Chronic renal disease
B. HELLP syndrome
A woman has a placenta praevia and requires classical caesarean section.
What from the following list would you advise her?
A. She should not conceive again
B. If she conceives again she is likely to end up with a ruptured uterus
C. Her chances of anaemia in her next pregnancy will be increased
D. She should have an elective caesarean section in her next pregnancy
D. She should have an elective caesarean section in her next pregnancy
At a caesarean section it is standard practice to use which one of the following drugs immediately after delivery of the baby? A. Intravenous oxytocin infusion B. Intravenous morphine C. Intravenous ergometrine D. Intravenous narcan
A. Intravenous oxytocin infusion
A woman aged 28 years books at 14 weeks in her first pregnancy. She has normal investigations and weighs 70 kilograms. At 20 weeks she had a routine ultrasound which confirmed her dates and the report states that there were no abnormalities. From 26 weeks her symphysis-fundal height measurements are greater than expected and at 36 weeks the liquor volume feels increased.
What is your most appropriate management from the options below?
A. Perform an amniocentesis for karyotyping
B. Investigate for diabetes
C. Serial cardiotocograph tracings
D. Perform an amniocentesis for maturity
B. Investigate for diabetes
A woman who is being induced with intravenous oxytocin develops fetal distress and a decision is made to carry out a caesarean section. There is a delay in getting her to theatre as the staff are busy with another CS.
What step/s would you take from the options below?
A. Get the patient to lie on her back and give her oxygen
B. Continue the oxytocin but at a lower rate
C. Stop the oxytocin and suppress labour
D. Reduce her blood pressure with neprasol
C. Stop the oxytocin and suppress labour
A healthy 30 year old woman in her first pregnancy is diagnosed with twins at 14 weeks gestation by ultrasound. She consults you about potential problems that may arise during the pregnancy. She asks you what the most likely complications could be.
Which from the list below would you choose to discuss with her? A. Preterm labour B. Placental abruption C. Chromosomal abnormalities D. Deep vein thrombosis
A. Preterm labour
A primigravid woman presents to your hospital at 32 weeks gestation by reasonably sure dates. She has had a normal ante-natal course after booking at 12 weeks. She complains of intermittent lower abdominal pain which you suspect is preterm labour.
Which of the options below is the single best indicator whether she will go on to deliver or not?
A. The duration of her episodes of pain
B. The frequency of her episodes of pain
C. The cervical dilatation
D. Whether she is pyrexial
C. The cervical dilatation
An infant is born to a 35 year old G3 P2 mother. She was noted at antenatal clinic on two occasions to have glycosuria. The infant’s birthweight at term is 4100g.
Infant of a diabetic mother
An infant is born at 40 weeks and weighs 2800 g
Term, appropriate birth weight
An infant is born at 39 weeks gestation and weighs 2400g. His head circumference and length plots on the 50th centile for gestational age. His legs appear thin.
Wasted infant
Which one of the following women are at the most increased risk of transmitting HIV to their fetus:
A. A woman who has tuberculosis
B. A woman who was infected with HIV before she fell pregnant
C. A woman who has had a previous pregnancy
D. A woman who becomes infected with HIV during pregnancy
D. A woman who becomes infected with HIV during pregnancy
