Problems In pregnancy

Question 1

What are good food sources for iron?

Answer 1

Prune juice
Raisins
molasses
pumpkin seeds
sesame seeds
sunflower seeds
beans
dark greens
organic beef liver

Question 2

What week gestation does HGB/HCT readings often dip because of increase in blood volume?

Answer 2

28 weeks

Question 3

What levels for HCT/HGB should a mother try to maintain throughout most of her pregnancy?

Answer 3

HCT 34
HGB 11.5

Question 4

What does MCV (mean corpuscular volume) indicate?

Answer 4

The average size of her red blood cells

Question 5

What does MCH (mean corpuscular hemoglobin) indicate?

Answer 5

Her average amount of hemoglobin per cell.

Question 6

What is microcytic(small cell) anemia?
[Iron deficiency]

Answer 6

The MCV is normal but the MCH is lower than usual.

Question 7

What is macrocytic or megaloblastic(large cell) anemia?
[B-12 + folate anemia]

Answer 7

The MCV is elevated but the MCH is normal.

Question 8

What are good food sources for folate?

Answer 8

Egg yolks
Orange juice
Melons
Strawberries
Dark greens

Question 9

What are good food sources for vitamin B-12?

Answer 9

Dairy Foods
Animal Products

Question 10

What are two types of hereditary, microcytic anemias?

Answer 10

Thalassemia
Sickle cell anemia

Question 11

How much weight gain is normal/average in pregnancy?

Answer 11

At least 10 lbs by 20 weeks and about 1 lb per week thereafter.

Question 12

What is it called when there is a miscarriage before 20 weeks?

Answer 12

Spontaneous Abortion

Question 13

What is it called when there is a miscarriage after 20 weeks?

Answer 13

Fetal Demise

Question 14

What is it called when there is bright red bleeding dramatic or slight and continuous for days or weeks?

Answer 14

Threatened Abortion

Question 15

What is it called when membranes rupture or cervix dilates in first half of pregnancy?

Answer 15

Inevitable Abortion

Question 16

What is an ectopic pregnancy?

Answer 16

Implantation occurring outside the uterine cavity. (Majority occur in the fallopian tubes-tubal pregnancy)

Question 17

What is the outcome of a tubal pregnancy?

Answer 17

The fetus may be expelled into the abdominal cavity as it grows too large, or may cause the tube to rupture between 10-13 weeks.

Question 18

What can a tubal pregnancy be mistaken for?

Answer 18

Pelvic Inflammatory Disease
Sever GI upset
Appendicitis

Question 19

What is the primary cause of tubal pregnancy?

Answer 19

Pelvic Inflammatory Disease
(Leaves scar tissue that may partially occlude the tube and cause reduced cilliation or the formation of blind pockets)

Question 20

What predisposes women to ectopic pregnancies?

Answer 20

STDs
Trauma from IUDs
Progesterone-based contraception
Infection following abortion
Prior tubal rupture
Reconstructive surgery

Question 21

What are symptoms of tubal pregnancy?

Answer 21

Pelvic pain(consistent and more intense than cramping)
Spot bleeding

Question 22

What are the signs of tubal pregnancy rupture?

Answer 22

Pain becomes more severe and may be referred to the shoulder area.
The degree of shock far exceeds what would normally be expected for the amount of blood loss.

Question 23

What is the treatment of tubal pregnancy?

Answer 23

Surgical Removal of the pregnancy
Methotrexate(dissolves pregnancy)

Question 24

What is hydatiform mole(molar pregnancy)?

Answer 24

When the chorionic villi which usually forms the membranes and placenta, instead develops into a mass of clear, grape-like vesicles that fill the uterus.

Question 25

What is a complete mole?

Answer 25

When an abnormal sperm inactivate the chromosomes of the ovum. There is no fetus.

Question 26

What is partial mole?

Answer 26

There is fetal tissue present, though chromosomes from sperm and ovum are abnormal in number and the fetus almost never survives.

Question 27

What are symptoms of hydatiform mole?

Answer 27

-Light brown bleeding persisting for weeks or months(though rarely past the first trimester)
-Uterus is large for dates
-Uterus is woody, hard, doughy to touch
-High HCG levels

Question 28

What are the complications of elevated HCG levels?

Answer 28

Taxes the livers
HTN
Proteinuria
Hyperemesis(later in pregnancy)

Question 29

Bleeding in late pregnancy:
What is bleeding from a ruptured cervical polyp like?

Answer 29

Sudden and somewhat dramatic but tends to resolve quickly.

Question 30

Bleeding in late pregnancy:
What is a marginal placental abruption?

Answer 30

Separation at the edge of the placenta only, causing bright red blood to flow from the vagina but pain is less intense.

Question 31

Bleeding in late pregnancy:
What is a concealed placental abruption?

Answer 31

Separation of the central portion of the placenta while margins remain attached, so bleeding is concealed. Acute, consistent abdominal pain(or back pain if placenta is implanted posteriorly) that is nonrhythmic and does not change with movement, with uterus woody hard and exceedingly tender.

Question 32

Bleeding in late pregnancy:
What is a complete placental abruption?

Answer 32

A total separation of the placenta. Vaginal bleeding is profuse and mother will rapidly go into shock.

Question 33

Bleeding in late pregnancy:
What is placenta previa?

Answer 33

Placenta implanted low in the uterus. Blastocyst seeks an unused/unscarred site in which to imbed.

Question 34

Bleeding in late pregnancy:
What are the risk factors for placenta previa?

Answer 34

Previous uterine surgeries
History of PID
Endometritus
Multiparty
Pregnancies with short intervals between
Large placenta(twins, etc)

Question 35

Elevated blood sugar in early pregnancy is linked to?

Answer 35

Birth defects
Miscarriage

Question 36

What are the risks for baby with elevated blood sugar levels as pregnancy advances?

Answer 36

Macrosomia(growth in chest region)
-prolonged labor
-shoulder dystocia
Respiratory Distress
Hypoglycemia
Hypocalcemia

Question 37

What are the risks for mother with elevated blood sugar levels as pregnancy advances?

Answer 37

Preeclampsia
Polyhydraminos
Postpartum hemorrhage

Question 38

What are symptoms of type 2 diabetes?

Answer 38

Increased thirst
Increased urinary output
Recurrent or chronic yeast infections
Acetone breath
Ketonuria
Persistent glucosuria

Question 39

What is protocol for women with diabetes risk factors or symptoms?

Answer 39

HgbA1c screen in first trimester
Additional screening at 24-28 weeks

Question 40

What is the glucose challenge test?
(GCT)

Answer 40

The mother ingests 50mg liquid glucose/orange pop with a blood draw 1 hour later. R/c carb loading for 3 days prior and have it performed at 24 weeks.

Question 41

If glucose levels exceed 140mg/dl with GCT, what is the next test?

Answer 41

Oral glucose tolerance test(OGTT)
Mother carb loads for 3 days before
Fast overnight for baseline
Ingest 75mg glucose
Blood draws repeated at 1 and 2 hours
During this time, no eating but light exercise.

Question 42

What are max sugar levels with OGTT?

Answer 42

Fasting: above 90 mg/dl
One hour: above 180 mg/dl
Two hours: above 155 mg/dl

Question 43

What is the standard treatment for HTN in the hospital?

Answer 43

IV mag sulfate

Question 44

What is severe gestational hypertension linked to?

Answer 44

Placental abruption and intrauterine growth restriction, as vasoconstriction affects uterine circulation and the flow of oxygen to the baby.

Question 45

What are early signs of preeclampsia?

Answer 45

Hemoconcentration
Hypertension
Protein in urine
Elevated liver enzymes
BUN
Uric acid

Question 46

What indicates a more serious sign of preeclampsia?

Answer 46

Hyperreflexia
-check for clonus(while sitting, lift and support calf, then dorsiflex foot, maintain the release. If jerking is noticed while dorsiflexed, or oscillation as it falls, the test is positive)

Question 47

What are signs the preeclampsia has worsened?

Answer 47

Severe headache
Epigastric pain
Visual disturbances
Decreased output of urine
Extreme nervous irritability
Decrease in fetal movement

Question 48

What can polyhydraminos lead to?

Answer 48

Premature Labor
Uterine Dysfunction
Placental Abruption
Postpartum Hemorrhage
(All from over-distention of the uterus)

Also, cord prolapse and fetal malpresentation.

Question 49

With oliohydraminos, the resulting cord compression leads to which complications?

Answer 49

IUGR
Postmaturity syndrome
Fetal distress/hypoxia in labor

Question 50

What are identical(monozygotic) twins?

Answer 50

The union of one egg and one sperm, with the fertilized ovum separating into two. Share a placenta and may share a sac.

Question 51

What are fraternal(dizygotic) twins?

Answer 51

The union of two eggs and two sperm, that is two pregnancies occurring simultaneously. Separate placentas and separate sacs.

Question 52

What are the risks of twin births?

Answer 52

Cord prolapse
Hypoxia(less uterine volume can cause constriction on placenta vessels)
Placental abruption
Postpartum hemorrhage

Question 53

Prematurity is defined as birth prior to how many weeks?

Answer 53

37 weeks

Question 54

What are the main risks of prematurity?

Answer 54

Polycythemia
Immature lungs resulting in RDS

Question 55

What are the causes of prematurity?

Answer 55

Vaginal Infection
UTI resulting in chorioamnionitis and ROM
Incompetent cervix
Polyhydramnios
Multiple pregnancy
Uterine anomalies
Faulty implantation of placenta
Substance abuse
Short interval between pregnancies
Malnutrition
Fetal Death
Extreme or chronic stress
Strenuous physical activity
Chronic gum disease
Maternal dehydration

Question 56

What are the causes for IUGR?

Answer 56

Malnutrition
Severe anemia
Chronic hypertension
Substance abuse
Fetal malformation or infection
Placenta and cord abnormalities
Prolonged pregnancy
Chronic stress and overwork

Question 57

The current definition of postdatism is pregnancy progressing past how many weeks?

Answer 57

42 weeks

Question 58

What is fetal dysmaturity syndrome?

Answer 58

When maternal malnutrition and chronic dehydration lead to reduced blood volume and oliohydraminos, which in turn can cause cord compression and fetal compromise.