Inpatient Obstetrical Certification NCC
Leading cause of perinatal admissions to the ICU Correct Answer: Hemorrhagic disorders
Percentage of
... [Show More] deaths related to pregnancy related hemorrhages Correct Answer: 17-25%
Most maternal deaths from obstetric hemorrhage after first trimester of pregnancy are due to Correct Answer: Placental abruption
Race most likely to die from post-partum hemorrhage Correct Answer: African Americans
Mortality rate (2006) for white women, African American women and Hispanic women in the US, stated as deaths per 100,000 live births Correct Answer: White women 13.3/100,000
African American women 32.7/100,000
Hispanic women 10.2
68% of post-partum hemorrhage deaths occur within _______hours of delivery Correct Answer: 48
Obstetric hemorrhage is defined as a TBL or more than Correct Answer: 1000cc
The classic sign of placenta previa is Correct Answer: painless vaginal bleeding in the second or third trimester of pregnancy
If you see painless vaginal bleeding in the second or third trimester of pregnancy, suspect Correct Answer: Placenta previa
Risk factors for placenta previa Correct Answer: previous placenta previa, advanced maternal age greater than 40, previous cesarean, short interval between pregnancies, multiparity,previous abortions with curettage, smoking, race (Asian women at greatest risk), large placenta
In patients with suspected placenta previa, which comes first, a speculum examination or a confirmatory ultrasound? Correct Answer: Do the ultrasound first
Fetal blood volume is Correct Answer: 100ml/kg
Changes noted during significant blood loss Correct Answer: Rising pulse rate
Increase in respiratory rate
Skin changes to pallor
Falling blood pressure (a late finding)
Decreased urinary output
Decreased LOC
Characteristic findings in FHR if mother has a significant blood loss Correct Answer: Initially, tachycardia
Then bradycardia
Sinusoidal-fetal anemia, hypoxia and academia
Persistent late decelerations
Percentage of accreta among women with previa Correct Answer: 5-10%
If patient has had 2 or more cesarean sections, the likelihood of an accreta is Correct Answer: Greater than 50%
Vasa previa Correct Answer: Fetal vessels cross the placental membranes in the lower uterine segment and cover the cervical os
Velamentous cord insertion Correct Answer: Fetal vessels run across chorion and amnion without protective Wharton's jelly before entering the placental surface
Succenturiate placenta Correct Answer: One or more small accessory lobes of placental vascular tissue in membranes that are attached to main placenta by fetal vessels
Hemolysis Correct Answer: lysis of erythrocytes with the release of hemoglobin
HELLP Correct Answer: Hemolysis, Elevated Liver Enzymes, Low Platelets
Per AWHONN, patients with placenta previa should not be discharged to home until they have gone_____hours with not bleeding Correct Answer: 72 hours
Classic symptom of placental abruption Correct Answer: Painful vaginal bleeding after 20 weeks gestation
Risk factors for placental abruption Correct Answer: Smoking increases risk 90%
Maternal hypertension 500% increased risk
Multiparity
Abortions
Illicit drug use
Short umbilical cord
Abdominal trauma
Rupture of membranes(due to sudden uterine decompression)
Leiomyoma behind placenta
ACOG standard for fetal monitoring for maternal abdominal trauma Correct Answer: Minimum of 2-6 hours
DIC stands for Correct Answer: disseminated intravascular coagulation
DIC is Correct Answer: a pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external or internal bleeding or both
Specific diagnostic test for DIC Correct Answer: D-dimer is positive in 34% of cases of DIC
Gestational Trophoblastic Disease Correct Answer: condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity
Hydatidiform mole is characterized by Correct Answer: chronic or acute bleeding and a uterus that is large for gestational age. 1 in 1200 pregnancies. 5% turn into choriocarcinoma
Preeclampsia in the first trimester, HCG levels above 100,000 mIU/mL, and an enlarged bleeding uterus are clinical signs of what? Correct Answer: Hydatidiform mole
Five groups of hypertensive disorders in pregnancy
Correct Answer:
1. Gestational hypertension-hypertension developing after 20 weeks gestation without proteinuria
2. Preeclampsia-hypertension developing after 20 weeks gestation with proteinuria
3. Eclampsia--Seizure activity or coma in patient with eclampsia
4. Chronic hypertension
5. Preeclampsia superimposed on chronic hypertension
_______% of women with preeclampsia develop HELLP syndrome Correct Answer: 5
Initiate antihypertensive if BP > 160/110. List top drug choices, in order of AWOHHN preference Correct Answer: Hydralazine
Labetalol
Nifedipine
How long does it take before the lung maturity benefits of betamethasone are seen? Correct Answer: 24 hours after administration
Magnesium sulfate toxicity can occur rapidly. Toxicity could result in impaired_______function. Correct Answer: Renal function--always use a urimeter
______% of eclampsia and HELLP cases occur after delivery Correct Answer: 30
TORCH is an acronym for Correct Answer: Toxoplasmosis, Other (hepatitisB), Rubella, CMV, Herpes
SGA Correct Answer: Small gestational age; growth is below 10th percentile
IUGR from placenta insufficiency usually reduces ___________more than _______. Correct Answer: birth weight length
Which is more ominous, symmetrical or asymmetrical growth restriction? Correct Answer: Neonates with symmetrical growth restriction have the poorest long-term prognosis and commonly have chromosomal abnormalities; postnatal nutrition is unable to correct for growth deficits: symmetrically grown SGA babies may never catch up in size when compared to unaffected babies
Growth restriction at less than 28 weeks is generally (symmetrical or asymmetrical) in nature. Correct Answer: Symmetrical. Infants are symmetrically grown and all organ systems are small. Much more ominous than asymmetrical growth restrictions.
Growth restriction at more than 28 weeks is general (symmetrical or asymmetrical) in nature. Correct Answer: Asymmetrical. This type of infant has a better prognosis than one who is symmetrically IUGR. Optimal postnatal nutrition generally restores normal growth potential because the number of body cells is normal.
LGA Correct Answer: Large for Gestational Age. Having a birth weight greater than the 90th percentile on intrauterine growth charts.
Caput succedaneum Correct Answer: is a localized, easily identifiable, soft area of the scalp, generally resulting from a long and difficult labor or vacuum extraction. Extra fluid should be reabsorbed within 12 hours after birth. Crosses suture lines.
Cephalohematoma Correct Answer: a collection of blood between the periosteal membrane and a skull bone. Caused by rupture of capillaries from the pressure of birth. No pressure on brain, takes 3-6 weeks to resolve
Postterm Correct Answer: Delivery after 42 weeks gestation
Transition is Correct Answer: Transition is a response, in part, to the increased level of oxygen in the circulation once air breathing has begun; if oxygen levels remain low, the fetal pattern of circulation may persist, causing blood flow to bypass the lungs.
Fact--Preterm infants may have impaired regulation of blood pressure in the face of apnea, bradycardia, and mechanical ventilation. Correct Answer: Resulting fluctuations in cerebral blood flow are common. These fluctuations predispose the fragile blood vessels in the brain to rupture, causing intracranial hemorrhage. Fluctuations in blood pressure can cause loss of brain blood flow, resulting in ischemia. These fluctuations also predispose the preterm infant to develop retinopathy of immaturity.
Fact--Procedure to follow if meconium is present in the amniotic fluids: Infants who are depressed at birth or make poor attempts to take the first breath should be intubated in the delivery room and suctioning of the trachea should occur to remove meconium below the vocal cords. Infants who attempt to breathe and clear their own airway should be allowed to do so without intervention. Correct Answer: Approximately one third of infants with meconium below the vocal cords become ill and require intensive care. [Show Less]