NCC obstetric inpatient Exam 52 Questions with Verified Answers
Gestational age criteria for PRETERM LABOR candidates receiving antenatal steroids? -
... [Show More] CORRECT ANSWER All fetuses between 24.0 and 34.6 weeks gestation at preterm risk within 7 days.
OR
Fetuses greater than 34 weeks w/ an immature lung profile
OR
If the mother is eligible for tocolytics
Gestational age criteria for preterm PROM candidates receiving antenatal steroids? - CORRECT ANSWER Less than 32.0 weeks gestation; in the absence of chorioamnionitis (Tx at 32-33 weeks may also be beneficial)
Antenatal corticosteroids are most effective when given within what time frame? - CORRECT ANSWER 24 hours and up to 7 days after administration of the second dose.
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significant reduction in infant mortality is still associated when <24hrs has passed so steroids should always be given, if possible.
When can a rescue course of antenatal steroids be given? - CORRECT ANSWER If more than 2 weeks has passed since last dose; fetus is <32.6; and likely to deliver w/in 7 days
Royal College of Obstetricians and Gynecologists advises that antenatal steroids should be given to ______. - CORRECT ANSWER All women for whom an elective c/s is planned prior to 38.6 weeks gestation.
Betamethose (Celestone) indications and dosage? - CORRECT ANSWER Indicated for reduction of neonatal mortality, RDS, and IVH (intraventricular hemorrhage) in women at risk for preterm deliver less than 34 weeks gestation.
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Dosage: 12mg IM q24h x2 doses
Dexamethasone (Decadron) indications and dosage? - CORRECT ANSWER Indicated for reduction of neonatal mortality, RDS, and IVH (intraventricular hemorrhage) in women at risk for preterm deliver less than 34 weeks gestation.
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Dosage: 6mg IM q12h x4 doses
17 alpha-hydroxyprogesterone caproate (Delalutin, Makena) (aka synthetic progestin) indications and dosage? - CORRECT ANSWER Documented history of previous spontaneous singleton birth before 37 weeks gestation.
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Dosage: 200mg IM every week from 16 to 36 weeks gestation.
Progesterone (Progestin) indications and dosage? - CORRECT ANSWER In women with a singleton pregnancy, no hx for preterm birth, and cervical length 20cm or less before 24 weeks.
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200mg vaginal suppository nightly until 36 weeks
OR
Vaginal progesterone gel 8% gel (90mg daily)
Nifedipine (Procardia) indications and dosage? - CORRECT ANSWER Acute tx of preterm labor
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20mg PO (may repeat in 30 min if CTX persist) then q3-8h after CTX have been controlled
OR
10mg PO q20min for 3 total doses then 20mg PO q4-6h
MAXIMUM DOSE 160mg per day
Discontinue after 48 hrs, pulse >120BPM, or BP 90/60
Nifedipine contraindications? - CORRECT ANSWER Allergy to nifedipine, sick sinus syndrome, secondary or tertiary heart block, hypotension, and hepatic dysfunction.
Nifedipine side effects? - CORRECT ANSWER Tachycardia, cutaneous flushing, HA, dizziness, nausea, vasodilation, and sever hypotension in hypovolemic pts. Drug induced maternal hepatoxicity has also been reported.
Sulindac (Clinoril) indications and dosage? - CORRECT ANSWER Acute tx of preterm labor
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200mg PO q12 hours x 48h
*d/c after 48h
Sulindac (Clinoril) classification? - CORRECT ANSWER NSAID (prostaglandin synthetase inhibitor/ cyclo-oxygenate COX inhibitor)
Sulindac (Clinoril) side effects? - CORRECT ANSWER GI irritation, heartburn, n/v, and possible HTN with beta blockers. Premature closure of fetal ductus arteriosis, decreased fetal renal function, and oligohydramnios. (Check AFI after 48h of therapy)
Sulindac (Clinoril) contraindications? - CORRECT ANSWER Hx of peptic ulcer, hemolytic dfxn, kidney or liver disease, after 32wks gestation, IUGR, chorio, oligo, ducal dependent cardiac defects, and twin transfusion syndrome. Use caution in asthmatics.
Terbutaline (Brethine) indications and dosage? - CORRECT ANSWER Acute tx of preterm labor
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0.25mg SC q15-30min up to 0.5mg in 4 hours. Then 0.25mg q3h.
*D/C after 48h or if pulse >120bpm
Terbutaline (Brethine) contraindications? - CORRECT ANSWER Hx of cardiac disease, poorly controlled DM, ante
Artum hemorrhage, HTN, hyperthyroidism, fetal distress, severe preeclampsia, IUGR, chorio, and abruption.
Terbutaline (Brethine) side effects? - CORRECT ANSWER Chest pain, dyspnea, tachycardia, palpitation, tremor, HA, hypokalmia, hyperglycemia, n/v, nasal stuffiness, pulmonary edema, and fetal tachycardia.
Surgical infection - CORRECT ANSWER An infection occurring within 30 days of medical procedure (CDC)
Incidence of abdominal incision infections following cesarean birth - CORRECT ANSWER 3-15% (average 5%)
With antibiotic prophylaxis, the incidence of abdominal incision infections following c/s - CORRECT ANSWER 2% or less.
Risk for cesarean postpartum VTE - CORRECT ANSWER 1:1000
Cesarean complications in subsequent pregnancies, incidence of abnormal placenta room (accreta, increta, percreta) - CORRECT ANSWER Accreta- 75-78%
Increta- 17%
Percreta- 5%
TORCH - CORRECT ANSWER Group of viral, bacterial, and protozoan infections that gain access to fetal bloodstream transplacentally via chorionic villi (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus)
Toxoplasmosis - CORRECT ANSWER T. Gondii (oocyst formed in the cat intestine and subsequently excretes in the feces)
Definition of postpartum infection - CORRECT ANSWER Temperature of 100.4 (38c) occurring in any two successive days within the first 10 days postpartum exclusive of the first 24 hours
Endometritis - CORRECT ANSWER Infection of the lining of the uterus
The most common cause of postpartum fever - CORRECT ANSWER Endometritis
Chorioamnionitis - CORRECT ANSWER An inflammation of the fetal membranes (chorion and amnion) caused by bacteria (can occur up to 10% of all pregnancies)
Syphilis - CORRECT ANSWER Caused by the spirochete Treponema pallidum. Has four clinical categories: primary, secondary, tertiary and neurosyphilis. Screening: VDRL and RPR
Fetal lung maturity - CORRECT ANSWER 2:1 ratio of phospholipids lecithin/spingomyelin (L/S ratio) and presence of phosphatidyglycerol (PG)
Surfactant production - CORRECT ANSWER Lowers the surface tension of alveoli preventing collapse during inspiration/expiration
Atelectasis - CORRECT ANSWER Incomplete expansion or collapse of the alveoli, possibly resulting from a deficiency of surfactant
Transient tachypnea (wet lung) - CORRECT ANSWER Newborn develops rapid realizations with minimal radiographic and blood gas abnormalities
Pneumothorax - CORRECT ANSWER Air leaks occur when alveoli become overdistended and burst
Mechanisms of heat loss (4 types) - CORRECT ANSWER Evaporation (liquid to gas), convection (wind), conduction (laying on cold surface), radiation (not wearing a hat or clothes)
A naked newborn exposed to an environmental temperature of 75F suffers the same heat loss as a names adult in 32F - CORRECT ANSWER True
IgG - CORRECT ANSWER The only antibody that crosses the placenta to the fetus, make up 75-80% of all antibodies in newborn
IgA - CORRECT ANSWER Present in breastmilk and provides passive immunity
IgM - CORRECT ANSWER Antibodies produced in response to an infection while exposed in utero
Neonatal infections early onset vs late onset - CORRECT ANSWER Early: hours to 7 days, maternal source
Late: 7 days to 3 months, check 2nd twin, many sources.
Fetal glucose is [___]% the same as maternal blood sugar at time of birth - CORRECT ANSWER 80%
Clinical manifestations of newborn hypoglycemia - CORRECT ANSWER Tremors, jitteriness, respiratory distress,cyanosis, poor suck, irritability, high pitched cry, limpness, lethargy, seizures, temperature instability, pallor, diaphoresis
Causes of neonatal seizures - CORRECT ANSWER 49%: hypoxic-ischemic encephalopathy
12%: cerebral infarction
7%: cerebral trauma
5%: infections
3%: metabolic abnormalities like hypoglycemia
4%: narcotic drug withdrawal
Newborn blood volume at term - CORRECT ANSWER 80cc/kg
Newborn polycythemia - CORRECT ANSWER Central venous hct of > 65% or hgb > 20-22
Newborn anemia - CORRECT ANSWER Hgb <14 at term or hgb < 13 preterm
Hyperbilirubinemia - CORRECT ANSWER Bili level >12mg/dL
Bilirubin conjugation - CORRECT ANSWER Unconjugated (indirect)- free, not bound, fat soluble, not yet metabolized and not easily excreted
Conjugated (direct)- bound to protein, has been metabolized, water soluble and readily excreted
Indirect uterine monitoring is also known as - CORRECT ANSWER External uterine monitoring
Non-shivering thermogenesis - CORRECT ANSWER Brown fat metabolism [Show Less]