OB EXAM 1|125 Questions with Verified Answers
Conception - CORRECT ANSWER UNION OF EGG AND SPERM DAY 1
Fertilization - CORRECT ANSWER SPERM ENTERS
... [Show More] THE OVUM OCCURS IN AMPULLA OF FALLOPIAN TUBE CREATES ZYGOTE. the membrane becomes impenetrable to other sperm
Implantation - CORRECT ANSWER ATTACHMENT OF OVUM TO UTERINE WALL IDEALLY OCCURS ~7-9 DAYS AFTER FERTILIZATION
PRE-EMBRYONIC STAGE: WEEKS 0-2 - CORRECT ANSWER Conception & Zygote Formation -Cell Division to Morula: Morula Includes - Trophoblast (Outer Layer Cells; Becomes Placenta and Fetal Membranes) and - Embryoblast (Inner Layer Cells; Becomes the Blastocyst/Fetus)
EMBYONIC STAGE: WEEKS 2-8 - CORRECT ANSWER § CRICITCAL TIME FOR ORGAN STRUCTURE DEVELOPMENT - VULNERABLE TO TERATOGENS - DEVELOPMENT OF GERM LAYERS -ECTODERM: BRAIN AND SPINAL CORD, HAR, SKIN, NAILS - MESODERM: HEART, TISSUES, BLOOD SUPPLY, KIDNEYS, REPRODUCTIVE STRUCTURES, SPLEEN -ENDODERM: LINING OF GI & RESP TRACT, BLADDER AND URETHRA, & EAR CANAL; LIVER, THYROID
FETAL STAGE: 9 WEEKS TO BIRTH - CORRECT ANSWER § FEWER MAJOR ANOMALIES CAUSED BY TERATOGENS. - ORGAN FUNCTIONS ARE DEVELOPING - FETUS DEVELOPS IN A CEPHALOCAUDAL FORMATION (HEAD TO RUMP), CENTRAL-PERIPHERAL, & SIMPLECOMPLE
WEEK 3-4 - CORRECT ANSWER HEART BEATS/PUMPS BLOOD; NEURAL TUBE CLOSES
WEEK 5-6 - CORRECT ANSWER Brain Growth
8 WEEKS - CORRECT ANSWER SPINAL CORD DEVELOPMENT; EAR AND KIDNEY DEVELOPMENT; WEIGHS ~1-2GM
8-12 WEEKS - CORRECT ANSWER HEART TONES HEARD ON DOPPLER; ORGANS BEGIN TO MATURE
12 WEEKS - CORRECT ANSWER KIDNEYS PRODUCE URINE; SEX MAY BE DETERMINABLE BY ULTRASOUND
16-20 WEEKS - CORRECT ANSWER § MUSCLES WELL DEVELOPED; QUICKENING "BABY MOVING"
20 WEEKS - CORRECT ANSWER § VERNIX AND LANUGO DEVELOP; FETUS SLEEPS, SUCKS, KICKS; EYEBROWS, EYELASHES, AND HEAD HAIR; PRACTICE BREATHING MOTIONS; BROWN FAT STORES DEVELOP; WEIGHS ~200-400GM
24 WEEKS - CORRECT ANSWER § PROPORTIONAL BODY; ABILITY TO HEAR; AGE OF VIABILITY; SURFACTANT FORMING
28 WEEKS - CORRECT ANSWER EYELIDS OPEN AND ABILITY TO SEE; ABILITY TO BREATHE, SWALLOW, & REGULATE TEMPERATURE; INCREASE IN FETAL WEIGHT
32 WEEKS - CORRECT ANSWER BROWN FAT DEPOSITS DEVELOP; FETUS BEGINS STORING IRON, CALCIUM, AND PHOSPHORUS
36-40 WEEKS - CORRECT ANSWER UTERUS @ FULL OCCUPANCY; MATERNAL ANTIBODIES TRANSFERRED TO FETUS TO PROVIDE IMMUNITY; LIGHTENING OCCURS 40 WEEKS: FULL TERM
Placenta (structure & functions) - CORRECT ANSWER § Parts: Fetal (Shiny and Toward Baby) and Maternal Side (Meaty and Toward Uterus & Mom) Maternal/Fetal Blood Do Not Mix Functions: Gas Exchange Nutrient Transfer Waste Removal Antibody Transfer Endocrine Hormones Production
Amniotic Fluid (structure & Functions) - CORRECT ANSWER Parts: Amnion: Inner Membrane (Fluid Filled Sac) Chorion: Outer Membrane (Fetal Side of Placenta) Functions: Cushioning Against Impact Stabilize Temperature Barrier Against Infection Assists in Lung Development
Umbilical Cord (structure and function) - CORRECT ANSWER § Parts: 2 Arteries and 1 Vein (AVA) Function: Arteries: Carry DEOXYGENATED Blood AWAY FROM Embryo to Mom Veins: RETURN OXYGENATED Blood from Mom to the Embryo Wharton Jelly: Connective Tissue that Surrounds the Vessels for Protection
AVA purposes - CORRECT ANSWER § The vein caries oxygen and nutrient rich blood from the placenta to the baby.
The two arteries carry carbon dioxide and waste products from the baby to the placenta to be eliminated by the mother
§ Maternal Supine Hypotension (What Is It, What Symptoms Present, How Can it be Prevented?) - CORRECT ANSWER • When the pregnant woman is supine the weight of the pt and uterus occludes the blood flow through the vena cava and aorta. Symptoms: Faintness, Lightheadedness, Dizziness, Nausea, Agitation, and Syncope; Also Decreases Blood Flow to Placenta Treatment: Side Lying (Turn to a Lateral Recumbent Position)
§ Physiological Anemia Of Pregnancy (What is Hemodilution, What will Result, Which Lab Values can be Expected?) - CORRECT ANSWER The pregnant woman has an increase of plasma to prevent blood clots since pregnancy is a hypercoagulable state & creates dependent edema. A decline in hemoglobin and hematocrit is expected
§ Fundal Height
How to Measure, How to Interpret Results, • What is a Cause of Measuring Too Small/Large? - CORRECT ANSWER Measurement between top of symphysis Pubis to top of uterus
• Measurement (cm) should correlate with gestational age.
o Small less than 3 cm from expected- IUGR, Oligohydramnios, gestational diabetes
o Large more than 3 cm from expected- Macrosomia, multiple babies, polyhydramnios.
Presumptive Pregnancy - CORRECT ANSWER o Period Absent (Amenorrhea)
o Really Tired (Fatigue)
o Enlarged Breast Sore Breast; Breast Changes
o Urination Increases
o Movement Perceived/"Fluttering" (Quickening)
o Emesis/Nausea
o Skin Changes
Probable Pregnancy - CORRECT ANSWER o Positive Pregnancy Test (HcG)
o Return of Fetus When Uterus Pushed with Fingers (Ballottement)
o Outline of Fetus Palpated
o Braxton Hick's Contractions
o A Softening of the Cervix Tip (Goodell Sign)
o Bluish Color (Chadwick Sign)
o Lower Uterine Segment Soft. (Hegar Sign)
Enlarged Uterus or Abdomen
Positive Pregnancy - CORRECT ANSWER o Fetal Heart Tones Auscultation
o Visualization of Baby (Delivery, Ultrasound)
Fetal Movement Felt by Provider
Nulli - CORRECT ANSWER None
Multi - CORRECT ANSWER Multiple
Primi - CORRECT ANSWER first
Gravida/G - CORRECT ANSWER Woman who is or has been pregnant, regardless of the outcome.
Para/P - CORRECT ANSWER • # of pregnancies that have completed @ 20 weeks gestation or greater, regardless of the outcome. -Includes Living or Stillborn/Fetal Demise/Miscarriage
Gravidity/G - CORRECT ANSWER Number of Times Woman Has Been Pregnant
Term births/T - CORRECT ANSWER Number of Pregnancies that Reached 37+0 Weeks Gestation
Preterm Births/P - CORRECT ANSWER Number of Pregnancies that Reached 20+0 - 36+6 Weeks
Abortion/A - CORRECT ANSWER Number of Pregnancies less than 20 weeks
Living Children/L - CORRECT ANSWER • Number of Children Living *HERE IS WHERE TWINS, TRIPLETS, ETC COUNT INDIVIDUALLY & OUTCOMES ARE INCLUDED*
GTPAL - CORRECT ANSWER Gravidity, term births, preterm births, abortions, Living
Nagele's Rule
Calculation of EDD - CORRECT ANSWER LMP + 9 MONTHS + 7 DAYS + CORRECT YEAR IF NEEDED`
LMP date - CORRECT ANSWER § The first date of the last period regardless of how many days the period lasted.
Initial Visit - CORRECT ANSWER Chief complaint (reason for seeking care), Obstetric history (LMP, G&Ps, History and Status of Current Pregnancy, STI Hx, Menstrual/Contraceptive History), Health and Nutrition (Medical and Surgery History, Physical Conditions, BMI, Medications, Mental Health), Social history (Cultural Background, Socioeconomic Status, Support System, Occupation, Smoking/Alcohol/ Drug Use Abuse: Intimate Partner Violence), Physical Assessment (Baseline Vital Signs Baseline Weight Head to Toe),
Prenatal Labs (Blood Type and Rh Factor Urinalysis Pap Smear Results (Gonorrhea and Chlamydia) CBC (Baseline H&H) Antibody Screenings: - HIV - Hepatitis B Surface Antigen - Syphillis (RPR/VDRL) - Rubella Titer (>1:8 = Immunnity))
Initial Prenatal Labs - CORRECT ANSWER § (Blood Type and Rh Factor Urinalysis Pap Smear Results (Gonorrhea and Chlamydia) CBC (Baseline H&H) Antibody Screenings: - HIV - Hepatitis B Surface Antigen - Syphillis (RPR/VDRL) - Rubella Titer (>1:8 = Immunnity))
Follow up Labs / tests - CORRECT ANSWER § (Urinalysis @ Every Visit Glucose Tolerance Test (24-28Wks) GBS (Group Beta Strep): Recto-Vaginal Swab (36 Wks) 3rd Trimester Labs: Repeat CBC, HIV, Hep B Surface Antigen), Ultrasounds (1st Trimester: # of Fetuses, Heart Tones, Uterine Abnormalities; Typically Performed Transvaginally; US in 1st Trimester Best Confirmation of Gestational Age 2nd - 3rd Trimester - Anatomy Scan! Size-Date Discrepancies, Placenta Location and Abnormalities.)
Follow up Visits - CORRECT ANSWER § interview, physical exam, gestation, quickening (at 20w for 1st pregnancy and 16 w for multi), Fetal assessment (Fetal Heart Tones Detectable at ~10-12 Weeks Normal Fetal Heart Rate: 110-160bpm),
Labs (Urinalysis @ Every Visit Glucose Tolerance Test (24-28Wks) GBS (Group Beta Strep): Recto-Vaginal Swab (36 Wks) 3rd Trimester Labs: Repeat CBC, HIV, Hep B Surface Antigen), Ultrasounds (1st Trimester: # of Fetuses, Heart Tones, Uterine Abnormalities; Typically Performed Transvaginally; US in 1st Trimester Best Confirmation of Gestational Age 2nd - 3rd Trimester - Anatomy Scan! Size-Date Discrepancies, Placenta Location and Abnormalities.)
o Psychological Adaptations to Pregnancy 1st Trimester - CORRECT ANSWER § Uncertainty (No Physical Validation of Pregnancy) Ambivalence (Conflicting Feelings) Mood Changes (Ultrasenstive, Joy, Fear) Concern of Changes in Career, Finances, Responsibilities)
o Psychological Adaptations to Pregnancy 2nd trimester - CORRECT ANSWER § Pregnancy Becomes Real Experience Physical Evidence of Pregnancy (Growing Belly; Quickening) Focus On Baby Begins to Foster Narcissism (Introverted and Self Absorbed) Concern on Changes to Self
o Psychological Adaptations to Pregnancy 3rd Trimerster - CORRECT ANSWER Vulnerability Increasing Dependence Preparation for Birth Concern on a Healthy Delivery for Mom and Baby
General Pregnancy Education- - CORRECT ANSWER • - Avoid travel after 36w due to risk of thrombosis, Do not exceed current exercise regimen, Prenatal, Birth, Lactation, and Parenting Classes Care Options (Providers, Birth Plans) Every 4 Wks Until 28 Wks Every 2 Wks Until 36 Wks Then Weekly Until Birth
Nausea and vomiting: - CORRECT ANSWER dry crackers in morning, 5-6 smaller meals, bland foods (limit greasy, fried, fatty, spicy foods), prenatal vitamins in evening
Heartburn - CORRECT ANSWER 5-6 smaller meals, do not eat/drink before bedtime, bland foods, eliminate smoking, coffee and carbonation (stimulates acid formation)
Backache - CORRECT ANSWER good posture, avoid excess weight gain, squat over bending, avoid heavy lifting, exercise
Round ligament pain - CORRECT ANSWER avoid sudden movements of position changes, apply heat and lie on the right side
Constipation - CORRECT ANSWER increase water intake, increase fiber, exercise
Urinary frequency - CORRECT ANSWER • drink fluids during day and decrease intake at night, avoid caffeine, kegel exercises
Leg cramps - CORRECT ANSWER elevate the legs, massage
Hemorrhoids - CORRECT ANSWER avoid constipation, lie on side, anesthetic ointments
Weight Gain schedule - CORRECT ANSWER § Weeks 1-13 gain 1-4lbs
§ Weeks 14-40 gain 1lb a week
Weight Gain (BMI) - CORRECT ANSWER § Normal Weight (BMI 18.5-24.9) 25-35 lb
§ Underweight (BMI <18.5) 28-40 lb
§ Overweight (BMI 25-29.9) 15-25 lb
§ Obese (BMI >30) 11-20 lb
o Nutrient Needs of Pregnancy (Remember to Consider Food Sources) - CORRECT ANSWER § Additional 200-500 calories in the 2nd & 3rd trimester
§ Protein 60g a day (avoid fish with high mercury levels shark, swordfish, king mackerel) Needed for B12
§ Iron- Food Sources: Green, Leafy Veggies, Beans, Meat, Poultry to increase absorption increase vitamin C
§ Folic Acid- Food Sources: Fruits, Veggies (Spinanch and Strawberries); prevent neural tube defects.
§ Calcium 1000mg a day
o Effect of Poor Nutrition on Pregnancy
§ Risks for birth defects Low Birth Weight, Preterm Delivery, and PreEclampsia
poor nutrition - CORRECT ANSWER § Risks for birth defects Low Birth Weight, Preterm Delivery, and PreEclampsia
Ultrasounds - CORRECT ANSWER § Purpose- First Trimester Purpose: # of Babies, **Gestational Aging (Crown to Rump Measurement), Confirming Fetal Viability (Heartbeat), and Evaluate Maternal Structures (Placenta Attachment, Location of Pregnancy) 2nd/3rd Trimester Purpose: Evaluation of Fetal Anatomy, Assessment of Fetal Growth Progress, Evaluation of Amniotic Fluid Volume, Determine Fetal Presentation, Evaluation Location of Placenta and Umbilical Cord, Doppler Blood Flow Analysis
§ Timing-1st 2nd and 3rd trimester
Advantages & Risks- Advantages: Safe, Noninvasive Evaluation; Immediate Results; Portable Disadvantages: Cannot Identify EVERY defect.
AFP (alpha-fetoprotein) - CORRECT ANSWER § Purpose- Low Levels Indicate Chromosomal Anomalies High Levels Indicate Open Neural Tube Defects, Abdominal Wall Defects, or Threatened Abortion/Demise
§ Timing- Timing: Ideal Between 16 and 18 Weeks Gestation -Maternal Blood Sample
§ Advantages & Risks- Least Invasive Diagnostic Screening for Open Neural Tube Defects or Chromosomal Anomalies; Parents can Prepare Disadvantages: Results Can Be Altered if Inaccurate EDD or Multifetal Gestation is Present
Amniocentesis - CORRECT ANSWER § Purpose- Aspiration of Amniotic Fluid from the Amniotic Sac for Examination. 2nd Trimester: Identify Chromosomal/Biochemical Abnormalities; 3rd Trimester: Determine Fetal Lung Maturity
§ Timing- Performed 2nd (Wk 15-20) and 3rd Trimester for Different Purposes Informed Consent Necessary; Ultrasound Guided
§ Advantages & Risks- Advantages: Simple, Brief, Low Pain Procedure with Few Complications. Disadvantages: Results takes Weeks & Performed Later; Risks: Pregnancy Loss, Uterine Infection, Injury, and Rh Sensitization (Rhogam for Rh-); Higher Risk The Earlier Performed
§ Pt education- Report Any Fever or Vaginal Bleeding or Passage of Amniotic Fluid, Clots, or Tissues Following Procedure. Avoid Strenuous Activity; Resume Normal Activities in 24 Hours
NST (non-stress test) - CORRECT ANSWER § Purpose- Identifies if Increase in FHR Occurs with Fetal Movement, Movement = Oxygenation = Healthy Central Nervous System! Procedure: Record FHR (EFM) & Fetal Movement with Marker; Noninvasive
§ Timing- Results/Interpretation: Reactive: >32 Weeks: At least 2 Accelerations (15X15) in a 20 Minute Period of Time; Accels Correlate with Fetal Movement Markers. (<32 Weeks Accels Can Be 10X10).><32w accels can be 10x10
§ Advantages & Risks- Disadvantage: Results Can Be Altered by Sleep Cycles
o CST (contraction stress test) - CORRECT ANSWER § Purpose- Induce Contractions by Nipple Stimulation or Pitocin Administration and Monitoring Fetal Tolerance to Stress with Contractions.
§ Timing- Results/Interpretation: Negative (Reasurring): No Late Decels Noted Positive (Nonreassuring): Late Decels Present
Advantages & Risks- Contraindicated: Preterm Labor or High Risk for Preterm Labor, Placenta Previa, C-Section Need
BPP (biophysical profile) - CORRECT ANSWER § Purpose- Evaluates 5 Parameters of Fetal Well-Being: NST, Fetal Breathing Movements, Fetal Movements, Fetal Tone, and Amniotic Fluid Volume
§ Timing- NST + Ultrasound FIndings Results 0-10 (2 Points Per Parameter) >/=8 is Reassuring, NST + Amniotic Fluid Index OR 4 Parameters (Omit NST)
Advantages & Risks- Advantages: Noninvasive; Less Costly; Results Immediate; Can Guide Treatment of High-Risk Patients Disadvantages: Each Parameter is Given Equal Weight But Some May be More Critical than Others
Teenage Pregnancy - CORRECT ANSWER § Incidence High Due to Being Sexually Active Younger & Peer Pressure, Inconsistent (Or Lack Of) Contraceptive Use, and Invincibility Feeling.
§ Socioeconomic Concerns; Social Service Consult & CPS Report Needed
§ Maternal Risks: Anemia, Dystocia (infant is stuck), PreEclampsia, Preterm Birth, Victim of Violence, and Depression
§ Infant Risk: Prematurity and Low Birth Weight, Leading to Increased Infant Mortality
o Substance Abuse - CORRECT ANSWER § Caffeine, tobacco, alcohol, marijuana, cocaine, amphetamines & methamphetamines, antidepressants, and opioids have teratogenic effects on the baby and can cause serious birth defects. It is important to provide proper education in the initial visit to discourage substance abuse and inform the mother on programs to curb abuse
Intimate Partner Violence - CORRECT ANSWER § Involves Physical, Sexual, Emotional, Social, and Economic Abuse
§ Abuse is More Common in Pregnancy (Especially PP) & More Common Than PreEclampsia, Diabetes, etc.)
§ Maternal Risks: STIs, Malnutrition, PPD
§ Infant Risks: Preterm Labor, Low Birth Weight Cycle of Violence
Develop a Safety Plan (Referrels, Education)
o Fetal Loss - CORRECT ANSWER § Avoid "At Least" Comments
§ Allow Expression of Feeling; Grief Needs to be Acknowledged and Expressed
§ Acknowledge the Infant (Name, Touch, Hold)
§ Memory Boxes and Packets
§ Referrals to Support Groups and Internet Resources
o Anomalies - CORRECT ANSWER § Produces Strong Emotions of Shock and Grief.
§ Timing and Manner of Being Told is Critica
§ l Promote Bonding
§ Assist with Grieving Process As Relevant
Abortions - CORRECT ANSWER § Loss of Pregnancy Before Viability (capability to live outside the uterus - usually 500gm and 20 wks). Spontaneous (Miscarriage) or Induced (Elective Termination)
• Spontaneous: Symptoms: Red Vaginal Bleeding, Cramping
• Diagnosis: Ultrasound
• Goal: Reduce Pain and Prevent Hypovolemic Shock
• Treatment: Bedrest, Pelvic Rest, Pad Counts, Assess for Tissue Passage or Foul Discharge (Sign of Infection), Supportive Care May
• Require D&C (Dilation and Curretage) Procedure
• >14 Weeks - Oxytocin or Prostaglandin is Required to Stimulate Contractions
Ectopic Pregnancy - CORRECT ANSWER § Implantation Outside of Uterus
• Symptoms: Missed Menstrual Period, Abdominal/Pelvic PAIN, Red Vaginal Bleeding, May Have +Pregnancy Test, Referred Shoulder/Neck Pain
• Diagnosis: Ultrasound; Low Beta-HcG Levels
• Goal: Prevent Rupture (Early ID) Rupture Can Lead to Intraabdominal Hemorrhage Can Lead to Hypovolemic Shock
• Risk Factors: IUDs, STI, PID, Previous Ectopic Pregnancies, Failed Tubal Ligation
• Treatment: Depends if Ruptured or Intact
• Methotrexate: Inhibits Cell Division (If Intact)
• Salpingectomy: Remove Tube; Ligate Bleeding Vessels
• Teaching: Avoid Intercourse Until Beta-HcG Levels Are Undetectable
Hydatiform Mole - CORRECT ANSWER § Trophoblasts Develop Abnormally; Excessive Proliferation and Edema of Chorionic Villi
• Placenta But No Fetus
• Symptoms: Grapelike Clusters Fill the Uterus; Dark Brown Vaginal Bleeding, Larger than Expected Uterus, Excessive N/V.
• Diagnosis: Ultrasound of No Gestational Sac; High Beta-HcG
• Treatment: Vacuum Aspiration; Oxytocin or Cytotec AFTER Aspiration (Never Before - Can Lodge Products into Circulation), D&C
• Avoid Pregnancy X 1 Year
• Run Pathology Report for Determination of Choriocarcinoma (Chemo if Needed)
§ Placenta Priva - CORRECT ANSWER • Implantation of the Placenta in the Lower Uterus (Can Be Marginal Partial, Total) Symptoms: Painless, Bright Red Uterine Bleeding in Latter Half of Pregnancy (Nonconcealed); High Fundal Height; Nontender Uterus Diagnosis: Ultrasound Nursing Consideration: Hold Oxytocin Use and Manual Exams; Care Dependent on Position and Location of Placenta; Oupatient: Bed Rest/Home Care Instructions (Rest, assess bleeding or discharge, omit sexual intercourse, count fetal movement). Inpatient: Ceserean Birth after 36 weeks/Fetal Lung Maturity; Prepare for Blood Loss (Type and Cross)
• Painless, Bright Red Bleeding Relaxed, Soft Nontender Uterus and Abdomen Episodes of Bleeding Visible Bleeding Intercourse Post Bleeding Abnormal Fetal Position/ Normal FHR
§ Placenta Abruption - CORRECT ANSWER • Separation of the Placenta from the Uterus (Parital or Complete) Risk Factors: Cocaine Use, Abdominal Trauma, PreEclampsia Symptoms: Dark Red, Concealed, Vaginal Bleeding, Severe Abdominal Pain, Uterine Tenderness, Hard, Boardlike Abdomen, Nonreasurring FHR (Late Decels, Decreasing Variability) Goal: Prevent Hypovolemic Shock Nursing Considerations: Replace Blood Loss, Oxygen, Emergent Birth
Dark, Red Bleeding Extended Fundal Height Tender Uterus Abdominal Pain/ Contractions Concealed Bleeding Hard Abdomen Experience DIC Distressed Baby
Rh and ABO Incompatibility - CORRECT ANSWER § MOm is Blood Type O BABy is A, B, or AB. People with O Blood Develop Anti-A or Anti-B Antibodies Fetal Risk: Anemia, Jaundice Affects Current Pregnancy
§ Mom is Rh- Baby is Rh+. Maternal Antibodies Can Develop After Exposure to Rh+ Fetal Blood. Rhogam (Prevents Production of Antibodies) Administered at 28 Weeks, with 72 Hours Postpartum (If Baby Rh+), or If Maternal-Fetal Blood Mix Blood Product Fetal Risk: Anemia, Jaundice If Not Treated, Subsequent Pregnancies are Harmed
Toxoplasmosis - CORRECT ANSWER § Parasitic disease found in raw meat & cat feces
• S/S in child- Blindness, hydrocephalus, mental retardation
Syphilis - CORRECT ANSWER § Bacterial STI
o S/S in child- Rash on palms & soles, Hutchinson's teeth saddle nose, frontal bossing
Varicella - CORRECT ANSWER • viral
o S/S in child- limb atrophy, damage to brain & eyes
HIV - CORRECT ANSWER • viral STI bloodborne
o S/S in child - poor weight gain, repeated infections (AVOID BREASTFEEDING)
Rubella - CORRECT ANSWER § Viral
• S/S in child- Patent ducts arteriosus, cataracts, deafness, miscarriage. Most dangerous in the 1st trimester. (vaccinate baby and mom nonpregnant
Cytomegalovirus - CORRECT ANSWER § viral (body fluids)
S/S in child- premature birth, low birth weight, hearing loss, microcephaly, seizures (avoid kissing baby on mouth & hand hygiene)
Herpes simplex - CORRECT ANSWER § Viral STI & Saliva
• S/S in child- Skin leasions, CNS herpes (seizures, poor feeding, tremors, lethargy)
Transmitted during vaginal delivery
UTI & Yeast infections - CORRECT ANSWER § Fungal
• UTI- early labor & low birth weight
• Yeast infection- may spread to baby via vaginal delivery and cause oral thrush in baby
Group B strep - CORRECT ANSWER § Bacteria that is frequent in the vagina & rectum
• May pass to baby in vaginal delivery
Testing at 36w to determine birth plan
o External
what are the pros and cons
when can they be used and not used - CORRECT ANSWER o FHR Monitoring: ultrasound transducer
o Uterine activity: tocotransducer
o *Can be effected by obesity or baby's position/ movement*
Internal
what are the pros and cons
when can they be used and not used - CORRECT ANSWER o *Membranes have to be ruptured; avoid with HSV, HIV, GBS*
o Fhr monitoring : fse: fetal scalp electrode
o Spiral electrode to fetal scalp
o Uterine activity: iUPC: intrauterine pressure catheter
o *Not Effected by obesity or baby's position/ movement*
Contraction Duration - CORRECT ANSWER Length of each contraction from beginning to end) Ranged value: 40-50 seconds
Contraction Frequency - CORRECT ANSWER Beginning of one contraction to the beginning of the next Ranged Value: over the course of 3-5 contractions
Contraction Intensity - CORRECT ANSWER § External/Palpation: Mild (Nose), Moderate (chin), Severe (forehead) Internal pressure: 40-70mm Hg (most accurate)
Tachysystole - CORRECT ANSWER >5 contractions in 10 minutes.
Hypertonic uterus - CORRECT ANSWER single contraction >2minutes
Baseline HR - CORRECT ANSWER 110-160bpm on a strip round to the closest 5 interval
Variability - CORRECT ANSWER Moderate variability goes up 6-35 bpm from baseline which is ideal. Minimal <5 bpm from baseline. Marked >25 from baseline
Accelerations - CORRECT ANSWER o - needs to peak 15x15 or 10x10 for infants less than 32 weeks needs to have 2 in 20 minutes
Decelerations - CORRECT ANSWER Early- lines up with the peak of the contraction and indicates head compression. Late- at the end of the contraction the HR decreases and indicates placenta issues. Variable- they are very abrupt and can look like a V or W must go down 15 beats. Indicates cord compression and mother should change positions
VEAL CHOP MINE - CORRECT ANSWER
Passenger Presentation - CORRECT ANSWER o - PRESENTING PART OF THE FETUS THAT ENTERS THE PELVIC INLET FIRST AND LEADS THROUGH THE BIRTH CANAL DURING LABOR.
§ CEPHALIC (HEAD FIRST): MOST COMMON
• VERTEX: PRESENTING PART OCCIPUT
• Vertex (crown of head), military (top of head), Brow (eyebrows/partial face), Face (face)
§ BREECH: (BUTTOCKS/FEET FIRST)
• PRESENTING PART: SACRUM
§ SHOULDER
• PRESENTING PART: SCAPULA
Passenger Lie - CORRECT ANSWER o RELATION OF LONG AXIS (SPINE) TO SPINE OF THE MOTHER
§ LONGITUDINAL/VERTICAL: FETUS PARALLEL TO MOTHER
§ TRANSVERSE/HORIZONTAL: FETUS PERPENDICULAR TO MOTHER
§ OBLIQUE: ANGLED; USUALLY CONVERT TO LONGITUDINAL OR TRANSVERSE DURING LABOR
Passenger ATTITUDE - CORRECT ANSWER o RELATION OF THE FETAL BODY PARTS TO ONE ANOTHER
§ WANT GENERAL FLEXION: BACK ROUNDED, CHIN/THIGHS, AND LEGS FLEXED TO CORE
Passenger Position - CORRECT ANSWER § FIRST: LOCATION OF THE PRESENTING PART IN THE RIGHT (R) OR LEFT (L) SIDE OF THE MOTHER'S PELVIS.
§ MIDDLE: SPECIFIC PRESENITNG PART - OCCIPUT (O), SACRUM (S), MENTUM (chin) (M), OR SCAPULA (SC)
LAST:LOCATION OF PRESENTING PART IN RELATION TO THE ANTERIOR (A), POSTERIOR (P), OR TRANSVERSE (T) PORTION OF MATERNAL PELVIS.
Passenger STATION - CORRECT ANSWER RELATIONSHIP OF PRESENTING PART TO IMAGINARY LINE DRAWN BETWEEN METERNAL ISCHIAL SPINES
o Preceding labor - CORRECT ANSWER § LIGHTENING- the baby drops
§ Braxton Hicks- practice contractions
§ BLADDER PRESSURE/URINARY FREQUENCY RETURN
§ BACKACHE
§ STRONG BRAXTON HICKS
§ Energy Spurt- nesting
BLOODY SHOW, MUCUS PLUG, INCREASED VAGINAL DISCHARGE
o True labor - CORRECT ANSWER § Requires cervical change
§ Contractions have consistent pattern and increase in frequency duration, and intensity.
Contractions increase Frequency and intensity with ambulation
o False Labor - CORRECT ANSWER § No cervical changes
§ Inconsistent frequency, duration, and intensity of contractions.
§ Activity does not alter contractions
More annoying than painful
Nursing Care Around Amniotomy - CORRECT ANSWER o Fetal FHR/contraction monitoring
o artificial rupture of membranes when the cervix is ripe
Oxytocin/Pitocin - CORRECT ANSWER hormone produced in the posterior pituitary gland that stimulates uterine contractions and milk ejection; (monitoring is crucial: assess fetal tolerance to medication and assess for tachysystole)
1ST Stage of Labor - CORRECT ANSWER o ONSET OF UTERINE CONTRACTIONS TO FULL DILATION
§ Latent- regular contractions creating cervical change to 5cm woman is still able to do things and take direction Contractions are mild to moderate, every 2-3 minutes and last 30-40 seconds
Active form 6-10 cm dilation woman is in a lot of pain and contractions are moderate to severe 1.5-5 mins apart and last- 40-90 sec
2ND Stage of Labor - CORRECT ANSWER o TIME FROM THE FULLY DILATED CERVIX TO BIRTH OF FETUS
§ Latent- Time from complete dilation to actively pushing; time of descension through the birth canal. Period of rest. Laboring down/Delayed pushing/ passive descent: increase in spontaneous vaginal births, decease in C/S, decrease in active pushing time, less maternal fatigue. Station: 0-+2. Quiet, Minimal urge to push
Active- Time From actively pushing until the birth of the baby. Assessment findings: vomiting, increased bloody show, uncontrolled shivering, verbalization of loss of control, inability to cope, Station: +2 to +4 (on the Floor), Grunting/Screaming, increased urge to bear down
3RD Stage of Labor - CORRECT ANSWER o TIME FROM BIRTH OF FETUS DELIVERY OF PLACENTA
§ Prompt separation and expulsion (With slight push) of the placenta achieved in the easiest, safest manner. A placenta cannot detach itself from a flaccid/relaxed uterus; you cannot force removal, Longer the stage = greater chance of hemorrhage, Retained after 30 minutes
4TH Stage of Labor - CORRECT ANSWER o DELIVERY OF PLACENTA UNTIL 2 HOURS AFTER BIRTH
§ Maternal hemostatic stabilization stage begins after delivery of placenta
• Signs of Placental Separation after Birth - CORRECT ANSWER o Lengthening of the umbilical cord
o Gush of dark blood
o Uterus shape change: discoid to a globular shape as the placenta moves into the lower uterine segment
Glucocorticoids (Betamethasone) - CORRECT ANSWER accelerate fetal lung maturity by stimulating fetal surfactant production; typical course - 2 shots im 24 hours apart
Tocolytics - CORRECT ANSWER medications to arrest labor
Magnesium sulfate - CORRECT ANSWER relaxes smooth muscles, monitor for toxicity, helps with infant neural development. Given for hypertension
Terbutaline - CORRECT ANSWER beta-adrenergic agonist; given subq; can cause fetal tachycardia
o Shoulder Dystocia - CORRECT ANSWER § Head is born but anterior shoulder cannot pass the pubic arch
§ High risk for asphyxia and fracture of clavicle or humerus (often the right arm)
Nursing care: mcroberts maneuvers (hyperflexion of legs), suprapubic pressure, gaskin maneuver (hands-and-knees position), document time of dystocia
o Prolapsed Cord - CORRECT ANSWER § Cord lying below presenting part of fetus
§ Frequently happens after ROM
§ Fetal hypoxia can lead to central nervous system damage or death of fetus
§ Care management
§ Relieve pressure, Lift head off cord, Emergency cesarean section,
o Postterm Pregnancy - CORRECT ANSWER § After 42 weeks 0 days
§ Complications:
§ labor dystocia, - stalls in labor
§ chorioamnioitis,
§ Macrosomic fetus /need for cesarean section
§ postpartum hemorrhage and perineal injury
§ Meconium stained fluid and aspiration
o Preterm Labor - CORRECT ANSWER § Prevention: preconception counseling (i.e. stop smoking), progesterone vaginal suppositories or creams, lifestyle modifications (bedrest with fetus off cervix and hydration), identify and treat infections timely
§ Signs and Symptoms:
§ Change or increase in vaginal discharge
§ Ruptured membranes
§ Cervical changes
§ Pelvic/lower abdomen pressure
§ Low, dull backache
§ Mild cramps
§ Regular, frequent contractions
o Chorio - CORRECT ANSWER § Bacterial infection of amniotic cavity
§ Diagnosed by maternal fever, maternal and fetal tachycardia, and purulent amniotic fluid
§ Risk factors: prolonged labor, multiple vaginal exams, internal FHR monitors
§ occurs in 1-5% of all births but 25% of preterm births
§ Risks to infant: pneumonia, bacteremia, and meningitis
§ Give broad spectrum antibiotics to prevent complications if suspected (ampicillin, gentamicin)
o Breech Delivery - CORRECT ANSWER § external cephalic Version (attempt to turn the fetus)
§ Increased Risk with Twins
§ C-Section Delivery Needed
Infant will need hip ultrasound at 6 weeks
o Uterine Rupture - CORRECT ANSWER Common finding is abnormal FHR tracing, sudden, sharp abdominal pain described as "ripping", signs of hypovolemic shock (hypotension/tachycardia
VBAC - CORRECT ANSWER § high risk for uterine rupture
§ Contraindicated if previous classical or vertical incision were made [Show Less]