question

Leading cause of perinatal admissions to the ICU

answer

Hemorrhagic disorders

question

Percentage of deaths related to pregnancy related hemorrhages

answer

17-25%

question

Most maternal deaths from obstetric hemorrhage after first trimester of pregnancy are due to

answer

Placental abruption

question

Race most likely to die from post partum hemorrhage

answer

African Americans

question

Mortality rate (2006) for white women, African American women and Hispanic women in the US, stated as deaths per 100,000 live births

answer

White women 13.3/100,000 African American women 32.7/100,000 Hispanic women 10.2

question

68% of post partum hemorrhage deaths occur within _______hours of delivery

answer

48

question

Obstetric hemorrhage is defined as a TBL or more than

answer

1000cc

question

The classic sign of placenta previa is

answer

painless vaginal bleeding in the second or third trimester of pregnancy

question

If you see painless vaginal bleeding in the second or third trimester of pregnancy, suspect

answer

Placenta previa

question

Risk factors for placenta previa

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

question

In patients with suspected placenta previa, which comes first, a speculum examination or a confirmatory ultrasound.

answer

Do the ultrasound first

question

Fetal blood volume is

answer

100ml/kg

question

Changes noted during significant blood loss

answer

Rising pulse rate Increase in respiratory rate Skin changes to pallor Falling blood pressure (a late finding) Decreased urinary output Decreased LOC

question

Characteristic findings in FHR if mother has a significant blood loss

answer

Initially, tachycardia Then bradycardia Sinusoidal-fetal anemia, hypoxia and acidemia Persistent late decelerations

question

Percentage of accreta among women with previa

answer

5-10%

question

If patient has had 2 or more cesarean sections, the likelihood of an accreta is

answer

Greater than 50%

question

Vasa previa

answer

Fetal vessels cross the placental membranes in the lower uterine segment and cover the cervical os

question

Velamentous cord insertion

answer

Fetal vessels run across chorion and amnion without protective Wharton's jelly before entering the placental surface

question

Succenturiate placenta

answer

One or more small accessory lobes of placental vascular tissue in membranes that are attached to main placenta by fetal vessels

question

Hemolysis

answer

lysis of erythrocytes with the release of hemoglobin

question

HELLP

answer

Hemolysis, Elevated Liver Enzymes, Low Platelets

question

Per AWHONN, patients with placenta previa should not be discharged to home until they have gone_____hours with not bleeding

answer

72 hours

question

Classic symptom of placental abruption

answer

Painful vaginal bleeding after 20 weeks gestation

question

Risk factors for placental abruption

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

question

ACOG standard for fetal monitoring for maternal abdominal trauma

answer

Minimum of 2-6 hours

question

DIC stands for

answer

disseminated intravascular coagulation

question

DIC is

answer

a pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external or internal bleeding or both

question

Specific diagnostic test for DIC

answer

D-dimer is positive in 34% of cases of DIC

question

Gestational Trophoblastic Disease

answer

condition in which trophoblastic tissue overtakes the pregnancy and propagates throughout the uterine cavity

question

Hydatidiform mole is characterized by

answer

chronic or acute bleeding and a uterus that is large for gestational age. 1 in 1200 pregnancies. 5% turn into choriocarcinoma

question

Preeclampsia in the first trimester, hCG levels above 100,000 mIU/mL, and an enlarged bleeding uterus are clinical signs of what?

answer

Hydatidiform mole

question

Five groups of hypertensive disorders in pregnancy

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

question

_______% of women with preeclampsia develop HELLP syndrome

answer

5

question

Initiate antihypertensives if BP > 160/110. List top drug choices, in order of AWOHHN preference

answer

Hydralazine Labetalol Nifedipine

question

How long does it take before the lung maturity benefits of betamethasone are seen?

answer

24 hours after administration

question

Magnesium sulfate toxicity can occur rapidly. Toxicity could result in impaired_______function.

answer

Renal function--always use a urimeter

question

______% of eclampsia and HELLP cases occur after delivery

answer

30

question

TORCH is an acronym for

answer

Toxoplasmosis, Other (hepatitisB), Rubella, CMV, Herpes

question

SGA

answer

Small gestational age; growth is below 10th percentile

question

IUGR from placenta insufficiency usually reduces ___________more than _______.

answer

birthweight length

question

Which is more ominous, symmetrical or assymmetrical growth restriction?

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

question

Growth restriction at less than 28 weeks is generally (symmetrical or asymmetrical) in nature.

answer

Symmetrical. Infants are symmetrically grown and all organ systems are small. Much more ominous than asymmetrical growth restrictions.

question

Growth restriction at more than 28 weeks is general (symmetrical or asymmetrical) in nature.

answer

Assymmetrical. 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.

question

LGA

answer

Large for Gestational Age. Having a birth weight greater than the 90th percentile on intrauterine growth charts.

question

Caput succedaneum

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.

question

Cephalohematoma

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

question

Postterm

answer

Delivery after 42 weeks gestation

question

Transition is

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.

question

Fact--Preterm infants may have impaired regulation of blood pressure in the face of apnea, bradycardia, and mechanical ventilation.

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.

question

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.

answer

Approximately one third of infants with meconium below the vocal cords become ill and require intensive care.

question

Kernicterus is caused by severe and inadequately treated hyperbilirubinemia during the neonatal period. Bili levels in excess of _______mg/dl may develop kernicterus.

answer

20

question

Fact--Research has shown that healthy full-term neonates in the absence of significant hemolysis or other underlying medical conditions with serum bilirubin levels of approximately 18mg/dl do not have any detrimental effects with an expectant management approach

answer

...

question

Omphalocele

answer

protrusion of the intestine and omentum through a hernia in the abdominal wall near the navel. Omphalocele is covered with a sac consisting of peritoneum and amniotic membrane. About 50% of newborns born with omphalocele have cardiac, gastrointestinal, genitourinary, musckuloskeletal, and CNS anomalies

question

Gastroschisis

answer

defect in abdominal wall not including the umbilicus, absence of peritoneal sac over the contents.

question

Congenital diaphragmatic hernia

answer

part of the stomach and intestine herniate through a large posterolateral defect of the diaphragm; always occurs on the left b/c of the liver on the right. Occurs in 1/2200 newborn infants. One lung (usually left) fails to develop normally b/c of the abdominal viscera in the thoracic cavity. This causes pulmonary hypoplasia and ~45% mortality among live-born infants.

question

Avoid bag and mask ventilation with the baby with congenital diaphragmatic hernia because

answer

air can be forced into the intestine, which will further compromise lung space in the chest.

question

Position the baby with diaphragmatic hernia

answer

on the affected side, allowing the unaffected lung to expand. In other words, lie the baby on it's left side, allowing the right lung to expand.

question

PDA

answer

An anatomic and functionally open shunt exists between the pulmonary artery and the aorta. In babies between 500-1500 grams, PDA occurs in 37%. In full term infants, the PDA becomes functionally closed by 12 hours of age.

question

Coarctation of the aorta

answer

A narrowing of the upper thoracic aorta that produces and obstruction to the flow of blood through the aorta.

question

Acyanotic defects shunt oxygenated blood to the body. The infant remains "pink". Name four acyanotic defects:

answer

Patent ductus arteriosus Atrial septal defects Ventricular septal defect Coartication of the aorta

question

Cyanotic defects shunt unoxygenated blood to the body. The infant is "blue". Name three cyanotic defects:

answer

Tetralogy of Fallot Transposition of the Great Ateries Hypoplastic left heart syndrome or single ventricle

question

Two goals of antepartum testing

answer

To identify fetuses that are at risk for permanent injury or death due to disrupted oxygenation To identify fetuses that are healthy, thus preventing the use of unnecessary intervention

question

Crown rump length is the most accurate measurement for EGA when in the ______________trimester

answer

First

question

Biparietal diameter is among the most accurate measurements for EGA in the ______________trimester

answer

Second

question

Although infants born at ______weeks gestation have been known to survive, most authorities believe that _______weeks is the time of earliest survival.

answer

22 23

question

Surfactant is made up of phospholipids. The two most common phospholipids in surfactant are

answer

Lecithin and phosphatidylgllycerol (PG)

question

Pulmonary maturity usually is achieved by 37 weeks gestation. The role of surfactant is to

answer

prevents the collapse of the alveoli

question

Alpha-fetoprotein

answer

A blood test that measures the level of alpha-fetoprotein in the mothers' blood during pregnancy as an indicator of possible neural tube defects

question

Quad screening

answer

blood test done at 16-18 weeks to measure AFP, HCG, Estriol, and Inhibin A

question

Doppler measurement of the peak velocity of systolic blood flow in the ___________can safely replace invasive testing in the management of the Rh-alloimmunized pregnancies.

answer

middle cerebral artery

question

AFI of less than 5 cm is considered diagnostic for oligohydramnios. 5cm equals __________ of fluid.

answer

500ml

question

Polyhydramnios is an AFI of greater than_______cm of amniotic fluid.

answer

25 cm which equals 2000 ml

question

Normal AFI at term is

answer

10-24 cm of fluid.

question

Low normal AFI at term is

answer

5-9.9 cm of fluid

question

___________% of newborns have a major anomaly

answer

1-2

question

Fetal lung maturity is determined by an amniocentisis. The lab test is called the _________ratio.

answer

L/S ratio. The lecithin/sphingomyelin ratio. The chance of lung maturity is 98% if the concentration of lecithin is twice that of the sphingomyelin.

question

L/S ratio is not a valid indicator of lung maturity if the mother is diabetic. In diabetic mothers, the presence of _______is highly predictive of fetal lung maturity.

answer

PG (phosphatidylglycerol)

question

Definitive fetal lung maturity testing requires

answer

L/S ratio greater than 2:1 AND the presence of PG

question

Reactive NST for the term fetus

answer

2 or more accelerations≥15 bpm, lasting at least 15 seconds within 20 minutes. Maximum testing period 40 minutes.

question

Reactive NST for the preterm fetus

answer

2 or more accelerations of at least 10bpm, lasting at least 10 seconds within a 20 minute period. Maximum testing period 90 minutes

question

For fetuses >30 weeks gestation, a FHR greater than_______bpm is considered tachycardia.

answer

160

question

Nonreactive NST at term is defined as

answer

no accelerations or no accelerations that meet the 15x15 criteria, within a 40 minute period. Even one accelerations is considered inadequate. Remember, this is in the presence of no contractions.

question

Nonreactive NST in the preterm fetus is defined as

answer

an NST with no accelerations or no accelerations that meet the 10x10 criteria within the maximum testing time of 90 minutes

question

If variable decelerations are present during an NST

answer

an assessment of amniotic fluid is indicated

question

If variable decelerations are seen during the NST and they are nonrepetitive and less than 30 seconds in duration,

answer

then the fetus is considered to not be compromised and there is little, if no, need for intervention

question

The proper placement for the fetal accoustic stimulator is

answer

near the fetal head

question

The appropriate use of the fetal accoustic stimulator is

answer

1-2 seconds for the first application. If there is no fetal response, the stimulus may be repeated every 1 minute up to three times to achieve longer durations of time, not to exceed 3 seconds for each stimulus. The maximum time of application is 9 seconds (three applications that equal a total of 9 seconds). Once a fetal response (i.e. accelerations) is achieved, additional stimuli are not required.

question

The fetal acoustic stimulation should not be used in these three conditions:

answer

1. during a vaginal examination 2. during contractions 3. in the presence of decelerations

question

If, in response to accoustic stimulation, the fetus elicits a prolonged acceleration of tachycardia,

answer

there is no need to elicit any additional accelerations. However, the FHR should return to the previously established FHR baseline before discharging the patient to home.

question

Accoustic stimulation is not to be used on a fetus demonstrating

answer

fetal bradycardia

question

Intrauterine apgar is another term for

answer

bio-physical profile

question

The five CNS reflex activities that are evaluated during a bio-physical profile are

answer

1. NST (this can be eliminated only if the other four parameters are normal) 2. Fetal breathing movements 3. Gross body movements 4. Fetal tone 5. Qualitative amniotic fluid volume

question

On a bio-physical profile,fetal tone disappears when fetal pH is

answer

<7.0

question

On a bio-physical profile, fetal movement disappears when fetal pH is

answer

7.1 to 7.2

question

On a bio-physical profile, fetal breathing movements disappear when fetal pH is

answer

<7.0

question

A reactive FHR baseline begins to function at _____weeks gestation

answer

26-28

question

A reactive FHR baseline is abolished when fetal pH is

answer

<7.19

question

A hypoxic baby may shunt blood away from the kidneys, which will

answer

decrease urine output, resulting in a drop in amniotic fluid index

question

If oligohydramnios is the reason for the BPP score of 8

answer

further evaluation is warranted. Predicted perinatal morbidity with 8/10-oligohydramnios=89/1000.

question

Indications for a CST

answer

Patients with nonreactive NST, nonreactive accoustic stimulation test, should have CST.

question

Contraindications (relative) to CST

answer

high risk for preterm labor, history of uterine surgery, know placenta previa, third trimester bleeding, incompetent cervix or multiple gestation.

question

Parameters for CST

answer

3 or more contractions lasting 40 seconds each in a 10 minute period

question

A positive CST

answer

is an indication that the fetus needs to be delivered

question

A negative CST

answer

indicates that the fetus is likely to survive labor should labor occur within 1 week of the test

question

Phases of labor-active phase

answer

During the active phase of labor, contractions become longer and more intense. Most contractions last as long as 45 seconds, and are three minutes apart. The cervix dilates from four to eight centimeters during this phase. If the bag of waters has not already broken, the treating doctor or midwife, will most likely break them at this time. The contractions during this phase are much more painful than in the early phase, and expectant mothers may try breathing techniques, massage, pressure or request pain medications.

question

Phases of labor-latent

answer

During the early phase of labor, contractions are usually mild, and can be 15 to 20 minutes apart. These contractions, which can last as long as 90 seconds, can be uncomfortable, causing the expectant mother to feel crampy throughout her lower back and lower abdomen. The early phase of labor is also when an expectant mother may experience bloody show, or her bag of waters breaking. As this stage of labor progresses, the contractions become more frequent, as well as more intense. During this phase, the cervix dilates to 4 centimeters. Read more at Suite101: The Three Phases Of Labor http://www.suite101.com/article.cfm/labor_delivery/86449#ixzz0gewR3G12

question

Three phases of labor

answer

latent, active, transition

question

First stage of labor

answer

the period of the birth process lasting from the first regular uterine contractions until the cervix is fully dilated

question

Second stage of labor

answer

Stage of labor that begins when the cervix is completely dilated and ends with birth,. Contractions continue every 2-3 minutes, lasting 60-90 seconds. Client encouraged to use abdominal muscles to bear down with each contraction.

question

Third stage of labor

answer

Stage of labor that begins with the delivery of the fetus and ends with delivery of the placenta. Placenta should be delivered within 30 minutes of birth.

question

Fourth stage of labor

answer

First hour after delivery during which the mother's body begins to return to a nonpregnant state. Blood pressure has moderate decline, pulse increases and then gradually slows.

question

Bishop score

answer

this is used to determine maternal readiness for labor induction (done before the induction. It evaluates cervical status & fetal position. Five factors assigned a score of 0-3. They are Dilation, Effacement, Consistency of cervix, Position of cervix & Station of presenting part. Score of 6 or more indicates a readiness for labor induction.

question

Bandl's ring

answer

an abnormal retraction ring that occurs in obstructed labor. It is a sign of impending rupture of the lower segment of the uterus, which becomes progressively thinner as Bandl's ring rises upwards. Immediate action to relieve the obstruction is then necessary, usually in the form of Caesarean section

question

General anesthesia is used only for emergency Cesarean sections due to increased risk for fetal hypoxia. Induction of anesthesia to birth should be less than____minutes.

answer

8

question

NICHD

answer

National Institute of Child Health and Human Development

question

Normal fetal sleep cycles

answer

20-40 minutes

question

Baseline heart rate

answer

determine the mean FHR during a 10 minute window. There needs to be 2 minutes of interpretable data to determine FHR BL. The 2 minutes do not have to be continguous. They may be 2 consecutive minutes or two 1 minutes segments. It is assessed when the mother is not contracting. If a FHR baseline cannot be determined the BL is interpreted as INDETERMINATE.

question

Fetal tachycardia

answer

<160 bpm over a 10 minute time segment, between contractions.

question

Fetal bradycardia

answer

<110 bpm over a 10 minute time segment, between contractions.

question

Bradycardia less than 60 bpm or associated with decreased variability requires

answer

immediate attentiona and collaborative management

question

In a nonreassruing FHR, fetal scalp stimulation is

answer

NOT recommended. Scalp stimulation in this instance will elicit a vagal response that overrides the sympathetic response and results in aa furtherfurtherdrop in the FHR

question

Variabiltiy is defined as

answer

the fluctuation in the FHR over time

question

AFI of 8 means how much fluid?

answer

800 cc

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