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162 Cards in this Set

  • Front
  • Back
Out-of-hospital birth is contraindicated when fibroids are ______________.
contiguous with placental implantation
Components of prenatal care unique to HIV + pregnant women includes:
Monitoring immune system function
Briefly (1 sentence) explain why, theoretically, labor onset may be delayed in a pregnancy with an anencephalic fetus.
Without a normal brain, the fetus does not secrete necessary chemicals that contribute to labor initiation pathways.
Your client is 17 weeks pregnant, has been exposed to Fifth's disease (parvovirus). What testing, if any, should you offer her?
Antibodies for parvovirus to determine immunity status.
Leaving aside the issue of “diagnosing” full dilation, list 3 signs that you could use to feel confident that the baby’s presenting part is descending without doing an vagina exam.
rectal/perineal bulging;

visibility of head at introitus

spontaneous UTP

appearance of bowel movement
The normal physiology of glucose metabolism in pregnancy can best be described as:
accelerated starvation, increased fat storage and insulin resistance.
What is the normal physiologic rise of maternal blood pressure in labor due to pain (according to varney)
15 – 20 mm Hg
Define

Intensity
the rise in intrauterine pressure during contraction
Neonatal Alloimmune Thrombocytopenia


Maternal plt count (approx) _______
Maternal effects __________
Fetal/neonatal effects __________
normal (>150,000)
none
Profound thrombocytopenia, increased risk of intracranial bleeds
In an OOH birth setting how can you correct for:

"passenger"
mobility, pelvic rocks, stroking, lunging, stair climbing, squatting
List 3 characteristics of both caput and cephalohematoma that differentiate them from one another.
Any 3: Caput:
fluid filled, indentable, crosses suture lines, evident at birth, resolves in 24 hrs.

Any 3:Cephalohematoma:
hard, discreet, blood-filled, not indentable, doesn’t cross suture lines, evident > 24 hrs., may take weeks to resolve.
Listeriosis is a concern during pregnancy because
A. It has a high morbidity and mortality rate for infected neonates.
B. It is airborne and therefore highly contagious.
C. Its transmission mechanisms are poorly understood.
D. It is one of the most common sources of neonatal sepsis.
A. It has a high morbidity and mortality rate for infected neonates.
List 4 labor complications that are increased in a woman with polyhydramnios.
Cord prolapse, PTL, malpresentation, PROM, dysfunctional labor, PPH
Chromosome disorder that is usually fatal.
Trisomy 18
Prolonged second stage (Friedman) is defined as > ____ hours in a primpara and > ____ hours in a multipara.
3 hrs, 1 hour
According to Friedman, the average nulliparous active phase lasts approximately:
6 hours
Congenital heart disease occurs in 0.5 - 1% of newborns. The most common defect is_____________________
Ventricular Septal Defect
(Foramen ovale)
Why is oligohydramnios considered a problem? Mark all the statements below that are true.

A. associated with congenital anomalies in the fetus
B. may increase risk of meconium aspiration syndrome
C. often a sign of uteroplacental insufficiency
D. increases the risk of preterm labor
E. babies are often growth retarded
F. increases the risk of placental abruption
G. may require preterm delivery
A. associated with congenital anomalies in the fetus
B. may increase risk of meconium aspiration syndrome
C. often a sign of uteroplacental insufficiency
E. babies are often growth retarded
G. may require preterm delivery
Signs and symptoms that may indicate some type of acute hepatitis infection include:
Right upper quadrant pain, jaundice, and light colored stools
What is the earliest and most reliable sign of uterine rupture in VBAC labors?
Non-reassuring fetal heart rate
Antiphospholipid Syndrome (APS) is defined as:
A. an obstetric complication characterized by thrombotic events, autoimmune thrombocytopenia and fetal loss.
B. an obstetric complication in which a pregnant woman with underlying autoimmune disease develops high levels of circulating antiphospholipid antibodies.
C. an autoimmune condition affecting pregnant women characterized by certain clinical features and moderate to high levels of circulating antiphospholipid antibodies.
D. an autoimmune condition affecting children and adults of both sexes, characterized by certain clinical features and moderate to high levels of circulating antiphospholipid antibodies.
D. an autoimmune condition affecting children and adults of both sexes, characterized by certain clinical features and moderate to high levels of circulating antiphospholipid antibodies.
An anatomic and physiologic change that predisposes pregnant women to UTI is:
the effects of progesterone result in dilation and decreased tone of the ureters and bladder, leading to reduced peristalsis and increased stasis.
When there is a diagnosis of polyhydramnios, what fetal anomaly associated with poly might not be ruled out, even with the best ultrasound?
Trachial-esophageal fistula or esophageal atresia
Normal post 1 hour 50 gram glucose screen is <120

True /False
False
State 2 complications of general anesthesia that are responsible for most of the maternal deaths that are due to obstetric anesthesia:
failed intubation, aspiration after vomiting
Distinct clinical manifestations of localized neonatal HSV-1 disease most commonly appear as:
discrete vesicles of the skin, eye & mouth
A client calls 5 days postpartum complaining of a temp of 102 F and feeling ill.

List 4 possible areas of infection, and 2 symptoms of each type of infection.
uterine infection: odor of lochia, describe amount of flow, abdominal tenderness.

Breasts: engorgement, lumps, red areas on skin.

UTI: frequency, urgency, etc.

Wound infection: heat or redness around the site, pussy discharge, and increased tenderness.

Is anyone else in the house ill?
The landmark on the fetal skull located at the junction of the coronal, frontal and sagittal sutures is the:
Anterior Fontanelle
Monozygotic twins can best be diagnosed by
Single placenta
How might a midwife be able to detect the presence of a baby with Trachial-esophageal fistula (esophageal atresia)?
Yes. Newborn would not tolerate feeds (regurgitate); dx confirmed when unable to pass feeding tube to stomach.
The primary etiology of folic acid deficiency is:
nutritional deficiency
How is the pathophysiology of preeclampsia best characterized?
vasospasm
Beth gave birth 24 hours ago and now has a pulse of 110. What are two possible problems that you should be suspicious of?
infection and hemorrhage
The PRIMARY fetal effect of Rh sensitization is:
A. hypoxia
B. growth restriction
C. kernicterus
D. hemolysis
D. hemolysis
The major adverse effect of the use of narcotics during labor is __________ and the name of the medication used to reverse this effect is __________.
Respiratory depression in newborn and naloxone (Narcan)
The intrapartum events which may increase the risk of HIV
1. Prolonged labor
2. Rupture of membranes greater than 4 hours
3. Internal fetal monitor in labor cesarean
When a hemoglobin electrophoresis indicates a hemoglobinopathy trait in a pregnant woman, the next step would be to:
offer tests to see if the father has the trait
In the absence of any RhIG administration in the AP or PP period, the rate of alloimmunization of Rh negative women in their first incompatible pregnancy is approximately:
17%
In an OOH birth setting how can you correct for:

“passageway”
various positions that widen pelvic diameters
List your most complete differential diagnosis for bleeding in the first trimester of pregnancy.
Should include:
Impending miscarriage, threatened abortion
Sub-chorionic hemorrhage
Ectopic pregnancy
Molar pregnancy
Implantation
Friable cervix, polyp
Other cervical lesions (cancer)
Infections causing bleeding of vaginal mucosa
Non-vaginal (hemorrhoids)
Distinct clinical manifestations of disseminated HSV-2 infection in the neonate most commonly appear as
Irritability, seizures and respiratory distress
define

superimposed pre-eclampsia
chronic hypertension and pre-eclampsia
Why is oligohydramnios considered a problem? The below are true, Except.

A. associated with congenital anomalies in the fetus
B. may increase risk of meconium aspiration syndrome
C. often a sign of uteroplacental insufficiency
D. increases the risk of preterm labor
E. babies are often growth retarded
F. increases the risk of placental abruption
G. may require preterm delivery
D. increases the risk of preterm labor
F. increases the risk of placental abruption
What are the differential diagnoses for S>dates with solid dating?
Maternal obesity, normal variation, large fetus (not GDM alone), Fibroids, Polyhydramnios, breech presentation, multiple gestation, fetal anomaly.
List 3 precautions the birth attendant and anesthetist can do or be aware of that can limit the possible negative effects of a labor epidural on the progress of labor
Wait until at least 4 cm dilation and engaged presenting part, or wait as long as possible., Use dilute anesthetic., “Laboring down”, waiting to push until urge to push or head at +1 to +2 station., Decrease epidural medication infusion in second stage to improve motor function., No “Delivery dose” unless indicated.
At her first visit a client expresses fear of getting "that cat disease". Which of the following is the most sound advice regarding avoiding this exposure?
A. wear a mask while changing kitty litter
B. don't eat sush
C. wash hands after changing diapers when she baby sits other children
D. cook meat and wash vegetables thoroughly
D. cook meat and wash vegetables thoroughly
HIV+ women receiving appropriate antiretroviral therapy at term should be advised that:
The recommendation for mode of delivery should be based on the maternal viral load, CD4+ counts and other risk factors.
In case of a woman with BP trending up with no proteinuria or significant edema...
list danger signs that require she contact you or another obstetric care provider immediately.
severe headache, visual changes, dizziness, malaise, epigastric or right upper quadrant pain, nausea and/or vomiting, reduced fetal movement
Your client has a long history of recurrent HSV. Today, at her 39 week visit, she tells you she thinks she may have a lesion. You are unable to see anything, but she says she feels that "sensation" she always gets. The most appropriate management plan for her care now:
Counsel her that if labor should begin with these symptoms, a Cesarean birth is recommended
What are characteristics of labs of developing preeclamsia?
increased serum creatinine
thrombocytopenia
proteinuria
List 3 findings in a woman's obstetrical history that that would warrant testing her for Antiphospholipid Syndrome (APS).
Unexplained fetal death or stillbirth, Recurrent pregnancy loss, PIH < 34 wks, Severe IUGR
The risk of miscarriage in a woman experiencing vaginal bleeding in the first trimester is about____%
50%
Define

Duration
the time from the start of one contraction until that contraction ends
Which of the following statements about GBS is correct?

A. Approximately 40% of pregnant women will culture positive for GBS in pregnancy.
B. Of the GBS + mothers, less than 5% of babies are colonized with the bacteria at birth.
C. When particular risk factors are present, risk of EOGBS increases from 5% to 40%.
D. Intrapartum antibiotic prophylaxis in GBS+ mothers reduces risk of EOGBS from approximately 25% to 3%.
C. When particular risk factors are present, risk of EOGBS increases from 5% to 40%.
What are 2 signs of "inevitable abortion"
tissue protruding or passed, internal os open to sterile q-tip
The argument for universal screening of all pregnant women for GDM is based on the statistic that ___% of women who have GDM will be missed if screening is based on risk factors alone
50%
Chromosome disorder with no unusual findings on newborn exam.
Klinefelter
A Kleihauer-Betke test determines the:
A. quantity of fetal cells in the maternal blood
B. presence of maternal antibodies in neonatal blood
C. presence of antibodies in the maternal blood
D. degree of erythroblastosis in the neonate
A. quantity of fetal cells in the maternal blood
List the 3 most important signs or symptoms of incomplete abortion a client doing expectant management should report to you.
(Any 3)
Excessive bleeding (2 pads/ hour)
Bleeding persists for more than several days/week without passing products of conception; if heavy, not more than 1 day
Fever, uterine pain, signs of infection
In an OOH birth setting how can you correct for:

"psychology"
change environment, discuss fears, close labor support, offer encouragement, options, pain relief
Glycosuria in pregnancy
A. means the patient likely has diabetes
B. should be treated with diet modification
C. is usually the result of lowered renal threshold
D. is abnormal and requires physician consultation
Is usually the result of lowered renal threshold
The initial lab work for your pregnant client which you drew when she was 10 weeks LMP, includes the following:
CBC// RBC 3.8 Hgb 10.8 Hct 31.7 MCV 80 MCH 31 MCHC 32.8%

This CBC indicates findings suggestive of_______________
iron deficiency anemia
Studies have shown that asphyxia is more likely to occur with shoulder dystocia if delivery is delayed more than
6 minutes
Excluding ultrasound findings (including Doppler FHT’s), list 4 signs or symptoms of molar pregnancy.
Any 4:
vaginal bleeding
excessive nausea & vomiting
S>D
hypertension
ovarian cysts
very high HCG levels
The best test to determine if a client is developing Hepatitis after an exposure is?
IgM antibody to strain of exposure
Laboratory data indicating that a pregnant woman is experiencing a true primary infection of HSV is:
viral culture positive, antibody serology negative
Which of the below lab findings is diagnostic of a UTI in pregnancy?
A. 100,000 bacteria of the same species per milliliter
B. 100,000 bacteria of mixed species per milliliter
C. 200,000 bacteria of mixed species per milliliter
D. 100,000 bacteria of the same nonpathenogenic organism per milliliter
A. 100,000 bacteria of the same species per milliliter
Briefly describe the function flexion serves in the mechanism of labor.
Allows the smallest diameter of the fetal head to negotiate the pelvis.
The pathophysiology of GDM can best be described as:
insufficient insulin production to meet normal glucose shifts in pregnancy and/or greater insulin resistance
As a general rule, about how long does a dose of RhIG maintain protection against Rh alloimmunization?
12 weeks
With a single postpartum dose of RhIG to Rh negative women, the rate of alloimmunization is reduced to:
1 – 2%
With routine AP & PP prophylaxis, the rate of alloimmunization in an Rh negative woman is:
0.1 – 0.2%
The primary fetal effect of Parvovirus infection in the second trimester is
A. severe anemia
B. CNS damage
C. microcephaly
D. intrauterine growth restriction
A. severe anemia
List 2 risks of postterm pregnancy that affect the mother.
All associated with macrosomia:
Labor problems –leading to CS, which have risks: (PPH, thromboembolic, endometritis)
Severe lacerations
Briefly describe internal rotation and why it happens.
The fetal head rotates from an oblique or transverse diameter (i.e. LOA or LOT), which fits the pelvic inlet, to an anterior-posterior diameter, (i.e. OA) which better fits the outlet. This involves the neck twisting 45 - 90 degrees. (It rotates because it must -- meets resistance)
Which of the following should be avoided to reduce the risk of iatrogenic cord prolapse?

A. AROM with unengaged presenting part
B. Ambulation after spontaneous rupture of the membranes
C. Allowing mom to push with incompletely dilated cervix
D. Attempt to rotate malpositioned head
A. AROM with unengaged presenting part
Anita is 9 weeks LMP and is calling with a concern about red vaginal bleeding. The best predictor of whether or not this is an inevitable miscarriage is
presence of cramping
The results of which anemia lab values indicate that a pregnant woman should be offered hemoglobin electrophoresis?

A. increased Hgb with reduced MCHC
B. reduced Hgb and Hct with low iron stores
C. reduced TIBC with normal iron stores
D. reduced MCV and normal iron stores
D. reduced MCV and normal iron stores
What life-threatening condition may be a sequela of molar pregnancy?
choriocarcinoma
What is the treatment protocol for a newborn of a chronic Hep B carrier?
HBIG 0.5 ml IM and HBV 0.5 ml IM in different sites within 12 hours of birth
Laboratory data indicating that a pregnant woman is experiencing a non-primary first episode of HSV is:
viral culture positive, antibody serology positive
define

Eclampsia.
Convulsions (or seizures) or coma unrelated to other cerebral conditions with signs and symptoms of preeclampsia.
Although the pathway is very complex, all of the following hormones are thought to increase as part of the initiation of human labor, EXCEPT:
A. estrogen
B. progesterone
C. prostaglandin
D. corticotropin-releasing hormone (CRH)
B. progesterone
Define:

Interval:
the time from the start of one contraction to the start of the next.
(in US we time contractions this way: "q 3 min")
Precpitate labor is defined as _____________________.
total length of labor =/< 1-3 hours
The most common presentation of a woman newly infected with hepatitis C infection
asymptomatic
Define

Tonus
the lowest intrauterine pressure between contractions (during labor)
Define:

Craniotabes
softening of the skull bones which may occur in up to 30% of newborns. Presents as soft areas of skull often along suture lines that may pop in and out. Resolves without treatment unless related to a more serious co-diagnosis such as rickets
According to the CDC, the lower limits of normal hemoglobin during pregnancy includes:
12 weeks: 11.0 g/dL
28 weeks: 10.7 g/dL
40 weeks: 11.9 g/dL
The most common maternal complication of an epidural is_________________, which can in turn cause the problem of _____________.
maternal hypotension and fetal intolerance of labor or non-reassuring fetal heart rate.
List 4 indications for M.D. consultation/referral in a client who is having first trimester bleeding.
Any 4:
Persistent missed abortion/failed expectant management
Client elects surgical intervention in non-viable pregnancy
Excessive or persistent bleeding
Ectopic diagnosed or suspected
S/sxs of infection
Define:

nevus flammeus
Also called a port wine stain. They are deep red or purple color, usually present at birth, blanch minimally with pressure, and do not disappear with time. If it appears over the forehead and upper eyelid it may indicate Sturge-Weber syndrome. Other syndromes may be associated with nevus flammeus as well.
Prolonged latent phase in a primipara lasts greater than _____ hours
20-24 hours
client at term phones you to report leakage of some clear fluid from her vagina. List 4 different questions you should ask her about this report.
Any 4:
color of fluid, activity before this happened, any contractions?, amount, ongoing leaking?, baby moving? Any show or bleeding?
List 3 observable characteristics of uncoached or physiologic pushing.
spontaneous

pushes are short and do not begin or end with contraction ( in other words, start after and finish before contraction);

open glottis;

get more intense as baby descends

not every contraction is “pushy”
If a woman experiences a CMV infection, which trimester produces the most severe fetal injury?
first trimester
Although the etiology of preeclampsia remains unknown, supplementation of which of the following currently shows the most promise for prevention of the disease?
Vitamins C and E
When considering the second stage of labor, the critical factor impacting maternal and fetal outcomes is duration of________________.
active pushing
The mortality rate for newborns at term experiencing early onset GBS (EOGBS) disease is:
A. 3 - 4%
B. 10 - 15 %
C. 20 - 40%
D. > 50%
A. 3 - 4%
List 3 observable characteristics of Valsalva technique or coached pushing:
directed, strong, pushing “on command”, regardless of urge to push

sustained pushing with contractions

holding the breath and pushing as long as possible

associated with decels in FHT
Define:

"Laboring down"
Allowing passive descent until an urge to push is felt or head is visible
The main benefit of laboring down is_______________________
Increased spontaneous vaginal deliveries
Define:

The Curve of Carus
Describes a 90 degree turn in the birth canal that encourages fetal extension.
The “magic numbers” for BP that ACOG states constitute a diagnosis of SEVERE preeclampsia is a systolic pressure > (a) ____ or a diastolic pressure > (b) _____.
systolic 160; diastolic 110
List 3 research-based disadvantages of episiotomy compared to spontaneous laceration.
Any 3:
More pain postpartum

More extensions to 3rd, 4th degree

More perineal trauma, generally

More blood loss
If the midwife deems an episiotomy is necessary, she should make the incision when the head is
not receding and showing 3 cm between contractions
Immune Thrombocytopenia Purpura (ITP)

Maternal plt count (approx) _____
Maternal effects _________
Fetal/neonatal effects _________
<100,000
increased risk PPH
thrombocytopenia, possible bleeding
List 4 obstetrical contraindications for the use of prostaglandin preparations.
Any 4:
CPD, EFW < 1800g, grandmultiparity, multiple gestation (controversial), placenta previa, vasa previa, umbilical cord prolapse, prior classical c-section or other uterine surgery (LTCS controversial), abnormal fetal lie, active herpes, chorioamnionitis
A one minute old baby has a heart rate of 110, is not making any sounds (no chest rise), is limp, color is pale and grimaces slightly when the heels are slapped. What is this infant's Apgar score?
3
At five minutes this baby's heart rate is 130, she is taking irregular breaths, flexing her arms and legs slightly, has blue extremities and a pink body and grimaces when you wipe her face. Now the Apgar score is:
6
A newborn with a 5 minute Apgar score less than ___ requires intervention
7
The most important prognostic sign in the Apgar score is
Heart rate
What is the percentage of women whose GDM is controlled by diet therapy alone?
80%
An Informed Choice Agreement should contain certain elements. Two of these include: benefits and disadvantages of home birth, and the services provided by the midwife. List 3 more.
Any 3:
risks and benefits of treatments and procedures
rights of clients to accept or refuse elements of care
clients’ responsibilities
fees and payment schedule
the midwives’ and assistants’ qualifications and experience
contacting the midwives with problems or when labor begins
physician consultation, referral and emergency transport
transfer of care for medical reasons, personality differences, and/or breakdown of trust
refunds and nonpayment of fees
List 5 factors that can play a role in contributing to an arrest in the active phase of labor in a woman laboring out of the hospital.
Any 5:
size of baby
position: occiput posterior, transverse arrest, asynclitic
pelvic diameters are diminished
quality of contx: frequency, intensity, duration (may use separately)
maternal fear, other psych.
presentation/lie is abnormal
maternal exhaustion/dehydration
others may be considered…
Define:

large for gestational age (LGA):
newborn > 90th percentile weight for gestation
A large caput

A. Is a sign of CPD
B. Is a sign of malposition
C. Can lead to misjudging descent
D. Can indicate fetal intolerance of labor
C. Can lead to misjudging descent
Spina bifida is due to a

A. Disruption
B. Deformation.
C. Syndrome
D. Malformation
D. Malformation
Both polyhydramnios and oligohydramnios may be associated with fetal anomalies. Name 2 different anomalies associated with poly and two associated with oligo.
Poly: GI obstruction, fetal tumors, CNS lesions (anencephaly), Cardiac disorders, Fetal hydrops, Chromosomal disorders, skeletal dysplasia

Oligo: prune belly syndrome, Turner's syndrome, Potter's (renal agenesis), renal anomalies, trisomies, Endocrine disorders
Often fatal, may be unable to ventilate baby even with high pressures

A. Diaphragmatic hernia
B. Tracheo-esophageal fistula
C. Choanal atresia
D. Pneumothorax
A. Diaphragmatic hernia
List 4 corrective measures that may need to be taken when uterine hyperstimulation occurs with the use of nipple stimulation, a prostaglandin or Pitocin.
Oxygen, 8-10L by mask, to mother

Change position of mom to improve placental perfusion, decrease cord compression

Bolus of IV fluids

Discontinue medication if possible (stop Pit infusion, pull cervidil)/ or stop nipple stimulation

Use tocolytic drug
What are three signs and/or symptoms of ectopic pregnancy?
unilateral adnexal pain, cervical motion tenderness, light brown bleeding
When is it better to cut a mediolateral episiotomy?
When distance between fourchette and rectal sphincter is short
mastitis is caused by _______
milk stasis and/or an infected opening on the nipple’s surface
What are 3 essential parts of treatment (besides antibiotics) for mastitis?
Rest
Fluids
Milk removal
What are 3 signs/symptoms of endometritis?
Any 3: Fever (100.4) in absence of other obvious source. Uterine tenderness. Foul smell to lochia . Positive endometrial culture with fever
Define:

Choanal atresia
When the nares are not patent. Congenital abnormality of the skull resulting in closure of either one or both posterior nasal cavaties
Which of the twin presentations carries the risk of locked twins?
Breech-vertex
List as complete a differential diagnosis for bleeding in the third trimester of pregnancy as you can.
Should include: Abruption; Previa; Labor, preterm or term; Vasa previa (must have ROM); Uterine rupture; Infection of cervix, vagina; Laceration; Lesion, i.e. cx polyp, rectal fissure
A healthy pregnant client at 29 weeks gestation with her first baby calls in the evening with a complaint of abdominal pain that she says began earlier in the day, has persisted for several hours and has not improved with rest. She has never experienced this pain before, it is located on her right flank and radiates to her back and feels worse by the hour. She has no appetite. Given this preliminary information, in your mind, you are forming a preliminary differential diagnosis, which would include:
ovarian torsion, appendicitis, gall bladder disease
List 2 potential adverse effects that are the same for both prostaglandins and oxytocin.
Hyperstimulation & uterine rupture
Always requires a cesarean if present at the onset of labor and cannot be verted.
Transverse lie
Which are the risks associated with ECV?
Cord accidents
Placental abruption
Cesarean delivery
What are the contraindication to ECV?
Oligohydramnios
Significant fetal anomaly
Placenta previa
Gestational Thrombocytopenia

Maternal plt count (approx) ______
Maternal effects _______
Fetal/neonatal effects _________
>70,000 to <150,000
none
none
In an OOH birth setting how can you correct for:

"power"
nipple stimulation, mobility, hydration, nourishment, herbs, AROM
Which of the following statements about face presentation is FALSE?

A. “If the face is making progress, leave it alone”
B. Vaginal delivery is not possible unless the mentum rotates to anterior.
C. Face presentation may easily be mistaken for breech
D. In the absence of CPD, face presentation presents no additional risk to mother or fetus.
D. In the absence of CPD, face presentation presents no additional risk to mother or fetus.
Define:

Small for gestational age (SGA):
newborn <10 percentile weight for gestation
Tachypnea in a 2 hour old neonate is defined as a respiratory rate per minute
> 60
Mastitis is usually caused by what microbe?
Staph
Of the following, a baby born at home with which problem would require transport to hospital soon after birth?
A. Cleft palate
B. Hip dysplasia
C. Polydactyly
D. Choanal atresia
D. Choanal atresia
List 2 possible symptoms, reported by a woman that you detected during a heart exam that would warrant further cardiac workup.
Dyspnea with rest, exercise or nocturnal, chest pain, syncope/fainting preceded by palpitations/exercise, hemoptysis
The Amniotic Fluid Index (AFI) is the method most commonly used now to assess amniotic fluid volume. Oligohydramnios is defined as an AFI of _____, polyhydramnios is defined as AFI _______.
<5 &
>18-24.
Define:

Macrosomia:
birthweight > 4000 or 4500 g regardless of gestation
When attending the emergency birth of an undiagnosed breech remember:
Hands off the breech until the umbilicus is born
Most patients with fetal demise should have labor induced as soon as possible to prevent complications of coagulation disorders.

True/False
False
Which answer best describes the signs and symptoms of deep vein thrombosis?

A. Pain, local heat at site, improves with analgesics
B. Pain, pallor, cool skin at site, shortness of breath
C. Pain when foot is flexed and swelling at site
D. Pain, slight tachycardia, redness at site, improves with heat and massage
C. Pain when foot is flexed and swelling at site
Define:

Intrauterine growth restriction (IUGR):
fetus has failed to grow normally, usually seen in 3rd trimester, dx with serial U/S
List 3 aspects of a pregnant woman's medical history, unrelated to obstetrical history that would warrant testing her for Antiphospholipid Syndrome (APS).
false + VDRL, thrombosis, autoimmune disease, autoimmune thrombocytopenia, stroke, transient ischemic attacks, strong family history of thrombosis.
You are conducting an initial physical assessment on a nulliparous pregnant woman. List 2 possible signs on the heart exam which would warrant further work-up.
loud systolic murmur or click, diastolic murmur, significant arrhythmia, persistent jugular venous distention, cardiomegaly, persistent split second sound
The most common maternal cause of polyhydramnios is: ________________
and why?
Gestational Diabetes

Increased maternal glucose causes fetus to have higher blood glucose, which causes it to urinate more, causing increased AF.
The most important features of fibroids (myomas) in pregnancy that predict morbidity are______________ and__________.
Size and location in uterus.
An objective measure of the severity of a shoulder dystocia is the:
number of different maneuvers required to effect delivery
How can a midwife best prevent anaphylaxis?
Document mother’s history of allergic reactions to drugs and other substances
Which newborn’s problem is most likely to be cardiac disease?

A. RR 60, HR 120, T 97.8, pink, good tone, some grunting, retractions.
B. RR 90, HR 170, T 98.2, cyanotic, decreased tone, color improves with blow-by oxygen.
C. RR 70, HR 140, T 98, cyanotic, good tone, color improves with blow-by oxygen.
D. RR 70, HR 160, T 97, cyanotic, good tone, no change in color with blow-by oxygen
D. RR 70, HR 160, T 97, cyanotic, good tone, no change in color with blow-by oxygen 100%
The first sign of amniotic fluid embolism is______________
Respiratory distress
The most common complication of multi-fetal pregnancy is
Prematurity
You are a midwife in a busy group practice. One Saturday when you are on call, you receive a call from Alice, who is a 27 year old G3 P2, 32 weeks pregnant with an uneventful prenatal history. She reports she is having some red vaginal bleeding this morning that is concerning her. List 5 questions you will want to ask Alice, assuming the only facts you have are given above.
Any 5: Is bleeding obviously vaginal? Onset, activity preceding it (intercourse, BM?) Quantity of bleeding? Quality of bleeding (mucous? color?) Pain? (Where, type, severity) Contractions? Has she been feeling fetal movement since bleeding noted? Has she had a normal ultrasound this pregnancy (if so you can r/o previa)? Blood type, and if Rh neg, did she have AP RhIG and if so, when?
What is the best care for a baby born with gastroschisis or omphalocele prior to transport to hospital from home or birth center?
Cover lesion in a clean, sterile if possible, manner that maintains moisture
Chromosome disorder always associated with profound mental retardation.
Trisomy 18
The incidence of major congenital anomalies in human newborns is approximately what percentage?

A. 0.1-0.5
B. 1
C. 2-3
D. 4-5
C. 2-3
What is the diagnosis that best fit the with a NB who is
Pink when crying, won’t nurse, sounds stuffy.
A. Meconium Aspiration Syndrome
B. Transient tachypnea of the newborn
C. Choanal atresia
D. Pneumothorax
C. Choanal atresia