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198 Cards in this Set
- Front
- Back
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What does AFP/MSAFP test for? |
Trisomies 16, 18 (Edwards), 21 (Downs) Neural Tube Defects Chrom abnml/fetal aneuploidy |
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When is this AFP/MSAFP test done? |
15-20 wks |
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What are the risks? |
None |
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What does Nuchal Translucency Screen (NT) U/S screen for? |
Trisomies 16, 18 (Edwards), 21 (Downs), Turner syndrome, cardiac defects |
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When is NT done? |
10-14wks |
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What are the risks of a NT U/S? |
None |
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What are the biochemical markers to screen for Trisomy 21 (Downs)? |
hCG levels @ 10-22wks = high PAPP-A levels @ 10-14wks = lower uE3 @ 14-22wks = lower AFP @ 15-20wks = lower Inhibin A @ 15-20wks = higher |
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What integrated screening is Biochemical Markers screened with? |
Nuchal Translucency (NT |
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What do these invasive tests require for Rh- mothers following the proceduer? |
Rhogam |
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How is the Chorionic Villus Sampling done? |
Transcervically or transabdominally |
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When is the CVS testing done? |
anytime after 10wks |
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What does the CVS test? |
Diagnostic measure to identify genetic diseases affecting the fetus |
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What are the risks? |
High miscarry rate, oligo, ROM, subchorionic hematoma, limb reduction |
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What is the Amniocentesis test? |
Removal of fluid from the uterine cavity (transabdominally) |
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What does the Amniocentesis assess? |
Genetic and biochem diagnosis, fetal disease, fetal maturity |
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When is the amniocentesis performed? |
15-16/18wks |
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What is Cordocentesis? |
direct method of sampling fetal blood |
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What is another name for cordocentesis? |
Percutaneous umbilical cord sampling (PUBS) |
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How is Cordocentesis/PUBS performed? |
Transabdominal needle puncture of the fetal cord (also used to transfuse or medicate baby) |
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When would Cordocentesis/PUBS need to be performed? |
Need for karotyping of fetus by DNS, assess and treatment of Rh issoimunization, measure of cord blood gasses for severe IUGR, diagnosis of fetal disease (cytomegalovirus, toxoplasmosis), treatment of fetal disorder |
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When is cordocentesis/PUBS performed? |
2nd trimester |
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What is the Quad Screen Test? |
A maternal blood screening test that looks for four specific substances |
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What are the 4 substances a quad screen test looks for? |
AFP: alfa fetaprotein, protein produced by fetus hCG: human chorionic gonatropin, hormone produced by placenta Estrial: estrogen produced by fetus and placenta Inhibin-A: protein produced by placenta and ovaries |
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When is a quad screen performed? |
16-18wks |
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What does the Triple Marker Screen test for? |
Alfafetaprotein, hCG, Estial |
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What are the 8 things you look for in a urinalysis? |
Color, clarity, odor, specific gravity, protein, ketones, glucose, leukocytes |
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When do you test for gestational diabetes? |
28wks |
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What results for Glucose Tolerance Screening require further testing? |
>140 |
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What is tested in a CBC? |
HGB, HCT, WBC, RBC, Platelets, RPR/VDRL, Rubella, Hep B, HIV screening, Blood type and factor, antibody screening |
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What is HGB role? |
O2 carrying capacity of RBC |
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What is normal range of HGB during pregnancy? |
10-14 |
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What should HGB NOT be less than in 3rd trimester? |
10 |
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Normal HGB < 8 wks? |
13-15 |
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Normal HGB > 28wks? |
10-12 |
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What is hemodilution? |
Normal drop in value of 2 pts around 28 wks due to blood volume expansion |
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What % of HCT should HGB be? |
33% |
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What does low HGB indicate? |
Iron deficiency, potential for PP hemorhhage, aplastic or sickle cell anemia, thalassemia, leukemia |
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What does HCT measure? |
# of RBC in given volume of blood |
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What is normal HCT range? |
30-36% |
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What is normal HCT range < 8 wks? |
39-46% |
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What is normal HCT range > 28wks? |
30-36% |
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What does a high HCT indicate? |
Macroyctic anemia, contracted blood volume, impending toxemia, polycythemia or dehydration |
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What does low HCT indicate? |
Iron deficiency, PP hemorrhage |
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What are white blood cells? |
# of Leukocytes |
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What is normal WBC range? |
5,000-22,000 |
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What is normal WBC range < 12 wks? |
5,000-10,000 |
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What is normal WBC range in labor? |
Up to 17,000-22,000 |
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What does a high WBC count indicate? |
High resistance to infection and hemorrhage |
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What does love WBC count indicate? |
poor resistance to infection, severe hemorrhage |
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What are RBC? |
# of erythrocytes in given volume of blood |
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What do RBC do? |
Carry O2, nutrients and waste products from tissue |
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What is normal RBC range? |
3.6-5 |
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What does low RBC indicate? |
Iron deficiency, blood volume expansion |
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What does high RBC indicate? |
High altitude, contracted blood volume |
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What do platelets do? |
Play a role in blood clotting |
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What is normal platelet range? |
100/140-400 |
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What do low platelets indicate? |
Hemorrhage, vit B deficiency |
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What do high platelets indicate? |
PP hemorrhage, polycythemia, sickle cell anemia |
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What does RPR/VDRL screen for? |
Syphyliis |
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What is are normal results for RPR/VDRL? |
Non-reactive |
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What does positive test result for RPR/VDRL indicate? |
Disease present |
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What does Rubella test for? |
Presence of rubella antibody |
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What is the normal range for Rubella? |
> 1:10 or < 1:10 |
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Immune results for rubella? |
> 1:10 |
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Non immune results for rubella? |
< 1:10 |
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Rubulla present results? |
> 1:64 |
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Which blood type is the universal recipient? |
AB |
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What is Rh factor? |
Antigen present on blood cell |
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What is Rh- risk? |
Isoimmunization and has option of rhogam during pregnancy and or PP |
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What does the antibody screen detect? |
RBC antibodies |
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What is the normal result for antibody screen? |
Negative |
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When is antibody screen performed? |
26-28wks, 32-36wks, 38 wks for those at risk |
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What are the antibody titer results that indicate Rh- sensitization? |
> 1:4 |
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How much vitamin E should mom have? |
400 units |
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How much Vitamin C should mom have? |
500 mg |
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How much Iron should mom have? |
75mg |
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What supplement is crucial for vegans? |
B12 |
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How much protein should mom have? |
80-100 grams |
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How much fluid intake should mom have? |
80-100oz |
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How much calcium should mom have? |
1200mg |
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Which herbs are good sources of calcium? |
Nettle and red raspberry leaf infusions |
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What does adequate absorption of calcium require? |
Magnesium, phosphorus, vitamin A, C, D |
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What are the effects of smoking? |
Nicotine causes blood vessels to constrict contributing to hypertension The body elevates the BP and heart pumps faster in effort to counteract loss of blood volume |
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What are the risks of smoking? |
Miscarriage, fetal and neonatal death, placenta problems such as abruption, previa and increased risks of SIDS and childhood cancer |
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What are the risks of alcohol? |
Fetal alcohol syndrome, prenatal or postnatal growth in childs weight or head circumference is delayed, narrow lip, short upturned nose or flattened midfacial areas, abnormalities of CNS, signs of brain dysfunction, delays in behavioral development or cognitive impairment, odds of SAB increase 3% |
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How is Hep B screening done? |
Blood test |
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How is HBV transmitted? |
Blood or blood by products, saliva, vaginal secretions, semen |
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When should babies born to infected mothers be immunized? |
12 hours after birth |
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How is Hep C transmitted? |
Blood and blood by products, sexual transmission |
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Is breast milk affected? |
No |
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Who is HIV screening advisable for? |
All women particularly if engaged in high risk behaviors of unprotected sex or needle sharing |
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Which test is used for HIV screening? |
ELISA test |
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Evidence of incompetent cervix? |
2nd trimester painless dilation, ROM and expulsion of fetus |
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What is the cause of a hydatiform mole? |
Developmental anomaly of the placenta |
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What does a hydatiform mole resemble? |
A bunch of grapes |
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What is a complete hydatiform mole? |
All vesicles |
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What is a partial hydatiform mole? |
Nonviable fetus or amniotic sac as well |
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Signs of a hydatiform mole? |
Normal 1st trimester, persistent nausea and vomitting, uterine bleeding by the 12th week, possible anemia, large for dates uterus, shortness of breath, no FHT, no fetal activity, fetal parts not evident via paplation, PHI, preeclampsia before 24 weeks |
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How does an ectopic pregnancy occur? |
When blastocyst implants anywhere except endometrium lining the uterine activity |
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What are predisposing factors of ectopic preg? |
Pelvic infections, IUD, previous ectopic preg, prior tubal surgery |
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When can hyperemesis graviduram occur? |
Any trimester |
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Spontaneous abortion? |
Occurs naturally without having to be induced - miscarriage |
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What is a habitual abortion? |
Spontaneous abortion that has terminated the course of 3+ consecutive pregnancies |
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What is an abortion? |
The termination of a pregnancy by expulsion of conception prior to ability of fetus to survive if born |
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What are newborn breathing vitals? |
40-60 BPM |
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What is normal NB temp? |
97.7F - 99.5F |
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Normal NB FHR? |
100-180 bpm |
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How much of the time do healthy newborns sleep? |
60% of the time |
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How long does lochia rubra last? |
(bright red) 2-3 days PP |
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How long does lochia serosa last? |
(paler version, serous and pink) ends 7-8days PP, later as pink, yellow or white |
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How long does lochia serosa last? |
(creamy white) starts at 10th day PP and dwindles to nothing in another week or so |
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When does breast milk come in? |
Day 3-4 PP |
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When does colostrum gradually convert to mature milk? |
Day 15 PP |
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What is the size of the uterus immediately after birth? |
2-3 x size of pre pregnancy |
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What should be considered if fundus is above the umbilicus? |
Filling of blood or blood clots in early PP, displaced, distended bladder |
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What does a high pulse indicate? |
Infection or delayed PP hemorrhage |
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When should temp return to normal? |
Within 1st 24 hours |
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What are the hormonal forms of birth control? |
Morning after pills, injectable birth control, IUD, patch, hormonal birth control pill |
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When does the morning after pill need to be taken? |
Within 72 hours after sex |
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How much does the morning after pill reduce risk of pregnancy? |
60-75% |
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What are contraindications for an IUD? |
Pregnancy, PID of hx, cervical/uterine carcinoma, uterine cavity abnml, copper allergy, high risk of STD, hx of ectopic pregnancy, acute cervicitis or vaginitis |
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What are non hormonal forms of birth control? |
Condom, diaphragm, calendar method, ovulation method (cervical mucus), LAM, spermicide |
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How does the condom work? |
Prevents semen from entering the vagina |
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How does the diaphragm work? |
prevents semen from entering the cervix |
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Diaphragm contraindications? |
Severe uterine prolapse, severe cystocele, severe anteversion or retroversion of uterus, fistula, known allergy to rubber or spermicides, severe UTI's |
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How does the calendar method work? |
Abstain from sex around ovulation |
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What are the 4 different types of pelvis'? |
Gynecoid, playpoid, anthropoid, android |
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Describe an gynecoid pelvis |
Round shape, most common in european descent, most conducive to childbearing |
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Describe a android pelvis |
Male pelvis, heart shaped, encroaching spines, narrow arch, deep transverse arrest is seen |
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Describe an anthropoid pelvis |
Anertior posterior oval, most common in black descent, posterior babies common |
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Describe a platypeloid pelvis |
Kidney shaped (transverse oval), most rare, least likely to have a vaginal birth |
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What does TORCH stand for? |
Toxoplasmosis Rubella Cytomegalovirus Herpes |
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What is rubella? |
German measles |
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What does prenatal testing for rubella do? |
Determine if mother is immune |
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What is congenital rubella syndrome (CRS) associated with? |
Cataracts, cardiac defects, deafness, IUGR and postnatal growth retardation |
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What is cytomegalovirus (CMV)? |
Herpes virus |
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What is herpes simplex-1? |
Severe systemic viral infection associated with high morbidity and mortality |
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What is varicella? |
Herpes |
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How is parovirus B19 transmitted? |
Respiratory secretions and blood products |
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What is a sign of parvovirus B19? |
Rash covering body |
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What is the #1 STD in the US? |
Syphillus |
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What is HIV associated with? |
Stillbirth, preterm birth, IUGR |
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Which herbs are contraindicated in pregnancy? |
Goldenseal, Ephedra, cotton root bark, blue cohosh, peenyroyal, and birthroot |
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Benefits of hydro therapy? |
Bath and shower reduce muscle tension and stress, associated with faster labor |
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What is shock? |
A complex syndrome involving reductions of blood flow to the tissues, may result in irreversible organ damage and progressive collapse of circulatory system |
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Signs of shock? |
Elevated pulse Low BP Clammy pale skin Rapid resps Low body temp Possible loss of conciousness |
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Non allopathic treatment of shock? |
Rescue remedy Calms |
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Benefits of (water soluble) vitamin C? |
Tissue formation, increase iron absorption, builds immune system |
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Vitamin C dosage? |
500mg |
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Benefits of (fat soluble) vitamin E? |
Tissue growth, protects RBC, prevents clots |
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Vitamin E dosage? |
400 units, 10 IU |
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What vitamin should you recommend (water soluble) vitamin B-complex? |
Vegans and possible vegetarians |
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Benefits of vitamin B-6? |
Forms antibodies, metabolizes amino acids, fat, and glycogen |
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B-6 dosage? |
2.6mg |
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B12 benefits? |
Prevents megaloblastic anemia, protein metabolism |
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B21 dosage? |
4mcg |
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Iron benefits? |
Makes HGM, protects stores in case of PPH, |
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Iron dosage? |
75mg |
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Calcium benefits? |
Blood clotting, muscle contraction, bone and tooth health, |
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Calcium dosage? |
1200mg |
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Magnesium benefits? |
Energy, protein absorption, tissue growhth |
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Magnesium dosage? |
450mg |
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Vitamin A benefits? |
Reproduction, embryonic development, vision and immunity, deficiency can cause cleft lip and infertility |
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Vitamin D benefits? |
Bone formation and maintenance |
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Vitamin K benefits? |
Coenzyme for proteins involved with blood clotting and bone |
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Benefits of lidocaine? |
Fast acting, local anesthesia, has no effect on uterus or contractions, |
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Lidocaine disadvantages? |
Distorts the tissue, making tissue approximation and judgement of tightness of the sutures more difficult |
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Lidocaine administration? |
Injected by sterile technique with 10cc, 22 or 23 gauge, 11/2 or 3/4 inch attached to 10mL syringe. 1% lidocaine, 10mg/mL injected around edge of wound, wait for minutes, inject 5-10cc |
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O2 benefits? |
oxygenates the body orally, acts as analgesic, relieving muscle tension as well as nausea and pain |
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O2 risks? |
May produce coughing, chest pain, paresthesias (numbing/tingling extremities), nausea, vomitting, fatigue and malaise within 6-24 hrs |
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How do you avoid carbon dioxide build up? |
Start at 6 1/min of flow |
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Methergine beneifts? |
Help contract the uterus and causes vasoconstriction in case of PP hemorrhage and uterine atony (acts direction on smooth muscles of uterus and stimulates a sustained tetanic contraction) |
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Methergine risks? |
May cause BP to rise |
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Methergine contraindications? |
Women with impaired liver or kidney function, heart or vascular disease, sepsis, severe hypertension, preeclampsia, eclampsia, or hx of PPD |
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Oral Methergine administration? |
Oral: 0.2 mg by mouth, every 4 (or 6-8) hours for 6 doses |
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IM methergine administration? |
IM: 0.2mg/ml in a 1-ml syringe IM q 2-4 hours up to max of 5 doses |
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When do you administer methergine? |
After placenta is born |
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Eye ointment benefits? |
Eye prophylaxis against infections caused by G/C |
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Eye ointment administration? |
0.5% erythromycin ointment, spread from newborns inner to outer canthus of each eye |
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When should it be administered? |
After the 1st period of reactivity (1st half hour) |
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Pitocin benefits? |
Stimulates intermittent contractions (primarily on fundus) with little to no effect on BP |
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Pitocin side effects? |
Occasional nausea and vomitting |
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Pit administration? |
IM injection of 10 units or 10-40 unites in 1000 ml/NS or lactated ringers postpartum is standard single starting doese |
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How long does Pit take to see effect? |
3-7 min and lasts 30-60 min |
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Rhogam benefits |
Fractionated plasma product that suppresses the mothers productions of antibodies in response to receipt of the Rh positive antigen, reduces risk of isoimmunization |
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Rhogam risks? |
Transmission of viruses such as HIV, hep, etc |
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Rhogam administration? |
300mg of Rh D immune globulin / vial standard dose within 72 hours 50 mcg of Rh D immune globulin / vial micro dose |
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When in pregnancy is it administered prophylactically? |
28-30 wks |
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Vitamin K administration? |
1mg IM in NB thigh within 1 hour of birth 2.0 mg orally given on the 1st and 7th days of life, then again at 1 month and monthly thereafter until solid food is introduced to infant |
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GBS antibiotic risks? |
Yeast, possible allergy to medicine |
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GBS antibiotic administration? |
1000aa given at 125cc/hr |
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US benefits? |
Gestational age assessment Identify fetal anomalies Assess fetal growth Identifies fetal demise, placenta location, false position and fetal number |
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Appropriate referrals for US? |
Vaginal bleeding, evaluate fetal growth, determination of fetal presentation, suspected mult gest, serial evaluation of fetal growth in mult gestation, estimate fetal weight, complications Adjunct to amniocentesis, fetoscopy, cordocentesis, chorionic villus sampling, in vitro, cervical cerclage placement, ECV |
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Benefits of BPP? |
Evaluates the fetus by both electronic fetal behavior with NST and measurements of volume of amniotic fluid |
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What are the 5 things a BPP looks for? |
1. Fetal HR reactivity: 2 episodes accel for 15sec or more 2. Breathing movements: 1 episode 20 sec durat. 3. AFV: 1 pocket, 2cm or higher 4. Movement: +2 movements in 30 min 5. Tone: extension and flexion |
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What is BPP scoring? |
8-10 means fetus is doing well and should continue to for at least 1 more week < 7 indicates induction |
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Indications for BPP? |
IUGR, oligo, preeclampsia, postdates, mult pregnancy, non reactive NST or postive CST |
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When is BPP performed? |
41 wks then 2x week |
