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207 Cards in this Set

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How early can gestational age be determined on ultrasound?
Starting at 5 weeks
Name this stage of pregnancy:

From fertilization until 8 weeks
embryo
Name this stage of pregnancy:

From 8 weeks until birth
Fetus
Name this stage of pregnancy:

From Birth until 1 year of age
Infant
What age range is a fetus considered preterm?
A fetus delivered between 24 - 37 weeks
At how many weeks is a fetus considered term?
From 37-42 weeks
Define parity (P)
The number of pregnancies that led to a birth beyond 20 weeks gestation OR an infant weighing more than 500 g.
What is Nagele's rule?
Determines the estimated date of delivery (EDD or EDC):

Starting with the LMP, add 1 year, substract 3 months, then add 7 days.
Name some cardiovascular changes assoc'd with pregnancy:
-C.O. increases by 30-50%
-Systemic vascular resistance decreases due to elevated levels of progesterone that causes smooth muscle contraction
Name some pulmonary changes assoc'd with pregnancy:
-Tidal volume increases by 30-40%, but TLC decreases by 5% due to elevation of the diaphragm
When does morning sickness usually resolve in pregnancy?
By 14-16 weeks gestation
Name some GI changes assoc'd with pregnancy:
-Relaxation of the lower esophageal sphincter
-Prolonged gastric emptying
Why are pregnant women at increased risk of developing pyelonephritis?
Ureters dilate during pregnancy and the kidneys increase in size
Why is there a decrease in BUN and Cr in pregnant women?
b/c the GFR increases by 50% early in pregnancy and is maintained until delivery
Name some hematologic changes assoc'd with pregnancy:
-Plasma volume increases by 50%
-RBC volume increases 20-30%
-Decreased Hct
When are fetal heart tones (FHT) first audible?
Using doppler US, FHT's are first heard at 10-12 weeks gestation

Using a fetoscope auscultation, FHT's are first heard at 18-20 weeks
What is quickening?
Maternal sensation of fetal movement.

Usually occurs at 18-20 wks GA in first time pregnant mothers, and 16-20 weeks in mutiparida women
What 4 main elements are measured on a fetal US after the 2nd trimester?
1. Femur length
2. Head circumference
3. Biparietal diameter
4. Abdominal circumference
Name the trimester:

13-26 weeks GA
2nd
Name the trimester:

From conception to 12 weeks
1st
Name the trimester:

From 27 weeks to 40 weeks
3rd
What are Braxton-Hicks contractions?
Painless, low-intensity contractions usually palpated starting at 14 weeks GA (2nd trimester)
What effect do anticholinergic drugs have on urinary incontinence?
The actually cause urine retention
What type of urinary incontinence do Alpha antagonists cause?
They decrease sphincter tone in the proximal urethra, causing leakage of urine and URGE incontinence.
What type of urinary incontinence do Alpha agonists cause?
They increase sphincter tone in the proximal urethra, causing urinary retention and OVERFLOW UI.
What type of urinary incontinence do Calcium channel blockers cause?
They can reduce smooth muscle contractility in the bladder and occasionally cause urinary retention and OVERFLOW UI.
A fecal impaction can cause what type of urinary incontinence?
Urge or overflow UI
What is the most common form of urinary incontinence?
-Urge incontinence (50% to 75% prevalence)

- Detrusor contracts when it should be relaxed
Sphincter is closed when it should be open, and the detrusor is relaxed when it should contract
Overflow incontinence
Detrusor contracts when it should be relaxed.
Urge incontinence
Name this form of urinary incontinence:
Sphincter is open when it should be closed
Stress incontinence
Name the type of incontinence:

small amounts of urine leak with stress such as cough, sneeze, laughing, or physical activity
Stress
Name the type of incontinence:

large amounts of urine, sudden, uncontrollable; often have nocturia
Urge
Name the type of incontinence:

small amounts of urine, poor stream, straining, dribbling
Overflow
What do Activities of Daily Living (ADL) assess?
ADL's reflect a patient's ability to perform basic self-care.
What do Independent Activities of Daily Living (IADL) assess?
IADL's reflect a patient's ability to perform tasks that are required to maintain an independent household.
What are presumptive signs of pregnancy?
These are changes UNRELATED to the uterus or fetus.

N/V, skin changes, breast tenderness, ammenorrhea, Chadwick's sign
What are Chadwick's signs?
Presumptive signs of pregnancy that include bluish discoloration of the vulva, vagnia, and cervix
Changes related to the uterus or placenta are called what type of signs?
Probable signs:

These include uterine enlargement, + B-hCG test, uterine contractions, palpation of fetal parts, Hegar's sign
What is Hegar's sign?
A propable sign of pregnancy:
softening btwn the fundus and cervix
Changes related to the fetus are called what type of signs?
Definitive signs:

Ultrasound imaging is the most specific!, also auscultation of fetal heart tones, x-ray imaging of the fetus, fetal movements by the examiner
What RISK FACTORS are assoc'd with pregnancy?
-Diabetes mellitus
-HTN
-Seizure disorder
-Previous perinatal death, fetal anomaly, preterm delivery
-Inherited dz's, retardation, birth defect, perinatal deaths
-EtOH, tobacco, drug use, poor nutrition, eating disorders
What lab tests should you order at a first prenatal visit?
-CBC, UA, sickle cell, TB
-Serology (VDRL or rapid plasma reagin, HIV
-Oral glucose tolerance test
-Atypical Ab's
-Blood type, Hepatitis B surface Ag, Rubella Ab's
-Triple marker screen
-Sonogram
How often should a mother come for prenatal visits during the first 28 wks gestation?
Every 4 weeks
How often should a mother come for prenatal visits from 28-36 wks gestation?
Every 2 weeks
How often should a mother come for prenatal visits from 36 wks gestation and on?
Every 1 week!
If a pregnant woman is overweight, how much weight should she gain during her pregnancy?
15-20 lbs
If a pregnant woman is underweight, how much weight should she gain during her pregnancy?
30-40 lbs
If a pregnant woman is of norml weight, how much weight should she gain during her pregnancy?
25-30 lbs
What should you do to prevent nutritional anemias during pregnancy?
-Give iron 30 mg daily
-Give folate supplementation 0.4 mg daily
At what # weeks GA should the uterus be palpable at the umbilicus?
20 weeks GA
At what # weeks GA should the uterus be palpable at the pubic symphysis?
12 weeks GA
At what # weeks GA should the uterus be palpable midway bwtn the pubic symphysis and the umbilicus?
16 wks GA
An amniotic fluid index > 25 cm indicates what fetal pathology?
Polyhydramnios
An amniotic fluid (AFI) index < 5 cm cm indicates what fetal pathology?
Oligohydramnios (inadequate amniotic fluid)
How do you determine an IUGR?
Intrauterine growth restriction is dx when sonographic fetal growth falls BELOW the 10th %ile expected for gestational age.
Name the two types of IUGR
Symmetric: Fetal in origin due to decreased growth potential

Asymmetric: Placental etiology due to inadequate nutritional substrate availability
What is station?
The degree of extenstion of the presenting part through the birth canal.

-above the level of the ischial spines, represented as a negative #

-Below the level of the ischial spines, represented as a positive #
What is attitude?
The degree of extension or flextion of the fetal head

-Most common attitude is VERTEX = fetal head flexed w/ chin against chest
What is position in normal labor?
The relationship btwn a reference point on the fetal presenting part and the maternal bony pelvis.

-Most common position is OCCIPUT ANTERIOR
Name the stages of labor in order!!!
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Name the stages of labor in order
Stage 1: Latent --> Active
Stage 2: Descent
Stage 3: Expulsion
Name this stage of labor:

Begin at the onset of regular uterine contractions, ends with acceleration of cervical dilation

Duration is usually < 20 hr in primiparas, and < 14 hrs in multiparas
Effacement - Latent phase
Name this stage of labor:

Begins with acceleration of cervical dilation and ends with cervical dilation = 10 cm
Dilation (active phase of labor, rapid cervical dilation)
What constitutes a reactive non-stress test (NST)?
Remember the 15/15 2/20 rule:
There must be an increase in fetal heartbeat of 15 beats or greater that lasts for at least 15 seconds.

There must be 2 accelerations of the fetal heart rate in a 20 minute period
What does the non-stress test measure?
The NST is a test of the fetal heart rate.
What 3 tests comprise antenatal testing of fetal wellbeing?
1. Non-stress test (NST)
2. Contraction stress test (CST) or Oxytocin challenge test
3. Biophysical profile (BPP)
What are some risk factors for ectopic pregnancy?
- Hx of STD or PID
-Prior ectopic preg
-Previous tubal surgery
-Endometriosis
-Use of IUD for birth control
-Current use of estrogen or progesterone
What is the classic laboratory finding in a woman suspected of having an ectopic pregnancy?
beta-hCG level that is LOW for gestational age and doesn't increase at the expected rate
beta-hCG levels that do not double every 48 hrs are suspicous for what condition of pregnancy?
Ectopic pregnancy
Am IUP seen on transvaginal ultrasound should correlate with a beta-hCG level equal to what?
1,500 mlU/ml
A fetal heartbeat should correlate with a beta-hCG level of what?
> 5,000 mlU/ml
What is the pharmacologic treatment of choice for ectopic pregnancy?
Methotrxate
Implantation of the pregnancy outside of the uterine cavity
Ectopic pregnancy

-About 1% of all pregancies are ectopic
Name this condition:

Pt presents with unilateral pelvic pain, vaginal bleeding, and you palpate an adnexal mass
Ectopic pregnancy
A pregnancy that ends before 20 weeks gestation is classifed as what?
spontaneous abortion; occur in 15-25% of all pregnancies
Any intrauterine bleeding before 20 weeks GA, without dilation of the cervix or expulsion of products of conception (POC)
Threatened abortion
A fetus that weighs less than 500g or is less than 25 cm is called a what?
Abortus
Name some conditions assoc'd in the ddx of 1st trimester bleeding
-SAB
-Post-coital bleeding
-Ectopic pregnancy
-Vaginal or cervical lesions/lacerataions
-Extrusion of molar pregnancy
What are some methods used to remove products of conception (POC)?
D&C: Dilation and cutterage

Misoprostol that causes cervical dilation and uterine contractions
What is the most common cause of 1st trimester abortion?
Chromosomal abnormality
What is the difference between and Dilation and Cutterage (D&C) vs. a Dilation and Evacuation (D&E)?
D&C - for abortions that occur prior to 20 weeks GA

D&E - for aborions that occur after 20 weeks GA (2nd trimester abortions, etc.)
What are some common causes of 2nd trimester abortions?
Secondary to cervical or uterine abnormalities, trauma, systemic disease, infection
Name this condition:

Painless dilation and effacement of the cervix
Incompetent cervix

Accounts for 15% of 2nd trimester losses
Risk factors for cervical incompetence include what?
-Hx of cervical lacerations w/ vaginal delivery
-Hx of DES exposure
-Uterine anomalies
-Hx of cervical surgery (cone biopsy, dilation of the cervix)
What syndrome should you suspect in a woman with many recurent SAB's?
Antiphospholipid antibody syndrome
When can amniocentesis be performed?
Anytime after 15 weeks GA.

It is used to obtain the fetal karyotype once the chorion and amnion have fused.
When can chorionic villous sampling (CVS) be performed?
Can be performed earlier than an amniocentesis! Usually between 9-11 weeks GA.
Which procedure is assoc'd with a greater risk of complications: Amniocentesis or chorionic villous sampling?
CVS
If we need to asses the fetal hematocrit or give an intrauterine blood transfusion, what procedure should be used?
PUBS= periumbilical blood sampling

This can also be used to obtain a more rapid fetal chomosome analysis
How do you distinguish PROM from PPROM?
PPROM= preterm; a rupture of membranes that occurs before 37 weeks GA

PROM= rupture of membranes that occurs after 37 weeks GA
How do you assess for PROM on physical examination?
-Speculum exam to asses for fluid collection in the vaginal vault of fluid leaking from the cervix

-Nitrazine test: test fluid w/a strip of acid-base paper --> amniotic fluids are alkaline, so paper should turn blue (compared to vaginal secretions that are acidic and turn red)

-Fern test: Place drop of fluid onto slide to look for pattern that resembles a fern leaf. Estrogens from amniotic fluid cause crystallization of salts also found in amnio fluid causing fern pattern.
A Bishop score of what vaule suggests a cervix is favorable for SVD or induction of labor?
8 or greater
Name the components of the Bishop score:
1. Cervical dilation (cm)
2. Effacement (%)
3. Station
4. Cervical consistency
5. Cervical position
What methods are used to induce labor?
-Prostaglandins (such as PGE2 gel, cervidil, or misoprostol)
-Oxytocin
-AROM
-Mechanical dilation of the cervix
What MATERNAL contraindications are there to the use of prostaglandins in the induction of labor?
If the mom has asthma or glaucoma
What is the normal range for fetal heart rate?
110-160 bmp
A baseline fetal heart rate above 160 bmp indicates what condition(s) in the fetus?
-Infection
-Hypoxia
-Anemia
What is the pregnancy rate for male condoms?
12%
What is the pregnancy rate for OCP's?
3%
What is the pregnancy rate for Depo-Provera?
<1% - This is the best pregnancy rate among the methods of contraception!
What is the pregnancy rate for the contraceptive ring?
8%
What are some risk factors for developing osteoporosis?
Early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease.
When should you begin screening for osteoporosis in a post-menopausal woman?
Starting at age 65
What 2 vaccines are contraindicated in a woman who is pregnant or has the possibility of becoming pregnant within the next 4 weeks?
1. MMR
2. Varicella
Does the respiratory rate change during pregnancy?
No! The rate does not change, but the tidal volume increases which also causes an increase in minute ventilation.
During pregnancy, the majority of estrogen is produced by what organ/structure?
The majority of estrogen is produced by the placenta! The ovaries also contribute to insulin production but to a lesser extent.
What hormone does the placenta produce to help maintain progesterone production by the corpus luteum?
hCG
At what week gestation does hCG reach peak levels?

At what week gestation does hCG reach steady state levels?
Peaks at 10-12 weeks GA

Steady state after 15 weeks GA
Name the functional subunits of hCG.
Alpha subunit: is identical to the alpha subunits of LH, FSH, and thyroid stimulating hormone (TSH)
What is the role of human placental lactogen?
hPL is also known as human chorionic somatomammotropin.

hPL ensures a constant nutrient and energy supply to the fetus during pregnancy.

Causes lipolysis to increase circulating free fatty acids

It decreases maternal insulin sensitivity leading to increased insulin resistance and a diabetic state.
Pregnancy women should not take valproic acid because of an increased risk of what birth defects?
Neural tube defects, hydrocephalus and craniofacial malformations.
Chorionic villus sampling (CVS) is used to detect what defects?
Often performed at 10-12 weeks

The sampled placental tissue may be analyzed for fetal chromosomal abnormalities, such as Trisomy 21, biochemical, or DNA-based studies.

It CANNOT be used to asses for neural tube defects!
What serum marker distinguishes a triple screen from a quad screen?
Inhibin A: a more sensitive screening test for Down syndrome
What tests make up the triple marker screen?
The three components are
1. Maternal serum AFP
2. hCG
3. Unconjugated estriol (the estrogen of pregnancy)

Used to screen for Down syndrome, trisomy 18 and neural tube defects.
What tests comprise the quad screen?

When is the quad screen performed?
1. Maternal AFP
2. beta-hCG
3. Estriol
4. Inhibin A (more specific marker for Down's Syndrome)

Performed at 15-18 weeks GA
How are levels of the following markers affected in a woman pregnant with a Down's Syndrome fetus?

-AFP
-Estriol
-hCG
-Inhibin A
AFP and estiol levels are DECREASED

bHCG and Inhibin A are INCREASED
When should a triple screen be performed?
At 15-18 weeks GA, but before 20 weeks GA to allow for elective termination of the pregnancy if desired
What is the best available test for Down syndrome screening in women who present for care in the second trimester?
Quad screen
What is the risk of fetal loss associated with chorionic villus sampling (CVS)?
Approximately 1.2 %
What is the most common INHERITED form of mental retardation?
Fragile X syndrome
What is the most common form of mental retardation not due to an inherited cause?
Down's Syndrome - due to a chromosomal anomaly
Name the first trimester screening tests for Down's Syndrome:
1. Nuchal translucency
2. Serum PAPP-A
3. Free beta-hCG
Name some risk factors assoc'd with maternal gestational diabetes:
Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios and fetal macrosomia
What daily dose of folic acid should be taken by women who have had a previous child with a neural tube defect?
4mg
Obese women who are pregnant should be advised to gain how much weight during their pregnancy?
15-20 lbs total
What is the time period for oganogenesis in a developing fetus?
The first 8 menstrual weeks
What percentage of women with gestational HTN will go on to develop pre-eclampsia?
Up to 25 %
A 24-urine protein of what value can diagnose mild preeclampsia?

For severe preeclampsia?
> 300 mg/24-hr

>5000 mg/24-hr (5 grams)
What are some risk factors for the development of preeclampsia?
Previous history of the disease, chronic HTN, multifetal pregnancy and molar pregnancy
Is history of previous spontaneous abortion a risk factor for preeclampsia?
No!!!!
When treating a woman with MgSO4 to prevent eclampsia, what are some of the associated effects of magnesium toxicity?
Pulmonary edema at levels > 12mEq/L
Cardiac toxicity at levels > 15 mEq/L

NOTE: The therapeutic range for magnesium is 4-7 mEq/L
What is the most common cause of sepsis in pregnancy?
Pyelonephritis
What is the most reliable method for dating a fetus in the first trimester?
Ultrasound measurement of crown rump length
What classifies a 1st degree laceration during delivery?
Tear of the vaginal mucosa
What classifies a 2nd degree laceration during delivery?
Tear of the vaginal fascia and the perimeum
What classifies a 3rd degree laceration during delivery?
partial or complete transection of the rectal sphincter
What classifies a 4th degree laceration during delivery?
Tear through the external and internal anal sphincter, along with the rectal mucosa
A fetal head measurement greater than what length is an indication for C-section?
> 12 cm
Fetal bradycardia is defined as a heart rate of what?
Fetal heart rate < 110 beats per minute
Name some contraindications for starting tocolysis:
-severe vaginal bleeding
-advanced labor
-mature fetus
-intrauterine infection
-severely anomalous fetus
This test is an assessment of fetal well-being that measures the fetal heart rate response to fetal movement.
The non-stress test (NST)
What constitutes a normal or reactive NST?
Two fetal heart rate accelerations that rise at least 15 bpm over baseline that each last for a duration of 15 seconds that occur within 20 minutes of each other.
What might you observe on the fetal heart tracing in a woman with maternal fever or chorioamnionitits?
Prolonged periods of fetal tachycardia (HR > 160 bpm)
What is the physiologic cause of EARLY decelerations?
Caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate.

This type of deceleration starts and ends with uterine contraction.
Uteroplacental insufficiency is associated with what type of deceleration on a fetal heart tracing?
late decelerations
Variable decelerations are associated with what type of fetal anomaly?
Umbilical cord compression
What is the physiology behind LATE decelerations?
A symmetric fall in the fetal heart rate, beginning AT or AFTER the peak of the uterine contraction and returning to baseline only after the contraction has ended.

Associated with uteroplacental insufficiency.
What is the normal pH of vaginal fluid?

What is the normal pH of amniotic fluid?
4.5 - 5.5

7.0 - 7.5
What tests can you perform to detect for premature rupture of membranes?
1. Nitrazine pH test of vaginal fluid - if membranes have ruptured, the pH will be alkaline (> 6.5); but must watch out for false + from blood which is also alkaline

2. Ferning: a fern-like pattern that can be seen on microscopic exam when estrogen and amniotic fluid mix together and cause salt crystallization
An elevated post-void residual volume, usually >300 cc, is found in what type of urinary disfunction?
overflow incontinence
What hormone is responsible for the synthesis of breast milk?
Prolactin
What hormone is responsible for milk let-down?
oxytocin
What bacteria from the baby's mouth is a common cause of mastitis?
streptococci
Physiologic Changes of Pregnancy:

plasma volume
increases by 40-60% btwn 12 and 36 wks GA
Physiologic Changes of Pregnancy:

total erythtocyte volume
increases 15% without iron supplementation; increases 30% with iron supplementation
Physiologic Changes of Pregnancy:

Hematocrit
decreases
Physiologic Changes of Pregnancy:

erythoocyte sedimentation rate
increases greatly
Physiologic Changes of Pregnancy:

white cell count
increases due to increased number of neutrophils

Approaches approx 16,000
Physiologic Changes of Pregnancy:

serum iron concentration
decreases by 35% by term
Physiologic Changes of Pregnancy:

serum transferrin
= iron storage capacity

Increases by 100% by 2nd trimester

TIBC increases by 25-100%
Physiologic Changes of Pregnancy:

serum ferritin
= storage form of iron

decreases
What hormone of pregnancy is associated with the development of insulin resistance in the mother?
human placental lactogen
Physiologic Changes of Pregnancy:

Erythropoietin levels
increases
Physiologic Changes of Pregnancy:

Heart Rate

Stroke volume
increases from 70-85 bpm

increases
Physiologic Changes of Pregnancy:

peripheral resistance
DECREASES
Physiologic Changes of Pregnancy:

Maternal cerebral blood flow
UNCHANGED
At what week gestation is an ultrasound most accurate?
measuring crown rump length at 5-12 weeks GA
What is the relative beta hCG level at the following weeks GA?

4 wk
6 wk
10 wk
2nd and 3rd trimester
1000
10,000
100,000
15,000-25,000
A laceration that tears through the anal sphincter is classified as what degree laceration?
3rd degree
What is the average blood loss for:

Vaginal delivery

C-section
500 mL

1000 mL
Mandatory resuscitation of a newly delivered infant is necessary when the APGAR score is what?
3 or less
What interventions are necessary in a newly delivered infant with an APGAR score of 7 or greater?
None! Place the baby on the warmer.
What is the most common neurologic sequelae of eclampsia?
Hemipareisis - it often involves the middle cerebral artery
Name some common causes of 3rd trimester bleeding
placenta previa - must do a c-section!
Abruption
Vasa previa - must do c-section!
Labor with bloody show
Low lying placenta
Trauma
Sexual intercourse - semen contains prostaglandins that can lead to uterine contractions and thinning of the cervix
A placenta that grows through the uterus
placenta percreta
A placenta that imbeds into the myometrium
plaenta increta
A placenta that imbeds through the decidua
placenta accreta - the most common form of abnormal placentation
What is Asherman syndrome?
formation of intrauterine adhesions which typically result from scars that develop after uterine surgery.
Name some common causes of postpartum hemorrhage
overdistended uterus (twins, macrosomnia, polyhydraminos)

prolonged labor

chorioamnionitis

precipitous labor
Early decelerations are commonly caused by?
fetal head compression
Variable decelerations are commonly caused by?
Compression of the umbilical cord - often due to a change in maternal position
Late decelerations are commonly caused by?
acute placental insufficiency
When should RhoGAM be given to a mother susceptible to isoimmunization?
At 28 weeks GA and postpartum
What is the most common cause for a uterine rupture?
90% of cases are due to a prior uterine scar, such as from a C-section or other uterine surgery

Presentation: sudden onset of intense abdominal pain
Premature separation of the normally implanted placenta from the uterine wall
Placental abruption (abruptio placentae)

50% of cases occur before labor and after 30 weeks GA
Name some predisposing factors that increase a woman's chance of having a placental abruption:
Advanced maternal age
Multparity
Pregnant with multiples
Diabetes Mellitus
Trauma
Motor Vehicle Accident
In a woman with placenta previa, what portion of the physical exam is contraindicated and why?
You should not perform a vaginal exam because it can lead to more bleeding. Instead, you should dx with an ultrasound
Placenta develops over the internal cervical os, thus covering a portion of the os
Placenta previa
Abnormal invasion of the placenta into the uterine wall
Placenta accreta
Placenta that invades into the myometrium
Placenta increta
Placenta that invades through the myometrium and into the serosa
Placenta percreta
The triple marker screen has what sensitivity for detecting Trisomy 21?
About 60%
What is the etiology of EARLY decelerations?
Compression of the fetal head (this is vagally mediated)
What is the etiology of VARIABLE decelerations?
Compression of the umbilical cord (this is vagally mediated)
What is the etiology of LATE decelerations?
Uteroplacental insufficiency
Name the 5 components of the biophysical profile (BPP)?
1. Non-stress test
2. Amniotic fluid index
3. Fetal breathing movements
4. Gross body movements
5. Extremity tone
How do you score a biophysical profile (BPP)?
Each of the 5 parameters is assigned a score of 0-2. Max score is 10, lowest score is 0.

Score 8-10 = REASSURING, follow up w/ repeat BPP

Score 4-6 = Equivocal, f/u with delivery of the fetus if gestation >36 weeks; or repeat BPP

Score 0-4 = Delivery baby immediately!
What does a NEGATIVE contraction stress test (CST) mean? Is this reassuring or worrisome?
This means there were NO late decelerations seen in the presence of 3 uterine contractions that occurred within 10 minutes. This is REASSURING! Follow up with a repeat CST weekly.
What does a POSITIVE contraction stress test (CST) mean? Is this reassuring or worrisome?
This means there are repetitive late decelerations seen with 3 consecutive uterine contractions within 10 minutes. This is WORRISOME! Deliver the baby now!
What does a positive "lemon and banana sign" on ultrasound indicate?
This is consistent with a fetal neural tube defect.

Increased amniotic fluid acetylcholinesterase level confirms an OPEN neural tube defect.
What is the easiest and most readily available method for confirmation of fetal well-being?
Non-stress test (NST)
A multigravida at 33 weeks report decreased fetal movement. What is the next best step in management?
Perform a NST
What is the perinatal mortality rate assoc'd with a reactive NST?
3 in 1,000
You perform a NST on a pregnant mother with Type 1 diabetes. The tracing is non-reactive. What is the next best step in management?
Perform vibroacoustic stimulation
Normal fetal scalp pH
7.20 or greater

pH <7.20 indicates fetal acidosis, so deliver the fetus immediately
For third trimester bleeding, what is the most common cause of the following:

1. Painless bleeding
2. Painful bleeding
3. All 3rd trimester bleeding
1. Placenta previa
2. Abruptio placentae
3. Abruptio placentae