| An incomplete separation of the embryonic disk results in _______ _______. | Conjoined twins |
| What is the infant mortality rate in the US? | 5.6 per 1000 live births |
| What percentage of babies are born prematurely? | 10% |
| What does morbidity mean? | State of having disease |
| Thiamine deficiency can cause which condition in the fetus? | Encephalopathy |
| Although the cause of hyperemesis gravidarum is unknown, what is thought to be a factor? | Elevated levels of HCG |
| Which women are at higher risk of developing hyperemesis gravidarum? | Experienced disorder in the past
Primigravidas |
| What should be obtained of the woman with hyperemesis gravidarum to determine the impact of the vomiting? | Electrolyte profile |
| What is the only medication approved by the FDA to treat vomiting during pregnancy? | Pyridoxine (Diclegis) |
| Monozygotic twins are known as ______ twins | Identical |
| What is the medical term for fraternal twins? | Dizygotic |
| Monozygotic twins begin with how many fertilized ovums? | 1 |
| Dizygotic twins almost always have separate _________. | Placentas |
| Two separate ova being fertilized at the same time results in _______ twins | Dizygotic |
| Which condition are more common in women with twins? | Spontaneous abortion
Maternal anemia
Gestational hypertension
Hydramnios
Bleeding from placenta previa
Abruptio placentae |
| An incomplete separation of the embryonic disk results in _______ _______. | Conjoined twins |
| What are the two types of hydatidiform mole? | Complete or partial |
| How often does a pregnancy involving twins occur in the US? | 33.4 in 1000 live births |
| A higher incidence of hydatidiform mole is reported in women of which descent? | Asian |
| What does a complete mole result from? | Fertilization of an egg whose nucleus has been lost or inactivated |
| Any symptoms of GH (gestational hypertention) before 20 weeks can indicate which condition? | Hydatidiform mole |
| 20% of cases of complete mole progress toward which condition? | Choriocarcinoma |
| A woman who has experienced a molar pregnancy must avoid becoming pregnant for how long? | One year |
| Cells of a molar pregnancy may be left behind and mey develop into _________ | Malignancy |
| Where does implantation most commonly occur in an ectopic pregnancy? | Fallopian tube |
| What kind of ectopic pregnancy may be salvageable? | Abdominal |
| What are some risk factors for the development of an ectopic pregnancy? | Pelvic inflammatory disease
Endometriosis
Tubal structure defects
Surgery to reproductive organs
Smoking
Low progesterone |
| What do HCG levels look like in an ectopic pregnancy? | Lower than normal for gestational age |
| What kind of medication is a folic acid antagonist? | Methotrexate |
| What does methotrexate do? | Destroys rapidly dividing cells |
| What kind of medication may be prescribed to a woman with unruptured ectopic pregnancy? | Methotrexate |
| What percentage of women have a normal pregnancy after an ectopic pregnancy? | 50% |
| What are the 8 classifications of abortion? | Threatened
Spontaneous
Inevitable
Complete
Incomplete
Missed
Septic
Habitual |
| What length cervix is indicative of incompetent cervix? | Less than 20 mm long |
| The use of a suture to constrict the internal os of the cervix is called: | Cerclage |
| A prophylactic cerclage is done at what week of gestation? | 10 to 14 weeks |
| Cerclage is rarely done after what week gestation? | 26 weeks |
| When the placenta implants in the lower uterine segment, this is called: | Placenta previa |
| What is the main presenting symptom of placenta previa? | Painless, bright red, vaginal bleeding that occurs after 20 weeks of gestation |
| What is the common birthing practice of a woman with placenta previa? | Cesarean birth is scheduled at 36 weeks gestation |
| ________ ________ is not allowed in the woman with placenta previa | Sexual intercourse |
| The premature separation of the placenta from the uterine wall is called: | Abruptio placentae |
| When does abruptio placentae usually occur? | Late in pregnancy |
| List the predisposing factors of abruptio placentae | Trauma
Chronic hypertension
GH |
| The use of which drug increases the risk of abruptio placentae? | Cocaine |
| Abruptio placentae is 3 times more likely to occur in women of gravidity of more than ____ | Five |
| What are the major symptoms of abruptio placentae? | Sudden severe pain accompanied by uterine rigidity |
| Which factors should be assessed when any bleeding occurs during pregnancy? | Duration, amount, color, characteristic
Vital signs
Pain
FHR
Emotional response |
| Which laboratory tests determine the amount of blood loss? | Hemoglobin and hematocrit |
| What is the leading cause of maternal death? | Abruptio placentae |
| What does DIC result from? | Alterations in normal clotting mechanism |
| DIC is usually a secondary diagnosis, and seen in which conditions? | Abruptio placentae
Incomplete abortion
Hypertensive disease
Infectious process |
| What is the body attempting to do in DIC? | Prevent excessive blood loss |
| What are the clinical manifestations of DIC? | Chest pain
Restless and cyanotic
Frothy blood-tinged mucus |
| DIC therapy includes continuous IV infusion of what medication? | Heparin |
| How should the mother position herself to maximize blood flow to the fetus? | Side-lying tilt |
| Early post partum hemorrhage is blood loss greater than ____mL after vaginal birth, or ___ mL after C-section | 500 mL, 1000mL |
| What are the most common causes of early hemorrhage? | Atony
Retained placental fragments
Perineal lacerations |
| What are the causes of uterine atony? | Excessive distention of uterus (from multiple pregnancies)
Hydramnios
Large infant |
| What percentage of women experience postpartum hemorrhage? | 5% |
| What is the most common cause oflate postpartum hemorrhage? | Retained placental fragments |
| Which pharmacologic therapies are linked to postpartum hemorrhage? | Magnesium sulfate
Nifedipine |
| Tachycardia and hypotension are reflective of excessive ________ ________. | Blood loss |
| How should the uterus feel for the first 24 hours after childbirth? | Firmly contracted ball, the size of a grapefruit |
| Where should the uterus be easily located in the first 24 hours after birth? | Level of the umbilicus |
| What is considered a large amount of lochia? | Soaking more than one peripad per hour |
| What is considered an excessive amount of lochia? | Soaking more than one peripad in 15 minutes |
| Which position is not advised for the woman with postpartum hemorrhage? | Trendelenburg |
| Blood pressure levels are normally _______ during the first trimester | Reduced |
| When do blood pressure levels return to pre pregnancy baseline? | 20 weeks gestation |
| What is the likelihood of a woman with chronic hypertension to develop preeclampsia? | 1:4 |
| When does the condition of gestational hypertension begin? | After 20 weeks gestation |
| Unlike preeclampsia, gestational hypertension is not accompanied by _____________ | Proteinuria |
| The hypertension of preeclampsia and eclampsia are accompanied by which symptoms? | Albuminuria
Edema
Headache
Visual disturbances
Epigastric pain |
| List some risk factors for preeclampsia and eclampsia | First pregnancy
African American race
Chronic or gestational hypertension
Obesity
Family history
Diabetes
Gestational trophoblastic disease |
| Which ages are at higher risk for preeclampsia and eclampsia? | Under 18, and over 30 |
| What kind of blood pressure reading indicates a problem (mild preeclampisa? | Increase of 30 mmHg systolic, and 15mmHg diastolic
Or a reading of 140/90 |
| What does urine testing show in a woman with mild preeclampsia? | 1+ to 2+ albumin readings |
| What is the urinary output of a woman with mild preeclampisa? | At least 500 mL/24 h |
| What are the blood pressure findings of a woman with severe preeclampsia? | 160/110 mm Hg or higher on two separate readings 6 hours apart |
| What will urine testing for albumin show in the woman with severe pre eclampisa? | 3+ to 4+ |
| What is the urinary output of a woman with severe pre eclampsia? | Less than 500mL/24hr |
| What can epigastric or upset stomach in a patient with preeclampsia or eclampsia be indicative of? | Distention of hepatic capsule; can warn that a convulsion is approaching |
| What position of bed rest is recommended for a patient with preeclampsia? | Left lateral recumbent |
| When are antihypertensive medications prescribed to the woman with preeclampsia? | When blood pressure exceeds 160/100 |
| Fetal kicks of less than ___ per hour must be reported | 3 kicks |
| Fetal activity decreases in the presence of __________ | Hypoxia |
| List the nurse's responsibilities to protect the woman and fetus during convulsion | Remain with the woman, call for help
Turn woman to left side
Note time and sequence
Insert and airway after convulsion
Observe fetal monitor patterns
Notify physician |
| List 5 eclamptic seizure precautions & interventions | 1. Keep environment quiet
2. Keep call button nearby
3. Have calcium gluconate ready
4. Move carefully and calmly
5. Emergency birth pack accessible |
| Bed rest for the preeclamptic woman is vital because it slows ______ and relieves _______ | Metabolism, edema |
| What is the only cure for preeclampsia and GH? | Delivery of the baby |
| What does HELLP syndrome stand for? | Hemolysis, Elevated liver enzymes, Low platelet count |
| In order to be diagnosed with HELLP syndrome, what must the platelet count be? | Less than 100,000/mm3 |
| What is the prominent symptom of HELLP syndrome? | Pain in right upper quadrant, lower chest, or epigastric area |
| What kind of birth is preferable if the woman has a hypertensive condition during pregnancy? | Vaginal |
| HELLP syndrome necessitates what kind of birth? | Cesarean |
| In addition to HELLP syndrome, what blood glucose level is associated with a high maternal mortality rate? | Less than 40 mg/dL |
| Pregnancy is regarded as what kind of condition? | Immunosuppressive |
| Mastitis is often caused by which bacteria? | Staphylococcus aureus |
| When should breast feeding from a breast infected with mastitis be discontinued? | If an abscess forms and ruptures into the milk ducts |
| How often should the mother with mastitis breast feed or pump the affected side to prevent stasis? | Every 1.5 to 2 hours |
| Which side should the mother begin breastfeeding on when infected with mastitis? | Unaffected side |
| Weaning during an episode of mastitis may increase _________ and __________. Encourage the mother to keep breast feeding. | Engorgement and stasis |
| What does "TORCH" infection stand for? | Toxoplasmosis, Others such as Rubella, Cytomegalovirus, and Herpes |
| What are common presenting problems of HIV infection in women? | Chronic vaginitis, and candidiasis |
| What are HIV infected women at risk for during pregnancy? | Preterm labor/birth
Premature rupture of membranes
IUGR
Perinatal mortality
Postpartum endometriosis |
| Giving birth within ___ hours of membrane rupture greatly reduces the transmission of HIV to the neonate | 4 hours |
| What are the risk factors in the development of gestational diabetes mellitus? | Older than 25
Family history of diabetes
History of gestational diabetes
Nonwhite race
Obesity
Hypertension |
| When is a 1-hour, 50-g diabetes screening or glucose tolerance test performed? | 24 to 28 weeks gestation |
| Which test for diabetes is not reliable during pregnancy? | Glycosylated hemoglobin (A1c) |
| What is prescribed for women with type 2 diabetes while pregnant? | Insulin |
| Why are hypoglycemic medications contraindicated during pregnancy? | Possible teratogenic agents |
| Why is insulin safe during pregnancy? | It does not cross the placental barrier |
| What are the potential complications of the mother with diabetes during pregnancy? | Risk for operative birth
Tissue trauma from large for gestational age infant |
| What are the fetal complications of a diabetic pregnancy? | Preterm delivery
Macrosomia |
| The symptoms of cardiomyopathy are similar to those of _______ ______ ________. | Congestive heart failure |
| When is cardiomyopathy usually seen? | Last month of pregnancy or postpartum period |
| What are the most common cardiac problems of maternity patients? | Rheumatic heart disease
Congenital heart defects
Mitral valve prolapse |
| Rheumatic heart disease is the result of what kind of infection? | Streptococcal infection |
| During labor which position of the mother enhances respiratory effort and improves circulation? | Semi-Fowler's or side-lying |
| What kind of birth is recommended for the woman with heart disease? | Vaginal |
| What is used to minimize the mother's use of valsalva's maneuver during labor? | Vacuum extraction
Outlet forceps |
| What is the mother with heart disease at risk for during the first 48 hours after birth? | Cardiac decompression |
| What kind of fluids are used for amnioinfusion? | Lactated Ringer's solution
Saline |
| What are the physiologic concerns associated with adolescent pregnancy? | GH
Cephalopelvic disproportion
Abruptio placentae
Low birth weight
IUGR
Anemia
Infection
Preterm delivery
Perinatal death |
| Why are oral contraceptives not usually recommended immediately after birth? | Woman is at risk for thromboembolic disease in the immediate postpartum period (first 4 weeks) |
| Which oral contraceptives are recommended for adolescents? | medroxyprogesterone (Depo-Provera)
levonorgestrel (Norplant( |
| Each year after the age of 35 years increases the risk of conceiving a child with _____ _________. | Down syndrome |
| The incidence of which conditions increases as the woman ages | Ectopic pregnancy
Placenta previa
Diabetes
Hypertension |
| What are the three types of thrombus that the postpartum period may be affected by? | Superficial venous thrombus
Deep vein thrombosis
Pulmonary embolism |
| What kind of respiratory changes signal pulmonary embolsim? | Tachycardia and dyspnea |
| A positive Homan's sign is not considered a definitive test of ______ _________ _______ | Deep vein thrombosis |
| Oral anticoagulation therapy for deep vein thrombosis should be continued for how long during the acute phase? | 3 months |
| What kind of IV therapy is used in managing pulmonary embolism? | IV heparin therapy |
| What kind of blood thinner is contraindicated in pregnany? | Warfarin |
| How long will the patient anticipate to take oral anticoagulants or subcutaneous heparin therapy after the acute phase of pulmonary embolism? | 6 months |
| What weeks of gestation is considered a preterm birth? | 20-37 weeks |
| 38 to 41 weeks gestation birth is considered: | Term |
| What week gestation is considered a post term birth? | 42 weeks |
| What is the preterm infants greatest potential problem? | Respiratory distress syndrome |
| What is the post term infant at risk for? | Asphyxia
Respiratory distress
Hypoglycemia |
| When does Rh incompatibility occur? | When the mother is negative, and the fetus is positive |
| A hemolytic anemia that occurs in newborns due to maternal-fetal blood incompatibility is called ________ _________. | Erythroblastosis fetalis |
| The destruction of fetal RBC's results in _______ ________. | Pathological jaundice |
| What is kernicterus? | Toxic accumulation of bilirubin in central nervous system tissues |
| Kernicterus may result in _______ damage or _________. | Neurologic damage or death |
| What does an indirect coombs test meaure? | Number of maternal antibodies |
| When should an amniocentesis be performed after an indirect coombs test? | If the titer exceeds 1:16 |
| Phototherapy is begun when bilirubin levels reach __ to ___ mg/dL | 12 to 15 mg/dL |
| When is RhoGAM administered to the mother? | At 28 weeks, and 72 hours after birth |
| Positioning the newborn on the ______ side reduces the risk of aspiration | Right side |
