Antrepartal Period and Fetal Risk
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Antrepartal Period and Fetal Risk

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Questions and Answers

What condition is caused by a mother's anti-Rh antibodies attacking a developing fetus with Rh positive blood?

  • Hyperbilirubinemia
  • Congenital heart defects
  • Erythroblastosis fetalis (correct)
  • Hydrocephalus

    • Which of the following is NOT a potential complication of a TORCH infection?

  • Intrauterine growth restriction
  • Congenital heart defects
  • Mental retardation
  • Cerebral palsy (correct)

    • What is the treatment for a newborn exposed to HIV during pregnancy?

  • Intravenous immunoglobulin (IVIG)
  • Phototherapy
  • Oral zidovudine (AZT) (correct)
  • IV antibiotics

    • When should a vaginal swab be screened for Group B streptococcus during pregnancy?

    <p>At 35-37 weeks of gestation</p> Signup and view all the answers

    Which type of maternal blood type poses the greatest risk for fetal incompatibility?

    <p>Type O</p> Signup and view all the answers

    What hormone acts as an insulin antagonist during pregnancy?

    <p>Human placental lactogen (HPL)</p> Signup and view all the answers

    What does elevated ALPHA-FETOPROTEIN (AFP) levels in pregnant women typically indicate?

    <p>Potential fetal demise</p> Signup and view all the answers

    Which vitamin should be consumed in increased amounts during pregnancy to prevent fetal abnormalities?

    <p>Vitamin A</p> Signup and view all the answers

    What is the recommended protein intake per day during pregnancy?

    <p>60-65 g</p> Signup and view all the answers

    What is the normal range of ALPHA-FETOPROTEIN (AFP) in pregnant women?

    <p>10-150 ng/mL</p> Signup and view all the answers

    Why should NARCAN not be administered to a mother on methadone or heroin?

    <p>It can cause a withdrawal crisis in the mother</p> Signup and view all the answers

    What dietary practice is related to iron deficiency during pregnancy?

    <p>PICA</p> Signup and view all the answers

    What should be done if an infant's meconium test is positive for drugs?

    <p>Notify Child Protective Services (CPS)</p> Signup and view all the answers

    What is a normal weight gain range during pregnancy?

    <p>25-35 pounds</p> Signup and view all the answers

    What is a significant factor contributing to higher rates of abuse among pregnant women?

    <p>Partner's feelings of control and power</p> Signup and view all the answers

    What is the primary characteristic of drugs in Category A during pregnancy?

    <p>Controlled studies in women fail to demonstrate risk to the fetus.</p> Signup and view all the answers

    In which category would a drug fit if animal studies revealed adverse effects on the fetus and no human studies have been conducted?

    <p>Category C</p> Signup and view all the answers

    What is a critical safety concern associated with Category D drugs during pregnancy?

    <p>They may cause serious fetal risk but offer significant benefits.</p> Signup and view all the answers

    What distinguishes Category X drugs in relation to pregnancy?

    <p>The risks clearly outweigh any potential benefits for pregnant women.</p> Signup and view all the answers

    What occurs when an Rh positive infant’s blood enters the circulation of an Rh negative mother?

    <p>The mother creates antibodies against Rh positive blood.</p> Signup and view all the answers

    When are Category C drugs considered appropriate for use during pregnancy?

    <p>Only in life-threatening conditions where no other options exist.</p> Signup and view all the answers

    Which statement best describes the implications of maternal Rh sensitization?

    <p>Future pregnancies may be at risk due to maternal sensitization.</p> Signup and view all the answers

    Under what circumstances should a drug from Category B be used during pregnancy?

    <p>When there are no controlled studies in women but potential benefits are warranted.</p> Signup and view all the answers

    Which symptom is indicative of Neonatal Abstinence Syndrome?

    <p>Excessive irritability</p> Signup and view all the answers

    What is the primary purpose of the Non-Stress Test (NST)?

    <p>To assess fetal heart rate in relation to fetal movement</p> Signup and view all the answers

    Which characteristic is a major feature of Fetal Alcohol Syndrome?

    <p>Microcephaly</p> Signup and view all the answers

    Which change in the body is primarily responsible for increased back strain during pregnancy?

    <p>Relaxation of joints</p> Signup and view all the answers

    What is the effect of estrogen on the virgin vagina during pregnancy?

    <p>Increases acidity</p> Signup and view all the answers

    What happens to the cervix during pregnancy as indicated by Goodell’s sign?

    <p>Softens</p> Signup and view all the answers

    What is a common physiological change in the cardiovascular system during pregnancy?

    <p>Increased clotting factors</p> Signup and view all the answers

    What does the lecithin/sphingomyelin ratio determine in a fetus?

    <p>Lung maturity</p> Signup and view all the answers

    Which of the following is a risk associated with supine hypertension during pregnancy?

    <p>Compression of the aorta</p> Signup and view all the answers

    What change occurs in the gastrointestinal system during pregnancy due to elevated progesterone levels?

    <p>Decreased gastric emptying</p> Signup and view all the answers

    What represents a long-term implication of Fetal Alcohol Syndrome?

    <p>Cardiac joint abnormalities</p> Signup and view all the answers

    During pregnancy, the thyroid gland typically:

    <p>Increases by 25%</p> Signup and view all the answers

    What common symptom may occur due to hormonal changes in the neurological system during pregnancy?

    <p>Headaches</p> Signup and view all the answers

    Study Notes

    Antrepartal Period

    • Category A: Controlled studies in women fail to demonstrate risk to the fetus in the 3rd trimester.
    • Category B: Animal reproduction studies have not demonstrated fetal risk.
    • Category C: Animal studies reveal adverse effects on the fetus, but controlled studies in women are lacking.
    • Category D: Positive evidence of human fetal risk, but benefits for the pregnant woman may outweigh the risk.
    • Category X: Studies in animals or humans demonstrated fetal abnormalities, or evidence of fetal risk based on human experience.
    • Rh Sensitization: When an Rh-negative mother carries an Rh-positive fetus, the mother's immune system may attack the fetus, causing hemolysis (erythroblastosis fetalis).
    • RhoGAM (300mcg): Treatment for Rh sensitization.
    • ABO Blood Incompatibility: More common than Rh incompatibility, but less serious. Rh-negative mothers produce anti-A and anti-B antibodies that cross the placenta, potentially causing red blood cell breakdown in A, B, or AB fetuses.
    • Hyperbilirubinemia: A condition caused by ABO incompatibility, treated with phototherapy.
    • TORCH Infections: A group of infections that include Toxoplasmosis, Others (HIV, Chlamydia, Group B Strep), Rubella, Cytomegalovirus, and Herpes.
    • TORCH Related Complications: Congenital heart defects, physical fetal anomalies, intrauterine growth restriction (IUGR), mental retardation, encephalitis, hydrocephalus.
    • TORCH Infection Transmission: Can cross the placenta, potentially affecting both the mother and baby.
    • Prenatal Screening for TORCH Infection: Important due to the asymptomatic nature of some viruses.
    • Group B Strep: A frequent cause of sepsis in mothers and neonates.
    • Screening for Group B Strep: Vaginal swabs are recommended at 35-37 weeks of gestation.
    • Treatment for Group B Strep: Positive mothers are treated with IV antibiotics during labor.
    • Alpha-Fetoprotein (AFP): Substance produced by the fetal liver.
    • Elevated AFP Levels: May indicate neural tube defects in the fetus.
    • Decreased AFP Levels: May indicate Down Syndrome (trisomy 21).
    • Normal AFP Levels: Between 10-150 ng/mL
    • Domestic Violence: Pregnant women are more susceptible to abuse than the general population, often linked to partners' feelings of lack of control or power.
    • Substance Abuse: Urine tests are recommended if the nurse suspects a drug use.
    • Meconium Drug Screen: Meconium (first stool) can be tested for drug presence.
    • Narcan (Naloxone): Should NOT be given to mothers on methadone or heroin, as it can precipitate drug withdrawal.
    • Neonatal Opioid Withdrawal Syndrome: Symptoms include tremors, irritability, sleep problems, high-pitched crying, tight muscle tone, hyperactive reflexes, seizures, yawning, stuffy nose, sneezing, poor feeding and sucking, vomiting, diarrhea, dehydration, sweating, fever or unstable temperature, rapid breathing (tachypnea - 60 bpm).
    • Fetal Alcohol Syndrome (FAS): Characterized by microcephaly, growth retardation, short palpebral fissures, maxillary hypoplasia, and smooth philtrum.
    • Nursing Interventions for FAS: Decrease environmental stimuli, provide gavage feedings for infants with uncoordinated sucking and swallowing.
    • Long-Term Implications of FAS: Mental retardation, poor coordination, facial abnormalities, behavioral deviation (irritability), cardiac and joint abnormalities.
    • Routine Prenatal Visits: Involve blood pressure, CBC, weight, abdominal exam, fetal heart rate (FHR) assessment, and assessment of fetal position.
    • Non-Stress Test (NST): Used to evaluate fetal status without uterine contractions.
    • Reassuring NST Result: Fetal heart rate accelerates 15 beats per minute for 15 seconds with fetal movement.
    • Contraction Stress Test (CST): Induced uterine contractions with pitocin or nipple stimulation to assess fetal heart rate and placental function.
    • Amniocentesis: The removal of amniotic fluid from the amniotic sac.
    • Amniocentesis Applications: Provides genetic information, sex of the fetus, chromosomal abnormalities, determines fetal health and maturity, and assesses lecithin/sphingomyelin ratio for lung maturity.
    • Chorionic Villus Sampling (CVS): A sample of tissue from the edge of the placenta used to detect genetic disorders.
    • CVS Timing: Performed at 8-10 weeks of gestation.
    • Biophysical Profile (BPP): Confirms fetal well-being and placental functioning.
    • Physiological Changes of Pregnancy:
      • Reproductive System: Uterine enlargement (20 times), irregular painless contractions, cessation of ovulation, vaginal softening and thickening, increased vascularity and acidity, breast enlargement and tenderness, darkening of the areola, colostrum excretion, cervical softening (Goodell's sign), cervical congestion with blood (Chadwick's sign), and mucus plug formation.
      • Musculoskeletal System: Relaxation of joints due to relaxin hormone, widening of the symphysis pubis, increased back strain, waddling gait, and lordosis.
      • Cardiovascular System: Blood volume increases by 30-50%, pulse increases by 10-15 bpm, clotting factor increases to prevent hemorrhage, RBC mass increases, BP remains essentially unchanged, 500-1000 mLs of blood flow to the uterus per minute, supine hypertension can occur, Hgb less than or equal to 11 g/dL, Hct less than or equal to 33% indicates anemia.
      • Respiratory System: Oxygen consumption increases by 20%, dyspnea is common, nosebleeds and stuffiness are common due to estrogen, rib cage widens, respiratory depth increases.
      • Gastrointestinal System: Gums appear red and swollen, nausea occurs in 50% of pregnant women in the first trimester, delayed gastric emptying, decreased motility in the large intestine, gallstones, increased thirst and appetite.
      • Urinary System: Frequent urination, particularly in the 1st and 3rd trimesters, urinary stasis, increased renal plasma flow, glucosuria may occur.
      • Neurological System: Loss of consciousness, headaches, altered reflexes, lightheadedness, fainting.
      • Endocrine System: Placenta becomes an endocrine organ and produces hormones, heat intolerance due to vasodilation. The thyroid gland becomes 25% larger, and the basal metabolic rate increases. Oxytocin and prolactin are secreted by the pituitary gland.
      • Metabolic Changes: Increase in protein and carbohydrate demand, glycosuria may be present, iron needs increase, increased water requirement, fluid retention.
    • Weight Gain During Pregnancy: Approximately 25-35 pounds, with 1 pound per week gained in the 2nd and 3rd trimester.
    • Nutritional Needs During Pregnancy: Well-balanced diet, increase in vitamin A and D.
      • PICA: The urge to eat non-nutritious food, often related to iron deficiency.
      • Nausea and Vomiting: Related to hCG and estrogen, ginger can be a safe anti-emetic.
      • Soft Cheeses: Avoid soft cheeses due to the potential presence of Listeria monocytogenes, which can cause listeriosis.
      • Listeriosis: Can cause meningitis, pneumonia, and sepsis, and increase stillbirths.
      • Fish Consumption: Avoid certain fish due to mercury poisoning.
      • Specific Nutritional Needs: Protein (60-65 g/day), Calcium (1,200 mg/day), average daily caloric intake of 2,500 kcal (300 extra for pregnant women, 500 extra for breastfeeding moms).
      • Folic Acid: Before conception 400 mcg/day, during pregnancy 600 mcg/day, to prevent neural tube defects such as spina bifida.

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    Antrepartal Period Review Midterm PDF

    Description

    This quiz focuses on the Antrepartal Period, detailing various risk categories for fetal exposure during pregnancy. It covers important topics such as Rh sensitization, the role of RhoGAM in treatment, and ABO blood incompatibility. Test your knowledge on these critical aspects of maternal-fetal medicine.

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