Recent

  • Show all results for ""

🎧 New: AI-Generated Podcasts Turn your study notes into engaging audio conversations. Learn more

Fetal Monitoring and Assessment Quiz
120 Questions
7 Views

Fetal Monitoring and Assessment Quiz

Created by
@TrustyFantasy

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What indicates a positive Contraction Stress Test result?

  • FHR remains stable during contractions
  • FHR increases by 15 bpm above baseline
  • No deceleration in FHR during contractions
  • Late decelerations in FHR with 50% of contractions (correct)

    • What is considered a normal range for the Amniotic Fluid Index (AFI)?

  • 0cm to 4cm
  • 5cm to 7cm
  • 25cm to 30cm
  • 8cm to 24cm (correct)

    • What does a reactive Nonstress Test (NST) require?

  • FHR remains constant during the monitoring period
  • FHR decrease by 10 bpm for 20 seconds at least twice
  • FHR increase by 20 bpm for 10 seconds at least three times
  • FHR increase by 15 bpm for 15 seconds at least twice (correct)

    • Which statement about late decelerations in fetal heart rate is true?

    <p>They begin after the contraction onset</p> Signup and view all the answers

    What characterizes oligohydramnios in relation to the Amniotic Fluid Index?

    <p>AFI less than 5cm</p> Signup and view all the answers

    What is the purpose of vibroacoustic stimulation during fetal monitoring?

    <p>To activate the fetal response and assess FHR</p> Signup and view all the answers

    What defines a non-reactive Nonstress Test (NST)?

    <p>No significant increase in FHR above baseline within the monitoring period</p> Signup and view all the answers

    Which of the following is a diagnostic characteristic of the biophysical profile?

    <p>Integration of NST with ultrasound findings</p> Signup and view all the answers

    Which physiological change in the uterus is primarily responsible for forming a protective barrier during pregnancy?

    <p>Hypertrophy of the cervical glands</p> Signup and view all the answers

    What is a potential effect of increased progesterone levels during pregnancy?

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

    Which factor contributes to edema in the lower extremities during pregnancy?

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

    What is the recommended position to alleviate pressure on the inferior vena cava during sleep in pregnant women?

    <p>Sleeping on the left side</p> Signup and view all the answers

    What is the significance of a score of 4/10 in NST with 30min U/S?

    <p>Non-reassuring, indicating the need for further evaluation</p> Signup and view all the answers

    Which of the following is NOT considered a presumptive sign of pregnancy?

    <p>Skin hyperpigmentation</p> Signup and view all the answers

    Which of the following changes in lab values can be expected during pregnancy due to cardiovascular adaptations?

    <p>Increase in plasma volume</p> Signup and view all the answers

    When is quickening typically first noticed by a primigravida?

    <p>18 to 20 weeks' gestation</p> Signup and view all the answers

    What is a common symptom associated with increased levels of estrogen and progesterone during pregnancy?

    <p>Nasal and sinus congestion</p> Signup and view all the answers

    What is the primary hormone detected in urine pregnancy tests?

    <p>Human chorionic gonadotropin (hCG)</p> Signup and view all the answers

    Which practice is NOT recommended for relieving lower extremity edema during pregnancy?

    <p>Prolonged standing</p> Signup and view all the answers

    Which of the following is characterized by the presence of a dark line from the umbilicus to the pubis?

    <p>Linea nigra</p> Signup and view all the answers

    What is the significance of daily fetal movement counts starting around 28 weeks of pregnancy?

    <p>Monitors fetal health and activity</p> Signup and view all the answers

    At what gestation weeks can cardiac movement of the fetus typically be sonographically visualized?

    <p>4 to 8 weeks</p> Signup and view all the answers

    What indicates a need for immediate delivery based on a NST with 30min U/S scoring?

    <p>A score of 2/10</p> Signup and view all the answers

    Which probable sign of pregnancy can be assessed by light tapping the cervix?

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

    What is the term for the production of congenital malformations in a developing fetus due to harmful agents?

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

    At what gestational age should screening for gestational diabetes typically occur?

    <p>24-28 weeks</p> Signup and view all the answers

    How is the obstetric history documented using the GTPAL system?

    <p>G = Number of times pregnant, T = Number of term infants born</p> Signup and view all the answers

    Which of the following is NOT a component of an initial prenatal visit?

    <p>Ultrasound confirmation</p> Signup and view all the answers

    When is group B streptococcus (GBS) screening typically conducted during pregnancy?

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

    Which component is assessed as part of the initial blood tests in a prenatal visit?

    <p>HIV screen</p> Signup and view all the answers

    Where does fertilization occur within the female reproductive tract?

    <p>Outer third of the fallopian tube</p> Signup and view all the answers

    What is the definition of infertility based on the inability to conceive and maintain a pregnancy?

    <p>35 6 months of inability to conceive</p> Signup and view all the answers

    What is the primary role of the ductus arteriosus in fetal circulation?

    <p>To connect the pulmonary artery to the descending aorta</p> Signup and view all the answers

    Which structure is responsible for nutrient and gas exchange between maternal and fetal blood?

    <p>Chorionic villi</p> Signup and view all the answers

    Which event causes the foramen ovale to close after birth?

    <p>Increase in blood returning to the left atrium</p> Signup and view all the answers

    Which hormones are produced by the placenta to support pregnancy?

    <p>Estrogen and progesterone</p> Signup and view all the answers

    What is the purpose of the trophoblast in the development of the placenta?

    <p>To implant into the uterine wall</p> Signup and view all the answers

    During fetal development, which structure carries highly oxygenated blood to the fetus?

    <p>Ductus venosus</p> Signup and view all the answers

    Which statement is true regarding the maternal side of the placenta?

    <p>It prevents maternal-fetal blood mixing</p> Signup and view all the answers

    What role does human placental lactogen (hPL) play during pregnancy?

    <p>Regulates maternal metabolism and promotes fetal growth</p> Signup and view all the answers

    What characterizes a positive result in a Contraction Stress Test?

    <p>Recurrent late decelerations in FHR during contractions</p> Signup and view all the answers

    Which condition is indicated by an Amniotic Fluid Index (AFI) of less than 5 cm?

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

    In a biophysical profile, what is considered the most predictive factor of perinatal outcomes?

    <p>Combination of NST with AFI</p> Signup and view all the answers

    How should the Nonstress Test (NST) Reaction be defined in terms of heart rate changes?

    <p>FHR above baseline by 15 bpm for 15 seconds</p> Signup and view all the answers

    Which physiological change in the uterus contributes to the formation of a protective barrier during pregnancy?

    <p>Hypertrophy of cervical glands</p> Signup and view all the answers

    Which statement regarding late decelerations following contractions is accurate?

    <p>They reflect a compromise in fetal oxygenation</p> Signup and view all the answers

    What is a common reason for a high false positive rate in Contraction Stress Tests?

    <p>Short duration of monitoring</p> Signup and view all the answers

    What is the primary cause of nasal and sinus congestion in pregnant individuals?

    <p>Rise in estrogen and progesterone</p> Signup and view all the answers

    What does a normal result from a Nonstress Test (NST) indicate regarding fetal health?

    <p>Fetal well-being is likely with adequate oxygen supply</p> Signup and view all the answers

    What is the primary characteristic of the quickening stage of pregnancy?

    <p>The woman can first feel fetal movements.</p> Signup and view all the answers

    How does increased venous pressure predominantly lead to edema in the lower extremities during pregnancy?

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

    In what circumstance is a Detailed Ultrasound primarily performed?

    <p>To evaluate fetal anomalies in the anatomy scan</p> Signup and view all the answers

    Which hormone(s) are primarily responsible for the relaxation of smooth muscle during pregnancy?

    <p>Progesterone and Estrogen</p> Signup and view all the answers

    What does a score of 6/10 on a Nonstress Test (NST) indicate?

    <p>The test results are equivocal and require repeat testing.</p> Signup and view all the answers

    What of the following is a probable sign of pregnancy that can be observed?

    <p>Nipples and areola becoming darker.</p> Signup and view all the answers

    What is one potential effect of diastasis recti during pregnancy?

    <p>Separation of abdominal muscles</p> Signup and view all the answers

    What is a consequence of muscle relaxation caused by progesterone in the renal system during pregnancy?

    <p>Increased likelihood of UTI</p> Signup and view all the answers

    At what gestational age can fetal cardiac movement typically be visualized by ultrasound?

    <p>4 to 8 weeks.</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the hormone hCG during early pregnancy?

    <p>Completely absent by the third trimester.</p> Signup and view all the answers

    What percentage of expected fetal movements should be detected in a 2-hour monitoring period after 28 weeks of gestation?

    <p>10 distinct movements</p> Signup and view all the answers

    What is one recommended method to relieve lower extremity edema during pregnancy?

    <p>Elevating the legs</p> Signup and view all the answers

    What is the significance of line nigra during pregnancy?

    <p>Normal skin hyperpigmentation associated with pregnancy.</p> Signup and view all the answers

    At what point can ballottement be assessed in pregnancy?

    <p>16 to 18 weeks.</p> Signup and view all the answers

    What is the correct definition of a presumptive sign of pregnancy?

    <p>Symptoms that suggest pregnancy but are not definitive.</p> Signup and view all the answers

    Which of the following components is NOT part of an initial prenatal visit?

    <p>Routine dental examination</p> Signup and view all the answers

    What does the 'T' in the GTPAL system represent?

    <p>Number of term infants born</p> Signup and view all the answers

    At what gestational age is screening for gestational diabetes typically performed?

    <p>24-28 weeks</p> Signup and view all the answers

    Which of the following topics is appropriate for prenatal education during the first trimester?

    <p>Early discomforts of pregnancy</p> Signup and view all the answers

    What is the maximum duration for which infertility is often defined?

    <p>6 months</p> Signup and view all the answers

    When should screening for Group B Streptococcus (GBS) be conducted during pregnancy?

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

    What is teratogenesis primarily concerned with?

    <p>Congenital malformations caused by teratogens</p> Signup and view all the answers

    Which screening test is typically included in a prenatal initial blood test?

    <p>RPR, VDRL (syphilis serology)</p> Signup and view all the answers

    What is the primary function of the ductus venosus in fetal circulation?

    <p>It allows oxygenated blood to bypass the liver.</p> Signup and view all the answers

    Which statement accurately describes the foramen ovale's function in fetal circulation?

    <p>It serves as a passageway for blood to flow from the right atrium to the left atrium.</p> Signup and view all the answers

    How does the ductus arteriosus respond after birth?

    <p>It constricts in response to increased oxygen levels and prostaglandins.</p> Signup and view all the answers

    What is the role of chorionic villi in the placenta?

    <p>They serve as projections for nutrient transfer from the mother.</p> Signup and view all the answers

    Which hormone does human placental lactogen (hPL) primarily regulate to support fetal growth?

    <p>Glucose metabolism in the maternal blood.</p> Signup and view all the answers

    What tissue forms the fetal side of the placenta?

    <p>Trophoblast cells.</p> Signup and view all the answers

    What physiological change triggers the closure of the foramen ovale postnatally?

    <p>Increase in oxygen saturation of blood.</p> Signup and view all the answers

    What categories of tissue contribute to the formation of the placenta?

    <p>Both fetal and maternal tissue.</p> Signup and view all the answers

    Which of the following must be present for a urine pregnancy test to be considered positive?

    <p>Presence of hCG</p> Signup and view all the answers

    At what point in gestation is the presence of cardiac movement in the fetus typically first visualized sonographically?

    <p>4 to 8 weeks</p> Signup and view all the answers

    Which fetal assessment scoring indicates a need for immediate delivery following a Nonstress Test (NST) with 30min U/S?

    <p>2/10</p> Signup and view all the answers

    What is the typical timeframe for the occurrence of quickening in a primigravida?

    <p>18 to 20 weeks</p> Signup and view all the answers

    Which of the following represents a probable sign of pregnancy observable in the skin?

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

    What is indicated by a score of 6/10 in a Nonstress Test (NST) accompanied by a 30 min U/S?

    <p>Equivocal result requiring repeat testing</p> Signup and view all the answers

    Which symptom commonly related to pregnancy occurs as a result of the enlarging uterus pressing on the bladder?

    <p>Frequent urination</p> Signup and view all the answers

    What is indicated by the term 'linea nigra' in relation to pregnancy?

    <p>Line from umbilicus to pubis</p> Signup and view all the answers

    What is primarily responsible for the softening of the vaginal muscle and connective tissue in preparation for birth?

    <p>Increased estrogen levels</p> Signup and view all the answers

    What is the primary physiological change associated with Braxton-Hick's contractions during pregnancy?

    <p>Increased contractibility of the uterus</p> Signup and view all the answers

    Which hormone is implicated in muscle relaxation in the cervix and pelvic floor ligaments during pregnancy?

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

    What is a significant cause of decreased renal flow in the third trimester?

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

    What lifestyle modification is recommended to alleviate lower extremity edema during pregnancy?

    <p>Sleeping on the left side</p> Signup and view all the answers

    What is the expected effect of increased progesterone on the gastrointestinal system during pregnancy?

    <p>Increased flatulence</p> Signup and view all the answers

    Which assessment is NOT included in the initial prenatal visit?

    <p>Cholesterol screening</p> Signup and view all the answers

    What physiological adaptation contributes to the formation of a mucus plug during pregnancy?

    <p>Hypertrophy of cervical glands</p> Signup and view all the answers

    When is it typically recommended to screen for gestational diabetes?

    <p>24-28 weeks</p> Signup and view all the answers

    What is the correct interpretation of the GTPAL system for documenting obstetric history?

    <p>T = Number of term infants born</p> Signup and view all the answers

    Which of the following is a misleading factor in the increase of RBC count and volume during pregnancy?

    <p>Reduction in hemoglobin levels</p> Signup and view all the answers

    Which factor does NOT contribute to teratogenesis?

    <p>Genetic predisposition</p> Signup and view all the answers

    At what gestational age should Group B Streptococcus (GBS) screening occur?

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

    Which of the following is NOT a component of a comprehensive initial prenatal visit?

    <p>Chorionic villus sampling</p> Signup and view all the answers

    Which maternal assessment is crucial for identifying intimate partner violence during an initial prenatal visit?

    <p>Psychosocial assessment</p> Signup and view all the answers

    What is the primary function of the urine test that indicates pregnancy?

    <p>To indicate a color change when agglutination occurs</p> Signup and view all the answers

    What characterizes a negative (normal) result in a Contraction Stress Test?

    <p>No deceleration in FHR with 3 contractions lasting no more than 40 seconds</p> Signup and view all the answers

    Which condition is indicated by an Amniotic Fluid Index (AFI) greater than 24 cm?

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

    What is the main purpose of conducting a biophysical profile?

    <p>To assess fetal well-being and placental function</p> Signup and view all the answers

    In the context of a Nonstress Test (NST), what does a reactive result require?

    <p>FHR increase by 15 bpm for 15 seconds at least 2 times</p> Signup and view all the answers

    What is a key characteristic of late decelerations observed in fetal heart rate monitoring?

    <p>Decelerations occur after the peak of a contraction</p> Signup and view all the answers

    What defines oligohydramnios according to the Amniotic Fluid Index (AFI)?

    <p>AFI less than 5 cm</p> Signup and view all the answers

    What is considered a significant limitation of the Contraction Stress Test?

    <p>It has a high false positive rate due to short monitoring periods</p> Signup and view all the answers

    What does a modified biophysical profile include in its assessment?

    <p>Nonstress Test combined with Amniotic Fluid Index</p> Signup and view all the answers

    What is the primary function of the ductus arteriosus in fetal circulation?

    <p>Shunting majority of blood from the pulmonary artery to the aorta</p> Signup and view all the answers

    Which statement accurately describes the process of how the foramen ovale functions before birth?

    <p>It allows oxygenated blood to flow from the right atrium to the left atrium.</p> Signup and view all the answers

    What type of tissue is the trophoblast primarily developed from?

    <p>Chorionic villi</p> Signup and view all the answers

    Which hormones are involved in the physiological changes facilitated by the placenta?

    <p>Estrogen and progesterone</p> Signup and view all the answers

    What is the primary role of chorionic villi in the placenta?

    <p>Transferring oxygen from the maternal blood to fetal blood</p> Signup and view all the answers

    What triggers the closure of the ductus arteriosus after birth?

    <p>Higher oxygen levels in the blood post-cord clamping</p> Signup and view all the answers

    What structure on the maternal side of the placenta is responsible for preventing the mixing of maternal and fetal blood?

    <p>Placental membrane</p> Signup and view all the answers

    Which physiological process primarily describes how the placenta exchanges nutrients and removes waste products?

    <p>Active transport and diffusion</p> Signup and view all the answers

    Study Notes

    Uterine Changes During Pregnancy

    • Hypertrophy of uterine wall: Uterus grows significantly in size.
    • Softening of vaginal muscle and connective tissue: Prepares the vaginal canal for childbirth.
    • Increased uterine contractibility: Leads to Braxton-Hicks contractions, which are practice contractions.
    • Hypertrophy of cervical glands: Formation of the mucus plug which acts as a protective barrier between the uterus and vagina.
    • Enlargement and stretching of uterus: Accommodates the growing fetus.
    • Expanded circulatory volume: Increased blood flow to the uterus leads to vascular congestion.
    • Abdominal muscle stretch: Leads to diastasis recti, a separation of the abdominal muscles.
    • Increased vascularity and hypertrophy of vaginal and cervical glands: Increase in leukorrhea (vaginal discharge).
    • Amenorrhea (absence of menstruation): Hormonal changes during pregnancy suppress ovulation.

    Hormonal Impact on Smooth Muscle

    • Muscle relaxation: Estrogen, progesterone, and prostaglandins relax smooth muscle leading to:
      • Respiratory changes: Dyspnea, nasal and sinus congestion, epistaxis (nosebleeds).
      • Renal changes: Increased urinary output (UO), incontinence, increased risk of UTIs.
      • Gastrointestinal changes: Bloating, flatulence, constipation.
    • Estrogen and progesterone relax smooth muscle in the cervix and pelvic floor ligaments: Prepares for labor and delivery.

    Edema in Lower Extremities

    • Increased venous pressure: Due to compression of iliac veins and inferior vena cava.

    • Decreased blood flow: Further compression of iliac veins and inferior vena cava.

    • Decreased renal flow: More prominent in the third trimester.

    • Relief:*

    • Sleep on left side: Prevents compression of inferior vena cava.

    • Elevation of legs: Reduces pooling of fluid.

    • Hydration: Helps dilute blood and decrease edema.

    • Exercise: Improves circulation.

    • Compression socks: Help support blood flow.

    Nasal and Sinus Congestion

    • Increased estrogen, progesterone, and prostaglandins: Lead to congestion and swelling of nasal passages.

    Cardiovascular Adaptations and Lab Values

    • ↑RBC count and volume: Increased need for oxygen carrying capacity.
    • ↑ plasma volume: Increased fluid volume to support placental blood flow.
    • ↓Hgb: Hemoglobin levels may decrease due to the increased plasma volume, potentially causing a dilutional effect.

    Fetal Well-being Assessments

    Daily Fetal Movement Counts (FMC)

    • Maternal surveillance: Monitors fetal movement after approximately 28 weeks.
    • Approaches:
      • 2-hour period: Perception of at least 10 distinct fetal movements.
      • 1-hour period: Perception of at least 4 fetal movements.

    Vibroacoustic Stimulation (VAS)

    • Used when NST is non-reactive: To stimulate fetal movement and assess reactivity.
    • Procedure: An artificial larynx is activated on the maternal abdomen, near the fetal head, in conjunction with the Non-stress test (NST).
    • Reactive: Fetal heart rate (FHR) increases by at least 15 bpm above baseline for at least 15 seconds, at least two times in 20 minutes.

    Contraction Stress Test (CST)

    • Used for term patients (≥37 weeks) with non-reactive NST: Assesses fetal ability to maintain a normal heart rate during uterine contractions.
    • Results:
      • Negative (Normal): No deceleration in FHR on a 10-minute strip with three contractions lasting no more than 40 seconds.
      • Positive (Abnormal): Late decelerations in FHR with at least 50% of contractions. Late deceleration begins after the onset of the contraction, and the FHR reaches its lowest point (nadir) after the peak of the contraction.

    Amniotic Fluid Index (AFI)

    • Measures pockets of amniotic fluid: Using ultrasound to assess fetal well-being and placental function.
    • Results:
      • Normal: AFI of 8 cm to 24 cm.
      • Abnormal:
        • Oligohydramnios: AFI < 5 cm.
        • Polyhydramnios: AFI > 24 cm.

    Biophysical Profile (BPP)

    • 30-minute ultrasound with NST: Assesses fetal well-being.
    • Modified version: NST with AFI.
      • Normal: Reactive NST and AFI > 5 cm.
    • Benefits: Less time-consuming and considered most predictive of perinatal outcomes.

    Diagnostic vs. Screening Tests

    • Diagnostic tests: Designed to identify the presence or absence of a specific disease or abnormality.

    • Screening tests: Used to identify individuals who may be at risk for a disease or abnormality. They are not diagnostic. If abnormal, further testing is required.

      • Amniotic fluid index (AFI)
      • Biophysical profile
      • Contraction stress test
      • Daily fetal movement count
      • Multiple marker screening
      • Nonstress test (NST)
      • Ultrasonography
      • Nuchal translucency
      • Umbilical artery doppler flow
      • Vibroacoustic stimulation

    Biophysical Profile Components

    • 30-minute ultrasound with NST: Assesses fetal well-being.
    • Indicators:
      • Fetal heart rate (FHR) activity: Assesses normal patterns of fetal heart rate.
      • Fetal breathing movement: Assesses periodic contractions of the fetal diaphragm.
      • Fetal movement: Assesses general body movements of the fetus.
      • Fetal tone: Assesses fetal muscle tone by evaluation of flexion and extension of limbs.
      • Amniotic fluid index (AFI): Measures the amount of amniotic fluid.
    • Scoring:
      • 8/10: Reassuring.
      • 6/10: Equivocal; repeat testing recommended.
      • 4/10: Non-reassuring, further evaluation needed.
      • 2/10: Strong indication for immediate delivery.

    Diagnosing Pregnancy

    Presumptive Signs (Subjective)

    • Amenorrhea (absence of menstruation): First sign of pregnancy.
    • Nausea and vomiting: Common from week 2 to week 12.
    • Breast changes: Enlargement, tenderness, tingling, increased vascularity.
    • Fatigue: Common during the first trimester.
    • Urination frequency: Related to pressure from the enlarging uterus on the bladder.
    • Quickening: First perception of fetal movement by the mother (around 18-20 weeks for primigravidas and 14-16 weeks for multigravidas).

    Probable Signs (Objective)

    • Uterine growth and abdominal growth: Uterus expands significantly during pregnancy.
    • Skin hyperpigmentation:
      • Melasma (chloasma): Brownish pigmentation over the forehead, temples, cheeks, and/or upper lip.
      • Linea nigra: Dark line running from the umbilicus to the pubis.
      • Nipples and areola: Become darker.
    • Ballottement: Passive movement of the fetus in the amniotic fluid caused by light pressure on the cervix during a pelvic examination (occurs at 16-18 weeks).

    Positive Signs (Definitive)

    • Auscultation of fetal heart sounds: Heard with a Doppler around 10-12 weeks.
    • Observation and palpation of fetal movement: By the examiner after 20 weeks.
    • Sonographic visualization of the fetus: Cardiac movement can be observed as early as 4-8 weeks.

    Pregnancy Test

    • Pregnancy tests are based on the detection of hCG (human chorionic gonadotropin): A hormone produced by the placenta.
    • Maternal blood pregnancy test: Can detect hCG levels before a missed period.
    • Urine pregnancy test: Best performed using a first morning urine sample, which contains a higher concentration of hCG.
    • Home pregnancy test: Urine test that uses enzymes and relies on a color change when agglutination occurs, indicating a pregnancy.

    Preconception and Prenatal Care

    Initial Prenatal Visit Components

    • Comprehensive and risk health assessment: Evaluate overall health and identify potential risks.
    • Pregnancy history: Review previous pregnancies and deliveries.
    • Physical and pelvic examination: Check for any abnormalities or risk factors.
    • Estimated Date of Delivery (EDD): Calculated based on the last menstrual period or ultrasound findings.
    • Nutrition assessment: 24-hour dietary recall to assess nutritional needs and identify any deficiencies.
    • Psychosocial assessment: Evaluate social support, stress levels, and mental health.
    • Assessment of intimate partner violence: Screen for potential domestic violence.

    Routine Laboratory Tests

    • Blood type and Rh factor: To determine compatibility between mother and fetus.
    • Antibody screen: Identifies antibodies against Rh-positive blood cells in Rh-negative mothers.
    • Complete Blood Count (CBC): Includes hemoglobin/hematocrit, red blood cell count, white blood cell count, and platelet count.
    • Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) (syphilis serology): Tests for syphilis infection.
    • HIV screen: Tests for HIV infection.
    • Hepatitis B screen (surface antigen): Tests for Hepatitis B infection.
    • Rubella titer: Checks for immunity to rubella (German measles).
    • Purified Protein Derivative (PPD) (tuberculosis screen): Tests for tuberculosis infection.
    • Urinalysis: Checks for urinary tract infection, proteinuria, and glucose.
    • Urine culture and sensitivity: Tests for bacterial infection in the urine.
    • Pap smear: Checks for cervical cancer (if indicated based on the individual's history).
    • Gonorrhea and chlamydia cultures: Tests for sexually transmitted infections.
    • Chorionic villus sampling (CVS): A prenatal test performed between 10 and 12 weeks to detect chromosomal abnormalities.

    Prenatal Education

    • Teratogenesis: The production of congenital malformations in a developing fetus due to exposure to teratogens (harmful agents).

    Prenatal Education Topics (by trimester)

    • First trimester: Early discomforts of pregnancy, medication safety, nutrition, and healthy lifestyle choices.
    • Second trimester: Signs of labor, fetal development, childbirth education, and pain management options.
    • Third trimester: Labor and delivery, postpartum care, breastfeeding, infant care, and parenting skills.

    Obstetric History Documentation (GTPAL)

    • G: Number of times pregnant (gravidity).
    • T: Number of term infants born (≥ 37 weeks).
    • P: Number of preterm infants born (< 37 weeks, twin births count as one birth).
    • A: Number of abortions (spontaneous or induced).
    • L: Number of living children.

    Gestational Diabetes Screening

    • 24-28 weeks of gestation: Recommended screening for gestational diabetes.

    Group B Streptococcus (GBS) Screening

    • 35-37 weeks of gestation: Routine screening for Group B Streptococcus.

    Infertility Definition

    • Inability to conceive and maintain a pregnancy: After 12 months of unprotected intercourse for individuals less than 35 years old and after 6 months of unprotected intercourse for individuals over 35 years old.

    Pregnancy and Fetal Development

    Fertilization

    • Outer third of the fallopian tube: Where fertilization occurs.
    • Zygote formation: The sperm nucleus enters the oocyte nucleus, forming a zygote with 46 chromosomes.
    • Blastocyst formation: Cell division occurs, creating a blastocyst which has two parts:
      • Embryoblast: Develops into the embryo.
      • Trophoblast: Develops into part of the placenta.
    • Implantation: The blastocyst embeds into the endometrium of the uterine wall.

    Fetal Circulatory System

    • Ductus venosus: Connects the umbilical vein to the inferior vena cava, bypassing the liver. Highly oxygenated blood enters the right atrium (RA) of the fetus.
    • Foramen ovale: Opening between the right atrium (RA) and left atrium (LA). Shunts oxygenated blood from the RA to the LA, bypassing the lungs.
    • Ductus arteriosus: Connects the pulmonary artery to the descending aorta, bypassing the lungs. Oxygenated blood is shunted to the aorta, with a small amount going to the lungs.

    Placenta

    • Formed from both fetal and maternal tissue: Two sides:
      • Fetal side: Chorionic membrane developed from the trophoblast. Chorionic villi project from the chorion into the decidua basalis (endometrial layer) forming placental fetal blood vessels and facilitating gas exchange.
      • Maternal side: Decidua basalis. Cotyledons are formed from the divided decidua basalis into lobes, preventing maternal-fetal blood mixing.
    • Functions:
      • Metabolic and gas exchange: Exchange of gases, nutrients, and electrolytes via diffusion and active transport.
      • Hormone production:
        • Estrogen: Stimulates growth of the breast and uterus.
        • Progesterone: Promotes implantation and decreases uterine contractility.
      • hCG (human chorionic gonadotropin): Stimulates the corpus luteum to produce estrogen and progesterone until the placenta takes over.
      • hPL (human placental lactogen): Promotes fetal growth by regulating glucose.

    Physiologic Adaptations of Pregnancy

    • Uterine Changes:
      • Hypertrophy: Uterine wall thickens
      • Softening: Vaginal muscles and ligaments soften for labor
      • Contractibility Increase: Causes Braxton-Hicks contractions
      • Cervical Changes: Cervical glands increase mucus production forming a protective plug
      • Enlargement and Stretching: The uterus expands significantly
      • Increased Blood Flow: Leads to vascular congestion
      • Abdominal Muscle Stretch: Diastasis recti: Separation of abdominal muscles
      • Vaginal and Cervical Gland Hypertrophy: Increased vascularity and hypertrophy of vaginal and cervical glands lead to increased leukorrhea (vaginal discharge)
      • Amenorrhea: Cessation of menstrual periods

    Hormonal Effects on Smooth Muscle

    • Respiratory System: Estrogen, progesterone, and prostaglandins can cause dyspnea (shortness of breath), nasal and sinus congestion, and epistaxis (nosebleeds).
    • Renal System: Progesterone causes increased urine output, incontinence, and increased risk of UTIs.
    • Gastrointestinal System: Progesterone can cause bloating, flatulence, and constipation.
    • Cervix and Pelvic Floor Ligaments: Estrogen and progesterone relax smooth muscle in the cervix and pelvic floor ligaments.

    Edema in Lower Extremities

    • Causes:
      • Increased venous pressure
      • Decreased blood flow due to compression of iliac veins and inferior vena cava
      • Decreased renal blood flow in the third trimester
    • Relief:
      • Sleep on your left side to prevent compression of the inferior vena cava
      • Elevate your legs
      • Stay hydrated
      • Engage in regular exercise
      • Wear compression socks
      • Avoid prolonged sitting or standing

    Nasal and Sinus Congestion

    • Increased estrogen, progesterone, and prostaglandins cause nasal and sinus congestion.

    Cardiovascular System Lab Value Changes

    • Increased RBC count and volume: To accommodate the increased blood volume.
    • Increased plasma volume: Necessary to increase blood flow to the uterus and fetus.
    • Decreased Hemoglobin: Due to the increase in plasma volume, hemoglobin levels appear diluted.

    Fetal Monitoring

    • Daily Fetal Movement Counts (FMC):

      • Maternal surveillance of fetal movements is recommended from 28 weeks onwards.
      • Methods:
        • 2 hours: 10 distinct fetal movements
        • 1 hour: 4 distinct fetal movements
      • If movements are not felt, instruct the mother to eat or drink and lie on her side.

    • Vibroacoustic Stimulation (VAS):

      • Used for non-reactive Non-Stress Tests (NST).
      • An artificial larynx is activated on the maternal abdomen near the fetal head.
      • Can be repeated at 1-minute intervals up to 3 times.
      • Reactive VAS: Increase in fetal heart rate (FHR) of 15 bpm above baseline for at least 15 seconds, at least twice in 20 minutes.

    • Contraction Stress Test (CST):

      • Used for patients at or beyond 37 weeks with a non-reactive NST.
      • Assesses the fetus's ability to maintain a normal FHR in response to uterine contractions.
      • Results:
        • Negative (Normal): No FHR deceleration with 3 contractions lasting no more than 40 seconds.
        • Positive (Abnormal): Late decelerations with at least 50% of the contractions.
      • Risk: High false positive rate due to short monitoring periods.

    • Amniotic Fluid Index (AFI):

      • Measures pockets of amniotic fluid in the 4 quadrants of the uterine cavity using ultrasound.
      • Assesses fetal well-being and placental function.
      • Results:
        • Normal: AFI of 8cm to 24cm
        • Abnormal:
          • Oligohydramnios: AFI less than 5cm
          • Polyhydramnios: AFI greater than 24cm

    • Biophysical Profile (BPP):

      • 30-minute ultrasound with NST.
      • Modified BPP: NST with AFI.
      • Normal BPP: Reactive NST and AFI of 5cm or greater.
      • Why? More time-efficient and considered more predictive of perinatal outcomes.

    Diagnostic vs. Screening Tests

    • Diagnostic Tests: Designed to identify individuals affected by a disease or abnormality.
    • Screening Tests: Non-diagnostic, used to identify individuals who may have a disease or abnormality. Further testing is required to confirm.

    Biophysical Profile Components

    • NST (Non-Stress Test): 30-minute ultrasound with fetal heart rate monitoring.
    • Indicators:
      • FHR activity
      • Fetal breathing movements
      • Fetal movements
      • Fetal tone
      • AFI (Amniotic Fluid Index)
    • Scoring:
      • 8/10: Reassuring
      • 6/10: Equivocal; repeated testing.
      • 4/10: Non-reassuring; further evaluation required.
      • 2/10: Indication for immediate delivery.

    Diagnosing Pregnancy

    • Presumptive Signs (Subjective):

      • Amenorrhea
      • Nausea and Vomiting
      • Breast Changes (enlargement, tenderness, tingling)
      • Fatigue
      • Frequent Urination
      • Quickening (first fetal movement felt by mother)

    • Probable Signs (Objective):

      • Uterine Growth and Abdominal Growth
      • Skin Hyperpigmentation (Melasma, Linea Nigra, Nipple and Areola Darkening)
      • Ballottement: Feeling the rebound of the fetus during a cervical exam.

    • Positive Signs (Definitive):

      • Auscultation of Fetal Heartbeat (10 to 12 weeks)
      • Observation and Palpation of Fetal Movement (20 weeks)
      • Sonographic Visualization of Fetus (4 to 8 weeks)

    • Hormonal Detection:

      • Urine and blood pregnancy tests detect the presence of hCG (human chorionic gonadotropin).
      • Blood tests are more sensitive and can detect hCG levels before a missed period.
      • Urine tests are best performed with a first morning urine sample, which has the highest concentration of hCG.

    Preconception and Prenatal Care

    • Initial Prenatal Visit:

      • Comprehensive health assessment
      • Pregnancy history
      • Physical and pelvic exam
      • Estimated Due Date (EDD)
      • Nutrition assessment (24-hour recall)
      • Psychosocial assessment
      • Intimate partner violence screening

    • Laboratory Testing:

      • Blood type and Rh factor
      • Antibody screen
      • CBC (Complete Blood Count)
      • RPR, VDRL (syphilis serology)
      • HIV screen
      • Hepatitis B screen
      • Rubella titer
      • PPD (tuberculosis screen)
      • Urinalysis
      • Urine culture and sensitivity
      • Pap smear
      • Gonorrhea and chlamydia cultures

    • Chorionic Villus Sampling: Performed between 10 and 12 weeks of gestation.

    Teratogenesis

    • Definition: Production of congenital malformations in the developing fetus due to exposure to teratogens (harmful agents).

    Prenatal Education

    • Trimester-Specific Topics:
      • Early discomforts of pregnancy (first trimester)
      • Signs of labor (second trimester)
      • Postpartum care, pain relief in labor, breastfeeding, parenting, and infant care (third trimester)

    Obstetric History Documentation (GTPAL)

    • G: Number of times pregnant
    • T: Number of term infants born (37 weeks or more)
    • P: Number of preterm infants born (twin births count as one birth)
    • A: Number of abortions (spontaneous or induced)
    • L: Number of children currently living

    Gestational Diabetes Screening

    • Recommended between 24 and 28 weeks of gestation.

    Group B Strep (GBS) Screening

    • Performed between 35 and 37 weeks of gestation.

    Infertility Definition

    • Inability to conceive and maintain a pregnancy after 12 months of regular, unprotected intercourse.

    Fetal Development

    • Fertilization: Occurs in the outer third of the fallopian tube.

      • The sperm nucleus combines with the oocyte nucleus forming a zygote.
      • Cell division creates a blastocyst with two parts:
        • Embryoblast: Develops into the embryo
        • Trophoblast: Part of the placenta
      • The blastocyst implants itself in the endometrium of the uterine wall.

    • Fetal Circulatory System Structures:

      • Ductus Venosus: Connects the umbilical vein to the inferior vena cava; delivers highly oxygenated blood from the placenta to the right atrium of the fetus.
      • Foramen Ovale: Opening between right and left atria; allows most highly oxygenated blood to be shunted directly to the left atrium, bypassing the lungs.
      • Ductus Arteriosus: Connects the pulmonary artery to the descending aorta; allows most oxygenated blood to be shunted directly to the aorta, bypassing the lungs.

    • Placenta: Formed from both fetal and maternal tissue.

      • Fetal side: Chorionic membrane; chorionic villi project from the chorion and embed into the decidua basalis (layer of endometrium).
      • Maternal side: Decidua basalis; divided into cotyledons (lobes).
      • Prevents mixing of maternal and fetal blood.
      • Facilitates gas and nutrient exchange.

    • Placenta Functions:

      • Metabolic and Gas Exchange: Nutrient delivery and waste product removal via diffusion and active transport.
      • Hormone Production:
        • Estrogen: Stimulates breast and uterine growth.
        • Progesterone: Maintains pregnancy and prepares the uterus for labor.
        • hCG: Stimulates the corpus luteum to produce estrogen and progesterone until the placenta takes over.
        • hPL (human placental lactogen): Promotes fetal growth by regulating glucose metabolism.

    Physiologic Adaptations to Pregnancy

    • Uterine Changes
      • Hypertrophy of uterine wall: Muscle cells of the uterus enlarge.
      • Softening of vaginal muscle and connective tissue: Prepares the vaginal canal for delivery.
      • Increased uterine contractibility: Leads to Braxton Hick's contractions (practice contractions).
      • Hypertrophy of cervical glands and formation of mucus plug: Creates a protective barrier between the uterus/fetus and the vagina.
      • Enlargement and stretching of uterus: The uterus grows to accommodate the growing fetus.
      • Expanded circulatory volume and increased vascular congestion: Increased blood flow to the uterus and placenta.
      • Abdominal muscle stretch and diastasis recti: Separation of the abdominal muscles.
      • Increased vascularity and hypertrophy of vaginal and cervical glands: Increased vaginal discharge (leukorrhea).
      • Amenorrhea: Absent menstrual periods.

    Hormonal Impact on Smooth Muscle

    • Muscle relaxation (Progesterone, Estrogen, Prostaglandins):
      • Respiratory: Leads to dyspnea (shortness of breath), nasal and sinus congestion, and epistaxis (nose bleeds).
      • Renal: Causes increased urine output, incontinence, and an increased risk of urinary tract infections.
      • GI: Can result in bloating, flatulence, and constipation.
      • Cervix & Pelvic Floor Ligaments: Eases the passage of the baby through the birth canal.

    Lower Extremity Edema

    • Causes:
      • Increased venous pressure in the lower extremities due to the weight of the uterus compressing the iliac veins and inferior vena cava.
      • Decreased renal flow during the third trimester.
    • Relief:
      • Avoid lying on your back to prevent compression of the inferior vena cava (sleep on your left side).
      • Elevate your legs.
      • Stay hydrated.
      • Exercise regularly.
      • Wear compression socks.
      • Avoid prolonged sitting or standing.

    Fetal Well-being Monitoring

    Daily Fetal Movement Counts (DFMC)

    • Maternal surveillance: Mothers monitor fetal movement after 28 weeks of gestation.
    • Two approaches:
      • 2-hour perception of 10 distinct fetal movements.
      • 1-hour perception of 4 fetal movements.
    • If fetal movement is not detected after eating or drinking, lie on your side.

    Vibroacoustic Stimulation (VAS)

    • Used when the non-stress test (NST) is non-reactive.
    • Done by activating an artificial larynx on the maternal abdomen near the fetal head in conjunction with the NST.
      • Repeated at one-minute intervals for up to three times.
    • Reactive = Fetal heart rate (FHR) increases by 15 bpm above baseline for at least 15 seconds, at least two times in 20 minutes.

    Contraction Stress Test (CST)

    • Used for term patients (≥ 37 weeks) with a non-reactive NST to assess the fetus's ability to maintain a normal FHR in response to uterine contractions.
    • Results:
      • Negative (normal): No deceleration in FHR on a 10-minute strip with 3 contractions, lasting no more than 40 seconds.
      • Positive (abnormal): Late decelerations in FHR with 50% of contractions.
        • Late deceleration: Begins after the onset of a contraction and FHR reaches the lowest point (nadir) after the peak of the contraction. This shows that the baby doesn't have enough oxygen reserve when the supply is cut off during a contraction.
    • Risk:
      • High false positive rate due to short monitoring periods.

    Amniotic Fluid Index (AFI)

    • Measures pockets of amniotic fluid within four quadrants of the uterine cavity via ultrasound to assess fetal well-being and placental function.
    • Results:
      • Normal: AFI = 8 cm to 24 cm.
      • Abnormal:
        • Oligohydramnios: AFI < 5 cm (low amniotic fluid).
        • Polyhydramnios: AFI > 24 cm (high amniotic fluid levels).

    Biophysical Profile (BPP)

    • 30-minute ultrasound combined with the NST.
    • Modified:
      • NST with AFI:
        • Normal: Reactive NST and AFI > 5 cm.
      • Why? Less time and considered the most predictive of perinatal outcomes..
    • Indicators:
      • Fetal heart rate activity
      • Fetal breathing movement
      • Fetal movement
      • Fetal tone
      • AFI
    • Scoring:
      • 8/10: Reassuring.
      • 6/10: Equivocal, repeat testing needed.
      • 4/10: Non-reassuring, further evaluation required.
      • 2/10: Indication for immediate delivery.

    Prenatal Care

    Initial Prenatal Visit

    • Comprehensive and risk health assessment (medical, social, and family history).
    • Pregnancy history.
    • Physical and pelvic exam.
    • Estimated date of delivery (EDD).
    • Nutrition assessment: 24-hour food recall.
    • Psychosocial assessment.
    • Assessment of Intimate partner violence.

    Prenatal Testing

    • Blood Type and Rh Factor
    • Antibody Screen
    • Complete Blood Count (CBC):
      • Hemoglobin/Hematocrit
      • Red Blood Cell Count
      • White Blood Cell Count
      • Platelet Count
    • RPR, VDRL (Syphilis serology)
    • HIV Screen
    • Hepatitis B screen (Surface antigen)
    • Rubella Titer
    • PPD (Tuberculosis screen)
    • Urinalysis
    • Urine Culture and Sensitivity
    • Pap smear (if indicated)
    • Gonorrhea and Chlamydia cultures

    Pregnancy and Fetal Development

    Fertilization

    • Occurs in the outer third of the fallopian tube.
      • The sperm nucleus enters the nucleus of the oocyte (egg) forming a zygote with 46 chromosomes (one pair from each parent).
      • Cell division occurs creating a blastocyst.
        • The embryoblast develops into the embryo.
        • The trophoblast participates in the formation of the placenta.
      • The blastocyst implants into the endometrium (uterine lining).

    Fetal Circulatory System

    • Ductus Venosus:
      • Connects the umbilical vein to the inferior vena cava through the placenta.
      • This shunts highly oxygenated blood from the placenta to the right atrium (RA) of the fetus.
    • Foramen Ovale:
      • Opening between the right atrium (RA) and the left atrium (LA).
      • Shunts oxygenated blood from the RA to the LA, bypassing the lungs.
      • Closes in response to increased blood returning to the LA after birth (up to 3 months).
    • Ductus Arteriosus:
      • Connects the pulmonary artery to the descending aorta.
      • Shunts the majority of oxygenated blood from the pulmonary artery directly to the aorta, bypassing the lungs. A minor flow of blood goes to the lungs for development.
      • Constricts in response to higher oxygen levels and prostaglandins after birth (when the umbilical cord is cut).

    Placenta

    • Formed from both fetal and maternal tissue.
      • Fetal side:
        • Chorionic membrane
        • Developed from the trophoblast
        • Chorionic villi projections extend from the chorion into the decidual basalis (layer of endometrium).
          • This forms the fetal blood vessels within the placenta.
      • Maternal side:
        • Decidua basalis
        • Cotyledons (lobes) are formed from the divided decidua basalis.
        • Prevention of maternal-fetal blood mixing.
        • Allows gas exchange of gases, nutrients, and electrolytes.
    • Functions:
      • Metabolic and gas exchange:
        • Via diffusion and active transport. Transports nutrients from the maternal system and removes fetal waste products and carbon dioxide.
      • Hormone production:
        • Estrogen: Stimulates the growth of the breasts and uterus.
        • Progesterone: Promotes implantation and decreases uterine contractility.
      • hCG (human chorionic gonadotropin):
        • Stimulates the corpus luteum to produce estrogen and progesterone until the placenta takes over.
      • hPL (human placental lactogen):
        • Promotes fetal growth by regulating glucose.
        • Participates in the development of the mammary glands.

    Diagnosing Pregnancy

    Presumptive Signs

    • Amenorrhea: Absence of menstruation.
    • Nausea and vomiting: Common from week 2 through 12.
    • Breast changes: Appear at 2 to 3 weeks.
      • Enlargement, tenderness, tingling, and increased vascularity.
    • Fatigue: Common during the first trimester.
    • Urination frequency: Related to the pressure of the enlarging uterus on the bladder (decreases as the uterus moves upward and out of the pelvis).
    • Quickening: A woman's first awareness of fetal movement; occurs around 18 to 20 weeks' gestation in primigravida (between 14 and 16 weeks in multigravidas).

    Probable Signs

    • Uterine growth and abdominal growth.
    • Skin hyperpigmentation:
      • Melasma (chloasma): Brownish pigmentation over the forehead, temples, cheeks, and/ or upper lip.
      • Linea nigra: Dark line that runs from the umbilicus to the pubis.
      • Nipples and areola: Become darker.
    • Ballottement: A light tap of the examining finger on the cervix causes the fetus to rise in the amniotic fluid and then rebound to its original position (occurs at 16 to 18 weeks).

    Positive Signs

    • Auscultation of the fetal heart: Heard using a Doppler at 10 to 12 weeks of gestation.
    • Observation and palpation of fetal movement by the examiner after about 20 weeks' gestation.
    • Sonographic visualization of the fetus: Cardiac movement is noted at 4 to 8 weeks.

    Pregnancy Tests

    • Laboratory tests are based on the detection of hCG (human chorionic gonadotropin) in maternal urine or blood.
    • Maternal blood pregnancy test: Can detect hCG levels before a missed period.
    • Urine pregnancy test: Best performed using a first morning urine specimen because it has the highest concentration of hCG and becomes positive about 4 weeks after conception..
    • Home pregnancy test: Urine test that uses enzymes and relies on color change when agglutination occurs, indicating pregnancy.

    Prenatal Education

    Prenatal Education Topics by Trimester

    • First trimester: Early discomforts of pregnancy.
    • Second trimester: Signs of labor.
    • Third trimester:
      • Pain relief in labor.
      • Postpartum care.
      • Breastfeeding.
      • Parenting and infant care.

    Obstetric History - GTPAL

    • G: Number of times pregnant.
    • T: Number of term infants born (37+ weeks).
    • P: Number of preterm infants born (twins count as one birth).
    • A: Number of abortions (spontaneous or induced).
    • L: Number of children currently living.

    Gestational Diabetes Screening

    • 24-28 weeks.

    Group B Strep (GBS) Screening

    • 35-37 weeks.

    Infertility Definition

    • 12 months of inability to conceive or maintain a pregnancy.

    Teratogenesis

    • Production of congenital malformations in a developing fetus due to exposure to teratogens (harmful agents).

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Exam 1- OB.docx

    Description

    Test your knowledge on fetal monitoring techniques and assessments, including contraction stress tests, nonstress tests, amniotic fluid indexes, and more. This quiz covers important physiological changes and their implications during pregnancy. Challenge yourself and enhance your understanding of maternal-fetal health!

    More Quizzes Like This

    Fetal Monitoring and Assessment Quiz
    9 questions

    Fetal Monitoring and Assessment Quiz

    OverjoyedPoincare avatar
    OverjoyedPoincare
    Obstetrics: Nonstress Test
    5 questions

    Obstetrics: Nonstress Test

    EasiestImagery avatar
    EasiestImagery
    CTG Interpretation in Fetal Monitoring
    6 questions

    CTG Interpretation in Fetal Monitoring

    StunningFoxglove avatar
    StunningFoxglove
    AWHONN Fetal Monitoring Course Flashcards
    18 questions

    AWHONN Fetal Monitoring Course Flashcards

    MatchlessAltoSaxophone avatar
    MatchlessAltoSaxophone
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser