Questions and Answers
What is the leading cause of perinatal admissions to the ICU?
What percentage of deaths is related to pregnancy-related hemorrhages?
17-25%
Most maternal deaths from obstetric hemorrhage after the first trimester are due to?
Placental abruption
Which race is most likely to die from postpartum hemorrhage?
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What was the mortality rate (2006) for white women, African American women, and Hispanic women in the US?
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68% of postpartum hemorrhage deaths occur within ______ hours of delivery.
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Obstetric hemorrhage is defined as a TBL or more than _______ cc.
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What is the classic sign of placenta previa?
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If you see painless vaginal bleeding in the second or third trimester of pregnancy, suspect?
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What are the risk factors for placenta previa?
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In patients with suspected placenta previa, which comes first, a speculum examination or a confirmatory ultrasound?
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Fetal blood volume is?
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What changes are noted during significant blood loss?
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Characteristic findings in FHR if the mother has significant blood loss?
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What is the percentage of accreta among women with previa?
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If a patient has had 2 or more cesarean sections, the likelihood of an accreta is?
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What is vasa previa?
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Velamentous cord insertion is defined as?
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What is a succenturiate placenta?
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What is hemolysis?
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What does HELLP stand for?
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According to AWHONN, patients with placenta previa should not be discharged to home until they have gone ______ hours without bleeding.
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What is a classic symptom of placental abruption?
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What are the risk factors for placental abruption?
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What is the ACOG standard for fetal monitoring for maternal abdominal trauma?
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What does DIC stand for?
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DIC is?
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What is a specific diagnostic test for DIC?
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What is Gestational Trophoblastic Disease?
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What is hydatidiform mole characterized by?
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What clinical signs indicate Hydatidiform mole?
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_______ % of women with preeclampsia develop HELLP syndrome.
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What are the top drug choices for initiating antihypertensives if BP > 160/110?
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How long does it take before the lung maturity benefits of betamethasone are seen?
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Magnesium sulfate toxicity can occur rapidly. Toxicity could result in impaired _______ function.
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______ % of eclampsia and HELLP cases occur after delivery.
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What does TORCH stand for?
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What does SGA stand for?
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IUGR from placenta insufficiency usually reduces __________ more than _______.
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Which is more ominous, symmetrical or asymmetrical growth restriction?
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Growth restriction at less than 28 weeks is generally (symmetrical or asymmetrical) in nature.
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Growth restriction at more than 28 weeks is generally (symmetrical or asymmetrical) in nature.
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What does LGA stand for?
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What is caput succedaneum?
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What is cephalohematoma?
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What is considered postterm?
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What is transition in the context of newborn care?
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Fact: Preterm infants may have impaired regulation of blood pressure in the face of apnea, bradycardia, and mechanical ventilation. What are the potential consequences?
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Fact: Procedure to follow if meconium is present in the amniotic fluids?
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Kernicterus is caused by severe and inadequately treated hyperbilirubinemia during the neonatal period. Bili levels in excess of ______ mg/dl may develop kernicterus.
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Fact: Research has shown that healthy full-term neonates with serum bilirubin levels of approximately 18 mg/dl do not have any detrimental effects with an expectant management approach. Elaborate.
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What is omphalocele?
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What is gastroschisis?
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What is congenital diaphragmatic hernia?
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Why should you avoid bag and mask ventilation with a baby that has congenital diaphragmatic hernia?
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How should you position a baby with diaphragmatic hernia?
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What is PDA?
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What is coarctation of the aorta?
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What are four examples of acyanotic defects?
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What are three examples of cyanotic defects?
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What are the two goals of antepartum testing?
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Crown rump length is the most accurate measurement for EGA when in the ______________ trimester.
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Biparietal diameter is among the most accurate measurements for EGA in the ______________ trimester.
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Although infants born at ______ weeks gestation have been known to survive, most authorities believe that _______ weeks is the time of earliest survival.
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Surfactant is made up of phospholipids. What are the two most common phospholipids in surfactant?
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What is the role of surfactant?
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What is alpha-fetoprotein?
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What is quad screening?
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Doppler measurement of the peak velocity of systolic blood flow in the ___________ can safely replace invasive testing in the management of Rh-alloimmunized pregnancies.
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AFI of less than 5 cm is considered diagnostic for oligohydramnios. 5cm equals __________ of fluid.
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Polyhydramnios is an AFI of greater than _______ cm of amniotic fluid.
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What is the normal AFI at term?
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What is the low normal AFI at term?
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___________ % of newborns have a major anomaly.
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Fetal lung maturity is determined by an amniocentesis. What is the lab test called?
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L/S ratio is not a valid indicator of lung maturity if the mother is diabetic. In diabetic mothers, the presence of _______ is highly predictive of fetal lung maturity.
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What does definitive fetal lung maturity testing require?
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What is reactive NST for the term fetus?
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What is reactive NST for the preterm fetus?
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For fetuses >30 weeks gestation, a FHR greater than ______ bpm is considered tachycardia.
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What is a nonreactive NST at term defined as?
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What is a nonreactive NST in the preterm fetus defined as?
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What should be done if variable decelerations are present during an NST?
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If variable decelerations are seen during the NST and they are nonrepetitive and less than 30 seconds in duration, what does this imply?
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The proper placement for the fetal acoustic stimulator is?
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What is the appropriate use of the fetal acoustic stimulator?
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When should the fetal acoustic stimulation not be used?
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What should be done if, in response to acoustic stimulation, the fetus elicits a prolonged acceleration of tachycardia?
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Study Notes
Perinatal Admissions and Hemorrhage
- Leading cause of ICU admissions in perinatal cases: Hemorrhagic disorders.
- Pregnancy-related hemorrhages account for 17-25% of maternal deaths.
- Maternal deaths from obstetric hemorrhage post-first trimester primarily due to placental abruption.
- Higher risk of postpartum hemorrhage deaths in African American women.
Maternal Mortality Rates
- Mortality rates per 100,000 live births (2006):
- White women: 13.3
- African American women: 32.7
- Hispanic women: 10.2
Postpartum Hemorrhage (PPH)
- 68% of deaths from PPH occur within 48 hours of delivery.
- Obstetric hemorrhage defined as blood loss over 1000cc.
- Painless vaginal bleeding in the second or third trimester indicates placenta previa.
Placenta Previa
- Risk factors include previous placenta previa, advanced maternal age (>40), prior cesareans, multiparity, and smoking.
- Confirmatory ultrasound should precede a speculum examination in cases of suspected placenta previa.
Fetal and Maternal Blood Loss Effects
- Fetal blood volume: 100 ml/kg.
- Significant maternal blood loss leads to tachycardia, respiratory increase, pallor, hypotension, decreased urinary output, and altered LOC.
- Initial FHR response to maternal blood loss: tachycardia followed by bradycardia and persistent late decelerations.
Placenta Accreta and Related Conditions
- 5-10% incidence of accreta in women with previa.
- Over 50% chance of accreta in women with ≥2 cesarean sections.
- Vasa previa signifies fetal vessels covering the cervical os, posing risks.
Complications Such as HELLP and DIC
- HELLP syndrome stands for Hemolysis, Elevated Liver Enzymes, Low Platelets.
- DIC: a pathologic coagulation condition leading to diffuse clotting and bleeding; D-dimer test positive in 34% of cases.
Gestational Trophoblastic Disease
- Characterized by abnormal trophoblastic tissue proliferation, potentially leading to hydatidiform moles (1 in 1200 pregnancies) which can convert to choriocarcinoma.
Hypertensive Disorders in Pregnancy
- Five main categories: gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension.
- 5% of preeclampsia cases progress to HELLP syndrome.
- Initiate antihypertensives if BP exceeds 160/110; preferred drugs: Hydralazine, Labetalol, Nifedipine.
Newborn Conditions and Monitoring
- Kernicterus related to untreated hyperbilirubinemia (bili levels >20 mg/dl).
- Positive fetal outcomes in high bilirubin levels with appropriate monitoring.
- Omphalocele involves intestinal protrusion through abdominal wall defects, often accompanied by multi-system anomalies.
Congenital Conditions and Management
- Gastroschisis: abdominal wall defect without a sac over contents.
- Congenital diaphragmatic hernia affects lung development and poses high mortality (approx. 45%).
- Non-invasive testing methods, like Doppler measurements, can replace invasive tests in managing Rh-alloimmunized pregnancies.
Assessment and Testing Procedures
- Amniotic fluid index (AFI) interpretations: oligohydramnios (AFI <5 cm), polyhydramnios (AFI >25 cm).
- Cord insertion abnormalities include velamentous insertion and succenturiate placenta.
NST and Fetal Monitoring
- Reactive NST for term fetuses: ≥2 accelerations of 15 bpm lasting 15 seconds within 20 minutes.
- Nonreactive NST indicates inadequate accelerations in the required timeframe; presence of variable decelerations during NST necessitates amniotic fluid assessment.
Bio-Physical Profile Evaluation
- Intrauterine Apgar or bio-physical profile assesses CNS reflex activities including NST, fetal breathing, body movements, tone, and qualitative amniotic fluid volume.
- Fetal tone disappears when fetal pH drops, indicating distress.
Growth Restrictions and Their Implications
- SGA: growth below the 10th percentile; IUGR affects birth weight more than length.
- Symmetrical growth restriction relates to poorer long-term outcomes compared to asymmetrical.
Summary of Fetal Well-being Indicators
- Surfactant predominantly consists of lecithin and phosphatidylglycerol, critical for lung maturity by 37 weeks.
- The serum L/S ratio aids in predicting fetal lung maturity, especially important in diabetic mothers.
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Description
This set of flashcards covers key concepts related to inpatient obstetrical certification. Topics include causes of perinatal ICU admissions, maternal mortality, and factors affecting obstetric hemorrhage. Ideal for healthcare professionals preparing for certification exams.