Pregnancy and Maternal Health Quiz

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Questions and Answers

What common emotion is typically experienced by a mother during the second trimester?

Anger

Joy

Introversion (correct)

Fear

Which of the following is NOT considered a maternal role task during pregnancy?

Ensuring safe passage throughout pregnancy and birth

Maximizing personal free time (correct)

Learning to give of oneself

Seeking acceptance of the infant by others

During which trimester is a pregnant mother typically most sexually active?

Third trimester

First trimester

Postpartum period

Second trimester (correct)

Is sexual activity considered safe during a normal healthy pregnancy?

Yes, it is fine up until labor and birth (A) Signup and view all the answers

Which type of medication is unsafe during pregnancy?

NSAIDs (B) Signup and view all the answers

What routine lab tests are typically taken during the first pregnancy visit?

CBC, blood typing and Rh factor (C) Signup and view all the answers

Which discomfort is commonly experienced during the second trimester of pregnancy?

Leg cramps (A) Signup and view all the answers

What is a danger sign in the first trimester of pregnancy?

Severe persistent vomiting (D) Signup and view all the answers

What is a potential risk associated with amniocentesis?

Rupture of membranes (D) Signup and view all the answers

What does a non-stress test primarily assess?

Uteroplacental function (A) Signup and view all the answers

What score on the biophysical profile indicates a need for further investigation?

6 or below (B) Signup and view all the answers

What is an example of a presumptive sign of pregnancy?

Absence of menstruation (B) Signup and view all the answers

What is a non-stress test performed after 28 weeks primarily used for?

Evaluate fetal heart rate (D) Signup and view all the answers

What is chorionic villus sampling performed for?

To diagnose chromosomal disorders (D) Signup and view all the answers

Which factor is NOT typically a reason to perform a non-stress test?

Healthy maternal lifestyle (B) Signup and view all the answers

Why is an elevated alpha-fetoprotein (AFP) analysis not used for definitive diagnosis?

It can yield false positives (A) Signup and view all the answers

At what gestational weeks is nuchal translucency screening typically performed?

11-14 weeks (D) Signup and view all the answers

What method is used to score the biophysical profile?

BATMAN method (D) Signup and view all the answers

What does a reactive non-stress test indicate?

Normal fetal activity (D) Signup and view all the answers

What does a low level of inhibin A indicate in the quad screening test?

Potential Down syndrome (D) Signup and view all the answers

What potential complications can arise from chorionic villus sampling?

Rupture of membranes (D) Signup and view all the answers

What is the primary purpose of Doppler flow studies during pregnancy?

To assess blood flow velocity within the fetus (D) Signup and view all the answers

What is the implication of increased nuchal translucency measurement during screening?

Potential for chromosomal abnormalities like Trisomy 21 (C) Signup and view all the answers

What is the consequence of a positive result in triple or quad screening tests?

Further diagnostic testing is recommended (C) Signup and view all the answers

What defines the vertex presentation of a fetus?

Head first with chin tucked (A) Signup and view all the answers

What is the significance of fetal position?

The relationship of a landmark on the presenting fetal part to the mother's pelvis (C) Signup and view all the answers

Which statement about maternal positions during labor is accurate?

Upright positions can aid labor (B) Signup and view all the answers

How is fetal position abbreviated?

It uses three letters (D) Signup and view all the answers

What occurs during the first stage of labor?

Onset of contractions and dilation of the cervix (A) Signup and view all the answers

What characterizes the second stage of labor?

10 cm dilated and delivery of the baby (A) Signup and view all the answers

Which symptom indicates the third stage of labor?

Gush of dark blood and separation of the placenta (B) Signup and view all the answers

What is the single greatest indicator of fetal well-being during labor?

Presence of moderate variability (D) Signup and view all the answers

What is a likely cause of early decelerations of fetal heart rate during labor?

Head compression from uterine contractions (B) Signup and view all the answers

Which factor is associated with variable decelerations of fetal heart rate?

Cord compression (B) Signup and view all the answers

What can cause late decelerations of fetal heart rate during labor?

Uteroplacental insufficiency (A) Signup and view all the answers

What are the appropriate interventions for intrauterine resuscitation during late decelerations?

Turn off Pitocin and apply oxygen (A) Signup and view all the answers

What is the primary function of amniotic fluid during pregnancy?

Cushion the fetus from trauma and allow for fetal movement (C) Signup and view all the answers

How can the different types of fetal heart rate decelerations be remembered?

Using the acronym VEAL CHOP (C) Signup and view all the answers

What is the function of the umbilical cord?

Transmits nutrients and waste between mother and fetus (D) Signup and view all the answers

What is the purpose of a pudendal block during childbirth?

To produce anesthesia in the perineum (D) Signup and view all the answers

What is a critical consideration before administering an epidural?

Platelet count must be above 100,000 (A) Signup and view all the answers

Which of the following is NOT a method of pain relief mentioned for natural childbirth?

General anesthesia (B) Signup and view all the answers

What is a potential side effect of using an epidural?

Hypotension (A) Signup and view all the answers

Which route is used to administer general anesthesia in emergency situations during pregnancy?

Intravenously or by inhalation (C) Signup and view all the answers

What is a spinal block used for during labor?

To provide quick pain relief for contractions (B) Signup and view all the answers

What is one of the main risks associated with the use of general anesthesia during pregnancy?

Postpartum hemorrhage (C) Signup and view all the answers

Which of the following statements about labor pain relief methods is correct?

Counterpressure can help alleviate back pain during labor (A) Signup and view all the answers

Study Notes

OB/GYN Test 1 Nursing Study Notes

Standard Days Method of Contraception: Count from first day of period for 14 days. Days 14-24 are fertile. Avoid sex during fertile days.

Basal Body Temperature Method of Contraception

Requires temperature measurement at the same time every morning before getting out of bed.
Ovulation is represented by a sharp dip and then spike in temperature.

Cervical Mucous Ovulation-Detection Method

Observe cervical mucous condition.
Avoid sex during "egg white" days (days when cervical mucous is clear and stretchy).

Male and Female Condoms

Only contraceptive method protecting against STIs.
Inconsistent use is a concern.
Never use both at the same time.

Cervical Sponge

Barrier method.
Rarely used.
Single-use.
More expensive than other barrier methods.

Cervical Cap

Barrier method.
Requires fitting.
Use with spermicide to increase efficacy.
Must be left in place at least 6 hours after intercourse, but no longer than 48 hours.
Risk of toxic shock syndrome.
Use other birth control during menstruation.

Diaphragm

Barrier method.
Requires fitting.
Re-evaluation annually.
Re-evaluate after weight loss/gain, birth, or surgery.
Can be placed 6 hours before intercourse.
Empty bladder before placement.
Use 2 teaspoons of spermicide in the diaphragm.
Leave in 6 hours after intercourse.

Combined Oral Contraceptives

Suppresses ovulation by adding estrogen and progesterone.
Increases cervical mucus thickness.
Inhibits ovulation.
Thins the uterine lining.

Oral Progestins

Do not contain estrogen.
Thickens cervical mucus.
Thins the uterine lining.
Safe for breastfeeding.

Missed Oral Contraceptive Pill

Take as soon as possible.
Take the next pill at the regular time; no back-up method is needed.

Missed 2 Pills (Week 1 or 2)

Take 2 pills a day for 2 days.
Finish the pack normally.
Use a backup method for 7 days.

Missed 2 Pills (Week 3)

Sunday start pack: Take 1 pill daily until Sunday. Start new pack on Sunday. Use backup method for 7 days.
Day 1 start pack: Throw away rest of the pack. Start new pack same day. Use backup method for 7 days.

Missed 3 or More Pills

Sunday start pack: Take one pill daily until Sunday; start a new pack on Sunday; use backup method for 7 days.
Day 1 start pack: Throw away the rest of the pack; start a new pack the same day; use a backup method for 7 days.

The Patch

Transdermal contraceptive system.
Applied to the lower abdomen, upper outer arm, buttocks, or upper torso (except breasts).
198 lbs or less allowed.
Apply the patch (same day for 3 weeks) and have one week without any patch.

Depo-Provera

Injectable progestin.
Given for the first 5 days of the menstrual cycle and then every 11-13 weeks.
Only method that can inhibit pregnancy for 12-18 months after stopping.
Great for teenagers

Vaginal Contraceptive Ring

Insert for 3 weeks.
Releases hormones to stop ovulation.
Take out for 1 week

Implantable Progestin (Nexplanon)

Placed under the skin of the arm.
Effective for at least 3 years.
Great for teenagers.

Intrauterine Device (IUD)

Constant contraception.
Hormonal and nonhormonal options.
Impairs sperm motility
Irritates uterine lining.
Thins endometrium.
Thickens cervical mucus.

IUD Complications

Period late, pregnancy, abnormal spotting or bleeding.
Abdominal pain, pain with intercourse.
Infection exposure, abnormal vaginal discharge.
Not feeling well, fever, or chills.
Missing string; shorter or longer.

Plan B

Emergency contraception used within 72 hours.

Vasectomy

Ligation and severance of the vas deferens.
Safe and simple procedure.
Does not impair male sexual function.
Reversal is possible.
Does not provide immediate contraception.
Does not protect against STIs.

Salpingectomy

Tying or removal of fallopian tubes.
Can be reversed.
Does not affect sexual function.
Risk of ectopic pregnancy

Chlamydia

Most frequently reported STIs in the U.S.
Often asymptomatic but may include cervicitis and yellow, foul discharge.
Untreated causes PID and newborn blindness.

Gonorrhea (Neisseria Gonorrhoeae)

Second most common bacterial STI.
Often coinfected with chlamydia.
Curable.
May be asymptomatic or include strawberry cervix, cervicitis, greenish-yellow discharge.

Trichomonas Vaginalis

Parasitic STI.
Symptoms typically begin 5 to 28 days after exposure.
Symptoms include itching, bad-smelling thin vaginal discharge, and burning with urination and pain with sex.
Curable.

Human Papillomavirus (HPV)

Most common viral infection in the US.
Causes essentially all cervical cancer.
Low-risk types cause genital warts.
High-risk types can cause cancer.
No cure.
Can be prevented with Gardasil 9; condom use, and abstinence;
Warts can be treated but often come back.

Herpes Simplex Virus (HSV)

HSV-1 (cold sores) and HSV-2 (genital herpes)
No cure.
Suppressive therapy is available.
Genital herpes causes painful sores on vagina, vulva, and penis.
May cause cervicitis.

Hepatitis

Transmitted through blood, saliva, semen, and vaginal secretions.
Results in liver damage.
Preventable through immunization.
No cure.

Dysmenorrhea

Extremely painful menstruation.

Menorrhagia

Heavy menstrual bleeding.

Dyspareunia

Painful intercourse

Mammograms

Age 40 unless high risk.

Breast Changes

Any changes in shape, size, contour, symmetry.
Skin discoloration or dimpling.
Bumps, lumps, sores, or scaly skin.
Discharge or puckering of the nipple.

Pap Smear, Cervical Cancer Screening

Women 21-29: Every 3 years.
Women 30-65: Every 5 years (if also getting HPV testing) or every 3 years without HPV testing.

Ultrasound (Pregnancy)

Uses sound waves to visualize the fetus.
Evaluates fetal heartbeat and malformations.
Accurate dating up to 12 weeks.
Assesses anatomical development at 18-20 weeks.
Evaluates fetal size and growth, placental position at 34 weeks.
Noninvasive and safe.

Chorionic Villus Sampling

Performed at 10-13 weeks.
Diagnoses chromosomal disorders.
Collects a sample of chorionic villi from the placenta.
Cannot detect neural tube defects.
May cause spontaneous abortion, hematoma, rupture of membranes, limb abnormalities, infection, fetal-maternal hemorrhage, vaginal bleeding and cramping.

Nuchal Translucency Screening

Measures the fold of the fetal neck.
Screens for (but does not diagnose) chromosomal abnormalities and structural abnormalities.
Performed at 11-14 weeks.
Increased NT may indicate Trisomy 21, 18, or 13.

Alpha-Fetoprotein (AFP) Analysis

Measures AFP by drawing maternal blood at 16-18 weeks.
Screens for neural tube defect; low AFP may mean Trisomy 21 or 18.
Screening tool often has false positives.

Marker Screening Test

Used to identify increased fetal risk for Trisomy 13, 18, and 21 and neural tube defects, and is more accurate for Down syndrome.
Performed at 16-18 weeks.
Triple or quadruple screening (quad more accurate for women under 35).

Doppler Flow Studies

Measures the velocity of blood flow within the fetus.
Performed later in second trimester in moms with chronic HTN or preeclampsia

Amniocentesis

Collection of amniotic fluid to examine fetal cells.
Confirms chromosomal abnormalities and neural tube defects.
Detects metabolic defects.
Performed at 15-20 weeks to test genetic abnormalities.
Performed at 35 weeks to determine fetal lung maturity.

Non-Stress Test

Indirect measure of uteroplacental function and fetal wellbeing.
Assesses fetal heartrate for 20 minutes.
Recommended in various pregnancies (diabetes, IUGR, preeclampsia, post-date pregnancy, renal disease, multiple gestation).
Reactive = 2 accelerations of at least 15 x 15 in 20 minutes (32 weeks or later).

Biophysical Profile

Ultrasound and a non-stress test to assess fetal well-being.
Reduces stillbirth risk by early detection of hypoxia.
Scoring using BATMAN method: 8/10 is considered normal; 6 or below requires further investigation.

Prenatal Signs of Pregnancy (Subjective)

Common symptoms of pregnancy that may also be attributed to other things.
Includes fatigue, breast tenderness, nausea and vomiting, amenorrhea, urinary frequency, hyperpigmentation of skin, fetal movements, uterine enlargement, breast enlargement.

Probable Signs of Pregnancy

Braxton Hicks contractions.
Positive pregnancy test.
Abdominal enlargement.
Ballottement.
Goodell's sign.
Chadwick's sign.
Hegar's sign.
Fetal movement felt by experienced clinician.

Positive Signs of Pregnancy

Ultrasound verification of embryo or fetus.
Fetal movement felt by experienced clinician.
Fetal heart tones heard by Doppler.

Uterine Changes in Pregnancy

Increase in size, weight, length.
Becomes ovoid.
Enhanced contractility and Braxton Hicks contractions.

Cervical Changes during Pregnancy

Ascent into abdomen after 3 months.
Fundal height at umbilicus at 20 weeks.
Softening (Goodell's sign).
Mucous plug formation.
Increased vascularization (Chadwick's sign).
Ripening about 4 weeks before birth.
Increased vascularity with thickening, lengthening of vaginal vault, secretions more acidic, white, and thick with leukorrhea.

Ovarian Changes During Pregnancy

Enlargement until 12-14 weeks of gestation.
Cessation of ovulation.

Breast Changes During Pregnancy

Increase in size and nodularity.
Increase in nipple size, becoming more erect and pigmented.
Production of colostrum.

Gastrointestinal System Changes During Pregnancy

Gums - easily bleed and swollen.
Increased risk of abscesses or cavities.
Drooling, decreased peristalsis.
Smooth muscle relaxation.
Constipation
Hemorrhoids.
Heartburn
Slowed gastric emptying.
Prolonged gallbladder emptying.
Nausea and vomiting.

Cardiovascular System Changes During Pregnancy

Increase in blood volume by 50% above pre-pregnant levels.
Increased red blood cells (RBCs).
Decreased blood pressure until mid-pregnancy and return to pre-pregnant levels.
Increased cardiac output.
Increased heart rate.
Hypercoagulable state.

Respiratory System Changes During Pregnancy

Breathing more diaphragmatic.
Increased oxygen consumption.
Congestion due to increased vascularity.

Renal/Urinary System Changes During Pregnancy

Increased glomerular filtration rate (GFR).
Increased kidney activity.
Increased length and weight of the kidneys.

Musculoskeletal Changes During Pregnancy

Increased swayback and upper spine extension.
Forward shifting of center of gravity.
Increase in lumbosacral curve.

Skin Changes During Pregnancy

Hyperpigmentation (mask of pregnancy).
Linea nigra.
Striae gravidarum (stretch marks).
Varicosities and vascular spiders on legs and vulva.
Palmar erythema (redness on hands).
Decline in hair growth but increase in nail growth

Nutritional Needs of a Pregnant Woman

Increased water consumption (2x normal).
Limit caffeine consumption to less than 200 mg daily.
Increased protein, iron, calories, and folate.
At least 400-800 mcg of folate/folic acid daily.
Limit fish containing mercury to 3 days or less per week.

Pica

Consumption of non-nutritive items (e.g., ice cravings, ambivalence)..

Emotional Changes in Pregnancy (by trimester)

First Trimester: Introversion or other emotional changes are common
Second Trimester: Introversion may still be present
Third Trimester: Acceptance of baby and planning

Maternal Role Tasks

Ensuring safe passage throughout pregnancy and birth.
Seeking acceptance of infant by others.
Seeking acceptance of self as a mother.
Learning to give of oneself.

Sexuality during pregnancy

Generally okay for healthy pregnancies until labor and delivery

Types of Unsafe Drugs

NSAIDs
Vasoconstrictors
Anti-seizure medications

Routine Pregnancy Lab Tests

Urinalysis.
CBC (Complete blood count).
Blood typing and Rh factor.
Rubella titer.
Hep B surface antigen.
HIV test.
RPR/VDRL (syphilis).
Blood pressure.

Continued Pregnancy Lab Tests

Urinalysis.
Blood pressure.
Urine analysis.
Fundal height.
Fetal movement.
Fetal heart rate.

Pregnancy Discomforts

First Trimester: Urinary frequency, fatigue, nausea and vomiting (N&V), breast tenderness, constipation, nasal stuffiness, cravings, vaginal discharge.
Second Trimester: Backache, Leg cramps, Varicosities, Hemorrhoids, Gas.
Third Trimester: Shortness of breath, heartburn, indigestion, edema, Braxton Hicks contractions.

Danger Signs in Pregnancy

First Trimester: Spotting/bleeding, painful urination, UTI, severe persistent vomiting, lower abdominal pain with dizziness and shoulder pain (sign of ectopic pregnancy).
Second Trimester: Regular uterine contractions, calf pain, sudden gush/leaking fluid from vagina, no fetal movement for more than 12 hours.
Third Trimester: Sudden weight gain, periorbital or facial edema, severe upper abdominal pain, headache with vision changes, decrease in fetal movements for over 24 hours.

True Labor

Strong, long contractions.
Does not stop with walking or changing position.
Felt in lower back and lower abdomen.
Progressive cervical dilation.
Bloody show.
Anterior fetal position (baby engaged in the pelvis).

False Labor

Irregular or regular contractions that stop with walking or changing position.
Short and mild contractions.
Felt in the upper back and upper abdomen.
No significant cervical dilation.
Posterior fetal position (baby not engaged in the pelvis yet).

Factors Affecting Labor and Birth

Passageway.
Passenger.
Powers.
Position.
Psychological response.

Pelvic Shape for Vaginal Delivery

Gynecoid is the ideal shape.

Pelvic Shapes Not Favorable for Vaginal Delivery

Android and platypelloid shapes.

Lie of the True Pelvis

Below the linea terminalis.

Cervical Dilation

Progressive opening or widening of the cervical canal (measured in cm).

Cervical Effacement

Thinning of the cervix (measured in percentages).

DES (Diethylstilbestrol)

A medication

Fetal Engagement

Presenting part of the fetus has passed through the maternal pelvic brim or inlet into the true pelvis.

Fetal Station

Relationship of the presenting part of the fetus to an imaginary line between the maternal ischial spines.

Fetal Presentation

Cephalic: Head first.
Vertex: Ideal cephalic presentation; head first, chin tucked.
Breech: Buttocks or feet first.
Breech (Frank): Buttocks first.
Breech (Footling): Feet first.

Fetal Lie

Longitudinal (cephalic or breech)
Transverse (shoulder)

Fetal Position

Relationship of a landmark (e.g., occiput, sacrum, mentum, acromion) on the presenting fetal part to the mother's pelvis quadrants.

Fetal Position Abbreviation

First letter: Location in pelvis (right or left).
Second letter: Presenting part (e.g., occiput, sacrum).
Third letter: Relation to maternal pelvis (anterior, posterior, or transverse).

Maternal Positions During Labor

Upright or lateral positions are typically good (e.g., peanut ball, flying cowgirl, princess, fire-hydrant).
Lying flat on the back is often not optimal.

Stages of Labor

First Stage: Onset of contractions to 10 cm dilated (latent and active phases)
Second Stage: 10 cm dilated to delivery of baby.
Third Stage: Delivery of baby to delivery of placenta.
Fourth Stage: First 24 hours after birth; focus on recovery and maternal stabilization, monitoring for complications.

Pain Relief Methods (for birthing people who want a natural pregnancy)

Support, ambulation, position changes.
Acupuncture and acupressure.
Guided imagery and focal points, massage and effleurage.
Breathing techniques.
Music, counterpressure.
Hypnosis/Bradley method (partner coaching).
Hydrotherapy/warm bath.

IV Narcotics for Labor Pain

Meperidine.
Morphine.
Nalbuphine.
Butorphanol.

Pudendal Block

Injection into the pudendal nerves near the ischial spine.
Regional anesthesia for second stage, episiotomy, or forceps/vacuum-assisted delivery.
Does not treat contraction pain.

Epidural

Continuous infusion or intermittent injection into epidural space.
Relieves labor pain.
Risks include hypotension and platelet counts less than 100,000.

General Anesthesia in Pregnancy

Used in emergency C-sections or when regional anesthesia is contraindicated.
Includes IV injection, inhalation, or both, followed by a muscle relaxant, and intubation.
High risk of postpartum hemorrhage.

Spinal Anesthesia in Pregnancy

Injection into the subarachnoid space.
Used in emergency labor and C-sections.
Risks include hypotension, spinal headache, and need to monitor for respiratory depression.

Risks of Narcotics in Labor

Respiratory depression in the mother and infant.
Abnormal FHR patterns.

Indicators of Fetal Well-being During Labor

Moderate variability.

Causes of Early Decelerations

Head compression from uterine contractions.
Vaginal examinations.
Fundal pressure.
Placement of internal fetal monitoring.

Causes of Variable Decelerations

Cord compression (prolapse).
Oligohydramnios.

Causes of Late Decelerations

Uteroplacental insufficiency.
Uterine tachysystole (rapid contractions).
Maternal hypotension.
Intrauterine growth restriction (IUGR).
Diabetes.

Intrauterine Resuscitation

Turn off Pitocin if needed.
8-10 L oxygen via non-rebreather mask.
Turn the patient on their side.
Bolus IV fluids.

Different Types of Decelerations and Interventions

VEAL CHOP to memorise and apply in practice

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Test your knowledge about key aspects of pregnancy and maternal health. This quiz covers various topics, including maternal roles, common discomforts, and safety during pregnancy. Ideal for expectant mothers or those studying obstetrics.