OB EXAM 3

What is oligohydramnios?

An amniotic fluid index (AFI) of less than 500 ml or less than expected for gestational age

What is polyhydramnios?

An amniotic fluid index (AFI) greater than 25 cm

What are the postpartum risks associated with polyhydramnios?

Uterine atony and postpartum hemorrhage due to uterine overdistension

Aneuploidy

having an abnormal number of chromosomes

fetal alarm signal

No fetal movement for 12 hours

What does a Biophysical Profile (BPP) score of 4 indicate?

Suspected chronic asphyxia, which may necessitate delivery

Reactive non-stress test

recording of a minimum of 2 FHR accelerations (15bpm for at least 15 sec per episode) w/ fetal movement w/in a 20 min period

non reactive non stress test

lacks insufficient FHR accelerations over 40 mins. no accelerations

What medication must be administered to Rh-negative patients following an amniocentesis?

RhoGAM

chorionic villus sampling (CVS)

A technique associated with prenatal diagnosis in which a small sample of the fetal portion of the placenta is removed for analysis to detect certain genetic and congenital defects in the fetus.

Percutaneous Umbilical Blood Sampling (PUBS)

Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis.

gestational hypertension

hypertension after 20 week without proteinuria

preeclampsia

hypertension after 20 weeks accompanied by proteinuria or systemic findings

Eclampsia

seizure in a preeclampsia women

What is the primary goal of magnesium sulfate administration in preeclampsia?

To prevent seizures

What does the acronym HELLP stand for in the context of severe preeclampsia?

Hemolysis, Elevated Liver enzymes, and Low Platelets

Disseminated Intravascular Coagulation

widespread clotting and obstruction of blood flow to the tissues

What are the clinical signs of Disseminated Intravascular Coagulation (DIC)?

Oozing from IV sites, petechiae, and hematomas

miscarriage

end before 20 weeks

Threatened miscarriage

spotting, cervical os closed, mild cramping

Inevitable miscarriage

moderate to heavy bleeding, mild to severe cramping, ROM, cervical dilation

Incomplete miscarriage

some, but not all, of the products of conception have been passed; retained products may be part of the fetus, placenta or membranes

cervical insufficiency

passive and painless dilation of the cervix leading to recurrent preterm births during the second trimester in the absence of other causes

Cullen's sign

bruising in the skin around the umbilicus

What is the classic presentation of placenta previa?

Painless, bright red vaginal bleeding with a soft, non-tender abdomen

What are the classic signs of placental abruption?

Painful vaginal bleeding, uterine tenderness, and contractions

placental abruption

premature separation of the placenta from the uterine wall

placenta previa

the abnormal implantation of the placenta in the lower portion of the uterus

Pregestational Diabetes Mellitus

Type I or Type II DM that existed before conception.

Why must patients avoid pregnancy for one year following a molar pregnancy?

Because hCG is a marker for potential cancer and must be monitored

Hyperemesis Gravidarum

Excessive, prolonged vomiting leading to weight loss greater than 5% of pre-pregnancy weight, electrolyte imbalance, and ketonuria

Preterm Labor (PTL)

regular contractions along with a change in cervical effacement or dilation or both or presentation with regular uterine contractions and cervical dilation of at least 2 cm

preterm birth (PTB)

Any birth occurring between 20 0/7 and 37 6/7 weeks of gestation

What is the definition of uterine tachysystole?

More than 5 contractions in 10 minutes

What cervical length measurement indicates a low risk for preterm birth?

Greater than 30 mm

Low Birth Weight (LBW)

A body weight at birth of less than 2500 grams.

dystocia

general lack of progress in labor for any reason

Dysfunctional Labor

long, difficult, or abnormal labor

Tocolytics

Act on uterine muscle to cease contractions

uterine tachysystole

more than 5 contractions in 10 minutes

What is the purpose of the Fetal Fibronectin (fFN) test?

To predict the likelihood of preterm delivery

What are the common side effects of Terbutaline?

Maternal and fetal tachycardia, palpitations, tremors, and hyperglycemia

What is the purpose of administering antenatal glucocorticoids in preterm labor?

To stimulate fetal lung surfactant production

What is the treatment for cervical insufficiency?

Cerclage (stitching the cervix closed)

Why are antenatal glucocorticoids administered to a pregnant patient?

To stimulate fetal surfactant production and promote lung maturity.

What is the primary purpose of administering Magnesium Sulfate in preterm labor?

To provide neuroprotection and prevent neonatal neurological morbidity like cerebral palsy.

Premature Rupture of Membranes (PROM)

spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labor at any gestational age

PPROM (preterm premature rupture of membranes)

ruptured membranes in preterm pregnancy (before 37 weeks)

What are the clinical signs of chorioamnionitis?

Maternal fever, maternal and fetal tachycardia, uterine tenderness, and purulent fluid.

What is the emergency intervention for oxytocin-induced tachysystole?

Discontinue oxytocin, reposition to side-lying, administer 500mL LR bolus, and provide oxygen at 10L/min.

What is the Bishop Score used for?

To evaluate the inducibility of the cervix by assessing dilation, effacement, station, consistency, and position.

What is a significant long-term risk of a classical (vertical) uterine incision?

High risk of uterine rupture in future pregnancies.

dystocia

lack of progress in labor for any reason

Dystocia causes

Macrosomia ● Malposition of the fetus ● Hypotonic contractions ● Hypertonic contractions ● Maternal pelvis

Dysfunctional Labor

long, difficult, or abnormal labor

shoulder dystocia

delayed or difficult birth of the fetal shoulders after the head is born

What is the 'Turtle Sign' in obstetrics?

Retraction of the fetal head against the perineum, indicating shoulder dystocia.

McRoberts maneuver

Pull knees to head to open up pelvis.

suprapubic pressure for shoulder dystocia

Pressure is applied immediately above the maternal symphysis pubis to push the fetal anterior shoulder downward.

Gaskin maneuver

Mom on all fours

Which maneuver should never be performed during shoulder dystocia?

Fundal pressure.

prolapsed umbilical cord

when the umbilical cord presents first and is squeezed between the vaginal wall and the baby's head

What is the immediate nursing intervention for a prolapsed umbilical cord?

Insert a gloved hand to manually hold the presenting part off the cord and place the mother in Trendelenburg or knee-chest position.

Uterine Rupture

a tear in the wall of the uterus

What are the classic signs of uterine rupture?

Abnormal FHR, loss of fetal station, sharp abdominal pain, hypovolemic shock, and palpable fetal parts through the abdomen.

What is an Amniotic Fluid Embolus (AFE)?

A condition where amniotic fluid containing fetal debris enters maternal circulation, causing respiratory distress, circulatory collapse, and hemorrhage.

Define involution.

The process of the uterus returning to a nonpregnant state after birth.

What is subinvolution?

The failure of the uterus to return to a nonpregnant state, often caused by infection or retained placental fragments.

uterine atony

inability of the uterus to contract effectively

What is the primary risk associated with uterine atony?

Postpartum hemorrhage.

Why is it critical for a patient to void before a fundal assessment?

A full bladder displaces the uterus, preventing effective contraction and leading to atony.

What is the expected rate of fundal descent postpartum?

Approximately 1 cm (one fingerbreadth) per day.

Where is the fundus typically located on the day of birth?

At the level of the umbilicus.

Lochia rubra

Red, distinctly blood-tinged vaginal flow that follows birth

Lochia serosa

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Lochia alba

Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum

What does a regression of lochia (e.g., from serosa back to rubra) indicate?

A potential complication that requires immediate notification of the healthcare provider.

What are the signs of a genital tract infection in the postpartum period?

Foul-smelling lochia, fever, chills, and uterine tenderness.

What is the purpose of uterine contractions during the postpartum period?

To compress intramyometrial blood vessels and prevent hemorrhage at the placental site.

What is the role of oxytocin in the postpartum period?

It is released by the posterior pituitary (stimulated by breastfeeding) to strengthen uterine contractions.

What is the definition of the puerperium?

The postpartum period, often referred to as the 'fourth trimester'.

What are the three warning signs that require immediate notification of a provider postpartum?

Sudden increase in discharge, foul odor, or temperature greater than 101°F (38.3°C).

How long does it typically take for cardiac output to return to pre-pregnancy levels?

6-8 weeks.

Which clotting factors remain elevated postpartum, increasing the risk of thromboembolism?

Factors I, II, VIII, IX, and X.

What is the primary role of oxytocin in the postpartum period?

It is responsible for the milk-ejection or let-down reflex.

What is the expected timeline for the return of normal bowel function postpartum?

By day 7, with the first bowel movement expected 2-3 days after delivery.

What does the 'B' in the BUBBLE-HEN mnemonic stand for regarding bladder assessment?

Monitoring voiding patterns, distention, and ensuring at least 150 mL per void.

What does the REEDA acronym stand for when assessing an episiotomy or incision?

Redness, Edema, Ecchymosis, Discharge, and Approximation.

What is the 'Taking-in' phase of maternal adaptation?

Days 1-2, where the mother focuses on her own basic needs and recounts her birth experience.

During which phase of maternal adaptation is the mother most receptive to teaching?

The Taking-hold phase (starts Day 2-3).

What is 'engrossment' in the context of paternal transition?

The father's absorption, preoccupation, and intense interest in the newborn.

What is the 'en face' position used to assess positive bonding?

Holding the baby so that faces are 12 inches (30 cm) apart.

What is the primary nursing intervention for uterine atony?

Fundal massage.

What instructions should be given to a non-breastfeeding mother for lactation suppression?

Wear a well-fitted support bra for 72 hours, avoid breast stimulation, and use ice packs or cold cabbage leaves.

What is the required waiting period before becoming pregnant after receiving the Rubella vaccine?

28 days.

When is RhoGAM administered to a postpartum mother?

When an Rh-negative mother delivers an Rh-positive infant.

What is the recommended weight loss expectation by 6-8 weeks postpartum?

10-12 lbs initially, plus approximately 5 lbs from diuresis, returning to pre-pregnant weight.

How many extra calories per day do nursing mothers require?

An extra 500 calories per day.

What is the clinical definition of Postpartum Hemorrhage (PPH)?

Cumulative blood loss of 1000 mL or more, or bleeding associated with signs of hypovolemia within 24 hours of birth.

What is the leading cause of postpartum hemorrhage?

Uterine atony.