CFRN Obstetrics Exam 41Questions with Verified Answers
MATERNAL CHANGES
1. Heart
2. Location of Heart
3. Blood Pressure
4. Blood
5. Sphincters / Ligaments
6. Lungs - CORRECT ANSWER 1. HR increases 15-20bpm (ther
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CFRN Obstetrics Exam 41Questions with Verified Answers
MATERNAL CHANGES
1. Heart
2. Location of Heart
3. Blood Pressure
4. Blood
5. Sphincters / Ligaments
6. Lungs - CORRECT ANSWER 1. HR increases 15-20bpm (therefore CO increases).
2. The heart elevates and rotates.
3. BP decreases 5-15mmHg during 2nd trimester and increases 10mmHg during third trimester.
4. Plasma volume increases 40% leading to dilutional anemia and coagulopathy. WBCs increase as well.
5. Progesterone relaxes sphincters and ligaments.
6. The lungs have decreased functional and residual volume.
Cervical Assessment:
1. Dilation
2. Effacement
3. Station - CORRECT ANSWER 1. 0-10
2. 0% - 100%
3. measured in centimeters, + (toward the vaginal opening) or - (away from the vaginal opening)
Which patients should not get a cervical exam? - CORRECT ANSWER Patients with ruptured membranes, placenta previa, or a prolapsed cord.
FETAL HEART RATE
1. Normal
2. Tachycardia
3. Bradycardia - CORRECT ANSWER 1. 120-160bpm
2. >160bpm for 10 min or more
3. <120bpm for 10 min or more
1. What is the cause of fetal tachycardia?
2. What is the cause of fetal bradycardia? - CORRECT ANSWER 1. Maternal fever or stimulant drugs.
2. Fetal Hypoxia
VARIABILITY
1. Minimal
2. Moderate
3. Marked - CORRECT ANSWER 1. 0-5bpm
2. 6-25bpm
3. >25bpm
_____ is the single most important predictor of fetal well being. - CORRECT ANSWER Variability
What causes poor variability? - CORRECT ANSWER Fetal hypoxia, medication administration to mom, maternal smoking, extreme fetal prematurity, and fetal sleep.
ACCELERATIONS
What is an acceleration and what does it mean? - CORRECT ANSWER An acceleration is a transient increase in fetal heart rate in response to stimulation. It signals that the baby is neurologically intact. Acidotic babies will not have accelerations.
EARLY DECELERATIONS - CORRECT ANSWER Early decelerations mirror the contraction. They are benign and due to fetal head compression against the cervix.
LATE DECELERATIONS - CORRECT ANSWER The start of a late deceleration occurs after the peak of the contraction. They are a sign of uteroplacental insufficiency and fetal hypoxia. They are common with PIH, abruption, maternal DM, maternal smoking, and late deliveries.
VARIABLE DECELERATIONS - CORRECT ANSWER Variable decelerations are unrelated to the mother's contractions. They are V pr W shaped and due to cord problems (i.e. prolapse, short cord, cord entanglement, or nuchal cord).
What is shouldering? - CORRECT ANSWER The FHR accelerates above the baseline as the deceleration resolves. This is common with variable decelerations. Shouldering may occur on either side of the deceleration.
SINUSOIDAL PATTERN - CORRECT ANSWER Sinusoidal patterns are caused by fetal acidosis secondary to hypovolemia or fetal anemia.
How is fetal distress treated? - CORRECT ANSWER 1. High flow oxygen
2. Fluids
3. Maternal position changes
4. Tocolytics
What are the signs of imminent delivery? - CORRECT ANSWER 1. Vaginal bleeding
2. Contractions more frequent than q 10 minutes
3. Increasing intensity of contractions
4. The urge to push
5. The need to have a bowel movement
6. Crowning
PRETERM LABOR
1. Causes?
2. Treatment? - CORRECT ANSWER 1. Infection (#1 cause), fever and dehydration.
2. Assess the cervix and status of membranes, place in mom in LLR position, assess mom for infections, administer prophylactic antibiotics for GBS, and administer magnesium sulfate, calcium channel blockers, or terbutaline to stop the contractions.
Terbualine (pre-term labor)
1. Dose?
2. Contraindications? - CORRECT ANSWER 1. 0.25mg SQ q 15 min
2. Maternal HR over 120, severe vaginal bleeding, and maternal IDDM.
Magnesium Sulfate (pre-term labor and preeclampsia)
1. Dose?
2. Antidote? - CORRECT ANSWER 1. 4-6g bolus over 15-30 min followed by 2-4g/hr
2. Calcium gluconate
Oxytocin (post-partum hemorrhage)
Dose? - CORRECT ANSWER 20-40 units in 1L LR at 125ml/hr
Porcardia (pre-term labor)
Dose? - CORRECT ANSWER 20mg q 30 min X 2, then 20mg q 3-8h
Hydralazine (PIH or preeclampsia)
Dose? - CORRECT ANSWER 2mg q 5min or 5-10mg q 20 min
ECTOPIC PREGNANCY TREATMENT - CORRECT ANSWER Maintain ABCs, treat for hypovolemic shock, type and cross the patient for a transfusion, and prepare for surgery. The patient will get Rhogam if Rh negative.
MATERNAL HYPERTENSION (PIH)
Definition - CORRECT ANSWER Any new onset of hypertension during pregnancy (an SBP of 140 or more on two separate occasions).
PREECLAMPSIA SYMPTOMS - CORRECT ANSWER Hypertension, proteinuria, and edema.
ECLAMPSIA DEFINITION - CORRECT ANSWER Pre-eclampsia that has progressed to the point that the mother begins seizing.
HELLP SYNDROME DEFINITION - CORRECT ANSWER Hemolysis, elevated liver enzymes, and low platelets.
Treatment for PIH, preeclampsia, and eclampsia. - CORRECT ANSWER Watch for late decelerations and deceased variability. Monitor fetal movement. Administer magnesium sulfate (this causes the brain to vasodilate and prevents it from becoming hypoxic). Administer steroids (Celestone) for fetal lung maturity. Consider labetalol or hydralazine for extreme hypertension. Administer valium for seizures.
What is the cure for eclampsia? - CORRECT ANSWER Delivery of the baby. However, the mother remains at risk for preeclampsia or eclampsia for 2 weeks post-delivery.
TRAUMA IN PREGNANCY - TREATMENT - CORRECT ANSWER Maximize fetal viability by aggressively treating mom. Have a high index of suspicion for placental abruption. Transport in full c-spine precautions with the board tilted to the left. MATERNAL PATIENTS CAN LOSE 30-35% OF THEIR TOTAL BLOOD VOLUME WITHOUT ANY SIGNS OF HYPOVOLEMIA. Give copious amounts of fluid and administer high flow oxygen.
UTERINE RUPTURE
1. Signs and symptoms?
2. Treatment? - CORRECT ANSWER 1. The abdomen may be grossly deformed or distended/rigid. Sometimes fetal parts are palpable.
2. Perform serial fundal height assessments, look for a previous C-section scar, transport rapidly and provide supportive care. Administration of oxytocin may reduce bleeding. GOAL - save mom's life. Fetus will likely die.
ABRUPTION
1. Signs and symptoms?
2. Treatment? - CORRECT ANSWER 1. Extreme ripping pain, scant dark red blood from the vagina, and uterine contractions (blood is irritating to the uterus).
2. High flow oxygen, fluids, and blood products. Assess contractions, fetal movement, FHR, and blood loss. Continually reassess fundal height. Consider tocolytics. Watch for signs of DIC.
PLACENTA PREVIA
1. Risk factors?
2. Signs and symptoms?
3. Treatment? - CORRECT ANSWER 1. Uterine scarring, multiparity with short intervals between pregnancies, and past D&C.
2. Painless bright red bleeding.
3. Track blood loss, administer oxygen, monitor vital signs, and administer fluids. Assess for contractions, fetal movement, FHR, and hemorrhaging. Consider tocolytics and blood products. Watch for signs of DIC.
NUCCHAL CORD
1. Definition?
2. Treatment? - CORRECT ANSWER 1. The umbilical cord is wrapped around the baby's neck. Variable decelerations may be present.
2. Gently loosen the cord and pull it over the baby's head. If this is not possible, clamp the cord and cut it before the shoulders are delivered and before suctioning.
UMBILICAL CORD PROLAPSE - TREATMENT - CORRECT ANSWER Insert a gloved hand into the vagina and elevate the presenting part off the cord. Place the patient in Trendelenburg position or knee to chest position. Administer tocolytics to reduce pressure on the cord during contractions.
BREECH PRESENTATION - TREATMENT - CORRECT ANSWER Do not touch the fetus until the umbilicus is delivered. Rotate the baby so that the baby's back is anterior Insert a hand into the vagina to create a passage for the cord. Perform Mauriceau's Maneuver.
MECONIUM DELIVERY
1. Cause?
2. Treatment? - CORRECT ANSWER 1. Stress to the baby or a past-due baby.
2. Suction the mouth, posterior pharynx, and nose after delivery of the head but prior to delivery of the shoulders. If the baby is vigorous, provide supportive care. If the baby is not vigorous, intubate the trachea continually and suction until clear.
Vigorous is defined as strong respiratory effort, good muscle tone, and HR > 100.
POST PARTUM HEMORRHAGE
1. Definition?
2. Treatment? - CORRECT ANSWER 1. Blood loss exceeding 500ml in the first 24 hours after delivery.
2. Vigorous fundal massage, oxytocin or methergine, and bimanual uterine compression. Transfuse if necessary.
UTERINE INVERSION
1. Cause?
2. Treatment? - CORRECT ANSWER 1. Precipitous delivery or tugging on the umbilical cord to facilitate delivery of the placenta.
2. If the uterus has not yet contracted, manually replace it. If it has contracted, administer tocolytics and then attempt to manually replace it. DO NOT REMOVE THE PLACENTA.
ANAPHYLACTOID SYNDROME OF PREGNANCY
1. Cause?
2. Treatment? - CORRECT ANSWER 1. Current research shows this is actually an anaphylactic -type reaction to fetal cells that results in DIC and blood clots.
2. Oxygen, intubation if needed (with PEEP), fluids, hemodynamic support, and replacing lost blood products.
DIC
1. Why are pregnant moms so susceptible?
2. Treatment? - CORRECT ANSWER 1. The 40% increase in plasma volume during pregnancy means that pregnant women have extra clotting factors. The placenta is also full of tissue thromboplastin (an agent that triggers the clotting cascade).
2. Manage the airway, stop ongoing hemorrhaging, replace lost volume, minimize needle sticks, and administer blood products.
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