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UTA NURS 4441 OB Exam 3

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Answer
high-risk pregnancy   one in which the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy.  
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free noninvasive assessment of fetus after 20 weeks   Daily fetal movement (or kick) counts  
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When vaginal U/S is the preferred method of sonogram   In the first trimester. Also useful in obese women whose thick abdominal layers cannot be penetrated adequately with an abdominal approach.  
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sonogram that requires mother to have a full bladder   Abdominal ultrasonography, to displace the uterus upward  
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five variables studied in a biophysical profile   Fetal breathing movements, gross body movements, fetal tone, reactive FHR, qualitative amniotic fluid volume  
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indications for an amniocentesis   when there is a prenatal diagnosis of genetic disorder or congenital anomalies (neural tube defect in particular), assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease.  
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earliest possible time when an amniocentesis can be done   14 weeks  
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CVS   chorionic villus sampling; Removal of fetal tissue from the placenta for genetic diagnostic studies.  
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Weeks gestation CVS can be performed   First or second trimester, ideally between 10 – 13 weeks  
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Weeks gestation MSAFP is reliable   Between 15-20 weeks  
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Disorders screened for in the triple or quad screen   Chromosomal abnormalities like Down’s syndrome (Trisomy 21) and other types of trisomy (Trisomy 18), and neural tube defects.  
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weeks gestation triple marker should be done   16-18 weeks  
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Coombs’ test   Indirect: determination of Rh-positive antibodies in maternal blood. Direct: determination of maternal Rh-positive antibodies in fetal cord blood. A positive test result indicates the presence of antibodies or titer.  
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goal of 3rd trimester testing   To determine whether the intrauterine environment continues to be supportive to the fetus  
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When woman presses button while doing an NST   When she feels fetal movement  
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criteria for a reactive NST tracing   Two accelerations in a 20 minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above the baseline.  
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two sources of oxytocin that may be used for the contraction stress test (CST)   IV oxytocin and nipple stimulation  
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positive result for a CST   Repetitive late decelerations occur with 50% or more of contractions (even if fewer than three contractions occur in 10 minutes)  
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pregnancy-related hypertension trend   On the rise  
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complications that hypertensive women are at risk for   Abruptio placenta, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure thrombocytopenia, DIC, pulmonary edema  
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Maternal death from preeclampsia causes   Hepatic rupture and placental abruption (abruptio placenta), or eclampsia  
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Gestational weeks that Gestational HTN begins   20 weeks  
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Gestational HTN manifestations   HTN not associated with proteinuria  
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Gestational weeks that preeclampsia develops   20 weeks  
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Preeclampsia initial manifestations   HTN and proteinuria  
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B/P measurement that defines HTN   Systolic >140 and diastolic >90  
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severe preeclampsia differentiation from mild   B/P β‰₯160/110 and proteinuria β‰₯5 gm/24 hours (β‰₯3 + on the dipstick).  
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Severe preeclampsia manifestations   Oliguria, headache, visual disturbances (like scotomata) or blurred vision, irritability or changes in affect. Hepatic involvement including epigastic pain, RUQ pain, impaired liver function, thrombocytopenia with platelets < 100,000 mm3; pulmonary edema  
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When preeclampsia becomes eclampsia   the onset of seizure activity or coma in a woman with preeclampsia, with no history of preexisting pathology, which can result in seizure activity  
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Chronic HTN differentiation from pregnancy-related HTN   Chronic hypertension in pregnant woman is present before pregnancy or diagnosed before 20 weeks of gestation and persistent after 6 weeks postpartum.  
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Pregnancy-related HTN differentiation from chronic HTN   New-onset proteinuria or significant increase in hypertension, plus new onset of symptoms, thrombocytopenia, or elevated liver enzymes signifies a pregnancy-related hypertension.  
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Preeclampsia main pathogenic factor   Poor perfusion as a result of vasospasm and decreased plasma volume.  
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Life-threatening liver complication that is a surgical emergency   Rupture of a subcapsular hematoma  
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Preeclampsia neurological manifestations   headaches, hyperreflexia, positive ankle clonus, and seizures  
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impaired placental perfusion affect on the fetus   restriction of fetal growth and the increased incidence of placental abruption, premature birth, and early degenerative aging of the placenta  
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HELLP syndrome   A laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP); it is not a separate illness.  
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typical ethnicity of women who develop HELLP syndrome   Caucasian  
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HELLP syndrome adverse outcomes   pulmonary edema, acute renal failure, DIC, placental abruption, liver hemorrhage or failure, ARDS, sepsis, and stroke, and preterm birth  
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Clonus assessment   examiner supports the leg with the knee flexed, with one hand sharply dorsiflexes the foot, maintains the position for a moment, and then releases the foot. Normal (negative clonus) response is when no jerks are felt  
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Evaluation of fetus for mild preeclampsia   Daily fetal movement counts, nonstress test or biophysical profile once or twice weekly, and serial ultrasound evaluations of amniotic fluid volume and estimated fetal weight.  
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Mild preeclampsia Self-monitoring   Urine dipstick protein (report if 2+ or more), B/P checking (report increase), and kick counts (report ≀ 4 movements/hr)  
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Earliest gestational age pregnancy can be induced   34 weeks  
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drug of choice to prevent seizures in preeclampsia and HELLP syndrome   magnesium sulfate  
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magnesium sulfate IV loading dose and typical hourly dose   loading dose of 4 to 6 g of magnesium sulfate is infused over 15 to 30 minutes (2 g/hr)  
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magnesium target therapeutic serum levels   4 to 7 mEq/L  
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magnesium toxicity manifestations   Mild toxicity: lethargy, muscle weakness, decreased or absent DTRs, double vision and slurred speech. Increasing toxicity: maternal hypotension, bradycardia, bradypnea and cardiac arrest  
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antidote for magnesium sulfate   calcium gluconate or calcium chloride  
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antihypertensives used for the treatment of HTN in preeclampsia   Hydralazine, Labetalol Hydrochloride, Methyldopa, Nifedipine  
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resolvement of preeclampsia manifestations after birth   48 hours after birth  
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PPH   postpartum hemorrhage  
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Medications used to increase uterine tone in preeclamptic woman with signs of PPH   oxytocin or prostaglandins. (Ergot products (e.g., Ergotrate, Methergine) are contraindicated because they increase BP)  
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spontaneous abortion/miscarriage   A pregnancy that ends as a result of natural causes before 20 weeks of gestation  
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percentage of confirmed pregnancies in the US that end in miscarriage   Approximately 10% to 15%  
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D & C   Dilation and curettage (D&C), a surgical procedure in which the cervix is dilated and a suction curette is inserted to scrape the uterine walls and remove uterine contents  
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incompetent cervix   Premature dilation of the cervi; passive and painless dilation of the cervix during the second trimester.  
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incompetent cervix management   bed rest, pessaries, antibiotics, antiinflammatory drugs, and progesterone supplementation. Surgical management, with placement of a cervical cerclage, may be chosen instead.  
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pessary   treatment for incompetent cervix or prolapse; Device placed inside the vagina to function as a supportive structure for the uterus.  
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Cerclage   Use of nonabsorbable suture to keep a premature dilating cervix closed; released when pregnancy is at term to allow labor to begin.  
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complete hydatidiform mole cause   fertilization of an egg in which the nucleus has been lost or inactivated  
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partial hydatidiform mole cause   two sperm fertilizing an apparently normal ovum.  
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molar pregnancy manifestations   Vaginal bleeding, uterus larger than expected, anemia, excessive nausea and vomiting, cramping, preeclampsia.  
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blood test used to test for Hydatidiform moles and GTN   hCG levels are persistently high or rising beyond 10 to 12 weeks of gestation, the time they would begin to decline in a normal pregnancy  
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GTN   gestational trophoblastic neoplasia; Persistent trophoblastic tissue that is presumed to be malignant.  
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DIC triggers   Abruptio placenta, retained dead fetus, amniotic fluid emboli, severe preeclampsia, HELLP Syndrome and gram negative sepsis  
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key to optimal pregnancy outcomes in patients with diabetes   strict maternal glucose control  
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gestational diabetes mellitus   any degree of glucose intolerance with the onset or first recognition occurring during pregnancy  
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fetal glucose level relationship to the maternal glucose levels   directly proportional  
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Where the fetus get its insulin   It manufactures its own insulin, since insulin does not cross the maternal fetal barrier.  
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susceptibility to hyper or hypoglycemia during the first trimester   Hypoglycemia  
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When insulin resistance usually begins in pregnancy   As early as 14 – 16 weeks  
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disorders diabetics are at risk for that end up making the uterine size larger   Polyhydramnios (or hydramnios), and fetal macrosomia.  
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Hydramnios   Amniotic fluid in excess of 1.5 L; often indicative of fetal anomaly and frequently seen in poorly controlled, insulin-dependent diabetic pregnant women even if there is no coexisting fetal anomaly.  
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Fetal macrosomia   Large body size as seen in neonates of mothers with diabetes or prediabetes defined in several different ways, including: a birth weight more than 4000 to 4500 g; birth weight greater than the 90th percentile; and estimates of neonatal adipose tissue.  
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diabetic risk for preeclampsia   more likely than non-diabetics  
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DKA blood glucose levels in pregnancy   DKA may occur with blood glucose levels barely exceeding 200 mg/dl  
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DKA effect on the fetus   Fetal death  
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Frequency glucose levels checked in a laboring diabetic   Hourly  
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1-hour screening glucose level requiring a more extensive glucose test to determine if the woman is diabetic or not   130 – 140 mg/dl  
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weeks of pregnancy 1 hour glucose tolerance is typically done   24- 28 weeks  
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3-hour OGTT number of values that must be elevated to diagnose GDM   β‰₯ 2  
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usual number of calories per day allowed in the GDM diet   1500-2000 kcal/day  
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percentage of patients with GDM that will need to take insulin   Up to 20%  
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medications often prescribed for hyperemesis gravidarum   Pyridoxine, doxylamine, Phenergan and metoclopramide  
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Antenatal corticosteroids   medication given to accelerate fetal lung maturity  
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IUGR   intrauterine growth restriction; Fetal undergrowth of any cause, such as deficient nutrient supply or intrauterine infection, or associated with congenital malformation; birth weight below population 10th percentile corrected for gestational age.  
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PTL   preterm labor; Gestational age between 20 – 37 weeks, uterine activity (contractions) and progressive cervical change.  
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deleterious effects of bedrest   Decreased muscle tone, weight loss, calcium loss, glucose intolerance, bone demineralization, constipation, fatigue, isolation, loneliness, anxiety and depression.  
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Tocolytic contraindications   When dilation reaches 6 cm  
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adverse effects of beta-adrenergic agonists as tocolytics   SOB, coughing, nasal stuffiness, tachypnea, pulmonary edema. Tachycardia, palpitations, myocardial ischemia, hypotension, muscle cramps, hyperinsulinemia nausea and vomiting.  
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antenatal corticosteroids use   accelerate fetal lung maturity  
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PROM   premature rupture of membranes; the spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labor at any gestational age  
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What is PPROM   preterm premature rupture of membranes; occurs when membranes rupture before the completion of 37 weeks of gestation  
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Chorioamnionitis   potentially life-threatening bacterial infection of the amniotic cavity; occurs most often occurs after membranes rupture or labor begins, as organisms that are part of the normal vaginal flora ascend into the amniotic cavity  
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precipitous labor   Labor that lasts less than 3 hours from the onset of contractions to the time of birth  
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CPD   Cephalopelvic disproportion; fetus cannot fit through the maternal pelvis. Either the baby is too big or the pelvis is too small, and the baby cannot be born though the birth canalβ€”meaning it will have to be born via C/S  
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most common malpositions   Right occipitoposterior (ROP) or left occipitoposterior (LOP)  
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most common malpresentation   Breech  
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frank breech   hips flexed, knees extended  
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complete breech   hips and knees flexed  
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footling breech   when one foot or both feet present before the buttocks  
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long-term problems such as cerebral palsy is higher among what sort of births   multiple births  
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position that the mother may assume during labor that promotes fetal descent and shortens the second stage of labor   Upright positions such as sitting or squating  
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ECV   external cephalic version; Turning the fetus to a vertex position by exertion of pressure on the fetus externally through the maternal abdomen.  
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external version precautions   U/S, NST, possible tocolytic agents and informed consent  
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external version contraindications   Uterine anomalies, previous C/S, CPD, placenta previa or any third trimester bleeding, multiple gestation, oligohydramnios, evidence of uteroplacental insufficiency, evidence of a nuchal cord (cord around the neck)  
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most common methods of induction used in the US   Intravenous oxytocin (Pitocin) and amniotomy, with prostaglandins increasingly being used  
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β€œscore” designation used to determine inducibility of a pregnancy   Bishop score: 13 point scale that considers the dilation, effacement, station, cervical consistency and cervical position  
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cervical ripening methods   Prostaglandin E1 & E2, laminaria tents and lamicel, amniotomy and membrane stripping  
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frequency temperature should be checked after amniotomy   Every 2 hours after rupture of membranes, more frequently if signs of symptoms of infection are noted  
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common adverse reactions of oxytocin infusions   Water intoxication, uterine hyperstimulation leading to excessive contractions or rupture with fetal effects being decreased FHR and hypoxia  
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non-invasive methods of augmenting the process of labor   Emptying the bladder, ambulation, position changes, relaxation measure, nourishment and hydration, hydrotherapy (only before invasive interventions)  
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hours after admission delivery is desired in active management of labor   12 hours  
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mechanical (operative) methods of assisting vaginal birth and expediting second stage   Forceps and vacuum extractor  
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labor management approach that results in a lower risk for C/S   Early continuous one-on-one support throughout labor  
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C/S incision where VBAC is permitted   low transverse  
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postterm pregnancy   A pregnancy extending past the 42nd week  
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indications for amnioinfusion   Oligohydramnios (or meconium, sometimes)  
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oligohydramnios   Abnormally small amount or absence of amniotic fluid; often indicative of fetal urinary tract defect.  
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β€œturtle sign”   Retraction of the fetal head against the perineum immediately following its emergence  
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maneuvers for dealing with shoulder dystocia   Suprapubic pressure, McRoberts and Gaskin maneuvers, and other position changes like squatting or lateral recumbent positions  
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McRoberts maneuver   used to deal with shoulder dystocia; woman's legs flexed apart, with knees on her abdomen causing the sacrum to straighten, and the symphysis pubis to rotate toward the mother's head. The angle of pelvic inclination is decreased, which frees the shoulder.  
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Gaskin maneuver   hand-and-knees position  
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Positioning to deal with a prolapsed cord   Knee-chest position or any that uses gravity to help keep the head of the fetus off the pelvis to prevent cord compression  
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causes of uterine rupture   Past classic-type C/S, Intense contractions possibly from augmentation, over-distended uterus, malpresentation, version forceps  
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uterine rupture manifestations   Possibly decels or other non-reassuring FHR patterns, bleeding, sharp, shooting or tearing abdominal pain, cessation of contractions and possibly shock.  
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complete or large rupture of the uterus treatment   Hysterectomy and blood replacement  
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amniotic fluid embolism manifestations   Acute dyspnea, restlessness, cyanosis, pulmonary edema respiratory arrest  
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proportion of women who have first occurrence depression during pregnancy   1/3  
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three critical cues in identifying depression in pregnant women   Psychological symptoms, a suicide plan, major disruptions in sleep patterns  
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medication for coughing that if taken with an SSRI can cause serotonin syndrome to develop   Dextromorphan  
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physical birth defects caused by benzodiazepines   Cleft lip and palate  
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greatest single preventable cause of mental retardation   Prenatal alcohol exposure  
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illicit drugs that may cause placental abruption   Methamphetamine, cocaine  
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postpartum depression manifestations   Fear, anxiety, despondency, irritability, jealousy, and difficulty falling asleep and returning to sleep when awakened  
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medication considerations clinicians and pharmacists should consider for women with PP psychosis   Medications with the greatest documentation of prior use, lower FDA risk category, few or no metabolites, and fewer side effects  
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medication category of choice for the treatment of PP onset of anxiety disorders   SSRIs  
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maternal factors that predispose an infant to birth injuries   maternal age (younger than 16 years old or older than 35); primigravida, uterine dysfunction leading to prolonged or precipitate labor, preterm or postterm labor, and cephalopelvic disproportion.  
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fetal factors that predispose the fetus to birth injuries   Macrosomia, multifetal gestation, abnormal or difficult presentation, congenital anomalies  
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bone most commonly fractured during birth   clavicle  
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most common type of paralysis associated with a difficult birth   Erb-Duchenne palsy, or brachial plexus injury  
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Erb-Duchenne palsy   Paralysis caused by physical injury to the upper brachial plexus, occurring most often in childbirth from forcible traction during birth. Also called Erb's palsy and brachial plexus injury.  
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Erb-Duchenne palsy manifestations   loss of sensation in the arm and paralysis and atrophy of the deltoid, the biceps, and the brachialis muscles.  
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percentage of infants born to mothers with diabetes at risk for complications   All infants of mothers with diabetes are at some risk for complications.  
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mortality rate of unborn babies resulting from one episode of maternal ketoacidosis   50% or more  
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Excessive shoulder size in macrosomic infants may lead to which birth problem   Shoulder dystocia.  
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hypoglycemic blood glucose levels in term infants   Less than 40 mg/dl  
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infant hypoglycemia is most common   The macrosomic or LGA baby, also preterm  
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percentage of infants of diabetic mothers with hypocalcemia and hypomagnesaemia   50%  
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infants of diabetic mothers risk of developing hyperbilirubinemia and polycythemia   Increased risk  
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Possible cause of elevated bilirubin levels in neonates   amount of hemoglobin in the tissue from bruising (and even in cephalhematomas)  
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most common form of neonatal infection   Pneumonia  
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common animals toxoplasmosis is found   cats, dogs, pigs, sheep, and cattle  
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Risk of HIV transmission to baby if no precautions or treatment is given   approximately 12% to 40%.  
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Risk of HIV transmission to baby from breastfeeding   1/3 to 1/2  
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Vaccinations for HIV exposed infants   All HIV-1–exposed infants should receive routine immunizations; however, HIV-1-infected infants can receive only inactivated vaccines and, in the absence of severe immunosuppression, the varicella vaccine.  
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infection that is the leading cause of neonatal morbidity and mortality in the US   Group B Streptococci (GBS)  
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source of neonatal exposure to E.Coli   maternal birth canal or rectum during birth, although it also can be hospital acquired through person-to-person transmission or from the hospital environment  
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major source of colonization by S. aureus in the hospital   hands of medical and nursing personnel (p. 854)  
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jaundice or icterus   yellow discoloration of the sclera and mucus membranes of the head and face  
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Pathologic jaundice or hyperbilirubinemia   the level of serum bilirubin that left untreated can result in acute acute bilirubin encephalopathy or kernicterus.  
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Acute bilirubin encephalopathy   Acute manifestations of bilirubin toxicity that occur during the first weeks after birth.  
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kernicterus   Bilirubin encephalopathy involving the deposit of unconjugated bilirubin in brain cells, resulting in death or impaired intellectual, perceptive, or motor function and adaptive behavior.  
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RhoGAM mechanism of action   destroys any fetal RBCs in the maternal circulation and blocks the maternal antibody production  
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When RhoGAM should be given to the Rh negative pregnant/perinatal woman   At 28 weeks of pregnancy, within 72 hours after delivery, after an invasive procedure or any time there is risk of fetal blood entering mom’s circulationβ€”like after an auto accident.  
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major cause of deaths in the US among infants younger than 1 year of age   major congenital defects  
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most common congenital heart defect and acyanotic lesion   VSD  
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most common congenital heart defect and cyanotic disorder   Tetralogy of Fallot  
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critical time period for cardiovascular development   3-8 weeks  
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cardiac anomaly manifestations seen in a neonate   Cyanosis, paleness, mottling on exertion, restlessness, lethargy, brady or tachycardia, abnormal heart rhythms, murmurs. Tachypnea, sternal or costal retractions, nasal flaring, grunting, dyspnea. Pg.875 and my study guide.  
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neural tube defects (NTDs) causes   Ingestions of valproic acid, methotrexate, excessive maternal heat (febrile or hot tub), maternal folic acid deficit and low s/e class  
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positions infant with a myelomeningocele is placed   a prone-kneeling position and the knees protected from skin breakdown (878)  
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dressing a myelomeningocele will be covered with   a sterile, moist, nonadherent dressing, and cared for using sterile technique  
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choanal atresia   A bony or membranous septum located between the nose and pharynx originating as a laryngeal web.  
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Choanal atresia treatment   Perforating the web by emergency surgery.  
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Age repair of cleft lip usually done   6 – 12 weeks or when the infant reaches 3600 – 4000 gms  
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Age repair of Cleft palate usually done   1 – 2 years of age  
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common maternal finding in a pregnant woman whose fetus has esophageal atresia or tracheoesophageal fistula   history of polyhydramnios because the fetus is unable to swallow the amniotic fluid  
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esophageal atresia or tracheoesophageal fistula manifestations   Excessive oral secretions, drooling, feeding intolerance, coughing and gagging when taking anything orally, leading to choking and respiratory distress in some cases.  
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chronic illness in which meconium ileus is a manifestation   Cystic Fibrosis  
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device used to treat congenital hip dysplasia   Pavlik Harness  
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medical intervention for clubfoot   serial casting  
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Polydactyly treatment if there is no bone present in the digit   Tied with suture and allowed to fall off  
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most common anomaly of the penis   Hypopspadias  
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reason infants with hypospadias are not circumcised   The foreskin may be needed for surgical repair  
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periodic breathing   Respiratory pattern commonly seen in preterm infants where they exhibit 5- to 10-second respiratory pauses followed by 10 to 15 seconds of compensatory rapid respirations  
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factors that cause increased risk for neonates to be susceptible to RDS   Perinatal asphyxia, hypovolemia, male gender, Caucasian race, maternal diabetes (types 1 and 2), second-born twin, familial predisposition, maternal hypotension, cesarean birth without labor, hydrops fetalis, and third-trimester bleeding  
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cause of RDS   lack of pulmonary surfactant, which leads to progressive atelectasis, loss of functional residual capacity, and a ventilation-perfusion imbalance with an uneven distribution of ventilation  
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cause of having insufficient amounts of surfactant   not making enough, Abnormal composition and function, and disruption of production or a combination of factors  
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RDS cascade affect on the fetal structures of the heart   It could reopen the foramen ovale and ductus arteriosis  
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Reason RDS is self-limiting and decreases after 72 hours   Because of production of surfactant in the type 2 cells of the alveoli  
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RDS management   Positive pressure ventilation, bubble CPAP, oxygen therapy, exogenous surfactant  
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Intraventricular hemorrhage nursing care interventions   decrease risk of bleeding and supportive care; Head in midline position, HOB elevated slightly, avoid rapid IV infusions, monitor B/P and avoiding or minimizing activities that increase cerebral blood flow. Swaddle or comfort for painful procedures  
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necrotizing enterocolitis (NEC)   Acute inflammatory bowel disorder that occurs primarily in preterm or low-birth-weight neonates.  
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NEC causes   Perinatal asphyxia, colonization with harmful bacteria, and enteral feeding  
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Substance with protective effect from NEC   Breast milk  
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Age NEC usually manifest in term and preterm infants   Typically 1 – 3 days after birth for term; within 7 days for  
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GI Manifestations of NEC are   Abdominal distension, bile-stained gastric aspirate, vomiting bile or blood, grossly bloody stools, abdominal tenderness and erythema of the abdominal wall  
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cause of the air in the bowels and abdomen that is seen on X-rays of the abdomen   Gases produced by bacteria invading the intestinal walls  
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NEC management   NPO, O/G tube to suction, parenteral nutrition, control infection with handwashing, antibiotics, and surgical resection if needed  
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Grief   A cluster of painful emotional and related behavioral and physical responses experienced following a major loss or death; also called bereavement  
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three phases of grief   Acute distress, intense grief and reorganization  
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handling of a dead baby   When bringing the baby to the parents, it is important to treat the baby as one would a live baby.  
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physical needs of a postpartum bereaved mother vs. non-bereaved mother   The mother is still postpartum so has the same physical needs; yet will have no baby to nurse and will still have afterpains and the typical PP changes  
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When grieving parents should be referred to counseling   When they show signs of complicated grief or posttraumatic stress  
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