RNC OB INPATIENT OB CERTIFICATION
COMPREHENSIVE REVIEW 2026 QUESTIONS
AND DETAILED SOLUTIONS
◉ what is the normal cardiac process for pregnancy Answer:
Normally, cardiac output increases, stroke volume increases, HR
increases, vascular resistance decreases
◉ most common underlying issue with maternal cardiac disease is
Answer: congenital heart defects/disease
- pregnancy is hard on the heart, pre conditions make it harder
- Increase risk of MI, CHF, pulmonary edema, HTN with underlying
disease
◉ what is stroke volume Answer: is the amount of blood pumped
with each beat and this effects perfusion to uterine arteries and thus
fetal perfusion. NOTE: Problem, uterus is not considered a vital
organ!
◉ Pre-E and Stroke volume Answer: Problem with Pre-E is that due
to all the pressure and duration of time, stroke volume is
decreased>>> resulting in oligohydramnios to fetus
,◉ plasma volume increases ______ in pregnancy Answer: 50-60%
- increase workload on heart> can lead to CHF
◉ s/s of cardiac disease: Answer: 1. Dyspnea- limits normal activity
2. Progressive orthopnea/nocturnal dyspnea
3. Chest pain with activity- ischemia
4. excessive swelling and decreased urine output
◉ cardiac output = Answer: stroke volume x heart rate
◉ Prediction of cardiac events Answer: NOPE
- N= NYHA class > 2 (The higher the classification the more marked
symptoms with activity>>> Class 4 is the worst) with class 3 and 4
with vacuum/forceps or C/S as route of delivery
- O= Obstruction Left heart
- P= Prior cardiac event before pregnancy
- E=Ejection factor <40%
◉ cardiomyopothy Answer: heart muscle is thick and enlarged --->
leading to back flow and pulmonary edema
,◉ cardiomyopothy time period Answer: Last month of pregnancy or
5 months post delivery, 5th leading cause of death.... Future
pregnancy counseling if this occurs. HIGH, HIGH RISK OF
MATERNAL DEATH.
◉ why are DVTs/PEs common in pregnancy Answer: blood is
hypercoaguable
◉ treatment for cardiac concerns during pregnancy focuses on
Answer: decreasing sodium, avoiding anemia, and decreasing
anxiety
◉ tips for laboring with the cardiac mom Answer: - use cation with
epdural preloads or IVF boluses
- I&O, VS, O2 sat
- Pain mgt- epidural - Shorten 2nd stage, maybe vaccuum
- Vaginal delivery preferred
- O2
- If prosthetic valve/endocarditis>>> Need Ampicllin and
Gentamicin with labor
◉ why is the cardiac mom at high risk for CHF pp? Answer:
Demands PP increase over 60% in first 5 minutes 40% next 1 hour
(because all the blood that was going to baby and placenta is going
back to her)
, I&Os, TEDs/SCDs/AB as ordered
◉ Anemia Answer: hgB <10.5-11
HCT <32-33%
oxygen demands to tissue is not met because HGB binds oxygen
◉ s/s of anemia Answer: pale, fatigue, shortness of breath,
weakness, PICA, tachycardia, HEADACHE
◉ causes/types of anemia Answer: 1- Iron deficiency (not enough
iron to make HGB) HEADACHES AND ANEMIA>> Iron for serotonin
and lack of O2
2- B12( pernicious anemia)>>> gastrectomy/bypass and vegetarians
3- Folate Deficiency>>>>lack citrus fruits and grains
◉ thrombocytopenia Answer: < 100 K PLTs
due to decreased plt production or early destruction of PLTs (spleen)
◉ treatment for thrombocytopenia Answer:
Dexamethasone/Prednisone: orally/IM to delay spleen from filtering
out can increase up to 50K in one week
COMPREHENSIVE REVIEW 2026 QUESTIONS
AND DETAILED SOLUTIONS
◉ what is the normal cardiac process for pregnancy Answer:
Normally, cardiac output increases, stroke volume increases, HR
increases, vascular resistance decreases
◉ most common underlying issue with maternal cardiac disease is
Answer: congenital heart defects/disease
- pregnancy is hard on the heart, pre conditions make it harder
- Increase risk of MI, CHF, pulmonary edema, HTN with underlying
disease
◉ what is stroke volume Answer: is the amount of blood pumped
with each beat and this effects perfusion to uterine arteries and thus
fetal perfusion. NOTE: Problem, uterus is not considered a vital
organ!
◉ Pre-E and Stroke volume Answer: Problem with Pre-E is that due
to all the pressure and duration of time, stroke volume is
decreased>>> resulting in oligohydramnios to fetus
,◉ plasma volume increases ______ in pregnancy Answer: 50-60%
- increase workload on heart> can lead to CHF
◉ s/s of cardiac disease: Answer: 1. Dyspnea- limits normal activity
2. Progressive orthopnea/nocturnal dyspnea
3. Chest pain with activity- ischemia
4. excessive swelling and decreased urine output
◉ cardiac output = Answer: stroke volume x heart rate
◉ Prediction of cardiac events Answer: NOPE
- N= NYHA class > 2 (The higher the classification the more marked
symptoms with activity>>> Class 4 is the worst) with class 3 and 4
with vacuum/forceps or C/S as route of delivery
- O= Obstruction Left heart
- P= Prior cardiac event before pregnancy
- E=Ejection factor <40%
◉ cardiomyopothy Answer: heart muscle is thick and enlarged --->
leading to back flow and pulmonary edema
,◉ cardiomyopothy time period Answer: Last month of pregnancy or
5 months post delivery, 5th leading cause of death.... Future
pregnancy counseling if this occurs. HIGH, HIGH RISK OF
MATERNAL DEATH.
◉ why are DVTs/PEs common in pregnancy Answer: blood is
hypercoaguable
◉ treatment for cardiac concerns during pregnancy focuses on
Answer: decreasing sodium, avoiding anemia, and decreasing
anxiety
◉ tips for laboring with the cardiac mom Answer: - use cation with
epdural preloads or IVF boluses
- I&O, VS, O2 sat
- Pain mgt- epidural - Shorten 2nd stage, maybe vaccuum
- Vaginal delivery preferred
- O2
- If prosthetic valve/endocarditis>>> Need Ampicllin and
Gentamicin with labor
◉ why is the cardiac mom at high risk for CHF pp? Answer:
Demands PP increase over 60% in first 5 minutes 40% next 1 hour
(because all the blood that was going to baby and placenta is going
back to her)
, I&Os, TEDs/SCDs/AB as ordered
◉ Anemia Answer: hgB <10.5-11
HCT <32-33%
oxygen demands to tissue is not met because HGB binds oxygen
◉ s/s of anemia Answer: pale, fatigue, shortness of breath,
weakness, PICA, tachycardia, HEADACHE
◉ causes/types of anemia Answer: 1- Iron deficiency (not enough
iron to make HGB) HEADACHES AND ANEMIA>> Iron for serotonin
and lack of O2
2- B12( pernicious anemia)>>> gastrectomy/bypass and vegetarians
3- Folate Deficiency>>>>lack citrus fruits and grains
◉ thrombocytopenia Answer: < 100 K PLTs
due to decreased plt production or early destruction of PLTs (spleen)
◉ treatment for thrombocytopenia Answer:
Dexamethasone/Prednisone: orally/IM to delay spleen from filtering
out can increase up to 50K in one week
