NCC EFM LATEST EXAMS TEST PAPER QUESTIONS AND
ANSWERS RATED A+
✔✔Treatment for preterm labor - ✔✔1) Steroids (BMZ, DMZ): allows for synthesis of
surfactant & ↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give steroids
-SE: hyperglycemia, hypotension, tachycardia
-Not given w ↑HR, bleeding, uncontrolled diabetes
3) Nifedipine / procardia (Ca channel blocker): ↓ contractility of smooth muscles,
vasodilates
4) Indocin (NSAID, prostaglandin inhibitor): tocolytic
-AE: oligo, GI upset, renal failture, PP hemorrhage
5) Mag: neuroprotection, vasodilates ↑ blood flow to brain, ↓ risk of CP
-can cause fetal bradycardia & ↓ variability
✔✔Postdates pregnancy - ✔✔>42 wks
-risk of oligo, ↓ placental perfusion, & meconium aspiration
-newborn appearance: peeling dry wrinkled skin, long nails, thinner (weight loss)
-↑ rate of c/s, recommended to induce at 41 wks
-↑ late decels (old placenta) & variables (oligo)
✔✔Hypertension (HTN) - ✔✔BP > 140/90
-tx w Ca channel blockers, thiazides, BB
-avoid ACE inhibitors & ARBs (congenital defect)
1) Chronic: present prior to pregnancy
-risk of superimposed preeclampsia, abruption, stroke (endothelial damage to vessels),
stress on L ventricle (to overcome pressure)
2) Gestational: begins after 20 wks, returns to normal PP (no proteinuria: <300mg/<0.3
pcr)
-↑ BP is sustained 6 hrs apart
-risk of poor perfusion, SGA
✔✔Preeclampsia & HELLP - ✔✔↑BP & proteinuria or a s/s: poor implantation of
arterioles & trophoblasts cause ↓ blood flow to placenta, ↑ BP to compensate
-mild: 140/90, protein 300mg/24hr or 1-2g dipstick
-severe: 160/110, protein 5g/24hr or 3g dipstick, N/V, HA, hyperreflexia, clonus
-prevent w baby ASA in 1st trimester (vasodilate)
-damages kidneys, liver, heart, lungs, blood cells & vessels, neuro (cerebral edema),
optic nerve
-AE: oligo, IUGR, pulmonary edema, HA, epigastric pain, blurry vision, abruption, IUFD,
seizure, liver rupture, renal failure, DIC, CVA
-can cause eclampsia (seizure) from cerebral ischemia & edema, may abrupt or rapidly
dilate
, -HELLP: hemolysis, ↑ liver enzymes (AST, ALT), ↓ platelets (<100k)
✔✔Treatment of preeclampsia & HTN - ✔✔-Induce by 39 wks
1) Mag: muscle relaxant used to prevent seizure
-loading dose 4-6g/hr, maintenance 2-4g/hr
-therapeutic lvl: 4-8 mEq/L
-↓ FHR variability, hypotonia, resp depression
-antidote: calcium gluconate 1g/10ml D5W
-SE: NV, flushing, HA, ↓ reflexes, pulmonary edema, hypotension, resp depression,
oliguria
2) BB: don't use w asthma or ↓ HR, caution w diabetes (masks hypoglycemia)
3) Hydralazine: relaxes smooth muscles
-can cause rebound tachycardia
4) Ca channel blocker (procardia, nifedipine): relaxes smooth muscles, ↑ renal perfusion
& urinary output
5) Valium or keppra w eclampsia
✔✔Diabetes - ✔✔-Excess glucose delays surfactant production (RDS)
-T1 & T2 more likely to cause congenital abnormalities (heart & neural tube defect)
-Hypoglycemia at birth: glucose crosses placenta but not insulin, fetus has ↑ insulin
production & bottoms out after delivery
-Risk of LGA, fetal acidosis, impaired perfusion, polycythemia, demise, UTI,
polyhydramnios, abruption, PPH, Pre-E (r/t vascular damage), miscarriage
-Induce at 38-39 wks
✔✔Types of diabetes - ✔✔1) T1: insulin dependent (don't secrete insulin)
2) T2: insulin resistant
3) Gestational: placenta acts as antagonist to insulin, demand for production ↑ 2-3x
-resolves w placental expulsion
✔✔Infection - ✔✔1) GBS: bacteria normally found in the vagina & rectum, typically
harmless but can pass to fetus during delivery
-can cause meningitis, pneumonia, or sepsis
-screened from 36-38 wks, tx w antibiotics during labor if positive
2) Chorioamnionitis: infection of membranes, can cause PTD, requires antibiotic tx (risk
w PROM)
3) HepB: give infant hepB vax & HBIG
4) HIV: infant will need antivirals, no breastfeed
5) TORCH (toxoplasmosis, other, rubella, cytomegalovirus, herpes): commonly
associated w congenital abnormalities
-other: syphillis, varicella zoster, parvovirus B19
✔✔Maternal obesity - ✔✔-Risk of diabetes, preeclampsia, DVT, infection, PPH (↑
estrogen), miscarriage
-Fetus: NTD, heart defect, macrosomia (4000g, 8-13), PTD
-Recommended weight gain: 11-20 lbs (compared to 25-35 in average weight)
ANSWERS RATED A+
✔✔Treatment for preterm labor - ✔✔1) Steroids (BMZ, DMZ): allows for synthesis of
surfactant & ↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give steroids
-SE: hyperglycemia, hypotension, tachycardia
-Not given w ↑HR, bleeding, uncontrolled diabetes
3) Nifedipine / procardia (Ca channel blocker): ↓ contractility of smooth muscles,
vasodilates
4) Indocin (NSAID, prostaglandin inhibitor): tocolytic
-AE: oligo, GI upset, renal failture, PP hemorrhage
5) Mag: neuroprotection, vasodilates ↑ blood flow to brain, ↓ risk of CP
-can cause fetal bradycardia & ↓ variability
✔✔Postdates pregnancy - ✔✔>42 wks
-risk of oligo, ↓ placental perfusion, & meconium aspiration
-newborn appearance: peeling dry wrinkled skin, long nails, thinner (weight loss)
-↑ rate of c/s, recommended to induce at 41 wks
-↑ late decels (old placenta) & variables (oligo)
✔✔Hypertension (HTN) - ✔✔BP > 140/90
-tx w Ca channel blockers, thiazides, BB
-avoid ACE inhibitors & ARBs (congenital defect)
1) Chronic: present prior to pregnancy
-risk of superimposed preeclampsia, abruption, stroke (endothelial damage to vessels),
stress on L ventricle (to overcome pressure)
2) Gestational: begins after 20 wks, returns to normal PP (no proteinuria: <300mg/<0.3
pcr)
-↑ BP is sustained 6 hrs apart
-risk of poor perfusion, SGA
✔✔Preeclampsia & HELLP - ✔✔↑BP & proteinuria or a s/s: poor implantation of
arterioles & trophoblasts cause ↓ blood flow to placenta, ↑ BP to compensate
-mild: 140/90, protein 300mg/24hr or 1-2g dipstick
-severe: 160/110, protein 5g/24hr or 3g dipstick, N/V, HA, hyperreflexia, clonus
-prevent w baby ASA in 1st trimester (vasodilate)
-damages kidneys, liver, heart, lungs, blood cells & vessels, neuro (cerebral edema),
optic nerve
-AE: oligo, IUGR, pulmonary edema, HA, epigastric pain, blurry vision, abruption, IUFD,
seizure, liver rupture, renal failure, DIC, CVA
-can cause eclampsia (seizure) from cerebral ischemia & edema, may abrupt or rapidly
dilate
, -HELLP: hemolysis, ↑ liver enzymes (AST, ALT), ↓ platelets (<100k)
✔✔Treatment of preeclampsia & HTN - ✔✔-Induce by 39 wks
1) Mag: muscle relaxant used to prevent seizure
-loading dose 4-6g/hr, maintenance 2-4g/hr
-therapeutic lvl: 4-8 mEq/L
-↓ FHR variability, hypotonia, resp depression
-antidote: calcium gluconate 1g/10ml D5W
-SE: NV, flushing, HA, ↓ reflexes, pulmonary edema, hypotension, resp depression,
oliguria
2) BB: don't use w asthma or ↓ HR, caution w diabetes (masks hypoglycemia)
3) Hydralazine: relaxes smooth muscles
-can cause rebound tachycardia
4) Ca channel blocker (procardia, nifedipine): relaxes smooth muscles, ↑ renal perfusion
& urinary output
5) Valium or keppra w eclampsia
✔✔Diabetes - ✔✔-Excess glucose delays surfactant production (RDS)
-T1 & T2 more likely to cause congenital abnormalities (heart & neural tube defect)
-Hypoglycemia at birth: glucose crosses placenta but not insulin, fetus has ↑ insulin
production & bottoms out after delivery
-Risk of LGA, fetal acidosis, impaired perfusion, polycythemia, demise, UTI,
polyhydramnios, abruption, PPH, Pre-E (r/t vascular damage), miscarriage
-Induce at 38-39 wks
✔✔Types of diabetes - ✔✔1) T1: insulin dependent (don't secrete insulin)
2) T2: insulin resistant
3) Gestational: placenta acts as antagonist to insulin, demand for production ↑ 2-3x
-resolves w placental expulsion
✔✔Infection - ✔✔1) GBS: bacteria normally found in the vagina & rectum, typically
harmless but can pass to fetus during delivery
-can cause meningitis, pneumonia, or sepsis
-screened from 36-38 wks, tx w antibiotics during labor if positive
2) Chorioamnionitis: infection of membranes, can cause PTD, requires antibiotic tx (risk
w PROM)
3) HepB: give infant hepB vax & HBIG
4) HIV: infant will need antivirals, no breastfeed
5) TORCH (toxoplasmosis, other, rubella, cytomegalovirus, herpes): commonly
associated w congenital abnormalities
-other: syphillis, varicella zoster, parvovirus B19
✔✔Maternal obesity - ✔✔-Risk of diabetes, preeclampsia, DVT, infection, PPH (↑
estrogen), miscarriage
-Fetus: NTD, heart defect, macrosomia (4000g, 8-13), PTD
-Recommended weight gain: 11-20 lbs (compared to 25-35 in average weight)
