AMCB Study Material: Comprehensive Midwifery Exam Review Guide
Methergine - correct answer ✔✔0.2 mg IM
May repeat in 5 min
Then q 2-4 hr
Onset of action: 2-5 min
Peaks @ 20-30 min
*CI in HTN/pre-e*
Hemabate - correct answer ✔✔250 mcg IM
May repeat q 15-90 min, x 8 doses if needed
Peaks @ 30 min
*CI in asthma*
Misoprostol (Cytotec) - correct answer ✔✔600-800 mcg SL or 800-1000 mcg per rectum x 1
dose
Onset of action: 3-5 min
Peaks @ 40-60 min (rectal); @ 30 min (SL)
TXA - correct answer ✔✔1 gm IV, may repeat after 30 min.
Inhibits fibrinolysis so has potential risk of thrombosis.
*CI w/clotting disorders!*
Trichomoniasis: Tx during pregnancy - correct answer ✔✔Metronidazole 2 g PO × 1 during any
trimester.
,Trichomoniasis: tx (not in preg) - correct answer ✔✔Metronidazole 2 g PO x 1
Tinidazole 2 g PO x 1
or
Metronidazole 500 mg PO BID x 7 days
Bacterial Vaginosis: Tx during pregnancy - correct answer ✔✔Metronidazole 500 mg PO BID x 7
days
or
Metro gel 0.75% vag suppos @ hs x 5 days
Other alternatives:
Tinidazole 2 g PO x 2 days
Tinidazole 1 g PO x 5 days
Clindamycin 300 mg PO BID x 7 days
Clindamycin ovules 100 mg intravaginally @ hs x 3 days
Vulvovaginal candidiasis - correct answer ✔✔Fluconazole 150 mg PO x 1 *(avoid in pregnancy)*
Rx intravaginal:
Butoconazole, terconazole
OTC intravaginal:
Clotrimazole, miconazole, tioconazole
Chlamydia: Tx (not in pregnancy) - correct answer ✔✔Azithromycin 1 g PO x 1
or
Doxycycline 100 mg PO BID x 7 days
or
,Erythromycin 500 mg PO QID x 7 days
Chlamydia: Tx in pregnancy - correct answer ✔✔Azithromycin 1 g PO x 1
Amoxicillin 500 mg PO TID x 7 days
Erythromycin 500 mg PO QID x 7 days
Doxyclycline= CI in pregnancy
Condyloma Acuminata/Anogenital Warts: Tx in pregnancy - correct answer ✔✔Wart removal
may be considered
Imiquimod=low risk but should be avoided d/t scarcity of data
Podofilox, podophyllin, sinetechins should be avoided!
Provider administered tx of warts/HPV - correct answer ✔✔-Cryotherapy w/liquid nitrogen-
repeat 1-2 weeks x 6 wks
-Surgical removal w/tangential shave excision, curretage, laser, or electrosurgery
-Trichloracetic or bichloroacetic acid
Patient applied treatment for warts/HPV - correct answer ✔✔(use only on external warts)
-Imiquimod 3.75%-5% cream-- safety in preg unknown
-Podofilox 0.5% gel/sol'n--safety in preg unknown
-Sinecatechins 15% ointment
Firstline Tx for BP >160/110 - correct answer ✔✔Labetalol
Hydralazine
Nifedipine
*Sodium nitroprusside when HTN resistant to other meds--admin by anesthesia, MFM, etc*
, AP tx of HIV positive pt - correct answer ✔✔HAART
1. Two nucleoside analogues (zidovudine, didanosine, zalcitabine, or lamivudine)
-AND-
2. Protease inhibitor (indinavir, ritonavir, etc)
*Start after first tri unless need tx now*
# of days after birth it can take for sx's of drug withdrawal in neonates to develop - correct
answer ✔✔14 days
Tell me about parvovirus - correct answer ✔✔Parvovirus spreads through respiratory
secretions, such as saliva, sputum, or nasal mucus; when an infected person coughs or sneezes;
through blood or blood products; and vertically from pregnant person to infant.
There is no cure/treatment
Most common complication:
cholestasis of pregnancy - correct answer ✔✔-occurs in 2nd/3rd tri usually
-char. by pruritus and elevation in serum bile acid conc.
-onset-- dev of pruritus- may be intolerable; often generalized but predominates on palms and
soles of the feet and is worse at night.
HIV testing - correct answer ✔✔Antibody testing:
1. screening- EIA or ELISA (checks for proteins the body makes in presence of HIV
2. CDC no longer recommends Western Blot as form of confirmation testing
Direct Viral Screens
1. Nucleic acid testing if suspect acute retrovirus syndrome or recent infection
2. Confirm w/subsequent ab testing to document seroconversion
Methergine - correct answer ✔✔0.2 mg IM
May repeat in 5 min
Then q 2-4 hr
Onset of action: 2-5 min
Peaks @ 20-30 min
*CI in HTN/pre-e*
Hemabate - correct answer ✔✔250 mcg IM
May repeat q 15-90 min, x 8 doses if needed
Peaks @ 30 min
*CI in asthma*
Misoprostol (Cytotec) - correct answer ✔✔600-800 mcg SL or 800-1000 mcg per rectum x 1
dose
Onset of action: 3-5 min
Peaks @ 40-60 min (rectal); @ 30 min (SL)
TXA - correct answer ✔✔1 gm IV, may repeat after 30 min.
Inhibits fibrinolysis so has potential risk of thrombosis.
*CI w/clotting disorders!*
Trichomoniasis: Tx during pregnancy - correct answer ✔✔Metronidazole 2 g PO × 1 during any
trimester.
,Trichomoniasis: tx (not in preg) - correct answer ✔✔Metronidazole 2 g PO x 1
Tinidazole 2 g PO x 1
or
Metronidazole 500 mg PO BID x 7 days
Bacterial Vaginosis: Tx during pregnancy - correct answer ✔✔Metronidazole 500 mg PO BID x 7
days
or
Metro gel 0.75% vag suppos @ hs x 5 days
Other alternatives:
Tinidazole 2 g PO x 2 days
Tinidazole 1 g PO x 5 days
Clindamycin 300 mg PO BID x 7 days
Clindamycin ovules 100 mg intravaginally @ hs x 3 days
Vulvovaginal candidiasis - correct answer ✔✔Fluconazole 150 mg PO x 1 *(avoid in pregnancy)*
Rx intravaginal:
Butoconazole, terconazole
OTC intravaginal:
Clotrimazole, miconazole, tioconazole
Chlamydia: Tx (not in pregnancy) - correct answer ✔✔Azithromycin 1 g PO x 1
or
Doxycycline 100 mg PO BID x 7 days
or
,Erythromycin 500 mg PO QID x 7 days
Chlamydia: Tx in pregnancy - correct answer ✔✔Azithromycin 1 g PO x 1
Amoxicillin 500 mg PO TID x 7 days
Erythromycin 500 mg PO QID x 7 days
Doxyclycline= CI in pregnancy
Condyloma Acuminata/Anogenital Warts: Tx in pregnancy - correct answer ✔✔Wart removal
may be considered
Imiquimod=low risk but should be avoided d/t scarcity of data
Podofilox, podophyllin, sinetechins should be avoided!
Provider administered tx of warts/HPV - correct answer ✔✔-Cryotherapy w/liquid nitrogen-
repeat 1-2 weeks x 6 wks
-Surgical removal w/tangential shave excision, curretage, laser, or electrosurgery
-Trichloracetic or bichloroacetic acid
Patient applied treatment for warts/HPV - correct answer ✔✔(use only on external warts)
-Imiquimod 3.75%-5% cream-- safety in preg unknown
-Podofilox 0.5% gel/sol'n--safety in preg unknown
-Sinecatechins 15% ointment
Firstline Tx for BP >160/110 - correct answer ✔✔Labetalol
Hydralazine
Nifedipine
*Sodium nitroprusside when HTN resistant to other meds--admin by anesthesia, MFM, etc*
, AP tx of HIV positive pt - correct answer ✔✔HAART
1. Two nucleoside analogues (zidovudine, didanosine, zalcitabine, or lamivudine)
-AND-
2. Protease inhibitor (indinavir, ritonavir, etc)
*Start after first tri unless need tx now*
# of days after birth it can take for sx's of drug withdrawal in neonates to develop - correct
answer ✔✔14 days
Tell me about parvovirus - correct answer ✔✔Parvovirus spreads through respiratory
secretions, such as saliva, sputum, or nasal mucus; when an infected person coughs or sneezes;
through blood or blood products; and vertically from pregnant person to infant.
There is no cure/treatment
Most common complication:
cholestasis of pregnancy - correct answer ✔✔-occurs in 2nd/3rd tri usually
-char. by pruritus and elevation in serum bile acid conc.
-onset-- dev of pruritus- may be intolerable; often generalized but predominates on palms and
soles of the feet and is worse at night.
HIV testing - correct answer ✔✔Antibody testing:
1. screening- EIA or ELISA (checks for proteins the body makes in presence of HIV
2. CDC no longer recommends Western Blot as form of confirmation testing
Direct Viral Screens
1. Nucleic acid testing if suspect acute retrovirus syndrome or recent infection
2. Confirm w/subsequent ab testing to document seroconversion
