BIOL 36019 / OB HESI
STUDY GUIDE
OB HESI STUDY GUIDE
Version 1
1. Basic nursing skills/safety/newborn – radiant warmer – temperature probe
If the infant does not remain w/the mother during the 1st 1-2 hours after birth, the
infant is placed under a radiant warmer or incubator until body temperature stabilizes
Skin temperature is used as the point of control – maintained b/t 36 ̊ and 37 ̊
A thermistor probe (automatic sensor) is placed on the upper quadrant of the
abdomen immediately below the right or left costal margin
o Probe ensures detection of minor temperature changes before a dramatic
change in temperature develops
o Probe needs to be checked periodically to make sure it is in contact w/infants
skin
2. Med administration – math
3. Med administration – math
4. Antepartum – contractions – action
Frequent position changes
Encourage voiding minimum q2 hours
Encourage deep cleansing breaths
Provide pharmacological and non-pharmacological comfort measures
Provide maternal/fetal monitoring
Discourage pushing until fully dilated
5. Antepartum – CST
Contraction stress test (CST) – purpose is to identify the jeopardized fetus that is
stable at rest but showed evidence of compromise after stress. Woman is seated and
reclined (semi-Fowler). She is monitored electronically w/fetal ultrasound transducer
and uterine tocodynamometer. Tracing is observed for 10-20 minutes for baseline rate.
Two methods of the CST are the nipple-stimulation contraction test and the more
common oxytocin stimulated contraction test. If no late decelerations are observed w/
contractions, the findings are considered negative. Repetitive late decelerations (50%
or more of contractions) render a positive result
6. Antepartum – fundal height – action
Used as one indicator of fetal growth
Provides a gross estimate of the duration of pregnancy
o The height of the fundus in cm is approximately the same as the number of
weeks of gestation
Measurement is made from the upper border of the symphysis pubis to the upper
border of the fundus
, BIOL 36019 / OB HESI
STUDY GUIDE
Woman should have emptied her bladder and be lying supine with knees in flexed
position
7. Antepartum – gestational HTN
Gestational HTN - the onset of HTN w/out proteinuria after week 20 of pregnancy
o Systolic > 140, diastolic > 90
HTN should be recorded on at least two separate occasions at least 4-6 hours apart
and within a 1-week period
Occurs more frequently in women w/multifetal pregnancies
Women w/gestational HTN have no evidence of preexisting HTN, and their BPs return
to normal levels within 6 weeks after giving birth
8. Antepartum – indigestion – third trimester
It is common for indigestion to start in the 3rd trimester d/t the growing baby pushing
the stomach upward toward the esophagus
o Relief measures
Wait at least an hour after meals before lying down
Eat several small meals, take your time
Avoid foods that cause indigestion (fried/greasy foods)
Avoid caffeine/alcohol b/c they can aggravate indigestion
Don’t smoke
9. Antepartum - infertility – drug therapy
Action is often directed at stimulating ovulation or enhancing ovulation so more
oocytes mature
M/C medications include: clomiphene citrate, hMG, FSH, hCG, and GnRH
o Prevalence of multiple pregnancies w/use of these meds is > 25%
10. Antepartum – pregnancy – weight gain
Maternal and fetal risks increase when mom is severely over or under weight
Underweight women are more likely to have preterm labor and to give birth to LBW
infants
Obesity – increases likelihood of preeclampsia and gestational diabetes
Appropriate measure of evaluating weight gain is BMI
o <18.5 = underweight
o 18.5-24.9 = normal
o 25-29.9 = overweight
o 30 or > = obese
Pattern of weight gain
o 1st trimester – average weight gain is 1-2kg
o Thereafter the recommended weight gain increases to about 0.5 kg/week for
an underweight woman and 0.4 kg/week for a woman of normal weight
, BIOL 36019 / OB HESI
STUDY GUIDE
o The recommended weekly weight gain for overweight women during the 2nd
and 3rd trimester is 0.3 kg/week, and 0.2 kg for obese women
11. Antepartum – smoking in pregnancy
Smoking is associated w/an increased frequency of preterm labor, PROM, abruption
placentae, Placenta Previa, and fetal death
Encourage women to quit or cut down if they smoke and to avoid second hand smoke
12. Antepartum – supine hypotension
Supine hypotensive syndrome – when lying flat, a decrease in systolic of >30mmHg d/
t suppression of the vena cava, causes faintness
o Common in the 2nd and 3rd trimester b/c of the increasing weight of the baby;
lying in the supine position can cause compression of the inferior vena cava
o Instruct client to use a side lying position with knees slightly flexed, and
change positions slowly
13. Antepartum – triple screen
In the 2nd trimester, triple screening is available for fetuses w/Trisomy 21 and Trisomy
18
Screen is performed at 16-18 weeks
Measures the levels of 3 maternal serum markers; MSAFP, unconjugated estriol, and
hCG
o Fetus w/Trisomy 21 – MSAFP and unconjugated estriol levels are low
o Low levels of in all 3 markers are associated w/Trisomy 18 (Edward’s
syndrome)
14. Antepartum – ultrasound at 20 weeks
Uses
o Establish/confirm dates
o Confirm viability
o Detect polyhdraminos/oligohydraminos
o Detect congenital anomalies
o Detect intrauterine growth restriction
o Assess placental placement
o Used for visualization during amniocentesis
15. Antepartum – vaginal discharge – pregnancy
Leukorrhea
o Hormonally stimulated cervix becomes hypertrophic and hyperactive,
producing abundant amount of mucus
, BIOL 36019 / OB HESI
STUDY GUIDE
Not preventable, do not douche, wear perineal pads, wipe from front to
back, report to PCP if accompanied by pruritus, foul odor, or change in
character or color
16. Antepartum – Intrapartum – UTI
UTIs are a common medical complication of pregnancy; about 20% of all pregnancies
Instruct women taking ABX to finish the entire course of meds, take meds on time and
around the clock so the medication levels remain constant
o Many women will develop a yeast infection while taking ABX b/c the ABX kills
normal flora. We should encourage them to include yogurt, cheese, or milk
containing active acidophilus while on their ABX regimen
UTI prevention
o Wipe from front to back
o Cotton crotch underwear
o Avoid tight-fitting clothes
o Limit time spent in damp exercise clothes
o Avoid bath salts/bubble baths
o Avoid colored/scented toilet tissue
o Don’t wait to void
o Void before and after intercourse and before going to bed at night
o Drink at least 8 glasses of water daily
17. Intrapartum – back labor – relief
Physiology
o Exaggerated lumbar and cervicothoracic curves caused by change in center of
gravity d/t enlarging abdomen
Relief
o Maintain good posture and body mechanics
o Avoid fatigue
o Wear low heeled shoes
o Abdominal support may be useful
o Conscious relaxation
o Sleep on firm mattress
o Apply local heat/ice
o Get back rubs
o Do pelvic tilt exercises
STUDY GUIDE
OB HESI STUDY GUIDE
Version 1
1. Basic nursing skills/safety/newborn – radiant warmer – temperature probe
If the infant does not remain w/the mother during the 1st 1-2 hours after birth, the
infant is placed under a radiant warmer or incubator until body temperature stabilizes
Skin temperature is used as the point of control – maintained b/t 36 ̊ and 37 ̊
A thermistor probe (automatic sensor) is placed on the upper quadrant of the
abdomen immediately below the right or left costal margin
o Probe ensures detection of minor temperature changes before a dramatic
change in temperature develops
o Probe needs to be checked periodically to make sure it is in contact w/infants
skin
2. Med administration – math
3. Med administration – math
4. Antepartum – contractions – action
Frequent position changes
Encourage voiding minimum q2 hours
Encourage deep cleansing breaths
Provide pharmacological and non-pharmacological comfort measures
Provide maternal/fetal monitoring
Discourage pushing until fully dilated
5. Antepartum – CST
Contraction stress test (CST) – purpose is to identify the jeopardized fetus that is
stable at rest but showed evidence of compromise after stress. Woman is seated and
reclined (semi-Fowler). She is monitored electronically w/fetal ultrasound transducer
and uterine tocodynamometer. Tracing is observed for 10-20 minutes for baseline rate.
Two methods of the CST are the nipple-stimulation contraction test and the more
common oxytocin stimulated contraction test. If no late decelerations are observed w/
contractions, the findings are considered negative. Repetitive late decelerations (50%
or more of contractions) render a positive result
6. Antepartum – fundal height – action
Used as one indicator of fetal growth
Provides a gross estimate of the duration of pregnancy
o The height of the fundus in cm is approximately the same as the number of
weeks of gestation
Measurement is made from the upper border of the symphysis pubis to the upper
border of the fundus
, BIOL 36019 / OB HESI
STUDY GUIDE
Woman should have emptied her bladder and be lying supine with knees in flexed
position
7. Antepartum – gestational HTN
Gestational HTN - the onset of HTN w/out proteinuria after week 20 of pregnancy
o Systolic > 140, diastolic > 90
HTN should be recorded on at least two separate occasions at least 4-6 hours apart
and within a 1-week period
Occurs more frequently in women w/multifetal pregnancies
Women w/gestational HTN have no evidence of preexisting HTN, and their BPs return
to normal levels within 6 weeks after giving birth
8. Antepartum – indigestion – third trimester
It is common for indigestion to start in the 3rd trimester d/t the growing baby pushing
the stomach upward toward the esophagus
o Relief measures
Wait at least an hour after meals before lying down
Eat several small meals, take your time
Avoid foods that cause indigestion (fried/greasy foods)
Avoid caffeine/alcohol b/c they can aggravate indigestion
Don’t smoke
9. Antepartum - infertility – drug therapy
Action is often directed at stimulating ovulation or enhancing ovulation so more
oocytes mature
M/C medications include: clomiphene citrate, hMG, FSH, hCG, and GnRH
o Prevalence of multiple pregnancies w/use of these meds is > 25%
10. Antepartum – pregnancy – weight gain
Maternal and fetal risks increase when mom is severely over or under weight
Underweight women are more likely to have preterm labor and to give birth to LBW
infants
Obesity – increases likelihood of preeclampsia and gestational diabetes
Appropriate measure of evaluating weight gain is BMI
o <18.5 = underweight
o 18.5-24.9 = normal
o 25-29.9 = overweight
o 30 or > = obese
Pattern of weight gain
o 1st trimester – average weight gain is 1-2kg
o Thereafter the recommended weight gain increases to about 0.5 kg/week for
an underweight woman and 0.4 kg/week for a woman of normal weight
, BIOL 36019 / OB HESI
STUDY GUIDE
o The recommended weekly weight gain for overweight women during the 2nd
and 3rd trimester is 0.3 kg/week, and 0.2 kg for obese women
11. Antepartum – smoking in pregnancy
Smoking is associated w/an increased frequency of preterm labor, PROM, abruption
placentae, Placenta Previa, and fetal death
Encourage women to quit or cut down if they smoke and to avoid second hand smoke
12. Antepartum – supine hypotension
Supine hypotensive syndrome – when lying flat, a decrease in systolic of >30mmHg d/
t suppression of the vena cava, causes faintness
o Common in the 2nd and 3rd trimester b/c of the increasing weight of the baby;
lying in the supine position can cause compression of the inferior vena cava
o Instruct client to use a side lying position with knees slightly flexed, and
change positions slowly
13. Antepartum – triple screen
In the 2nd trimester, triple screening is available for fetuses w/Trisomy 21 and Trisomy
18
Screen is performed at 16-18 weeks
Measures the levels of 3 maternal serum markers; MSAFP, unconjugated estriol, and
hCG
o Fetus w/Trisomy 21 – MSAFP and unconjugated estriol levels are low
o Low levels of in all 3 markers are associated w/Trisomy 18 (Edward’s
syndrome)
14. Antepartum – ultrasound at 20 weeks
Uses
o Establish/confirm dates
o Confirm viability
o Detect polyhdraminos/oligohydraminos
o Detect congenital anomalies
o Detect intrauterine growth restriction
o Assess placental placement
o Used for visualization during amniocentesis
15. Antepartum – vaginal discharge – pregnancy
Leukorrhea
o Hormonally stimulated cervix becomes hypertrophic and hyperactive,
producing abundant amount of mucus
, BIOL 36019 / OB HESI
STUDY GUIDE
Not preventable, do not douche, wear perineal pads, wipe from front to
back, report to PCP if accompanied by pruritus, foul odor, or change in
character or color
16. Antepartum – Intrapartum – UTI
UTIs are a common medical complication of pregnancy; about 20% of all pregnancies
Instruct women taking ABX to finish the entire course of meds, take meds on time and
around the clock so the medication levels remain constant
o Many women will develop a yeast infection while taking ABX b/c the ABX kills
normal flora. We should encourage them to include yogurt, cheese, or milk
containing active acidophilus while on their ABX regimen
UTI prevention
o Wipe from front to back
o Cotton crotch underwear
o Avoid tight-fitting clothes
o Limit time spent in damp exercise clothes
o Avoid bath salts/bubble baths
o Avoid colored/scented toilet tissue
o Don’t wait to void
o Void before and after intercourse and before going to bed at night
o Drink at least 8 glasses of water daily
17. Intrapartum – back labor – relief
Physiology
o Exaggerated lumbar and cervicothoracic curves caused by change in center of
gravity d/t enlarging abdomen
Relief
o Maintain good posture and body mechanics
o Avoid fatigue
o Wear low heeled shoes
o Abdominal support may be useful
o Conscious relaxation
o Sleep on firm mattress
o Apply local heat/ice
o Get back rubs
o Do pelvic tilt exercises
