Inpatient Obstetrical Certification NCC
Questions And Answers
Leading cause of perinatal admissions to the ICU Correct Answers: Hemorrhagic disorders
Percentage of deaths related to pregnancy related hemorrhages Correct Answers: 17-25%
Most maternal deaths from obstetric hemorrhage after first trimester of pregnancy are due to Correct
Answers: Placental abruption
Race most likely to die from post-partum hemorrhage Correct Answers: African Americans
Mortality rate (2006) for white women, African American women and Hispanic women in the US,
stated as deaths per 100,000 live births Correct Answers: White women 13.3/100,000
African American women 32.7/100,000
Hispanic women 10.2
68% of post-partum hemorrhage deaths occur within _______hours of delivery Correct Answers: 48
Obstetric hemorrhage is defined as a TBL or more than Correct Answers: 1000cc
The classic sign of placenta prevail is Correct Answers: painless vaginal bleeding in the second or
third trimester of pregnancy
If you see painless vaginal bleeding in the second or third trimester of pregnancy, suspect Correct
Answers: Placenta prevail
Risk factors for placenta prevail Correct Answers: previous placenta prevail, advanced maternal age
greater than 40, previous cesarean, short interval between pregnancies, multiparty, previous
abortions with curettage, smoking, race (Asian women at greatest risk), large placenta
In patients with suspected placenta prevail, which comes first, a speculum examination or a
confirmatory ultrasound. Correct Answers: Do the ultrasound first
Fetal blood volume is Correct Answers: 100ml/kg
Changes noted during significant blood loss Correct Answers: Rising pulse rate
Increase in respiratory rate
Skin changes to pallor
Falling blood pressure (a late finding)
Decreased urinary output
Decreased LOC
Characteristic findings in FHR if mother has a significant blood loss Correct Answers: Initially,
tachycardia
Then bradycardia
Sinusoidal-fetal anemia, hypoxia and acidemia
Persistent late decelerations
, Percentage of accreta among women with previa Correct Answers: 5-10%
If patient has had 2 or more cesarean sections, the likelihood of an accreta is Correct Answers:
Greater than 50%
Vasa previa Correct Answers: Fetal vessels cross the placental membranes in the lower uterine
segment and cover the cervical os
Velamentous cord insertion Correct Answers: Fetal vessels run across chorion and amnion without
protective Wharton's jelly before entering the placental surface
Succenturiate placenta Correct Answers: One or more small accessory lobes of placental vascular
tissue in membranes that are attached to main placenta by fetal vessels
Hemolysis Correct Answers: lysis of erythrocytes with the release of hemoglobin
HELLP Correct Answers: Hemolysis, Elevated Liver Enzymes, Low Platelets
Per AWHONN, patients with placenta previa should not be discharged to home until they have
gone_____hours with not bleeding Correct Answers: 72 hours
Classic symptom of placental abruption Correct Answers: Painful vaginal bleeding after 20 weeks
gestation
Risk factors for placental abruption Correct Answers: Smoking increases risk 90%
Maternal hypertension 500% increased risk
Multiparity
Abortions
Illicit drug use
Short umbilical cord
Abdominal trauma
Rupture of membranes(due to sudden uterine decompression)
Leiomyoma behind placenta
ACOG standard for fetal monitoring for maternal abdominal trauma Correct Answers: Minimum of 2-6
hours
DIC stands for Correct Answers: disseminated intravascular coagulation
DIC is Correct Answers: a pathologic form of clotting that is diffuse and consumes large amounts of
clotting factors, causing widespread external or internal bleeding or both
Specific diagnostic test for DIC Correct Answers: D-dimer is positive in 34% of cases of DIC
Gestational Trophoblastic Disease Correct Answers: condition in which trophoblastic tissue overtakes
the pregnancy and propagates throughout the uterine cavity
Hydatidiform mole is characterized by Correct Answers: chronic or acute bleeding and a uterus that is
large for gestational age. 1 in 1200 pregnancies. 5%
Questions And Answers
Leading cause of perinatal admissions to the ICU Correct Answers: Hemorrhagic disorders
Percentage of deaths related to pregnancy related hemorrhages Correct Answers: 17-25%
Most maternal deaths from obstetric hemorrhage after first trimester of pregnancy are due to Correct
Answers: Placental abruption
Race most likely to die from post-partum hemorrhage Correct Answers: African Americans
Mortality rate (2006) for white women, African American women and Hispanic women in the US,
stated as deaths per 100,000 live births Correct Answers: White women 13.3/100,000
African American women 32.7/100,000
Hispanic women 10.2
68% of post-partum hemorrhage deaths occur within _______hours of delivery Correct Answers: 48
Obstetric hemorrhage is defined as a TBL or more than Correct Answers: 1000cc
The classic sign of placenta prevail is Correct Answers: painless vaginal bleeding in the second or
third trimester of pregnancy
If you see painless vaginal bleeding in the second or third trimester of pregnancy, suspect Correct
Answers: Placenta prevail
Risk factors for placenta prevail Correct Answers: previous placenta prevail, advanced maternal age
greater than 40, previous cesarean, short interval between pregnancies, multiparty, previous
abortions with curettage, smoking, race (Asian women at greatest risk), large placenta
In patients with suspected placenta prevail, which comes first, a speculum examination or a
confirmatory ultrasound. Correct Answers: Do the ultrasound first
Fetal blood volume is Correct Answers: 100ml/kg
Changes noted during significant blood loss Correct Answers: Rising pulse rate
Increase in respiratory rate
Skin changes to pallor
Falling blood pressure (a late finding)
Decreased urinary output
Decreased LOC
Characteristic findings in FHR if mother has a significant blood loss Correct Answers: Initially,
tachycardia
Then bradycardia
Sinusoidal-fetal anemia, hypoxia and acidemia
Persistent late decelerations
, Percentage of accreta among women with previa Correct Answers: 5-10%
If patient has had 2 or more cesarean sections, the likelihood of an accreta is Correct Answers:
Greater than 50%
Vasa previa Correct Answers: Fetal vessels cross the placental membranes in the lower uterine
segment and cover the cervical os
Velamentous cord insertion Correct Answers: Fetal vessels run across chorion and amnion without
protective Wharton's jelly before entering the placental surface
Succenturiate placenta Correct Answers: One or more small accessory lobes of placental vascular
tissue in membranes that are attached to main placenta by fetal vessels
Hemolysis Correct Answers: lysis of erythrocytes with the release of hemoglobin
HELLP Correct Answers: Hemolysis, Elevated Liver Enzymes, Low Platelets
Per AWHONN, patients with placenta previa should not be discharged to home until they have
gone_____hours with not bleeding Correct Answers: 72 hours
Classic symptom of placental abruption Correct Answers: Painful vaginal bleeding after 20 weeks
gestation
Risk factors for placental abruption Correct Answers: Smoking increases risk 90%
Maternal hypertension 500% increased risk
Multiparity
Abortions
Illicit drug use
Short umbilical cord
Abdominal trauma
Rupture of membranes(due to sudden uterine decompression)
Leiomyoma behind placenta
ACOG standard for fetal monitoring for maternal abdominal trauma Correct Answers: Minimum of 2-6
hours
DIC stands for Correct Answers: disseminated intravascular coagulation
DIC is Correct Answers: a pathologic form of clotting that is diffuse and consumes large amounts of
clotting factors, causing widespread external or internal bleeding or both
Specific diagnostic test for DIC Correct Answers: D-dimer is positive in 34% of cases of DIC
Gestational Trophoblastic Disease Correct Answers: condition in which trophoblastic tissue overtakes
the pregnancy and propagates throughout the uterine cavity
Hydatidiform mole is characterized by Correct Answers: chronic or acute bleeding and a uterus that is
large for gestational age. 1 in 1200 pregnancies. 5%
