AMCB CNM Prenatal care and fetal
assessment -Questions and Answers.
how soon do most pregnancies occur after intercoures -
\within 2 days of ovulation
What is a morula ? and when does it enter the uterine cavity? -
\solid ball of cells formed by 16 blastomeres. enters the uterus 3 days after fertilization
how long is the development of the embryo -
\the developing human organism from about 2 weeks after fertilization through the
second month (8weeks)
When does implantation occur? and where? -
\6-7 days after fertilization
upper posterior wall of the uterus
what gives rise to the placenta ? -
\the chorion
When does the amnion fuse with the chorion? -
\by the end of the 3rd month
what hormone is responsible for uterine growth, fallopian tubes, vagina and breast
development. -
\Estrodial-17B
Which type of estrogen is found in the urine of pregnant women -
\Estriol
why is maternal insulin levels lowered during pregancy -
\placental lactogen (hPL)
Relaxin has what effect -
\produced by the corpus luteum, relaxes the uterine myometrium during pregnancy
what does GnRH (gonadotropin-releasing hormone) do -
\stimulates release of FSH and LH
what is Corticotropin-releasing hormone (CRH) responsible for ? -
\Promotes secretion of adrenocorticotropic hormone (ACTH)
Somatostatin -
,\Inhibits secretion of growth hormone (GH) and thyroid-stimulating hormone (TSH),
prolactin and thyrotropin
Is there a placental barrier? -
\No the placenta does not maintain absolute integrity between the fetus and mother.
What is transported accorss the placenta and by what method.? -
\oxygen and glucose via facilitated diffusion
what vessels are contained in the umbilical cord? what do they do ? -
\Two arteries and 1 vein. the arteries carry deoxygenated blood away from the fetus to
the placenta. the 1 vein carried oxygenated blood to the fetus.
average range of length for the umbilical cord is -
\30-100cm, 55 avge in length with a diameters of 0.8-2cm
influenced by amniotic fluid
in what trimester does the fetus start to swallow, urinate and inspire amniotic fluid? -
\second trimester
if a newborn has tracheoesophageal atresia, what outcome can be expected? -
\polyhydramnios
whats the measurements for polyhydramnios? -
\AFI >24cm, DVP 8cm or more
what are some etiologies of polyhydramnios ? -
\twin-twin transfusion, gestational diabetes, multiples , isoimunization , fetal infection,
fetal anomalies
signs and symptoms of polyhydramnios -
\uterine size greater than dates ( fundal height 3-4cm off ) , difficult auscultation, materal
dyspnea, heartburn , nausea
Outcomes associated with having polyhydramnios -
\fetal mortality, preterm labor, PP hemorrhage , cord prolapse
what should you do for a patient with polyhydramnios? -
\monitor with serial NST and Weekly BPP starting at 34 weeks
offer amniocentesis if the AFI exceeds 35cm
indomethacin- impairs production of lung liquid or decreases fetal urine production
define measurements for oligohydramnios -
\afi < 5cm , dvP < 2cm
,an infant born to a mother with oiligohydramnios would have which condintion?
other possible causes are ?? -
\Renal agenesis
post term pregnancy
demise
growth restriction
anomalies
oligohydramnios can result in what serious condition? -
\pulmonary hypoplasia resulting in still birth
a mother with oligo might receive which treatment during IP -
\amnioinfusion
organogenesis begins -
\in the 3rd week and spans for 8 weeks.
what causes the pregnancy test to turn positive ? -
\Hcg found in the urine . produced by the corpus luteum.
Fourth week of the embryonic period -
\limb buds form; heart is noticeable and beating; nervous system is prominent; embryo
has a tail; other systems form
Sixth week of the embryonic period -
\Fingers and Toes are present; Skeleton is cartilaginous
when does fetal development begin.? -
\8 weeks after fertilization
10 weeks after LMP
a 12 week fetus can be palpated where?
20 weeks? -
\at the level of the symphisis
at the level of the umbilicus
how is fetal lung maturity measured ? -
\Lecithin:Sphingomyelin ratio >2 with the presence of phosphatidylglycerol
Presumtive signs of pregnancy -
\SUBJECTIVE
, -Nausea/vomiting, amenorrhea, breast changes, fatigue, urinary frequency, belief of
pregnancy
Probable signs of pregnancy -
\examiner suspects a women is pregnant. such as abdominal enlargement, hegar's
sign(softening and compressibility of the lower uterus), chadwick's sign (deepened
violet-bluish color of the cervix and vaginal mucosa), goodell's sign(softening of the
cervical tip), ballottement, braxton hicks, positive pregnancy test, fetal outline felt by
examiner.
Positive signs of pregnancy -
\Fetal skeleton on X-ray
Fetal presence on ultrasound
Auscultation of FHR (heard at week 8, most likely at 10 and should be heard by 12)
Examiner palpates fetal movement
crump rump length is accurate when ? -
\1st trimester 3-5 days
the FL and BPD are most accurate when ? -
\2nd trimester , 7-10 days
describe the uterus in the 1st trimester -
\soft and globular and aysymetric, at 12 weeks 8-10cm and rising out of the pelvis.
positive piskaceks sign
the softening of the itshmus would reveal what positive sign ? -
\Hegar sign- probable sign of pregnancy
how long does the corpus luteum work until the placenta kicks in ? -
\12 weeks . under the influence of HCG
What are the 4 pelvic types? -
\1. Gynecoid- female pelvis
2. Android- poor vaginal outcomes- c-sections
3. Anthropoid-favors posterior position of the fetus. large size- adequate for vaginal birth
4. Platypelloid- RARE - C-section
GI effects of pregnancy -
\bleeding gums
excess salvation
decreased lower esophageal sphincter
heartburn
decreased gastric emptying
displaced intestines appendix, cecum
altered liver production of enzymes
assessment -Questions and Answers.
how soon do most pregnancies occur after intercoures -
\within 2 days of ovulation
What is a morula ? and when does it enter the uterine cavity? -
\solid ball of cells formed by 16 blastomeres. enters the uterus 3 days after fertilization
how long is the development of the embryo -
\the developing human organism from about 2 weeks after fertilization through the
second month (8weeks)
When does implantation occur? and where? -
\6-7 days after fertilization
upper posterior wall of the uterus
what gives rise to the placenta ? -
\the chorion
When does the amnion fuse with the chorion? -
\by the end of the 3rd month
what hormone is responsible for uterine growth, fallopian tubes, vagina and breast
development. -
\Estrodial-17B
Which type of estrogen is found in the urine of pregnant women -
\Estriol
why is maternal insulin levels lowered during pregancy -
\placental lactogen (hPL)
Relaxin has what effect -
\produced by the corpus luteum, relaxes the uterine myometrium during pregnancy
what does GnRH (gonadotropin-releasing hormone) do -
\stimulates release of FSH and LH
what is Corticotropin-releasing hormone (CRH) responsible for ? -
\Promotes secretion of adrenocorticotropic hormone (ACTH)
Somatostatin -
,\Inhibits secretion of growth hormone (GH) and thyroid-stimulating hormone (TSH),
prolactin and thyrotropin
Is there a placental barrier? -
\No the placenta does not maintain absolute integrity between the fetus and mother.
What is transported accorss the placenta and by what method.? -
\oxygen and glucose via facilitated diffusion
what vessels are contained in the umbilical cord? what do they do ? -
\Two arteries and 1 vein. the arteries carry deoxygenated blood away from the fetus to
the placenta. the 1 vein carried oxygenated blood to the fetus.
average range of length for the umbilical cord is -
\30-100cm, 55 avge in length with a diameters of 0.8-2cm
influenced by amniotic fluid
in what trimester does the fetus start to swallow, urinate and inspire amniotic fluid? -
\second trimester
if a newborn has tracheoesophageal atresia, what outcome can be expected? -
\polyhydramnios
whats the measurements for polyhydramnios? -
\AFI >24cm, DVP 8cm or more
what are some etiologies of polyhydramnios ? -
\twin-twin transfusion, gestational diabetes, multiples , isoimunization , fetal infection,
fetal anomalies
signs and symptoms of polyhydramnios -
\uterine size greater than dates ( fundal height 3-4cm off ) , difficult auscultation, materal
dyspnea, heartburn , nausea
Outcomes associated with having polyhydramnios -
\fetal mortality, preterm labor, PP hemorrhage , cord prolapse
what should you do for a patient with polyhydramnios? -
\monitor with serial NST and Weekly BPP starting at 34 weeks
offer amniocentesis if the AFI exceeds 35cm
indomethacin- impairs production of lung liquid or decreases fetal urine production
define measurements for oligohydramnios -
\afi < 5cm , dvP < 2cm
,an infant born to a mother with oiligohydramnios would have which condintion?
other possible causes are ?? -
\Renal agenesis
post term pregnancy
demise
growth restriction
anomalies
oligohydramnios can result in what serious condition? -
\pulmonary hypoplasia resulting in still birth
a mother with oligo might receive which treatment during IP -
\amnioinfusion
organogenesis begins -
\in the 3rd week and spans for 8 weeks.
what causes the pregnancy test to turn positive ? -
\Hcg found in the urine . produced by the corpus luteum.
Fourth week of the embryonic period -
\limb buds form; heart is noticeable and beating; nervous system is prominent; embryo
has a tail; other systems form
Sixth week of the embryonic period -
\Fingers and Toes are present; Skeleton is cartilaginous
when does fetal development begin.? -
\8 weeks after fertilization
10 weeks after LMP
a 12 week fetus can be palpated where?
20 weeks? -
\at the level of the symphisis
at the level of the umbilicus
how is fetal lung maturity measured ? -
\Lecithin:Sphingomyelin ratio >2 with the presence of phosphatidylglycerol
Presumtive signs of pregnancy -
\SUBJECTIVE
, -Nausea/vomiting, amenorrhea, breast changes, fatigue, urinary frequency, belief of
pregnancy
Probable signs of pregnancy -
\examiner suspects a women is pregnant. such as abdominal enlargement, hegar's
sign(softening and compressibility of the lower uterus), chadwick's sign (deepened
violet-bluish color of the cervix and vaginal mucosa), goodell's sign(softening of the
cervical tip), ballottement, braxton hicks, positive pregnancy test, fetal outline felt by
examiner.
Positive signs of pregnancy -
\Fetal skeleton on X-ray
Fetal presence on ultrasound
Auscultation of FHR (heard at week 8, most likely at 10 and should be heard by 12)
Examiner palpates fetal movement
crump rump length is accurate when ? -
\1st trimester 3-5 days
the FL and BPD are most accurate when ? -
\2nd trimester , 7-10 days
describe the uterus in the 1st trimester -
\soft and globular and aysymetric, at 12 weeks 8-10cm and rising out of the pelvis.
positive piskaceks sign
the softening of the itshmus would reveal what positive sign ? -
\Hegar sign- probable sign of pregnancy
how long does the corpus luteum work until the placenta kicks in ? -
\12 weeks . under the influence of HCG
What are the 4 pelvic types? -
\1. Gynecoid- female pelvis
2. Android- poor vaginal outcomes- c-sections
3. Anthropoid-favors posterior position of the fetus. large size- adequate for vaginal birth
4. Platypelloid- RARE - C-section
GI effects of pregnancy -
\bleeding gums
excess salvation
decreased lower esophageal sphincter
heartburn
decreased gastric emptying
displaced intestines appendix, cecum
altered liver production of enzymes
