NM 702 EXAM 5 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
What is the source of bleeding usually during pregnancy?
Maternal
Can bleeding during the first 20 weeks of pregnancy be normal?
Yes
What 3 things are essential to check for early pregnancy vaginal bleeding?
(1) timing (2) amount of vaginal bleeding (3) visualization of the cervix
What are the primary pathological reasons for early bleeding in pregnancy?
(1) spontaneous pregnancy loss (2) ectopic pregnancy
What are some causes of 1st trimester bleeding?
(1) implantation bleeding (2) subchorionic hemorrhage (3) First trimester pregnancy loss
aka abortion (4) ectopic
What may pregnant patients with vaginal bleeding require?
Co-management
What would require a referral for first trimester vaginal bleeding?
(1) ectopic pregnancy (2) D&C or S&C
When a CNM suspects a first trimester pregnancy loss, what are the appropriate
next steps?
(1) ultrasound (2) beta hCG (3) blood type, Rh screen and antibody screen
What do you see with a threatened abortion?
,(1) closed cervix (2) uterus appropriate for gestational size
When the CNM suspect an ectopic pregnancy, what is the most important piece
of information in the history and exam to help with the diagnosis?
Pain (also bleeding, what the pain is like, where is the pain, LMP, history, positive
pregnancy test)
What are signs and symptoms of an ectopic pregnancy?
(1) where pain is located (2) does the pain radiate (3) amenorrhea (4) bleeding often
brownish (5) breast tenderness, nausea, and other pregnancy signs (5) adnexal mass,
acute pain, CT (6) signs of rupture: hypotension, nausea, pallor, shoulder pain, urge to
defecate
When do symptoms for ectopic pregnancy start to appear?
6-8 weeks
What is it when a fertilized ovum implants outside of the uterus?
Ectopic pregnancy
What is a common site for ectopic pregnancy?
Fallopian tubes
What is the best step in confirming an ectopic pregnancy?
Beta hCG and ultrasound
When can you see the yolk sac?
5 weeks
When can you see fetal pole identification?
5-7 weeks
When can you see cardiac activity identification?
, 7-8 weeks
For ectopic pregnancy, when there is no evidence of tubal rupture, minimal pain
or bleeding, patient reliable for f/u, starting beta hCG <1000 mIU/ml and falling,
ectopic or adnexal mass < 3m or not detected, no embryonic heart beat, what is
the treatment?
Expectant management
For ectopic pregnancy, stable VS, no medical contraindication for methotrexate
therapy, unruptured ectopic pregnancy, absence of embryonic cardiac activity,
ectopic mass of 3.5 cm or less, starting beta hCG < 5000 mIU/ml, what is the
treatment?
Medical mgmt with methotrexate
For ectopic pregnancy, unstable VS or signs indicating rupture, advanced ectopic
pregnancy (elevated beta hCG levels, large mass, cardiac activity), patient
unreliable for f/u, contraindications to expectant management or methotrexate,
what is the treatment?
Surgical mgmt
What is normal fetal heart rate?
110-160
What are 3 ways of assessing fetal well-being at every visit?
(1) FHT 110-160 (2) increasing maternal weight gain with increased fundal height
corresponding to gestational age (3) maternal perception of fetal movement following a
regular pattern once they are felt
SOLUTIONS VERIFIED
What is the source of bleeding usually during pregnancy?
Maternal
Can bleeding during the first 20 weeks of pregnancy be normal?
Yes
What 3 things are essential to check for early pregnancy vaginal bleeding?
(1) timing (2) amount of vaginal bleeding (3) visualization of the cervix
What are the primary pathological reasons for early bleeding in pregnancy?
(1) spontaneous pregnancy loss (2) ectopic pregnancy
What are some causes of 1st trimester bleeding?
(1) implantation bleeding (2) subchorionic hemorrhage (3) First trimester pregnancy loss
aka abortion (4) ectopic
What may pregnant patients with vaginal bleeding require?
Co-management
What would require a referral for first trimester vaginal bleeding?
(1) ectopic pregnancy (2) D&C or S&C
When a CNM suspects a first trimester pregnancy loss, what are the appropriate
next steps?
(1) ultrasound (2) beta hCG (3) blood type, Rh screen and antibody screen
What do you see with a threatened abortion?
,(1) closed cervix (2) uterus appropriate for gestational size
When the CNM suspect an ectopic pregnancy, what is the most important piece
of information in the history and exam to help with the diagnosis?
Pain (also bleeding, what the pain is like, where is the pain, LMP, history, positive
pregnancy test)
What are signs and symptoms of an ectopic pregnancy?
(1) where pain is located (2) does the pain radiate (3) amenorrhea (4) bleeding often
brownish (5) breast tenderness, nausea, and other pregnancy signs (5) adnexal mass,
acute pain, CT (6) signs of rupture: hypotension, nausea, pallor, shoulder pain, urge to
defecate
When do symptoms for ectopic pregnancy start to appear?
6-8 weeks
What is it when a fertilized ovum implants outside of the uterus?
Ectopic pregnancy
What is a common site for ectopic pregnancy?
Fallopian tubes
What is the best step in confirming an ectopic pregnancy?
Beta hCG and ultrasound
When can you see the yolk sac?
5 weeks
When can you see fetal pole identification?
5-7 weeks
When can you see cardiac activity identification?
, 7-8 weeks
For ectopic pregnancy, when there is no evidence of tubal rupture, minimal pain
or bleeding, patient reliable for f/u, starting beta hCG <1000 mIU/ml and falling,
ectopic or adnexal mass < 3m or not detected, no embryonic heart beat, what is
the treatment?
Expectant management
For ectopic pregnancy, stable VS, no medical contraindication for methotrexate
therapy, unruptured ectopic pregnancy, absence of embryonic cardiac activity,
ectopic mass of 3.5 cm or less, starting beta hCG < 5000 mIU/ml, what is the
treatment?
Medical mgmt with methotrexate
For ectopic pregnancy, unstable VS or signs indicating rupture, advanced ectopic
pregnancy (elevated beta hCG levels, large mass, cardiac activity), patient
unreliable for f/u, contraindications to expectant management or methotrexate,
what is the treatment?
Surgical mgmt
What is normal fetal heart rate?
110-160
What are 3 ways of assessing fetal well-being at every visit?
(1) FHT 110-160 (2) increasing maternal weight gain with increased fundal height
corresponding to gestational age (3) maternal perception of fetal movement following a
regular pattern once they are felt
