OB FINAL REVIEW
THE TEST IS COMPREHENSIVE. THERE WILL BE APPROXIMATELY 75-80 QUESTIONS.
APPROXIMATELY 20-25 QUESTIONS WILL COME FROM POSTPARTUM COMPLICATIONS, AND NEWBORN
COMPLICATIONS.
THE REST OF THE QUESTIONS WILL COME FROM THE AREAS COVERED PREVIOUSLY.
Know growth and development: KNOW THE ANATOMY OF THE
PREGNANCY - placenta, uterus, amniotic fluid, umbilical cord with 3 vessels;
KNOW THE JOB OF EACH OF THE FOLLOWING -- PLACENTA,
UMBILICAL CORD, & AMNIOTIC FLUID
• Uterus:
o The baby’s house
o Increases in size
o Palpable by the end of the 12th week above the symphysis pubis
o Estrogen, progesterone: hyperplasia, hypertrophy allow uterus to enlarge,
stretch
o The uterus’ weight increases from 70 g to 1100 g at term
• Fundus
o top part of pregnant woman’s belly/uterus; where contractions are the
strongest.
• Cervix: elongated piece of flesh that connects the uterus to vagina
o Dilatation/Dilation: the opening of the cervix
§ Measured: 0-10 cm
o Effacement: shortening, thinning, shrinking of cervix
§ Measured: 0-100%
o Mucus Plug:
§ collection of mucus that forms in the cervical canal in early pregnancy. It
prevents bacteria or infection from entering your uterus and reaching the
fetus. During the 3rd trimester, it comes out and may have blood.
• Pelvis:
o “False” Pelvis: shallow cavity above the
inlet; where the baby can move around,
spin, so whatever they want.
o “True” Pelvis: deeper/narrow portion of
the cavity below the inlet; narrow, tight
area in which the baby’s head has to fit
through. Baby can no longer move
around freely.
§ The 2 pointy things on both the
left & right side of the True
Pelvis are called ischial spines –
can be felt by RN/MD during
vaginal exam.
o Station:
, § When baby is in mom’s stomach, they usually sit up high and push on the
diaphragm causing breathing more difficult for mom.
§ As you progress through labor, baby will start to come down, the head will
get in the passageway and begin to move down.
§ Apart from dilating and effacing, there is a third number given during
labor called Station – where the baby’s head is in comparison to the 2
ischial spines (numbers go from -5 through 5). Every cm the baby moves,
the number changes.
• - numbers (-5, -4, -3, -2, -1) – when baby is high/how high up the
baby is (-5 being where the baby is the highest)
• 0 station – when baby’s head is aligned with the 2 ischial spines.
• + numbers (+1, +2, +3, +4, +5)– when baby’s head passes ischial
spines and comes out.
o Ex. Baby is a -5, it moves down 1 cm, baby is now at -4,
and on.
o Crowning = when you can see the top of your baby's head
through the opening of your vagina (usually at seen at +2).
• The Placenta:
o Placenta develops in the 3rd week and takes over the job of the yolk sac.
o Placenta is attached to the top upper part of uterus, it is thickened up with blood to
help give nutrition & blood supply to baby.
§ Blood vessels from the uterus DO NOT attach directly to the blood vessels
from the placenta. Materials can be interchanged ONLY by a process
called diffusion.
o Once placenta develops, 2 thin layers/membranes (also called bag of waters) grow
from the placenta around the baby.
§ There is an outer layer and inner layer.
§ These layers protect the baby and keeps it in its own area full of water.
§ Outer layer = Chorion
§ Inner layer = Amnion
o Coming off the placenta is the Umbilical Cord – it has 3 vessels (AVA – 1 vein, 2
arteries)
§ 1 Big Vein – carries oxygen, nutrients, & hormones (oxygenated blood)
§ 2 Little Arteries – carries wastes and carbon dioxide out (deoxygenated
blood)
• DISCLAIMER: In our body, veins carry deoxygenated blood and
arteries carry oxygenated blood. In a fetus, blood circulation is
OPPOSITE to ours.
§ The 3 vessels are protected by a white gelatinous hard substance called
Wharton’s Jelly.
o Functions of the Placenta:
§ Responsible for nutrition, respiratory and excretory exchange between
mother and fetus
§ Gas exchange by diffusion
§ Hormones – HPL, HCG, Progesterone (one of the most important
hormones for the maintenance of pregnancy), estrogen
, § Immunologic function –Maternal antibodies transfered
• Umbilical Cord:
o Umbilical cord contains 3 vessels – 2 arteries and 1 vein (AVA)
o Arteries carry deoxygenated blood and waste products from the fetus
o The vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
o Fetal heart rate 110-160 beats/minute
o Approximately 2 x maternal rate
o Usual location—center of placenta
o Wharton’s Jelly: protects vessels from umbilical cord from compression
• Amniotic Fluid:
o Amniotic sac contains 2 separate membranes:
§ Early protective structures
• Amnion—inner membrane, Produces amniotic fluid
• Chorion—outer membrane, forms fetal portion of placenta
o 800-1200 normal level of amniotic fluid. Fluid should NOT drop below 800.
o Oligohydramnios – less than 500 cc’s
§ If less than 500 cc’s, there is not enough fluid to keep the baby and
umbilical cord floating; The less fluid, everything will fall down and baby
will sit on the umbilical cord and compress it.
§ Moms w/ Oligohydramnios have to be monitored carefully.
§ Babies drink/swallow amniotic fluid, it goes to their kidneys, kidneys
process it, and they pee it out into the amniotic sac where they live. It
helps keep amount of amniotic fluid stable. Some fluid sits in lungs.
• If there is a problem with the kidneys, the amount of fluid in the
amniotic sac will be less than it should be (<800).
• When baby is born, an ultrasound of their kidneys will be done to
make sure they are working properly, because the baby was not
swallowing the fluid, processing it, and peeing it back out.
o Polyhydramnios – more than 2000 cc’s, seen w/ gestational diabetic pts.
o Essential for normal fetal lung development
o Baby lives in water, they don’t breathe through their nose/mouth, they get oxygen
through umbilical cord. However, they do breathing movements, their chest can
be seen rising & falling through ultrasound.
o Purpose of Amniotic Fluid:
§ Cushions embryo and fetus
§ Controls temperature that baby lives in
• The only time baby’s temp will increase is if mom has for ex.
infection. Mom will develop fever, baby will feel it and may
develop tachycardia (HR >160).
§ Promotes growth and development, allows movement for baby
§ Prevents fetal adherence to the amnion – fluid prevents baby from sticking
to the amnion layer.
§ Amount: 800 mL at 24 weeks
, § Fetal urine and lung secretions primary contributors – helps keep a normal
amount of fluid level.
§ Slightly alkaline
§ Contains antibacterial, other protective substances to help protect baby.
Jaundice- different types difference between pathologic and physiologic, when
they occur, what to do to fix it.
Jaundice
Yellow pigment deposited in lipid tissue.
Broken down/damaged RBC’s produce big amounts of unconjugated fat-soluble bilirubin & for
it to leave the body it has to go to the liver, the liver breaks it down to a water-soluble version &
the baby poops it out. However, bc there are a lot of RBC’s damage, there is too much
unconjugated fat-soluble bilirubin traveling to the liver & baby’s liver is not mature enough to
process it / manage the overload. When unconjugated fat-soluble bilirubin backs up, it goes into
lipid/fat tissue, sclera, & mucous membranes – causing Jaundice. As build up gets more severe,
it can go to the brain & cause Kernicterus – baby can have brain damage.
• Two types:
o Physiologic jaundice: icterus neonatorium
o Pathologic jaundice
• Types of Jaundice
o Physiologic Jaundice – when the baby physically gets damaged during the
birthing process only; baby gets bruised up (RBC’s get damaged) during birthing
process Ex. bc of a vacuum extractor, precipitate delivery
§ Seen in second or third day of life
o W/ physiologic jaundice, bruising has just happened so we won’t see
the yellowing of the skin or the buildup/increase of bilirubin levels
until after 24 hrs.
§ Treated with phototherapy – typical way to treat it
o However if it’s really severe, blood transfusions may be needed.
o Pathologic Jaundice – damage to RBC’s happen during the pregnancy (inside
mom).
Ex. ABO Incompatibility (similar to Rh factor but milder):
Mom: Is O blood type (universal donor – O blood type can donate blood to
everybody but can only receive from another O type)
Dad: If dad is type A or B, the baby can have either mom or dad’s blood type.
If baby has dad’s blood type, mom’s body will damage baby’s RBC’s bc she is
Type O & cannot get other blood types mixed w/ hers.
- Anytime we have a Type O blood mom we monitor baby carefully bc baby may
have jaundice.
§ Seen in first 24 hrs. Level above 12 mg/dL
THE TEST IS COMPREHENSIVE. THERE WILL BE APPROXIMATELY 75-80 QUESTIONS.
APPROXIMATELY 20-25 QUESTIONS WILL COME FROM POSTPARTUM COMPLICATIONS, AND NEWBORN
COMPLICATIONS.
THE REST OF THE QUESTIONS WILL COME FROM THE AREAS COVERED PREVIOUSLY.
Know growth and development: KNOW THE ANATOMY OF THE
PREGNANCY - placenta, uterus, amniotic fluid, umbilical cord with 3 vessels;
KNOW THE JOB OF EACH OF THE FOLLOWING -- PLACENTA,
UMBILICAL CORD, & AMNIOTIC FLUID
• Uterus:
o The baby’s house
o Increases in size
o Palpable by the end of the 12th week above the symphysis pubis
o Estrogen, progesterone: hyperplasia, hypertrophy allow uterus to enlarge,
stretch
o The uterus’ weight increases from 70 g to 1100 g at term
• Fundus
o top part of pregnant woman’s belly/uterus; where contractions are the
strongest.
• Cervix: elongated piece of flesh that connects the uterus to vagina
o Dilatation/Dilation: the opening of the cervix
§ Measured: 0-10 cm
o Effacement: shortening, thinning, shrinking of cervix
§ Measured: 0-100%
o Mucus Plug:
§ collection of mucus that forms in the cervical canal in early pregnancy. It
prevents bacteria or infection from entering your uterus and reaching the
fetus. During the 3rd trimester, it comes out and may have blood.
• Pelvis:
o “False” Pelvis: shallow cavity above the
inlet; where the baby can move around,
spin, so whatever they want.
o “True” Pelvis: deeper/narrow portion of
the cavity below the inlet; narrow, tight
area in which the baby’s head has to fit
through. Baby can no longer move
around freely.
§ The 2 pointy things on both the
left & right side of the True
Pelvis are called ischial spines –
can be felt by RN/MD during
vaginal exam.
o Station:
, § When baby is in mom’s stomach, they usually sit up high and push on the
diaphragm causing breathing more difficult for mom.
§ As you progress through labor, baby will start to come down, the head will
get in the passageway and begin to move down.
§ Apart from dilating and effacing, there is a third number given during
labor called Station – where the baby’s head is in comparison to the 2
ischial spines (numbers go from -5 through 5). Every cm the baby moves,
the number changes.
• - numbers (-5, -4, -3, -2, -1) – when baby is high/how high up the
baby is (-5 being where the baby is the highest)
• 0 station – when baby’s head is aligned with the 2 ischial spines.
• + numbers (+1, +2, +3, +4, +5)– when baby’s head passes ischial
spines and comes out.
o Ex. Baby is a -5, it moves down 1 cm, baby is now at -4,
and on.
o Crowning = when you can see the top of your baby's head
through the opening of your vagina (usually at seen at +2).
• The Placenta:
o Placenta develops in the 3rd week and takes over the job of the yolk sac.
o Placenta is attached to the top upper part of uterus, it is thickened up with blood to
help give nutrition & blood supply to baby.
§ Blood vessels from the uterus DO NOT attach directly to the blood vessels
from the placenta. Materials can be interchanged ONLY by a process
called diffusion.
o Once placenta develops, 2 thin layers/membranes (also called bag of waters) grow
from the placenta around the baby.
§ There is an outer layer and inner layer.
§ These layers protect the baby and keeps it in its own area full of water.
§ Outer layer = Chorion
§ Inner layer = Amnion
o Coming off the placenta is the Umbilical Cord – it has 3 vessels (AVA – 1 vein, 2
arteries)
§ 1 Big Vein – carries oxygen, nutrients, & hormones (oxygenated blood)
§ 2 Little Arteries – carries wastes and carbon dioxide out (deoxygenated
blood)
• DISCLAIMER: In our body, veins carry deoxygenated blood and
arteries carry oxygenated blood. In a fetus, blood circulation is
OPPOSITE to ours.
§ The 3 vessels are protected by a white gelatinous hard substance called
Wharton’s Jelly.
o Functions of the Placenta:
§ Responsible for nutrition, respiratory and excretory exchange between
mother and fetus
§ Gas exchange by diffusion
§ Hormones – HPL, HCG, Progesterone (one of the most important
hormones for the maintenance of pregnancy), estrogen
, § Immunologic function –Maternal antibodies transfered
• Umbilical Cord:
o Umbilical cord contains 3 vessels – 2 arteries and 1 vein (AVA)
o Arteries carry deoxygenated blood and waste products from the fetus
o The vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
o Fetal heart rate 110-160 beats/minute
o Approximately 2 x maternal rate
o Usual location—center of placenta
o Wharton’s Jelly: protects vessels from umbilical cord from compression
• Amniotic Fluid:
o Amniotic sac contains 2 separate membranes:
§ Early protective structures
• Amnion—inner membrane, Produces amniotic fluid
• Chorion—outer membrane, forms fetal portion of placenta
o 800-1200 normal level of amniotic fluid. Fluid should NOT drop below 800.
o Oligohydramnios – less than 500 cc’s
§ If less than 500 cc’s, there is not enough fluid to keep the baby and
umbilical cord floating; The less fluid, everything will fall down and baby
will sit on the umbilical cord and compress it.
§ Moms w/ Oligohydramnios have to be monitored carefully.
§ Babies drink/swallow amniotic fluid, it goes to their kidneys, kidneys
process it, and they pee it out into the amniotic sac where they live. It
helps keep amount of amniotic fluid stable. Some fluid sits in lungs.
• If there is a problem with the kidneys, the amount of fluid in the
amniotic sac will be less than it should be (<800).
• When baby is born, an ultrasound of their kidneys will be done to
make sure they are working properly, because the baby was not
swallowing the fluid, processing it, and peeing it back out.
o Polyhydramnios – more than 2000 cc’s, seen w/ gestational diabetic pts.
o Essential for normal fetal lung development
o Baby lives in water, they don’t breathe through their nose/mouth, they get oxygen
through umbilical cord. However, they do breathing movements, their chest can
be seen rising & falling through ultrasound.
o Purpose of Amniotic Fluid:
§ Cushions embryo and fetus
§ Controls temperature that baby lives in
• The only time baby’s temp will increase is if mom has for ex.
infection. Mom will develop fever, baby will feel it and may
develop tachycardia (HR >160).
§ Promotes growth and development, allows movement for baby
§ Prevents fetal adherence to the amnion – fluid prevents baby from sticking
to the amnion layer.
§ Amount: 800 mL at 24 weeks
, § Fetal urine and lung secretions primary contributors – helps keep a normal
amount of fluid level.
§ Slightly alkaline
§ Contains antibacterial, other protective substances to help protect baby.
Jaundice- different types difference between pathologic and physiologic, when
they occur, what to do to fix it.
Jaundice
Yellow pigment deposited in lipid tissue.
Broken down/damaged RBC’s produce big amounts of unconjugated fat-soluble bilirubin & for
it to leave the body it has to go to the liver, the liver breaks it down to a water-soluble version &
the baby poops it out. However, bc there are a lot of RBC’s damage, there is too much
unconjugated fat-soluble bilirubin traveling to the liver & baby’s liver is not mature enough to
process it / manage the overload. When unconjugated fat-soluble bilirubin backs up, it goes into
lipid/fat tissue, sclera, & mucous membranes – causing Jaundice. As build up gets more severe,
it can go to the brain & cause Kernicterus – baby can have brain damage.
• Two types:
o Physiologic jaundice: icterus neonatorium
o Pathologic jaundice
• Types of Jaundice
o Physiologic Jaundice – when the baby physically gets damaged during the
birthing process only; baby gets bruised up (RBC’s get damaged) during birthing
process Ex. bc of a vacuum extractor, precipitate delivery
§ Seen in second or third day of life
o W/ physiologic jaundice, bruising has just happened so we won’t see
the yellowing of the skin or the buildup/increase of bilirubin levels
until after 24 hrs.
§ Treated with phototherapy – typical way to treat it
o However if it’s really severe, blood transfusions may be needed.
o Pathologic Jaundice – damage to RBC’s happen during the pregnancy (inside
mom).
Ex. ABO Incompatibility (similar to Rh factor but milder):
Mom: Is O blood type (universal donor – O blood type can donate blood to
everybody but can only receive from another O type)
Dad: If dad is type A or B, the baby can have either mom or dad’s blood type.
If baby has dad’s blood type, mom’s body will damage baby’s RBC’s bc she is
Type O & cannot get other blood types mixed w/ hers.
- Anytime we have a Type O blood mom we monitor baby carefully bc baby may
have jaundice.
§ Seen in first 24 hrs. Level above 12 mg/dL
