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NS2221 Exam Questions With
Accurate Answers
Effects of syphilis in pregnancy - ANSWER Increase the risk of miscarriage and stillbirth It can cross the placenta Can cause neonatal congenital syphilis FLAPPER pneumonic - ANSWER Fundal height Lie Attitude Position Presentation Engagement Heart rate Effects of chlamydia and gonorrhoea in pregnancy - ANSWER Upper genital tract infection Preterm labour and birth Neonatal eye infections Trigger points for administering Anti D to a Rh (D) -ve woman - ANSWER 28 & 34 weeks Trauma or APH Birth Expected fundal height of a woman at 24 weeks - ANSWER At the umbilicus Action if a Rh (D) -ve woman has antibodies at 28 weeks - ANSWER Do not administer any anti D and notify the doctors What can the morphology scan do? - ANSWER Identify a number of fetal abnormalities Ascertains placental position Provides assessment of fetal growth
What is the routine amount of Anti (D) at 28 weeks - ANSWER 625 IU When is the whooping cough recommended for pregnant women in QLD - ANSWER From 20 weeks What blood test is offered at 26-28wks but not 34-36 - ANSWER GTT What is the denominator used in a vertex presentation? - ANSWER Occiput Recommended weight gain for a woman with a normal BMI - ANSWER 11.5-16kg Recommended weight gain for a woman with underweight BMI - ANSWER 12.5-18kg Recommended weight gain for a woman with an overweight BMI - ANSWER 7-11.5kg Recommended weight gain for a woman with an obese BMI - ANSWER 5-9kg What does an USS in the 3rd trimester assess - ANSWER Fetal growth and wellbeing Placental position Placental/cord blood flow CTG: what can cause a baseline of 100-109bpm - ANSWER Maternal opiate administration Postdates Fetal sleep CTG: what is shouldering? - ANSWER A transient increase of FHR before/after contraction What is uterine hypertonus? - ANSWER Contractions lasting 2+ minutes without FHR anomaly What is a normal fetal baseline? - ANSWER 110-160bpm What is normal baseline variability? - ANSWER 6-25bpm What is an acceleration? - ANSWER >15bpm above the baseline for >15 seconds What is the baseline rate that is abnormal but unlikely to indicate fetal compromise? - ANSWER 100-109bpm T/F: Contractions measured by the CTG can indicate the frequency and intensity? - ANSWER False Frequency, not intensity What is tachysystole? - ANSWER ≥ 5:10 contractions without FHR anomaly
4-6cm dilated and she has regular painful contractions
Which hormone directly causes the cervix to ripen - ANSWER Prostaglandins
Key features of the mechanism of labour - ANSWER Decent, flexion and rotation
Order of the mechanism of labour - ANSWER Descent and flexion (of the head) Internal rotation (of the head) Extension (head) Restitution (head) Internal rotation (of the shoulders) Lateral flexion (of the body)
4 adaptations of the cervix in a progressive labour - ANSWER Dilate Ripen/soften Efface Move from posterior to anterior
___ causes the uterine myometrium receptors to be more sensitive to ____ at term - ANSWER Oestrogen Oxytocin
The 3rd stage of labour is - ANSWER From the birth of the baby to the birth of the placenta and membranes
The 5 P's - ANSWER Powers Passage Passenger
Pain Psyche
Which presenting diameter of the fetus is not compatible with vaginal birth - ANSWER Mentovertical
___ describes how uterine muscle maintains tone in labour - ANSWER Retraction
the active phase of 2nd stage of labour - ANSWER When the woman's cervix is fully dilated and she has expulsive contractions
Which hormone is triggered through pressure on the cervix and where from? - ANSWER Oxytocin from the pituitary gland
What resp pH imbalances can maternal hyperventilation in labour cause - ANSWER Maternal: alkalosis Fetal: acidosis
What does the reduced blood flow to the uterus during a contraction result in for the maternal CVS - ANSWER Increased CO and BP
Benefit of delayed pushing - ANSWER Can reduce active pushing time in women with an epidural
The nulliparous woman is expected to have an active 2nd stage lasting less than __ - ANSWER 2 hours
Presumptive signs of second stage of labour - ANSWER Anal gaping and perineal flattening Grunting noise in contraction
Neonatal vigilance obs are conducted every ___ and include ___ - ANSWER 15 minutes Airway patency and RR
The first neonatal temperature needs to be measured within ____ after birth - ANSWER 1 hour
3 maternal benefits of early breastfeeding - ANSWER Stim uterine contractions Starts weight loss early Helps mother learn sooner
Uninterrupted time with the baby skin to skin promotes which 2 hormones - ANSWER Oxytocin Prolactin
APGAR measures - ANSWER HR RR Reflex response Colour Tone
Normal GTT method and results - ANSWER Done via blood tests
Normal Fast for 10 hours BGL<5. Drink 75g glucose drink 1 hour BGL< 2 hour BGL <8.
Risk factors for GDM - ANSWER BMI > Multiple pregnancy Previous GDM or elevated BGL Age 40+ Ethnicity - ATSI, Asian, Indian, Pacific Islander, Middle Easter, Maori Family history DM Previous macrosomia (LGA baby) Previous perinatal loss PCOS Medications
When is the GTT completed? - ANSWER 28 weeks Forms given 24-28 weeks
Signs and symptoms of anaemia - ANSWER Fatigue, dizziness Low blood pressure Palpitations, rapid HR, chest pain, angina Changed stool colour Muscular weakness Shortness of breath Pale, cold or yellow skin Yellowing in the eyes
Increased risk of STIs - ANSWER ATSI - woman or partner Adolescent STI in current preg or last yr Woman or partner ongoing sexual links
Placental position Growth and dopplers
Repeat morphology reason and timing - ANSWER 22-24 weeks If something is missed in the first scan E.g. missed face or heart due to baby position
Repeat placental position scan - ANSWER Done at 32-34 weeks if <3cm from OS
Purpose and time of growth dopplers - ANSWER Any gestation where there are growth concerns Doppler: flow of fluid in and out of umbilical cord
Normal blood pressure - ANSWER SBP <140 and/or DBP < Remain within 30SBP and 15DBP of baseline Abnormal findings redo 4 hours apart
Normal weight gain for someone with a normal BMI - ANSWER 11.5-16kg by term
Abnormal Urinalysis Findings - ANSWER 2+ proteins Recurrent 1+ proteins Nitrites and blood - risk of UTI
BMI Categories - ANSWER Underweight = <18. Normal weight = 18.5-24. Overweight = 25-29. Obesity = 30+
RBC Antibodies Test timing - ANSWER 26-28 and 34- Rh (D) negative women prior to giving the anti D at 28 weeks
Rh (D) positive women only if abnormal BI bloods
What does a FBC test for? - ANSWER Haemoglobin (Hb) Mean cell volume (MCV) Platelets White cell count (WCC)
When to do iron studies - ANSWER If Hb <105g/L or symptomatic of anaemia
Normal serum ferritin should be >
Ideal GTT timing? - ANSWER 28 weeks If high risk complete earlier e.g. BI
Syphilis testing - ANSWER Done at booking in, if high risk done again at 20 weeks, 26-28, 34-
Risk in NQ
Chlamydia and Gonorrhoea test method and timing - ANSWER Urine tests Only really done for high risk
Abdominal palpations: 20-30 weeks - ANSWER Symphysis-fundal height: cm = weeks +/- 2
2 amniotic membranes 2 chorionic membranes 1/3 of identical twin pregnancies are DCDA
MCDA - ANSWER Blastocyst duplicates on days 4- One chorionic Two amniotic One placenta Small % of babies Approx. 2/3 of identical pregnancies are MCDA
MCMA - ANSWER Zygote duplicates day 9- One chorion One amnion One placenta Less than 1% of all identical twins Most high risk
Naegal's Rule - ANSWER Consider x-21 = y days where x is the normal cycle length LMP - 3 months + y days + 1 year = EDD
Baseline fetal heart rate - ANSWER 110-160 bpm Never look at baseline where there is activity occurring (particularly contractions)
Baseline variability - ANSWER 6-25bpm Fluctuations around the baseline rate Single most important sign of fetal well-being
Accelerations - ANSWER FHR 15+ bpm for 15+ seconds Indicates response to stimulation or fetal movement Ideally 2 in 20 minutes
Contractions on a CTG - ANSWER Indicates frequency but not intensity Measured from the beginning of one contracting to the beginning of the next
Normal Contractions - ANSWER AN: none Intrapartum 1-4:10min Lasting <2 mins
Abnormal - unlikely fetal compromise CTG features - ANSWER Baseline rate 100-109bpmn (baseline bradycardia) Absent accelerations Early decelerations Variable decelerations
Usual causes of baseline bradycardia - ANSWER Term or post term Sleep period Maternal medication - narcotics/sedatives
Usual causes of absent accelerations - ANSWER Fetal sleep Fetal period of inactivity Maternal drug administration Labour
Uterine Hyperstimulation - ANSWER Tachysystole or uterine hypertonus WITH FHR abnormalities
Interpreting CTGs - ANSWER DR C BraVado Determine risk Contractions Baseline rate Variability Accelerations Decelerations Overall assessment
Absorption in pregnancy - ANSWER Administration -> circulating fluid
Decreased gut motility and HCl production Increased body mass, particularly fatty tissue Vomiting - HEG Liver function changes
Distribution in pregnancy - ANSWER How much of the medication distributes around the body to target site
In pregnancy Dec albumin (plasma proteins) - 2nd and 3rd trimester Increased fluid/plasma volume - peak at 28-30 weeks Increased body mass, particularly fatty tissue - lipid soluble dissolve better The placenta - lipid soluble passes more easily
Placental affects on distribution - ANSWER Blocks high molecular weight drugs (HMW) - heparin/clexane Metabolises some drugs Highly charged ions don't cross the placenta easily
Effects of nicotine and cocaine - ANSWER Block amino acid transporters in placenta and deprive fetus of essential proteins causing lower weight/malnourishment Cocaine - limited clearance from amniotic fluid
Distribution - fetus - ANSWER Lack of blood brain barrier means drugs go straight to the brain Skin permeable can reabsorb the drug they peed out
Distribution - neonate - ANSWER % of water:fat is higher Distribute water soluble drugs better around their body Less plasma proteins
Drugs and breast milk - ANSWER Most drugs pass through breast feeding but in minimal amounts
Metabolism in pregnancy - ANSWER Hepatic metabolising activity altered Particular enzymes affected - cytochrome P450 and CYP/UGT enzymes Caffeine metabolism decreased Increase nicotine metabolism
Metabolism: fetus and neonate - ANSWER Slower to metabolise 30% of an adults ability Higher exposure to drugs Might need less or more
Fetal presentation vertex Normal recovery for mother and baby
How many stages of labour and birth are there? - ANSWER 4
Stage 1: latent - ANSWER Period of time that can extend for days Possibly intermittent with irregular painful contractions Dilatation <4-6cm
Stage 1: active - ANSWER Regular painful contractions Cervical dilation at least 4-6cm
Stage 1: transition signs - ANSWER Cervix usually 7-9cm dilated Contractions may slow Possibly urge to push with contractions
Stage 1: 7 transition symptoms - ANSWER Loss of control Fear or panic Shivering Demanding pain relief Shouting and screaming Nausea Heavy show
Stage 2: passive - ANSWER Full cervical dilation before/in the absence of expulsive contractions Uterus no longer tight around the baby
Contractions ease
Stage 2: active - ANSWER Baby is visible OR Full cervical dilation and expulsive contractions
Signs of full cervical dilation - ANSWER Internal examination - no cervix palpable External (presumptive signs)
- Grunting noise at height of expulsive contraction
- Discomfort or pressure under ribs
- Rhombus of Michaelis visible
- Anal red-purple line at full length
- Woman arches her back
- Woman feels her bowels are emptying
- Dilation and gaping of anus and perineum flattening
- Presenting part visible at introitus
Physiology of 2nd stage - ANSWER Contractions Secondary powers Pelvic floor displacement
Contractions in 2nd stage - ANSWER Longer and stronger
Secondary powers in 2nd stage - ANSWER Presenting part exerts pressure on pelvic floor and rectum Triggers diaphragm and abdominal voluntary muscles to aid uterine contraction pressure
