1
Q
What is the definition of a short interpregnancy interval
A
less than 6 months
2
Q
what is a long interpregnancy interval
A
> 60 months
3
Q
what is the recommended time to wait in between pregnancies
A
at least 2 years but <60 months
4
Q
how much folic acid should women of child bearing age take
A
400mcg daily
5
Q
how does folic acid recommendations change if a woman or her partner have risk factors for NTD
A
4mg daily 3 months before conception then .4mg faily for the remainder of the pregnancy and 4-6 weeks postpartum or as long as breast feeding
6
Q
what is the greatest risk factor for preterm birth
A
prior preterm birth
7
Q
what is the precautionary principle
A
knowledge that some amount of hazard is unknown so should promote activities to reduce potential harm even if there is not full scientific certainty about the harm
8
Q
what foods should be avoided due to mecury levels in pregnancy
A
shark, swordfish, king mackerel, tile fish, fresh tuna
9
Q
why would a pregnant woman living in an older building be at risk and what can she do to prevent
A
lead from old pipes, should run water for a full minute after night or a day without use
10
Q
why might pregnant women living in rural areas be exposed to increased risk
A
contaminated soil or well water
11
Q
what is the CDC recommendation for max amount of radiation during pregnancy
A
max cummulative dose of 500mrad for entire pregnancy
12
Q
what supplement reduced risk of preeclampsia in pregnancy
A
calcium
13
Q
what is the most common nutritional deficiency in pregnancy
A
iron deficiency in 2nd and 3rd trimester
14
Q
when does the neural tube close
A
first 3-4 weeks post conception
15
Q
true or false: obesity increases risk of NTD despite folic acid supplementaiton
A
true
16
Q
what types of exercise should be avoided in pregnancy
A
hyperthermic spaces like hot yoga as they may be teratogenic
17
Q
what is the single largest modifiable risk factor for women of child bearing age
A
smoking
18
Q
what is the all or non period and what does it mean
A
2 weeks post conception. Regarding medications. They are either so harmful that the zygote does not implant or it recovers and has no further effects
19
Q
what vaccines cannot be given in pregnancy
A
live vaccines like MMR and varicella
20
Q
if a women has received a live vaccine, how long should she wait before becoming pregnancy
A
28 days
21
Q
true or false: Tdap and flu vaccine are not safe to give to pregnant women
A
false
22
Q
true or false: routine screening for mental health and depression is recommended for women of child bearing age
A
false, but should be alert for signs and symptoms
23
Q
what are first line antidepressants in pregnancy
A
SSRIs
24
Q
what serious and sometimes fatal condition may be caused by some fertility drugs
A
ovarian hyperstimulation sundrome (OHSS)
25
what is defibulation and how does it affect pregnancy
reversing the genital mutalation of closing the labia. Must occur for birth to happen and best to do before getting pregnant and doing it during pregnancy greatly increases risk of bleeding
26
what effect might estrogen containing contraceptives have on women with HTN
can worsen HTN
27
how would you recommendation for folic acid change for a woman with HTN
increased dose of folic acid 3 months before conception d/t increased risk of NTD
28
what should the practitioner be aware of regarding thyroid disease and pregnancy
there is ++ increased thyroid requirement during pregnancy, mostly in the first trimester
29
true or false: most anticonvulsants are safe to use in pregnancy
false, most are associated with congenital malformations
30
are inhaled bronchodilators and inhaled steroids safe in pregnancy?
yes
31
what is the most consistent tool for determining risk factors for disease across the lifespan
an accurate family health history
32
what is gestational trophoblastic disease
a spectrum of disorders from excess beta HCG
33
painless vaginal bleeding that is usually minimal to moderate and lasts for months is the hallmark of what condition
molar pregnancy
34
uterine size that is greater than expected,k excessive n/v, HTN and painless bleeding may be what condition
molar pregnancy
35
beta HCG >100,000 after 12 weeks is usually associated with
molar pregnancy or multiple gestation
requires an US
36
why should you do a CXR when concerns for a molar pregnancy
to check for metastases to the lungs
37
what is the next step after diagnosing a molar pregnancy
reger to OBGYN or gyne once for surgical intervention with D&C
38
what increases risk for a molar pregnancy
younger than 16, older than 35, history of gestational trophoblastic disease
39
what is required after treatment for molar pregnancy
BHCG weekly until none detected 3 times then monthly for 6 months, then bimonthly until 1 year post surgery
do not get pregnant for 12 months after surgery
40
what are risks for polyhydramnios
diabetes, syphilis, viral hepatitis, maternal substance use
41
What might you suspect with a low fundal height, fetal parts that are easily palpable and diminshed fetal movements
oligohydraminios
42
other than referral to a maternal fetal specalist, what is recommended for pregnancy with oligohydramnios?
bed rest and large amount of fluid intake
43
What is HELLP
hemolysis, elevated liver enzymes, low platelets
44
what lab results would you see with HELLP
elevated indirect bili
decreased haptoglobin
elevated LDL
45
what are the symptoms of HELLP
sometimes HTN with PEC, general malaise, epigastric pain, n/vd, headache (flu like symptoms)
46
what is the most sensitive marker for HELLP
severely depressed platelet count
47
what would your next step be for a prenatal patient with newly discovered HELLP
immediate transfer to tertiary care in a hospital. Cannot be managed at home
48
when are the doses of Rh immune globulin given for an Rh mismatch in pregnancy
300mcg at 27-28 weeks
if any bleeding, smaller dose given
if infant is born Rh (+) another dose within 72 hours of birth
if there is a miscarriage
49
what is the definition of recurrent pregnancy loss
three or more consecutive losses before 20 weeks gestation
50
what should be done for women with recurrent pregnancy loss
TVU to assess for short cervix and refer to specialist
51
what is the definition of infertility
not becoming pregnant after 1 year of having regular sexual intercourse without birth control
Or 6 months of over 35
52
what is fecundability
probability of conceiving within one menstrual cycle
53
what should be assessed in women with infertility
-r/o thyroid disease, galactorrhea, hirsutism, pelvic or abdo pain, dysmenorrhea and dyspareunia
-send semen for analysis
-assess ovulatory function
-assess uterine cavity and tubal patency
54
what are treatment options for oligomenorrhea and anovulation
clomiphene
aromatase inhibitors
gonadotropins
55
what is preeclampsia
HTN in pregnancy with proteinuria or any severe features
56
which antihypertensives may be teratogenic
ACE-I and beta blockers
57
what is the acronym TORCH
screening for infectious diseases:
Toxoplasma
other viruses (syphilis, HIV, measles)
rubella
cytomegalovirus
herpes
58
what causes flu like symptoms that progresses to a rash on the cheeks that looks like a slapped cheek
fifth disease (erythema infectiosum) caused by
HPV B-19 and can infect the fetus and cause severe or fetal consequences
59
what causes flu like symptoms then a facial rash that spreads to the rest of the body
rubella
60
exposure within what time frame of pregnancy may cause congenital rubella syndrome
first 8 weeks
61
when would you screen a pregnant woman for cytomegalovirus
those working in health care with immunosuppresed patients or those working in child care with infants and toddlers
62
what would you suggest to pregnant women at increased risk of contracting cytomegalovirus
meticulous hand washing
63
what is suggested for pregnant women with a history of HSV infection
prophylactic HSV supression at week 36
64
are low carb diets recommended for overweight pregnant women? why or why not
no because low carb diets increase risk of folic acid deficiency
65
medications were previously labelled for pregnancy safety as ABCD and X. What is the newest labelling system
Pregnancy and Lactation Labelling Rule (PLLR)
66
when is aneuploidy screening usually done in pregnancy
10-14 weeks
67
weight loss of 10% or more, ketonuria and SG >1.030 are indicators of what condition in pregnancy
hyperemesis gravidarum
68
true or false: normal PT, PTT, CBC and platelets will rule out von willebrand disease
false. If results are normal but hx suggests disease, should test for von willebrand factor and factor VIII levels
69
what bleeding disorder usually only affects men
hemophilia
70
what is factor V leiden mutaton
clotting disorder, most common mutation, causes resistant to activated protein C, increased risk of clots
71
true or false: all forms of diabetes increases risk of congenital malformations
false, only insulin dependent DM
72
what is caudal regression and what chronic disease is it strongly associated with
infants with agenesis or hypoplasia of femoae and lower vertebra
strongly associated with maternal diabetes
73
will a mother with well controlled hypothyroidism require any changes to her medication during pregnancy
yes, increased dose of thyroid replacement during pregnancy
74
what is the LIVES acronym
for asking about IPV
listen, inquire, validate, enhance safety, support
75
true or false: a mother with recurrent pregnancy loss carries a baby to term. Her risk of recurrent pregnancy loss has now dropped back down to normal
true, after carrying past 20 weeks, risk drops back down to normal
76
true or false: a woman with recurrent pregnancy loss has become pregnant, she should referred to a maternal fetal specialist for care during her pregnancy
true
77
what is first line pharmacological treatment for PSTD
SSRIs and novel antidepressants
78
what trend would you expect for BHCG in an ectopic or molar pregnancy
steady but slower increase with a plateau around 100,000
79
what is the difference between presumptive, probable, and positive signs of pregnancy
presumptive are signs that make a women think she may be pregnant
probable are findings from a health care provider that indicate pregnancy
positive is a definitive diagnosis of pregnancy
80
when does BHCG peak and how soon can it be measured
peaks around 8-11 weeks and can be detected in blood around 11 days and in urine at 12-14 days
81
what is naegels rule
to calculate estimated due date
first day of last period, add 1 year, subtract 3 months and add 7 days
82
when should the first prenatal visit occur
before 10 weeks
83
how often should you do prenatal visits
monthly until week 26
every 2 weeks from 26-36 weeks
weekly from 36 weeks onward
84
what is the risk of soft markers for aneuploidy in a second trimester ultrasound in an otherwise low risk patient
not clinically relevant as they have poor predictive value
85
if you suspect early pregnancy loss and the patient is stable, when should you book a follow up ultrasound
in 7-10 days
86
which antidepressant is controversial to use in pregnancy and why
paroxetine (paxil) and fluoxetine have an increased risk of congenital defects compared to other
87
are SSRIs and SNRIs safe in pregnancy
very small risk of SA or teratogenicity but much higher risks of not treating maternal depression
88
can mothers on SSRIs and SNRIs breastfeed
yes
89
what conditions, although very low risk, may be associated with prenatal SSRI and SNRI use
Poor neonatal adaptation syndrome (PNAS)
Persistant pulmonary hypertension of the newborn (PPHN)
90
if an infant develops poor neonatal adaptation syndrome, what advice should you give the parents
usually respond well to a quiet environment, swaddling, skin to skin and frequent feedings
usually resolves within days - 2 weeks
91
what should you do with a pregnant woman with erythema infectiosum and what is the risk
refer for frequent US to monitor for fluid retention
slightly increased risk of miscarriage and may cause fetal anemia
92
what symptoms would you expect from infection with toxoplasmosis
mild malaise, slight fever, swollen glands 2-3 weeks after exposure, rash 1-2 days later
93
when would maternal antibodies from a vaccine pass to the fetus
after 17-20 weeks gestation
94
when is the Tdap vaccine offered to pregnancy women
after 26 weeks gestation
95
what other medication might you consider giving with iron supplements and why
docusate for consipation causes by iron pills
96
true or false: gestational diabetes increases risk of developing type 2 DM later
true
97
when is screening done for gestational diabetes if no risk factors are present
24-28 weeks
98
true or false: nausea and vomiting in pregnancy beginning after 9 weeks gestation is normal
false, if beginning this late it should be further investigated
99
when does NVP usually resolve by
week 16
100
if patient is having NVP, what should you recommend in terms of folate, iron, and multivitamins
can safely stop iron and multivitamins until NVP resolves but should continue with folate
101
what is the medication of choice of NVP and what is the main side effect
Diclectin
drowsiness
102
if patient is experiencing hyperemesis gravidarum, what should you investigate for
hydatiform mole, hyperthyroidism, multiple gestation
103
is overwhelming tiredness a normal sign in first trimester
no this is a red flag and should be further investigated
104
what are the choices for management of early pregnancy loss
expectant, medical and surgical
105
what is anembryonic gestation
empty gestational sac without embryo development
106
true or fase: miscarriage may be prevented by bedrest, vitamin supplementation, progesterone or uterine muscle relaxants
false, there is no way to prevent a miscarriage, can only reduce risk by optimizing health before pregnancy
107
what is the discriminatory zone and what role does it play in managing possible miscarriage
BHCG level of 1500-200
if below, repeat levels every 48 hours until diagnosis is clear
if above, urgent US needed to r/o ectopic
108
what is expectant management for miscarriage
wait and see
90% success rate but may take a few weeks for complete passage
109
how much time should pass before recommending to switch from expectant to medical management of miscarriage
as long as there is no infection or hemorrhage, there is no limit to the time it takes to complete expectant
it is based on patient preference
110
what is medical management of miscarriage and what are the usual side effects
misoprostol 800mcg vaginally with repeat dose in 48 hours if needed
usually bleeding and cramping within 2-6 hours, peaking at 3-5 hours
111
what is surgical managment of miscarriage and when might it be recommended
uterine aspiration
for brisk bleeding that is prolonged with drop in hgb or signs of infection
112
true or false: a fever, 24 hours after receiving misoprostol for miscarriage may be normal and should not be considered a sign of infection
true
113
when should the full anatomy US be done for prenatal patients
18-22 weeks
114
if there is an abnormal finding on an incomplete US should you refer to maternal fetal specialist, or wait for a recall US
refer, do not delay referal for a recall US
115
what is 1st line treatment for asymptomatic bacturia in pregnancy
cephalexin, or nitrofurantoin
amoxicillin only if confirmed by lab due to high rates of resistance
116
when is nitrofuratonin contraindicated in pregnancy
36 weeks onward
117
what is the only OTC pain medication that can be used during pregnancy
Tylenol
118
what things help determine that shortness of breath is from pregnancy and not another pathology
gradual onset starting in 1st trimester
not assocaited with exercise, coughing, wheexing or pain
worse with sitting
119
when is 3rd trimester
week 26-36
120
most babies have turned into the correct position for birth by what week
week 36
121
any fetal presentation other than ____ is considered malpresentation
vertex
122
what are some risks of developing placenta previa
Asian ethnicity, uterine scarring, endometrial disturbamce from instrumentation, previous placenta previa, C-section
123
true of false: 90% of placenta previa will move away from the cervix as pregnancy continues
true
124
for a trauma patient requiring thoracostomy tube who is pregnant or unknown pregnancy status, what should be done
tubes should be placed 1-2 intercostal spaces higher than normal
125
true or false: a pregnant women presents at 24 weeks with vaginal bleeding, she is unknown to you and you have no US reports. You should complete a speculum exam to determine source of bleeding
false, bleeding occuing after 23 weeks do not do speculum if it is unknown whether they have placenta previa or not
126
severe pain with or without bleeding may be a sign of what medical emergency in pregnancy
placental abruption
127
what is the peurperium
first 6 weeks after delivery
128
what should women be aware of in the post partum period regarding mature milk coming in
may cause engorgement and mild fever but significant fever may be a sign of mastitis
129
how much would you expect the uterus to decrease each day after birth
should be just below umbilicus after birth
then descends about 1 finger width per day and usually not palpable after day 10
130
how long should a woman expect to have after pains post partum and how can they be managed
usually lasts 2-3 days post partum
can use NSAIDs and heat
131
how long does lochia ruba, serosa and alba last
rubra 2-4 days
serosa 4-10 days
alba 10-28 days
132
how long does it take for the endometrium to regenerate post partum
about 6 weeks
133
what are carnuculae myrtiformes
tears of hymenal tags causing changes to appearance of vagina
134
true or false: episiotomy is associated with more perinal pain, trauma and long term complications
true
135
what is the acronym REEDA used for
assessment of vagina and perineum post partum
Redness, echymosis, edema, discharge, approximation of wound
136
what is postpartum thyroiditis
thyroid gland and function increases during pregnancy so postpartum hypothyroidism is relatively common and can occur within first year post partum
137
what is telogen effluvium
loss of scalp hair postpartum, usually ends within 15 months but hair may never fully regrow
138
how is bone density affected by breast feeding
may lose up to 7% of bone mass but reversible after weaning
139
how is weight affected postpartum
most women remain about 3 pounds heavier than their prepregnant weight
140
is bradycardia normal postpartum
yes, usually resolved after 2-4 weeks
141
women are already twice as likely to have VTE in postpartum period compared to pregnancy, what other factors increase this risk further
V leiden or prothrombin gene mutations
previos C section
previous history of clots
142
at what point post partume would you expect a womens GFR and Cr to return to normal
by 8 weeks
143
at what point post partum would you expect a womens cholesterol and triglycerides to drops back to normal
by week 6-7
144
what should you be aware of in the post partum period for diabetic and insulin requiring women
blood glucose drops to its lowest level on day 2 and 3 post partum before returning to normal
145
true or false: women should use medications to try to "dry up" their milk if they are having problems with engorgement
false, this may cause rebound engorgement and these drugs have serious side effects
146
true or false: applying a small amount of breast milk to sore or dry nipples is an effective treatment
true
147
when breast feeding, the areola should be almost entirely taken in by the upper or lower lip and what is this called
lower lip
asymmetrical latch
148
if baby sleeps longer than ___ through the night, mother should wake to feed
4 hours
149
after 7 days, less than ___ wet diaper and less than ___ stools a day is a sign of poor feeding
less than 6 wet diapers and 4 stools a day
150
what is the most common reason for discontinued breast feeding
perceived or actual low milk supply
151
what are the most commonly used galactagogues after all other methods have been tried
domperidone and metoclopramide
152
what are contraindications to using domperidone as a galactagogue
hx of arrhythmias or currently taking abx
153
what is another option is women do not want to give their infant Vitamin D drops
can take 4000 IU units themselves if breastfeeding to increase the amount in their milk
154
what might cause a headache that is immediatley improved with laying down post partum
a postdural puncture or spinal headache from an epidural
155
what are the 4 T's responsible for controlling bleeding after birth
tone
tissue
trauma
thrombin
156
what is first line tx for PPH
oxytocin
157
what is a late PPH
excessive bleeding that occurs more than 24 hours and up to 6 weeks post partum
158
when do most late PPH present
1-2 weeks post partum
159
what are some causes of late PPH
infection, retained products, subinvolution of the uterus
160
what is the treatment for late PPH
TVU
curettage
possible broad spectrum anx and uterotonics
161
if bleeding continues post partum despite tx for PPH, what should be considered
a missed or deep laceration
162
what symptoms may indicate a postpartum hematoma
pain
swelling
bruising
palpable mass
may have signs of shock
163
what tx is recommended for a post partum hematoma in a stable patient
observation
ice packs
may need I&D if becomes unstable
164
true or false: a temperature of 38 within the first 24 hours postpartum may be normal
true
165
true or false: a fever after the first 24 hours post partum requires further workup
true
166
what is endometritis
contamination of the uterine lining with vaginal bacteria
167
what are signs of endometritis
fever, uterine tenderness, abdo tenderness, foul smelling lochia
usually within 48 hours of birth
168
what is treatment for endometritis
gentamicin and clindamycin
169
what is treatment for mastitis
bed rest
increased fluids
warm compress
empty breast
sometimes abx
170
why is a D-dimer less useful for diagnosing VTE in pregnany and post partum
already increased from pregnancy
171
what is peripartum cardiomyopathy
LV dysfunction in last month of pregnancy or within 5 months of delivery in a previously healthy woman
172
why is peripartum cardiomyopathy difficult to diagnose
HF is the most common presenting symptom but this mimics normal late pregnancy symptoms
173
why must women diagnosed with peripartum cardiomyopathy during pregnancy be planned to deliver ASAP
because most medication used to treat the HF are contraindicated in pregnancy
174
what is the difference between baby blues and post partum depression
baby blues is transiet labil within the first few weeks and is self limiting
post partum depression usually occurs after 4-6 weeks and is signs of major depression
175
does the canadian pediatric society recommend routine circumcision? why or why not
no because the benefits are relatively balanced to the harms
176
what are the possible benefits of circumcision
phimosis treatment
UTI reduction
STI reduction
Cancer reduction
177
What are the potential risks of circumcision
painful
acute minor bleeding, local infection, unsatisfactory cosmetic result
severe partial amputation, death from hemorrhage
meatal stenosis
partial readhesions
178
what are contraindications for circumcision
hypospadias
increased risk of bleeding from bleeding diathesis
179
what is the average age of menarche
12 years old
180
what is the average age of first intercourse in Canada
17 years old
181
why does sexual activity tend to decline with age
usually from lack of a partner, not lack of interest
182
what is the PLISSIT acronym
to assess and treat sexual health concerns
Permission - to discuss and of normality
Limited Information
Specific Suggestions
Intensive Therapy
183
does breast feeding typical increased or decrease sexual frequency and satisfaction post partum
usually decreased from supressed estrogen associated with breast feeding
184
dyspareunia post partum usually resolves within ___ and can be treated with ___
resolved within 6 months and can be treated with topical lubricants
185
the rapid decrease in estrogen from menopause may cause what issues regarding intercourse
reduced genital blood flow
atrophy
loss of elasticity
dyspareunia
reduced lubrication
low libido
186
what can be used for dyspareunia with menopause
water soluble lubricant
187
what is required to diagnose a functional sexual disorder
minimum 6 months duration
happens 75-100% of the time
causes significant distress
188
what are the 3 categories of female sexual disorder
desire and arousal
genito-pelvic pain/penetration
female orgasmic
189
true or false: people who identify as asexual fit criteria for desire and arousal disorder
false
190
what are some options for managing sexual dysfunction in men and women caused by SSRI use
buproprion or viagra
191
local or systemic estrogen should be used for genitourinary sexual disorders related to menapause and vaginal dryness
local
192
what is an alternative non hormonal treatment for dyspareunia
ospemifene
193
what medication may be helpful for low sexual desire related to menopause
testosterone
194
what two main chronic conditions may cause erectile dysfunction in men
atherosclerosis or DM
195
what is first line treatment for ED and what are common side effects
PDE5 inhibitors
headache, flushing, dyspepsia
196
what is second line treatment for ED and when should this treatment be avoided
alprostadil and vacuum devices
avoid if on anticoagulants or have sickle cell
197
ED may be a warning sign of what in men
CVD
198
what chronic disease may cause retrograde ejaculation in men
DM
199
what are contraindications for COC
breastfeeding and less then 6 weeks postpartum
smokers older than 35
SBP >160
vascular disease
heart disease or stroke
current breast CA
DM with target organ damage
active hepatitis or liver CA
200
how would a history of migraines impact choice of contraception
if hx is with aura should not use COC due to increased risk of stroke
if no aura, ok to use COC
201
what is the difference between the conventional start and quick start method for beginning OC
convential is starting on first day of menses or first sunday after menses begins
quick start is starting day it is prescribed as long as practitioner and patient are reasonably sure patient is not pregnant
202
if a patient forgets to take one OC pill, what should they be instructed to do
take 2 the next day
203
if a patient forgets to take 2 or more OC pills, what should they be instructed to do
continue with the aligned days of the pack and use back up contraception for remainder of cycle
204
what are the most common side effects of COC
breakthrough bleeding
nausea
mild headache
205
what should you instruct for a woman whose contraceptive patch fell off
as long as less than 24 hours off it can be reapplied or taped on
206
when using the ring for contraception, at what point should a back up method be used
if ring is out for more than 3 hours during the first 2 weeks
207
what is a common side effect of progesterone only pills
breakthrough bleeding because there is no estrogen component
208
what is an important thing to tell people taking POPs
they must be taken at the same time every day and if more than 3 hours late, should use back up for next 48 hours
209
how soon after birth can women start using POPs
6 weeks
210
what are the two commonly used medications for emergency contraception
levonorgestrel and ulipristal
211
what is the main difference between levonorgestrel and ulipristal
levonrgestrel must be taken with 72 hrs of intercoruse and ideally within 48 hours
ulipristal is prescription but can be waken with 120 hours of intercourse
212
true or false: the copper IUD is not a good option for emergency contraception
false, if placed within 5 days of unprotected sex, can be EC as well as long term management
213
true or false: the progesterone only IUD can be used for emergency contraception
false
214
what is the only absolute contraindication for depo injections
current diagnosis of breast CA
215
how long until fertility return after discontinuing depo injections
9-10 months but could be as long as 22 months
216
nexplanon lasts for how long
3 years
NURS522
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