AMCB Task Analysis Test Content: Exam Prep Study Guide
Evaluate for signs of pregnancy - correct answer ✔✔Presumptive Signs (Reported by Woman in
History):
- Amenorrhea in a woman who previously experienced regular cycles
- Breast or nipple tingling, tenderness, and/or enlargement
- Fatigue
- N/V
- Quickening (perception of FM)
- Pigmentation changes (cholasma, linea nigra)
- Sustained elevated basal body temp (in absence of infection)
- Urinary frequency
Probable signs (detected by physical exam or lab test):
- Breast changes (expression of colostrum, enlargement of breasts and nipples)
- Enlargement of abdomen
- Enlargement of uterus
- Changes noted on pelvic exam: ballottement, Chadwick's (bluish color), Goodell's (softening
cervix), Hegar's (softening lower uterus), Piskacek's (asymmetric lateral bulge in uterus)
- Palpable fetal outline or movement
- Palpation of uterine contractions
- Positive pregnancy test
Positive signs:
- Sonographic evidence
- Audible FHTs
,Assess the woman's acceptance of pregnancy - correct answer ✔✔Ask open-ended questions to
ascertain her own questions, concerns, and plans for the current pregnancy and listen carefully
to her responses
Determine woman's goals
Approx half of all pregnancies are unintended
Orders and evaluates serial hCG levels when indicated - correct answer ✔✔Serial
measurements of quantitative serum beta-hCG values repeated every 48-72 ho urs (often in
conjunction with early US) to help determine presence and viability of an intrauterine
pregnancy, rule out ectopic pregnancy, or follow decline when a spontaneous abortion has
occurred
Serum values increase exponentially in early pregnancy, doubling approx every 1.5-3 days in the
first 5-6 weeks, then doubling every 3-3.5 days in weeks 7-8, peaking at 8-10 weeks, then
plateauing
"discriminatory zone" at hCG of 1500-2000 (approx 91% of women with beta higher than this
range will have an intrauterine gestational sac visible if transvaginal US is performed
Once hCG reaches 3500, 99% of pregnancies visible on US
Provides counseling and support for women experiencing early pregnancy loss - correct answer
✔✔Expectant management: counsel to call provider if signs of infection or heavy bleeding,
discuss if wanting to collect POC for genetics with hx of 2 or more miscarriages; follow up urine
pregnancy test a week or more after to confirm completion
,Medical management: Cytotec (800mcg vaginally with option to repeat dose in 7 days if no
response to first dose); success is 80-90% within 7 days in women who are up to 10 weeks
gestational age at time of administration; counsel on expected symptoms and warning signs;
ensure access to emergency care if needed
Surgical management: may be advised for women who prefer this option, after failed expectant
management, women greater than 10 weeks gestation, or if woman has risk factors
contraindicating medical management; risk factors include cervical trauma, uterine perforation,
and intrauterine adhesions
Evaluates historical, physical, and lab data to determine current gestational age and due date -
correct answer ✔✔Accurate calculation of gestational age is necessary to appropriately select
interventions for threatened preterm labor, to determine adequacy of fetal growth, and to time
the initiation of fetal surveillance or IOL
EDD by LMP: date of LMP used as baseline for an initial determination of gestational age and
EDD (Naegele's rule: first day of LMP + 7 days - 3 months = EDD)
EDD by Pregnancy Wheels and Apps: calculates EDD based on 280 days for duration of
gestation; may vary by 1-7 days for EDD
ART: date of insemination or embryo transfer used instead of LMP because precise due date can
be calculated
First trimester US: calculation of gestational age and EDD based on US performed before 13 6/7
weeks is the most accurate method for dating pregnancy; crown-rump length is most accurate
Second trimester US: estimates fetal age based on composite measurements of fetal head
circumference, biparietal diameter, femur length; as well as woman's abdominal circumference
, Less reliable methods: fundal measurement, onset of quickening, clinician's notation of first
detection of FHTs, client's s/s of pregnancy
Orders first-trimester US to establish or confirm gestational age - correct answer ✔✔Most
accurate first trimester ultrasound measurement for determining gestational age is crown-rump
length measurement
<8 6/7: change EDD if >5 days discrepancy between LMP and US dates to support US dating
9 0/7 to 13 6/7: change EDD if >7 days discrepancy between LMP and US dates to support US
dating
Assesses for causes of first trimester bleeding and refers for treatment as indicated - correct
answer ✔✔Evaluation of First Trimester Bleeding:
- Initial goal: rule out life-threatening conditions such as active hemorrhage or ectopic
pregnancy
- History: diagnosis of pregnancy (obtain LMP, result of preg test, US results), reproductive hx
(previous miscarriages or ectopic?), bleeding pattern and associated events (profuse bleeding?,
intermittent?, with sex?), passage of any tissue?, pain?
- Physical Exam: VS, abdominal exam (palpate for tenderness/pain, FH, rebound tenderness,
FHTs?, palpate for CVAT), speculum exam (inspect for lacerations, lesions, vaginitis, cervicitis,
hemorrhoids, varicosities); perform wet prep if indicated; inspect cervical os)
- Bimanual exam: size of uterus; cervical effacement, dilation, CMT; adnexal masses or pain
- Lab Tests and US: obtain Hgb/Hct if indicated, perform US if indicated, serial hCG or
progesterone if indicated
Diff. diagnoses: non-uterine source of bleeding (cervical polyp, cervicitis), viable pregnancy,
nonviable pregnancy, uncertain pregnancy, pregnancy of uncertain location, or ectopic
pregnancy
Evaluate for signs of pregnancy - correct answer ✔✔Presumptive Signs (Reported by Woman in
History):
- Amenorrhea in a woman who previously experienced regular cycles
- Breast or nipple tingling, tenderness, and/or enlargement
- Fatigue
- N/V
- Quickening (perception of FM)
- Pigmentation changes (cholasma, linea nigra)
- Sustained elevated basal body temp (in absence of infection)
- Urinary frequency
Probable signs (detected by physical exam or lab test):
- Breast changes (expression of colostrum, enlargement of breasts and nipples)
- Enlargement of abdomen
- Enlargement of uterus
- Changes noted on pelvic exam: ballottement, Chadwick's (bluish color), Goodell's (softening
cervix), Hegar's (softening lower uterus), Piskacek's (asymmetric lateral bulge in uterus)
- Palpable fetal outline or movement
- Palpation of uterine contractions
- Positive pregnancy test
Positive signs:
- Sonographic evidence
- Audible FHTs
,Assess the woman's acceptance of pregnancy - correct answer ✔✔Ask open-ended questions to
ascertain her own questions, concerns, and plans for the current pregnancy and listen carefully
to her responses
Determine woman's goals
Approx half of all pregnancies are unintended
Orders and evaluates serial hCG levels when indicated - correct answer ✔✔Serial
measurements of quantitative serum beta-hCG values repeated every 48-72 ho urs (often in
conjunction with early US) to help determine presence and viability of an intrauterine
pregnancy, rule out ectopic pregnancy, or follow decline when a spontaneous abortion has
occurred
Serum values increase exponentially in early pregnancy, doubling approx every 1.5-3 days in the
first 5-6 weeks, then doubling every 3-3.5 days in weeks 7-8, peaking at 8-10 weeks, then
plateauing
"discriminatory zone" at hCG of 1500-2000 (approx 91% of women with beta higher than this
range will have an intrauterine gestational sac visible if transvaginal US is performed
Once hCG reaches 3500, 99% of pregnancies visible on US
Provides counseling and support for women experiencing early pregnancy loss - correct answer
✔✔Expectant management: counsel to call provider if signs of infection or heavy bleeding,
discuss if wanting to collect POC for genetics with hx of 2 or more miscarriages; follow up urine
pregnancy test a week or more after to confirm completion
,Medical management: Cytotec (800mcg vaginally with option to repeat dose in 7 days if no
response to first dose); success is 80-90% within 7 days in women who are up to 10 weeks
gestational age at time of administration; counsel on expected symptoms and warning signs;
ensure access to emergency care if needed
Surgical management: may be advised for women who prefer this option, after failed expectant
management, women greater than 10 weeks gestation, or if woman has risk factors
contraindicating medical management; risk factors include cervical trauma, uterine perforation,
and intrauterine adhesions
Evaluates historical, physical, and lab data to determine current gestational age and due date -
correct answer ✔✔Accurate calculation of gestational age is necessary to appropriately select
interventions for threatened preterm labor, to determine adequacy of fetal growth, and to time
the initiation of fetal surveillance or IOL
EDD by LMP: date of LMP used as baseline for an initial determination of gestational age and
EDD (Naegele's rule: first day of LMP + 7 days - 3 months = EDD)
EDD by Pregnancy Wheels and Apps: calculates EDD based on 280 days for duration of
gestation; may vary by 1-7 days for EDD
ART: date of insemination or embryo transfer used instead of LMP because precise due date can
be calculated
First trimester US: calculation of gestational age and EDD based on US performed before 13 6/7
weeks is the most accurate method for dating pregnancy; crown-rump length is most accurate
Second trimester US: estimates fetal age based on composite measurements of fetal head
circumference, biparietal diameter, femur length; as well as woman's abdominal circumference
, Less reliable methods: fundal measurement, onset of quickening, clinician's notation of first
detection of FHTs, client's s/s of pregnancy
Orders first-trimester US to establish or confirm gestational age - correct answer ✔✔Most
accurate first trimester ultrasound measurement for determining gestational age is crown-rump
length measurement
<8 6/7: change EDD if >5 days discrepancy between LMP and US dates to support US dating
9 0/7 to 13 6/7: change EDD if >7 days discrepancy between LMP and US dates to support US
dating
Assesses for causes of first trimester bleeding and refers for treatment as indicated - correct
answer ✔✔Evaluation of First Trimester Bleeding:
- Initial goal: rule out life-threatening conditions such as active hemorrhage or ectopic
pregnancy
- History: diagnosis of pregnancy (obtain LMP, result of preg test, US results), reproductive hx
(previous miscarriages or ectopic?), bleeding pattern and associated events (profuse bleeding?,
intermittent?, with sex?), passage of any tissue?, pain?
- Physical Exam: VS, abdominal exam (palpate for tenderness/pain, FH, rebound tenderness,
FHTs?, palpate for CVAT), speculum exam (inspect for lacerations, lesions, vaginitis, cervicitis,
hemorrhoids, varicosities); perform wet prep if indicated; inspect cervical os)
- Bimanual exam: size of uterus; cervical effacement, dilation, CMT; adnexal masses or pain
- Lab Tests and US: obtain Hgb/Hct if indicated, perform US if indicated, serial hCG or
progesterone if indicated
Diff. diagnoses: non-uterine source of bleeding (cervical polyp, cervicitis), viable pregnancy,
nonviable pregnancy, uncertain pregnancy, pregnancy of uncertain location, or ectopic
pregnancy
