NARM (VARNEY'S, HEART + HANDS )
Universal Precautions - Answer -Use barrier protection. Use gloves: blood/culture
collection, delivery, handling newborn, soiled items. Wash hands and contact Dr if
contaminated. Use sharps container. Never recap sharps.
Polyhydramnios - Answer -Excess amniotic fluid. Large fundal height at 28wks
increasing through preg.
Associated with: multiple gestation, Rh incompatible, diabetes. Fetal anomalies - atresia
of the esophagus, hydrocephaly, anencephaly or spina bifida.
D.x. fluid thrill
Uterine distension: Preterm labor, uterine dysfunction, placental abruption, PP
hemorrahge. Fetal malpresentation + cord prolapse. Hospital birth reco'd.
AFI greater than 24.
Contraindicated herbs during pregnancy - Answer -Blue cohosh. Goldenseal. Cotton
root bark. Ephedra. Pennyroyal. Birthroot.
Oligohydramnios - Answer -Reduced amniotic fluid.
Associated with: S.G.A., I.U.G.R., Postdatism.
Fetal mortality due to IUGR, postmaturity syndrome, congenital anomalies. Cord
compression. fetal distress and hypoxia in labor.
+ hydration, and r/o other problems.
AFI less than 5.0
Large uterus measurement for dates - Answer -Polyhydramnios, mulptiples, L.G.A
Multiple Pregnancy / twins - Answer -Large for dates fundal measurements. Palpate
many parts.
R/o L.G.A
dx: 28-32 wks. Two heartbeats. Ultrasound.
Dizygotic - fraternal. Two eggs and two sperms. Two placentas and two sacs.
Monozygotic - identical. One egg and one sperm. One placenta and one or two sacs.
Risks: anemia. Nutrition. Rest. TTTS. Cord prolapse. Hypoxia. Placenta abruption. PP
hemorrhage.
CPD (cephalopelvic disproportion) is the greatest risk in a breech birth because ... -
Answer -after the body is born, the head might not fit through the pelvis.
Breech risks - Answer -CPD - leads to fetal hypoxia - leads to mortality. Cord prolapse.
To deliver breech safely at home - Answer -Frank or Complete. Anterior or Transverse
position. Well-flexed head. Gynecoid pelvis. Average sized baby.
Newborn with HBV+ mom - Answer -Needs a Hep B vaccines - HBV and HBIG - within
12 hrs of birth.
,Can an HIV+ mom breastfeed? - Answer -No - infection can be transmitted through
breastmilk
GBS profylaxis during labor - Answer -Penicillin, ampicillin or cefazolin q 4hrs through
the hours of labor before birth.
Observe newborn 48hrs for s/s GBS
Most fetuses are in vertex position by - Answer -35-36 wks gestation. Only 10% of
breech will spontaneously turn to vertex after 36 wks.
Predisposing factors for breech presentation - Answer -Previous breech. Prematurity.
Multiple gestation. Multiparty with lax uterine tone, poly, oligo, placenta previa.
Bicornate uterus. Large fibroids low in uterus.
Hydrocephaly. Anencephaly.
Infant born before 37 wks is - Answer -Preterm.
Born between 34 and 36.6 is born in late preterm period.
Infant born before 34 wks is - Answer -Preterm.
Greatest risk of neonatal mortality - Answer -Preterm birth.
Risk factors for preterm labor - Answer -Risk assessment of preterm labor has low
specificity and sensitivity.
Mom was born premature. Cervix/uterine anomalies - short cervix. Poor nutrition,
hydration, BMI, weight gain. Substance use. Multiples. Polyhydramnios. Placenta
previa/abruption. PROM. Chorioamnionitis from vaginal or UTI infection. Recurrent UTI.
Chlamydia. BV. GBS. Periodontal infections.
Treat infections - UTI and chlamydia - to decrease risk of preterm birth.
Short cervix - Answer -Cervical length less than 25mm at 18-24wks gestation.
d.x.: transvaginal ultrasound (TVUS) measurement.
PROM - Answer -Rupture of membranes before 37 wks. Also refers to rupture of
membranes before onset of labor.
Newborn weight to diagnose prematurity - Answer -5# 8oz before 37wks.
Newborn/fetal lungs are almost always mature by - Answer -34 wks
Signs of RDS in newborn - Answer -Cyanosis. Tachypnea. Grunting. Retractions.
Nasal Flaring.
Immature newborn lungs lack surfactant - Answer -to lubricate and inflate the lung
alveoli.
, Lead to RDS.
Less than 34 wks.
Care for a woman predisposed to preterm labor - Answer -Hydration, fish oil, excellent
diet. Decrease stress. Monthly BV tests. Increase prenatal exams to every 2wks at 24
wks gestation. Gentle cervix check for change - if change no more sex. If regular ctx or
cervical change contact Dr. Screen at first sign of vaginal infection.
Medications for active pre term labor - Answer -Tocolytics (uterine relaxant): Mag Sulf.
Ritodrine. Terbutaline.
Suppress labor for 24-48 hrs up to 3-7 days.
I.U.G.R/ F.G.R (fetal growth restriction) - Answer -Are used interchangeably. Fetal
weight below 10th percentile for G.A. Send for ultrasound.
Can be a result of/result in S.G.A.
Fundal height normal until about 24 wks then steady decrease.
Asymmetrical I.U.G.R - Answer -weight under 10th percentile, head over. Result of fetal
compromise after 30 wks. Any condition reducing placenta blood flow and O2:
hypertension. diabetes. renal disease. heart disease.
Symmetrical I.U.G.R - Answer -Head and body under 10th percentile. Consistent from
early pregnancy: severe malnutrition. exposure to drugs/teratogens. Infection. Multiples.
Chromosomal anomalies.
S.G.A (small gestational age) - Answer -miscalculated dates. transverse or low-lying
fetus. hereditary disposition. I.U.G.R. Send for ultrasound
Management of decreased fetal movement - Answer -Fetal movement/kick counts. If
no risk of for uteroplacental insufficiency: eat something. Rest in semi recumbent
position. count FM. 10 in 1hr is good. Less than 10, repeat then office visit for NST to r/o
I.U.G.R and stillbirth.
Decreased fetal movement is associated with - Answer -Stillbirth. I.U.G.R. Send for
ultrasound.
Biophysical Profile - Answer -Ultrasound and NST: combo has fewer false pos/neg
results. Looking for s/s of fetal acidemia.
Used from 41wks twice a week. Any time concerned for fetal well being.
Score of less than 7 (scored like Apgar with 0-2 per 5 categories) induction.
Ultrasound - fetal tone (appears at 8wks). fetal movement (appears at 9wks). fetal
breathing (appears at 12wks). FHR reactivity (by late 2nd tri). AFI levels.
The first to appear (fetal tone) is last to disappear so absence of fetal tone predicts
acidemia 100% of the time. And FHR variability first to disappear.
AFI level ranges - Answer -Oligo: less than 5
Universal Precautions - Answer -Use barrier protection. Use gloves: blood/culture
collection, delivery, handling newborn, soiled items. Wash hands and contact Dr if
contaminated. Use sharps container. Never recap sharps.
Polyhydramnios - Answer -Excess amniotic fluid. Large fundal height at 28wks
increasing through preg.
Associated with: multiple gestation, Rh incompatible, diabetes. Fetal anomalies - atresia
of the esophagus, hydrocephaly, anencephaly or spina bifida.
D.x. fluid thrill
Uterine distension: Preterm labor, uterine dysfunction, placental abruption, PP
hemorrahge. Fetal malpresentation + cord prolapse. Hospital birth reco'd.
AFI greater than 24.
Contraindicated herbs during pregnancy - Answer -Blue cohosh. Goldenseal. Cotton
root bark. Ephedra. Pennyroyal. Birthroot.
Oligohydramnios - Answer -Reduced amniotic fluid.
Associated with: S.G.A., I.U.G.R., Postdatism.
Fetal mortality due to IUGR, postmaturity syndrome, congenital anomalies. Cord
compression. fetal distress and hypoxia in labor.
+ hydration, and r/o other problems.
AFI less than 5.0
Large uterus measurement for dates - Answer -Polyhydramnios, mulptiples, L.G.A
Multiple Pregnancy / twins - Answer -Large for dates fundal measurements. Palpate
many parts.
R/o L.G.A
dx: 28-32 wks. Two heartbeats. Ultrasound.
Dizygotic - fraternal. Two eggs and two sperms. Two placentas and two sacs.
Monozygotic - identical. One egg and one sperm. One placenta and one or two sacs.
Risks: anemia. Nutrition. Rest. TTTS. Cord prolapse. Hypoxia. Placenta abruption. PP
hemorrhage.
CPD (cephalopelvic disproportion) is the greatest risk in a breech birth because ... -
Answer -after the body is born, the head might not fit through the pelvis.
Breech risks - Answer -CPD - leads to fetal hypoxia - leads to mortality. Cord prolapse.
To deliver breech safely at home - Answer -Frank or Complete. Anterior or Transverse
position. Well-flexed head. Gynecoid pelvis. Average sized baby.
Newborn with HBV+ mom - Answer -Needs a Hep B vaccines - HBV and HBIG - within
12 hrs of birth.
,Can an HIV+ mom breastfeed? - Answer -No - infection can be transmitted through
breastmilk
GBS profylaxis during labor - Answer -Penicillin, ampicillin or cefazolin q 4hrs through
the hours of labor before birth.
Observe newborn 48hrs for s/s GBS
Most fetuses are in vertex position by - Answer -35-36 wks gestation. Only 10% of
breech will spontaneously turn to vertex after 36 wks.
Predisposing factors for breech presentation - Answer -Previous breech. Prematurity.
Multiple gestation. Multiparty with lax uterine tone, poly, oligo, placenta previa.
Bicornate uterus. Large fibroids low in uterus.
Hydrocephaly. Anencephaly.
Infant born before 37 wks is - Answer -Preterm.
Born between 34 and 36.6 is born in late preterm period.
Infant born before 34 wks is - Answer -Preterm.
Greatest risk of neonatal mortality - Answer -Preterm birth.
Risk factors for preterm labor - Answer -Risk assessment of preterm labor has low
specificity and sensitivity.
Mom was born premature. Cervix/uterine anomalies - short cervix. Poor nutrition,
hydration, BMI, weight gain. Substance use. Multiples. Polyhydramnios. Placenta
previa/abruption. PROM. Chorioamnionitis from vaginal or UTI infection. Recurrent UTI.
Chlamydia. BV. GBS. Periodontal infections.
Treat infections - UTI and chlamydia - to decrease risk of preterm birth.
Short cervix - Answer -Cervical length less than 25mm at 18-24wks gestation.
d.x.: transvaginal ultrasound (TVUS) measurement.
PROM - Answer -Rupture of membranes before 37 wks. Also refers to rupture of
membranes before onset of labor.
Newborn weight to diagnose prematurity - Answer -5# 8oz before 37wks.
Newborn/fetal lungs are almost always mature by - Answer -34 wks
Signs of RDS in newborn - Answer -Cyanosis. Tachypnea. Grunting. Retractions.
Nasal Flaring.
Immature newborn lungs lack surfactant - Answer -to lubricate and inflate the lung
alveoli.
, Lead to RDS.
Less than 34 wks.
Care for a woman predisposed to preterm labor - Answer -Hydration, fish oil, excellent
diet. Decrease stress. Monthly BV tests. Increase prenatal exams to every 2wks at 24
wks gestation. Gentle cervix check for change - if change no more sex. If regular ctx or
cervical change contact Dr. Screen at first sign of vaginal infection.
Medications for active pre term labor - Answer -Tocolytics (uterine relaxant): Mag Sulf.
Ritodrine. Terbutaline.
Suppress labor for 24-48 hrs up to 3-7 days.
I.U.G.R/ F.G.R (fetal growth restriction) - Answer -Are used interchangeably. Fetal
weight below 10th percentile for G.A. Send for ultrasound.
Can be a result of/result in S.G.A.
Fundal height normal until about 24 wks then steady decrease.
Asymmetrical I.U.G.R - Answer -weight under 10th percentile, head over. Result of fetal
compromise after 30 wks. Any condition reducing placenta blood flow and O2:
hypertension. diabetes. renal disease. heart disease.
Symmetrical I.U.G.R - Answer -Head and body under 10th percentile. Consistent from
early pregnancy: severe malnutrition. exposure to drugs/teratogens. Infection. Multiples.
Chromosomal anomalies.
S.G.A (small gestational age) - Answer -miscalculated dates. transverse or low-lying
fetus. hereditary disposition. I.U.G.R. Send for ultrasound
Management of decreased fetal movement - Answer -Fetal movement/kick counts. If
no risk of for uteroplacental insufficiency: eat something. Rest in semi recumbent
position. count FM. 10 in 1hr is good. Less than 10, repeat then office visit for NST to r/o
I.U.G.R and stillbirth.
Decreased fetal movement is associated with - Answer -Stillbirth. I.U.G.R. Send for
ultrasound.
Biophysical Profile - Answer -Ultrasound and NST: combo has fewer false pos/neg
results. Looking for s/s of fetal acidemia.
Used from 41wks twice a week. Any time concerned for fetal well being.
Score of less than 7 (scored like Apgar with 0-2 per 5 categories) induction.
Ultrasound - fetal tone (appears at 8wks). fetal movement (appears at 9wks). fetal
breathing (appears at 12wks). FHR reactivity (by late 2nd tri). AFI levels.
The first to appear (fetal tone) is last to disappear so absence of fetal tone predicts
acidemia 100% of the time. And FHR variability first to disappear.
AFI level ranges - Answer -Oligo: less than 5
