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Rnc-Nicu Review Watson Questions AndAnswers With Verified Solutions Already
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A patient who is G2P2 at 33 weeks' gestation arrives at the triage unit complaining
of regular uterine contractions. Her pregnancy history includes a preterm delivery
at 34 weeks. Prior to examining her, the nurse performs electronic fetal monitoring
and obtains a complete history. The patient reports no bleeding and no rupture of
membranes. She has had no vaginal examinations or sexual activity for more than
24 hours. The biochemical marker useful in this situation for predicting pre-term
birth is:
a. cervical ferritin
b. fetal fibronectin
c. corticotropin-releasing hormone
d. placental alpha-microglobulin-1 - ANSWER✔✔b. fetal fibronectin
fetal fibronectin (fFN) is uncommonly present in cervicovaginal secretion in the
late second and early third trimesters. fFN is an extracellular glycoprotein and is
thought to act as an adhesive between the fetal membrane and uterine wall and can
be disrupted by inflammation. A preterm birth within 2 weeks is probable after a
positive test result. Cervical ferritin is not a biomarker but an inflammatory marker
whose presence provides support for the theory that infection is a mediator for
preterm birth. Maternal plasma concentrations of corticotropin-releasing hormone
are elevated in both term and preterm pregnancies. It appears to be a component of
the common pathway of labor regardless of gestation. Placental alpha-
microglobulin-1 is a protein found in amniotic fluid that is a biomarker for rupture
of membranes.
,A patient comes to the triage unit at 32 weeks' gestation concerned because she has
been "leaking fluid" from her vagina for the past hour. She says she has felt no
contractions and reports normal fetal activity. A bedside immunoassay called
AmniSure is performed. The test identifies a glycoprotein abundant in amniotic
fluid. This glycoprotein is called:
a. prolactin
b. alpha-fetoprotein
c. fetal fibronectin
d. placenta alpha-microglobulin-1 - ANSWER✔✔d. placenta alpha-microglobulin-
1
Premature rupture of membranes is one of the most common complications of
pregnancy resulting in a newborn's admission to the NICU. A bedside
immunoassay test, AmniSure ROM, is simple, easy to perform, rapid (5-10
minutes), and minimally invasive. This test identifies a placental glycoprotein that
is abundant in amniotic fluid but present in lower concentrations in maternal blood
and cervicovaginal secretions. Prolactin is responsible for priming the breast tissue
in preparation for lactation. Alpha-fetoprotein is assessed to indentify neural tube
defects (high) and Down's Syndrome (low). Fetal Fibronectin is an extracellular
glycoprotein that is thought to act as an adhesive between the fetal membranes and
uterine wall and is a biomarker for predicting preterm birth.
When electric fetal monitoring is used, the BEST indicator of fetal oxygenation
status during labor is:
, a. fetal heart rate baseline within the normal range
b. moderate fetal heart rate variability
c. absence of decelerations of the fetal heart rate
d. presence of accelerations in the fetal heart rate - ANSWER✔✔b. moderate fetal
heart rate variability
Moderate fetal heart rate (FHR) variability is strongly associated with an arterial
umbilical cord pH higher than 7.15. Normal FHR variability provides reassurance
about fetal status and the absence of metabolic acidemia. FHR variability is the
sign most predictive of fetal well-being. The most important single FHR
characteristic variability. FHR baseline is 110 to 160 bpm regardless of gestational
age. Decelerations are a reflection of head compression, umbilical cord
compression, or a transient interruption of in oxygen transfer. Accelerations are
highly predictive of the absence of fetal metabolic acidemia and form the basis of
the nonstress test. They occur in association with fetal movement.
The biophysical profile (BPP) is currently the primary method for evaluating fetal
well-being through the assessment of various activities that are controlled by the
central nervous system and are sensitive to oxygenation. The five variable included
in the BPP are:
a. fetal tone, fetal breathing, fetal movement, non-stress test, and amniotic fluid
volume
b. fetal movement, fetal tone, nonstress test, amniotic fluid index, and fetal position
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