Walsh: Perinatal and Pediatric Respiratory Care, 3rd Edition

Chapter 03: Antenatal Assessment and High-Risk Delivery

Answers to Assessment Questions and Clinical Scenarios

1.	C
Rationale: Preeclampsia is traditionally described as a triad of hypertension, proteinuria (protein in the urine), and generalized edema; however, during severe preeclampsia diagnosis is made by the presence of: systolic blood pressure higher than 160 mm Hg, diastolic blood pressure higher than 110 mm Hg, proteinuria, pulmonary edema, intrauterine growth restriction, oliguria, thrombocytopenia, headache, epigastric or right upper quadrant abdominal pain, and hepatocellular dysfunction.
2.	D
Rationale: If a primary or recurrent herpes simplex virus (HSV) outbreak occurs at the time of membrane rupture or the onset of labor the virus may infect the fetus.
3.	D
Rationale: Polyhydramnios is frequently associated with fetal malformations including anencephaly, esophageal atresia, and tracheoesophageal fistula; it is also associated with hydrops fetalis, twin gestation, and maternal diabetes. The use of prostaglandin synthase inhibitors is commonly associated with oligohydramnios.
4.	A
Rationale: See Figure 3-5. Poor beat-to-beat variability, late decelerations, and bradycardia during labor may be signs of fetal compromise due to placental insufficiency.
5.	B
Rationale: Loss of deep tendon reflexes is usually the first sign of toxicity. Other potential toxic effects include pulmonary edema, respiratory depression, cardiac arrest, muscular paralysis, and profound hypotension.
6.	C
Rationale: Safety concerns have been raised in view of reports of uterine rupture occurring after misoprostol induction in patients with previous uterine scars such as those from caesarean section.
7.	A
Rationale::All women between 24 and 34 weeks of gestation with preterm labor and intact membranes are candidates for antenatal corticosteroid therapy. Patients with preterm labor and ruptured membranes may benefit from corticosteroid therapy between 24 and 32 weeks of gestation.