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Final Coaching by Sir V

Nov 04, 202421 min read4176 words

This is mainly a review of important concepts for the board exam rather than a comprehensive, structured lecture.

Obstetrics

  1. Ovulation occurs two weeks before a menstruation
  2. Calculating the fertile window
  3. Uterine contraction waveform: increment, acme (peak), and decrement
    • When are you going to take the blood pressure of the woman? During relaxation. In contractions, blood pressure increases and may return a falsely high reading.
    • What period improves uteroplacental perfusion? During relaxation. Constrictions produce vasoconstriction, reducing blood and oxygen supply to the placenta.
  4. Fetal Parameters:
    • Pulse rate should not go below 100 BPM. If it does, fetal distress is present.
      • Decelerations: slowing of the fetal heart rate. Uterine contractions normally decreases fetal heart rate, starting with the increment (e.g. 140 to 135), slowing at most in acme (e.g. down to 110), and recovering during decrement. In actual labor, there are three types:
        • Early Decelerations: FHR immediately slows down upon the onset of a contraction. A normal finding; this is likely due to head compression from contraction.
        • Late Decelerations: FHR continues going down even during decrement. This may be caused by uteroplacental insufficiency; an abnormal finding.
        • Variable Decelerations: the FHR changes in any period, even during relaxation. This is unrelated to uterine contractions. This may be caused by cord compression; an abnormal finding. This, along with late decelerations, is intervened by (a) left lateral positioning, (b) oxygen via face mask, and (c) cessation of oxytocin.
    • Weight: 2,500 grams to 4,000 grams upon birth
  5. Oxytocic and Tocolytic Drugs:
    • Oxytocic: syntocinon, pitocin, oxytocin, methergine.
      • Methergine is no longer used. It produces sustained contractions, which is likely to produce placental retention and postpartum hypertension.
      • Oxytocin is given one minute after the baby is delivered. This produces rhythmic contractions.
      • Pitocin and Syntocinon are given through infusion, and augment labor. These are likely to cause uterine atony.
    • Tocolytic: duvadilan, bricanyl (terbutaline)
      • Bricanyl is also a bronchodilator as a secondary effect.
  6. Bishop’s Scoring for induction and augmentation of labor. Induction is often done for postterm infants. Augmentation is used for prolonged labor. Both are done with oxytocic drugs (Pitocin, Syntocinon)
    • The minimum score required for induction is 8.
    • If the score is less than eight, the doctor is often concerned about the cervical consistency as it affects both dilatation and effacement. The doctor can ripen the cervix by using (1) prostaglandin gel and (2) cytotec (1/4th tablet given with 100 mcg/tab inserted as a suppository).
    • For cervical dilatation, a laminaria tent may be used: a cone-shaped tent is inserted into the cervix, which absorbs moisture and expands, forcing the cervix to dilate.
    • CBQ: highest score (13), minimum score for induction (8), required proficiency (IE), intervention for firm consistency (prostaglandin gel, cytotec), and intervention for dilatation (laminaria tent)
Criteria0123
Cervical Dilatation01-23-45-6
Cervical Effacement0-30%40-50%60-70%80%+
Fetal Station-3-2-1-01+
Cervical ConsistencyFirmMediumSoft-
Cervical PositionPosteriorMiddleAnterior-
  1. Prenatal Checkup: importantly facility-based, done at least four times. It is done to reduce both maternal and neonatal mortality rates by 40%. ENC and the subsequent EINC were both done for these goals.
    • Risk factors:
      • Age: (<18, >35 y.o.) hypertension, IUGR and SGA
      • Height: (<5”) cephalocaudal disproportion
      • Weight: (<90, >150 lbs) a woman, especially those with diabetes, may deliver an LGA baby.
        • Diabetic women are recommended to deliver earlier NOT because of the risk for LGA, but rather because of the risk for neurologic impairment from fetal ketosis in mothers with poor glycemic control.
        • Pregnancies with diabetes primarily utilize diet and exercise over insulin to control their blood sugar.
  2. Discomforts During Pregnancy:
    • Morning Sickness: nausea and vomiting in the morning caused by hCG (primarily) and estrogen. Intervention: crackers before arising in the morning
    • Supine Hypotensive Syndrome (Vena Caval Syndrome): (systolic) hypotension from compression of the inferior vena cava by the gravid uterus of 20 to 30 mm Hg. Intervention: left-lateral position.
    • Edema and Varicosities: edema is caused by increased progesterone, which increases aldosterone (salt-saving hormone). Varicosities are caused by the pressure of the uterus on femoral veins. Management: by (a) elevating the legs, and (b) knee-high stockings.
    • Leg Cramps occurs during the seventh month of pregnancy as calcium is used by the fetus for bone ossification. Management: dorsiflex the foot and extend the knee (hyperextend the affected muscle)
  3. Pelvic Exam: Rule: VOID; empty the bladder.
    • L1: Fundal Maneuver- Identify the lie and sometimes the presentation of the fetus
    • L2: Lateral/Umbilical Maneuver- Find the fetal back
    • L3: Pawlick’s Maneuver- Identity the lie and presentation of the fetus, and determine the fetal attitude
    • L4: Pelvic Maneuver/Grip- Done when the fetus is engaged, checked through ballottement
  4. Fetopelvic Relationship: fetal position in relation to the pelvis.
    • just review this part, it’s hard to describe without pictures
  5. Estimates of Pregnancy:
    • Naegele’s Rule: -3 mo., +7 days, +1 yr
    • Bartholomew’s Rule: landmark of the fundal height in correlation with gestational age
      • Just above the symphysis pubis: 2 months
      • At the umbilicus: 5 months
      • Xiphoid: early 9th month
      • fill in the rest lol
    • McDonald’s Rule: FH*8/7 or FH*2/7
      • less frequent in the board exam
    • Haase’s Rule: months squared for the first 5 months, and months times 5 for the remaining months.
      • apparently never been seen on the board exam
    • Johnson’s Rule: (FH - 11 or 12)*155 for fetal weight 11 if not engaged, 12 if engaged.
      • spotted once in the board exam
  6. Labor and Delivery
    • EINC: ENC in Dec, 2009 and EINC in May, 2014
      • As mentioned earlier, answering MDGs 4 and 5 (maternal and neonatal mortality and morbidity by 40%, respectively).
      • MDG 4 was achieved, but only 20% was achieved for neonatal mortality. This was what brought upon the development of EINC.
      • Caloric requirement- 2,000 calories in pre-pregnant, +300 to +500 in pregnant (total of 2,300 - 2,500/day)
      • Iron requirement: 30 non-pregnant, 60 in pregnant
      • Folic requirement: 400 mcg/day in pregnant women
      • Calcium: 1,200 mg/day
      • Vitamin A: 10,000 IU
      • Iodinated salt for brain development in pre-pregnant women, elemental iodine (250 mg/1 cap every pregnancy)
      • Exercise (walking, squatting for perineal muscles) , avoid alcohol and smoking. Smoking results in IUGR. Alcohol results in Fetal Alcohol Syndrome (FAS), which involves neurologic deficiency.
      • Antenatal steroids: used to improve fetal lung maturity by increasing surfactant production. Surfactant production begins on the 24th to 28th week; 6th to 7th month. If given before this period, surfactant will still not be produced.
        • Indications/Criteria for Steroids: women with a (1) history of preterm birth, (2) risk of preterm birth, (3) history of vaginal bleeding during the present pregnancy, and (4) those experiencing actual preterm labor. Any one of these can already be enough indication for steroids.
        • Drugs: Dexamethasone: 6 mg every 12 hours for 4 doses, Betamethasone: 12 mg every 24 hours for 2 doses.
        • Betamethasone (Celestone) is given in an emergent situations because of its larger dose, especially if actual preterm labor is present (delivery is imminent within 24 hours). The remaining criteria mentioned earlier can still finish the full course of each dose.
      • Intrapartal:
        • When are you going to admit the pregnant client? Active phase, when the patient reaches 4 cm of cervical dilatation or if there are 2 to 3 uterine contractions within 10 minutes.
        • How often is an internal examination done? Every four hours, with a shortest interval of two hours. This is to prevent infection.
      • Partography:
        • There are three aspects in a partograph: the progress of labor (dilatation, contractions), maternal parameters (vital signs, urine, vaginal bleeding), and fetal parameters (amniotic fluid, moulding)
        • Guidelines:
          • Cervical Dilatation (the center of the partograph) should progress at least 1 cm per hour whether primigravida or multigravida. If a delay is met, the doctor is informed.
          • Internal Examination is done no more than five times (q4, no more than q2).
          • Active labor lasting more than eight hours makes the client a candidate for CS. Notify the doctor.
          • Uterine Contractions should not exceed five contractions in 10 minutes; this is a hypertonic uterus, and the doctor must be informed. These are visually displayed based on duration: <20 seconds are dotted, 20 to 40 seconds are line-filled, and >40 seconds are fully shaded.
          • Amniotic Fluid: marked as (a) clear, (b) intact, (c) meconium-stained, (d) bloody, and (e) absent.
  7. Contraception
    • Fertility Awareness Methods:
      • Calendar Method (you know this one, -14 -5+3 for regular cycles)
      • CMT (Spinnbarkeit, Billing’s, Creighton’s): fertility is marked by clear, elastic, abundant cervical mucus due to the effect of estrogen
      • BBT: an increase in body temperature just before ovulation when progesterone (heat-generating) increases on the 14th day of menstruation (ovulation). This is preceded by a drop in progesterone levels in the 13th day of menstruation (remember 3rd-13th-13th-14th low-high low-high). The change is 0.2C to 0.5C.
      • Symptothermal Method: a combination of CMT and BBT methods to determine fertility.
      • 2-day Method: alteration of CMT, any occurrence of feelings of cervical wetness within the past two days indicate fertility.
    • Lactational Amenorrhea Method: the retention of high estrogen levels (inhibition of ovulation) through exclusive, frequent breastfeeding.
      • Only useable for six months. Afterwards, oral contraception may be used as birth control. COCP is contraindicated because estrogen can affect breastfeeding. POP is used.
    • Hormonal Methods: ovulation suppression
      • Pills: started on the first day of menstruation, artificially influencing the cycle of the woman
        • POP: 21 day pack containing progesterone. All pills have hormones in them, and a rest period of 7 days in between packs is observed, where the woman menstruates.
        • COCP: 28 day pack containing estrogen and progesterone. The same as POP, but the rest period of seven days is replaced with placebos or pills without hormones. This is still the period of menstruation.
          • Ignoring the rest period or placebos will cause amenorrhea, still in effect for three months (like in depo provera). The endometrium is shed to avoid it from getting too thick and potentially causing problems (i.e. endometriosis).
        • Skipping doses: forgotten on the same day, take it immediately; forgotten from previous day, take two; forgotten from two days, take two, then two tomorrow, then continue as normal; forgotten three days- discard and continue on the next menstrual period
        • Contraindications: vasoconstriction restricts the use of pills for those >35 y.o., smokers, hypertensive patients, those with diabetes, those with liver problems, those with heart disease, those with thromboembolic disease, and those lactating. Remember JACHES: jaundice, abdominal pain (liver damage), chest pain (heart disease), headache and eye problems (hypertension), and severe leg pain (thromboembolism).
      • Depo Provera: protects the woman for three months, the period of which there is no menstruation but with spotting, especially during the first dose.
        • Do not massage. This increases absorption, decreasing effective time of protection.
      • Ortho Evra: not yet been asked in the board exam; this is bought in packs: a patch-based hormonal contraceptive. Three patches each effective for 7 days each are placed on highly muscular areas of the body (e.g. deltoid, thigh)
      • Implants (Implanon): protects the woman for three years with a 99.98% success rate. This is the best protection from pregnancy besides tubal ligation and abstinence. It is a progesterone-based product. This produces headaches and weight gain (which is the primary reason for discontinuation).
    • Chemical Methods:
      • Spermicide: the least effective; 80% protection. This increases acidity to kill sperms. A common adverse effect is allergy to the chemical used. This is more effective when used in combination with mechanical methods, e.g., spermicides with cervical cap/diaphragm, or condom with spermicide.
    • Mechanical Methods
      • Cervical cap: blocks the cervix. These are kept in place 6 to 8 hours after ejaculation and changed in size when the woman loses or gains 10 or more pounds.
        • IUD: commonly a copper-based T-shaped IUD that acts as a spermicide and blocks the fallopian tubes with sterile inflammation effective for 10 years.
          • The most common issue with IUDs is expulsion of the device; displacement. This is manifested as a dyspareunia.
    • Surgical Methods:
      • BTL
      • Vasectomy: note that this requires two consecutive sperm-free sperm analyses is required to declare sterility.
      • BRAIDED Counseling:
        • Benefits: hassle-free
        • Risks: bleeding, infection
        • Alternatives: especially if the parents may still want children in the future
        • Inquiries and concerns are answered, such as expectations and costs
        • Decision to say “No” is respected
        • Explain the procedure
        • Documentation: informed consent, consent for sterilization

Ratio

  1. Postpartum urinary retention is commonly attributed to the effects of Cesarean operation and anesthesia. One hour after delivery, the nurse notices bleeding, hypotonic contractions, and that the bladder is full. The priority intervention would be to?
    1. Assist the client to void
    2. Administer methergine prn
    3. Massage the uterus
    4. Check the vital signs
  2. Pitocin, Methergine, Ergotrate, and Hemabate are the drugs given to prevent and control post-partum hemorrhage. Which of the following conditions of the mother would be a contraindication for methergine?
    1. Tachycardia
    2. Bradycardia
    3. Hypertension
    4. Unconscious
  3. After delivery, there are open blood vessels in the uterus caused by the placental retention, hence it is normal to have some blood loss postpartum. Massage, oxytocin and breastfeeding stimulate the uterus to contract, thereby closing the blood vessels and decrease the bleeding. Nurses should know the characteristics of the lochia in order to determine if bleeding is still normal. On the fifth postpartum day, the nurse observed that the client’s perineal pad has reddish brown discharges with small and large clots. Which is an appropriate intervention of the nurse?
    1. Record as it is normal discharge during the fifth postpartum day
    2. Ask the woman if she has been walking around too much
    3. Ask the client about the time when the client put on the perineal pad
    4. Check the vital signs and relay the finding to the doctor
  4. Sperm abnormalities include inadequate sperm production or maturation, inadequate motility, blockage of sperm along the male reproductive tract, and an inability to deposit sperm in the vagina. The nurse explains to the fertile couple that a decreased sperm count and motility woud likely happen due to:
    1. Heavy alcohol, marijuana, or cocaine use
    2. Mumps during adulthood
    3. Increased scrotal temperature from tight clothing
    4. All of the above
  5. When reviewing assisted methods of reproduction, artificial insemination is used to instill the sperm into the cervix or uterus to aid in conception. In-vitro fertilization embryo transfer entails removal of one egg via laparoscopy and reinsertion of fertilized eggs into a woman’s uterus. The nurse would understand that in-vitro fertilization and embryo transfer would be a viable reproductive alternative for which of the following:
    1. A couple where the woman is unable to carry a fetus
    2. A woman with damaged fallopian tubes but still ovulates regularly
    3. A couple where the male partner is fertile and the woman is infertile
    4. A woman unable to produce normal mature follicles with a fertile male partner

Types of Assisted Pregnancies

  1. GIFT: Gamete Intrafallopian Tube Transfer
  2. ZIFT: Zygote Intrafallopian transfer
  3. AI: Artificial Insemination, insertion of a zygote into the endometrium. This may be by (a) source: therapeutic husband or donor insemination or (b) placement: into the cervical canal or uterine cavity. A problem with this methodology is it is contraindicated in tubal patency issues as this may result in e
  4. IVF: In-vitro Fertilization, insertion of an embryo into the endometrium
  1. To prevent perinatal morbidity and mortality, a diabetic client should have her serum glucose maintained with a normal range of 70 to 120 mg/dL. The pregnant diabetic needs an increased dose of insulin in pregnanct. Which of the following should not be taught to the client?
    1. Increased needs of insulin in the 2nd and 3rd trimester
    2. Promote adherence to dietary regimen
    3. Diabetics are not encouraged to exercise
    4. Serial fetal growth evaluation and fetal surveillance testing
  2. Hyperemesis gravidarum is severe and excessive nausea and vomiting. A client with this most likely benefits from nursing care designed to handle which of the following diagnoses?
    1. Anticipatory grieving related to inevitable pregnancy loss
    2. Anxiety related to effects of hyperemesis of fetal well being
    3. Imbalanced nutrition: more than body requirements related to pregnancy
    4. INC 22:00
  3. Eclampsia is used to describe preeclampsia that has progressed to include maternal tonic-clonic seizures and coma. Which nursing action would be contraindicated in caring for a client during an episode of eclampsia?
    1. Ensure patency of airway
    2. Firmly restrain the client to prevent self-injury
    3. Maintain the siderails up and padded
    4. Not leaving the client
  4. Which is not associated in preventing the occurrence of thrombophlebitis?
    1. Keeping the woman on stirrups at least two hours postpartum
    2. Encouraging early ambulation postpartum
    3. Wearing support stockings before rising in the morning
    4. Increasing oral fluid intake to 2000 mL/day
  5. Mrs. Delilah is admitted to the postpartum unit after delivery of her first child. Upon assessment, the nurse finds that the client’s fundus is firm and at the level of the umbilicus. After an hour, the nurse observes that the fundus is boggy and located 3 cm above the umbilicus, slightly displaced. The initial action of the nurse is to:
    1. Assist the client in voiding
    2. Massage the fundus
    3. Apply warm compress on the fundus
    4. Report to the physician
  6. After giving birth, Sandra is observed to be extremely sad and always crying. A week has passed and her husband reports that “She still looks down and upset. I am not used to seeing her this way.” What is the nurse’s most appropriate response?
    1. Really? This is not norma. You should be worried.
    2. Your wife is experiencing postpartal depression like a lot of other women. We must refer her for counseling.
    3. Sandra is having “baby blues” which is normal. She needs a lot of support from you right now.
    4. She needs a psychiatrist to treat her postpartal psychosis.
  7. PIH is a condition in which vasospasm occurs during pregnancy in both small and large arteries which ultimately causes signs of hypertension, proteinuria and edema. Jenny is a 38-year-old call center agent who is pregnant with her first child. She is 5’6” and weighs 210 lbs. When she arrived at your clinic for her 7th month visit, you noted that she has BB 148/92. She states that she has had ankle edema for several months now but lately noted some swelling in her face and hands. You know that Jenny has:
    1. Gestational hypertension
    2. Mild pre-eclampsia
    3. Severe pre-eclampsia
    4. Eclampsia

Preeclampsia and Eclampsia

  1. Mild Preeclampsia: 140/90+, +1/+2 Proteinuria, Mildly to moderately edematous
  2. Severe Preeclampsia: 160/110+, +3/+4 Proteinuria, Severely edematous
  3. Eclampsia: a severe preeclampsia + seizures
  1. Rh incompatibility occurs when a pregnant mother forms antibodies against her fetal red blood cells that causes fetal hemolysis. In which of the following situations will need an RhIG injection most?
    1. She gave birth to an Rh negative babay
    2. 28th week of her first pregnancy
    3. History of miscarriage of Rh positive fetus
    4. Her husband has Rh negative blood type
  2. Epidural anesthesia involves injection of drugs through a catheter placed into the epidural space. For a prolonged effect, a continuous infusion of drugs may be employed. Which of the following would be unnecessary intervention for a postpartum client who has received epidural anesthesia?
    1. Maintaining the client on supine position for 8 to 12 hours
    2. Assessing the client’s ability to void within 6 hours after delivery
    3. Allowing the woman to move around in bed
    4. Encouraging the woman to ambulate upon return of sensation and strength
  3. The primary purpose of an episiotomy is to enlarge the vaginal opening and assist childbirth. It is done with local anesthesia and then sutured after delivery. Episiotomy is performed when?
    1. While the client is bearing down
    2. Before crowning to prepare the passage
    3. When the head is crowning
    4. While Ritgen’s maneuver is performed to extensive lacerations
  4. Women who have history of three spontaneous abortions that occurred in the same gestation age are said to have recurrent or habitual pregnancy loss. Which instruction should you give to a woman who is experiencing recurrent pregnancy loss in case bleeding in her first trimester occurs?
    1. Use a tampon instead of a napkin because this can also give pressure to the cervix to stop the bleeding
    2. Complete bled rest with minimal movements should be done for at least 24 hours
    3. Keep all linen and pads that were soiled of vaginal discharges
    4. Calm down because this is already of habitual spontaneous aborters like her.
  5. The station denotes the degree of engagement of the fetal head as it navigates the maternal pelvis. The landmark for determining the station is the maternal pelvis, which is incorrect about the different stations?
    1. At station 0, the fetal head engages in the maternal pelvis, which could happen two weeks before labor
    2. Clients may show no changes in station in case of cephalopelvic disproportion even with full cervical dilatation
    3. After station 0, the client feels the lesser pressure and pain on the pelvic bone and vaginal area
    4. At +3 to +5, the baby’s head is crowning.
  6. Oxytocin (Pitocin) is used to induce labor and also to prevent postpartum hemorrhage. A pregnant client at term is receiving oxytocin infusion for the induction of labor. During the nursing rounds, the nurse finds the client lying flat on bed, and states that she finds the position most comfortable to her. Upon assessing the client, the nurse finds that the contractions last 60 seconds and the fetal rate is 170 BPM. What is the priority intervention by the nurse?
    1. Record it as normal
    2. Stop the oxytocin infusion
    3. Turn the mother to the left side
    4. Call the doctor immediately
  7. The fetal heart tone is a priority assessment in determining the fetal well-being. Which of the following interventions would most ensure accuracy of auscultating the fetal heart sounds?
    1. Using the correct instrument to auscultate the FHT depending on the age of gestation
    2. Placing the stethoscope’s diaphragm on the mother’s abdomen
    3. Peforming LM first to assess the local of the fetal back
    4. Palpating the maternal radial pulse while listening to the FHT
  8. General signs of fetal distress are abnormal FHR, abnormal frequency of fetal movements, and abnormal color of the amniotic fluid. Which of the following is a sign of fetal distress?
    1. FHR of 160 BPM
    2. 30 fetal movements per hour
    3. 7 fetal movements per hour
    4. Greenish amniotic fluid in a breech presentation
  9. Muscle and leg cramps are common in pregnancy, as well. The client asked the nurse what she must do in order to manager her cramps. The nurse would provide a statement that is based on which correct intervention?
    1. Extent the knees and perform plantar flexion exercises
    2. Extend the knees and dorsiflex
    3. When exercising in the standing position, point the toes regularly
    4. Avoid calcium-rich foods as they cause cramping.
  10. The enlarging uterus presents pressure on the vena cava and lower leg veins, thereby affecting the rate of venous return. A pregnant client complained that her leg edema is worsening, particularly in the late afternoon. She is on her last trimester, and her job involves prolonged standing and sitting. She asked the nurse what to do about her problem. The nurse’s response would be based on:
    1. The need to lessen salt intake to lessen edema, similar to what’s happening in congestive heart failure.
    2. The severity of the problem, hence the need to contact the physician immediately, as pre-eclampsia could be present.
    3. The danger of her job to her pregnancy, hence the need to start her maternity leave early.
    4. The need to have breaks once in a while so she could elevate her legs
  11. In assessing the fundal height and estimating the age of gestation, the following landmarks are important: if the fundus is at the symphysis pubis, the age of gestation is approximately 12 weeks; at the level of the umbilicus, 20 weeks; at the xiphoid process, 36 weeks. Moreover, the nurses should also know how to relate the fundal height in centimeters with the age of gestation. What would the nurse expect the fundal height to be if the age of gestation is 28 weeks?
    1. 20 cm
    2. 30 cm (1 week of gestation = 1 cm)
    3. 36 cm
    4. 40 cm
  12. Women who cannot take estrogen pills because of certain conditions can take progesterone-based contraception. Which also offers lesser side effects, although it can cause breakthrough bleeding and irregular menses. Which of the following statements made by the client indicates a need for further instructions, after the nurse has provided health teaching regarding progesterone-based contraception?
    1. Progesterone pills such as Minipills thicken the cervical mucus, making it difficult for sperm to enter the uterus. It also makes the endometrial lining thinner, preventing implantation of the fertilized egg.
    2. If I use progesterone implants like Norplant, it will protect me from pregnancy for five years. If I stop using it, my ovulation will return after an average of three months.
    3. If I use DMPA like Depo-Provera, I will have injections every three months. If I stop, my ovulation will resume after an average of six months.
    4. None; all are valid statements
  13. RBC, fibrinogen, and clotting factors increase during pregnancy, making the woman prone to thrombophlebitis and deep vein thrombosis. In order to prevent the development of these conditions, the nurse provides the following health teaching to the woman except:
    1. Have regular leg exercises
    2. Support and protect the lower leg veins by wearing stockings that reach up to the knees at least
    3. Avoid prolonged sitting, standing, and bed rest
    4. Walk every few hours a day during pregnancy and ambulate ASAP on the first postpartum day.
  14. Progesterone and estrogen have special relationships with oxyutocin and prolactin, and with FSH and LH. What statement would not be appropriarte during these relationshiops?
    1. During pregnancy, the placenta produces estrogen and progesterone, which have inverse relationships with the pituitary gland’s prolactin and oxytocin, respectively.
    2. After delivery of the placenta, estrogen and progesterone levels

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