2- Prenatal Care

Question 1

What age is concerned advanced maternal age (AMA)?

Answer 1

> 35 yo

Question 2

Which vaccines is it most important to make sure a woman has prior to conceiving?

Answer 2

MMR, varicella

(live vaccines)

Question 3

Female pt should be taking prenatal vitamins with what 2 specific ingredients starting 1 month prior to trying to conceive?

Answer 3

Folic acid: 0.4- 0.8 mg, 4 mg if hx of NTD or AMA

DHA

Question 4

When should a pregnant pt present for their 1st visit?

Answer 4

8-10 weeks

Question 5

How do you determine obstetrical hx using Gravida (v), Para (w, x, y, z) (TPAL)?

Answer 5

v = # of pregnancies (multiple gestation counts as 1 pregnancy)

w = # of full term births (after 37 wks)

x = # of preterm births

y = # of abortions (spontaneous, induced, ectopic)

z = # of living children

Question 6

What is considered early, full, late, and post term pregnancies?

Answer 6

Early: 37-38 wks

Full: 39-40 wks

Late: 41 wks

Post: 42+ wks

Question 7

What rule is used to determine EDC (estimated date of confinement)/ EDD (estimated date of delivery)?

Answer 7

Add 7 days to LMP and subtract 3 months

Question 8

What sign of early pregnancy may be noted at the first prenatal care visit and is distinguished by a blue to purple tint of the vaginal walls/ cervix?

Answer 8

Chadwick’s sign

Question 9

What sign of early pregnancy may be noted at the first prenatal care visit and is distinguished by palpable softening of the isthmus?

Answer 9

Hegar’s sign

Question 10

What breast exam finding may be noted at first prenatal visit and can be initially concerning to pt?

(also: dilated veins, enlarged breasts with expanding/ darkening areola, TTP)

Answer 10

Montgomery tubercles

(sebaceous glands that appear as small bumps on areola)

Question 11

What is the most important lab ordered at the first prenatal visit?

Answer 11

Urine HCG

Question 12

Why do you perform an US at the first prenatal previsit?

Answer 12

Confirmation of EDD

R/o ectopic (empty uterus but (+) pregnancy test)

Question 13

What are common foods to avoid during pregnancy?

Answer 13

High mercury fish, raw meats/ eggs/ fish, processed meats (listeriosis), <200 mg caffeine daily

Question 14

How much exercise is recommended for pregnant and postpartum women?

Answer 14

150 minutes/ week

Question 15

What is considered an acceptable amount of weight to gain during pregnancy?

Answer 15

~30 lbs

Question 16

Once pregnant, pt should avoid travel due to risk of what?

Answer 16

ZIKA

Question 17

What weeks of pregnancy are considered 1st, 2nd, and 3rd trimester?

Answer 17

1st: week 1-12
2nd: week 13-26
3rd: week 27+

Question 18

How often should a pregnant pt be seen in:

• the first 28 weeks?
• weeks 28-36?
• weeks 36+?

Answer 18

First 28 weeks: q 4 wks

Weeks 28-36: q 2 wks

Weeks 36+: weekly

Question 19

When/ what is the first fetal movement felt by the mother?

Answer 19

18-20 wks, quickening

(sooner if not 1st pregnancy, 16-18 wks)

Question 20

How many fetal kick counts should be felt beginning at the 3rd trimester?

Answer 20

10 within 2 hours

(kicks/ rolls/ flutters)

Question 21

What is used to detect fetal heart tone (FHT) between 10-12 weeks and what rate is considered to be WNL?

Answer 21

Dopper, 110-160 bpm

Question 22

What is the location of the fundal height measurement at 12 and 20 weeks?

Answer 22

12 weeks = pubic symphysis

20 weeks = umbilicus

Question 23

What is defined as the point in time when the fundal height drops after 36-38 weeks due to the fetus dropping into the pelvis and deceasing AFI (amniotic fluid index)?

Answer 23

Lightening

Question 24

What labs should be checked at every visit for pregnant pt?

Answer 24

Urine sample- protein (pre-eclampsia), glucose (GDM)

Question 25

When/ with what is fetal gender determined?

Answer 25

US @ 16 weeks GA NIPT (non-invasive prenatal test) @ 9 weeks GA (serum draw)

Question 26

What is evaluted during the 2nd trimester US (performed between 18-22 weeks GA)?

Answer 26

Fetal anatomy

Question 27

What is included in the lab draw during the 3rd trimester visit (aside from CBC, RPR, ABO/ Rh, antibody screen)?

Answer 27

1 hr/ 3 hr glucose challenge +/- Rhogam

Question 28

1 hour glucose challenge test (performed during 3rd trimester visit) involves giving pt 50g oral glucose load. What results are considered normal/ abnormal and how would you proceed?

Answer 28

\< 140 mg/ dL = pass \> 140 mg/ dL = abnormal = proceed w/ 3 hr glucose tolerance test \> 200 mg/ dL = automatic fail = GDM

Question 29

3 hour glucose challenge test (performed during 3rd trimester visit) involves giving pt 100g oral glucose load with 4 total blood draws. What results are considered abnormal?

Answer 29

2 abnormal values = fail 1 value \> 200 mg/ dL = automatic fail = GDM

Question 30

What is determined by the 3rd trimester US (performed during 32-34 weeks of GA)?

Answer 30

Fetal growth/ position, state of placenta and AFI

Question 31

What can be used to determines the baby’s position in utero with hands on gravid abdomen?

Answer 31

Leopold Maneuvers

Question 32

What is determined by the 3rd trimester cervical exam (performed at 35-40 weeks GA)?

Answer 32

Dilation, effacement, station, position, presenting part

Question 33

When should you perform group B strep culture with swab of lower vagina and rectum and what is done if culture is (+)?

Answer 33

35-37 weeks GA If (+) intrapartum abx prophylaxis

Question 34

What Bishop scores are indicative of the highest chance of successful induction (vaginal delivery) and highest change of failed induction (therefore indicating c-section)?

Answer 34

Successful: 8-13 points Failed: 0-4 points

Question 35

What are the expected results of an NST (nonstress test) performed during the 3rd trimester of pregnancy?

Answer 35

Minimum of 2 accelerations Accelerations must increase in FHR by 15 bpm and last for 15 seconds

Question 36

What tests might be performed for high risk pregnancy in the 3rd trimester?

Answer 36

NST (nonstress test) BPP (biophysical profile)

Question 37

What is used for high risk pregnancy during the 3rd trimester to measure fetal movement, muscle tone, breathing movements, as well as AFI?

Answer 37

BPP (biophysical profile) Perfect score = 8/8 (or 10/10 if FHR included)

Question 38

What optional testing for prenatal care is a sonographic determination of nuchal translucency performed between 11-13.6 weeks GA and what might it indicate a higher risk for?

Answer 38

NT scan, Down Syndrome

Question 39

What optional testing for prenatal care is a serum draw that coincides with NT scan, measures PAPP-A/ Beta HCG and what might it indicate a higher risk for?

Answer 39

FTS (first trimester screening), Down Syndrome and Edwards Syndrome

Question 40

What optional testing for prenatal care is a serum draw performed as early as 9 weeks GA, have fetal fraction of 8%, and drawn in place of FTS if performed with NT scan?

Answer 40

NIPT (non-invasive perinatal screening) (expensive)

Question 41

What optional testing for prenatal care is a maternal serum marker for AFP, performed between 15-21.6 weeks GA and what might it indicate a higher risk for?

Answer 41

AFP only Higher risk of NTD

Question 42

What optional testing for prenatal care can be drawn in NT/FTS was no performed, is most accurate between 16-18 weeks, and shows serum markers for AFP, uE3, hCG, and inhibin A in maternal serum? What might it indicate a higher risk for?

Answer 42

Maternal serum screen NTD, Down Syndrome, Edward Syndrome

Question 43

What additional supplements are recommended for a woman of AMA?

Answer 43

4 mg folic acid/ day, daily ASA

Question 44

Earlier aneuploidy screening, involving maternal fetal medicine (MFM), level 2 ultrasounds, antenatal testing, and delivery @ 39 weeks is indicated when?

Answer 44

AMA (\> 35 yo)