Clinical Care of the Pregnant Person

Question 1

4 methods to diagnose a pregnancy

Answer 1

History
Physical
Beta hCG
Ultrasound

Question 2

3 methods to date a pregnancy

Answer 2

History (LMP, IVF)
Physical (uterine size)
Ultrasound (transvaginal or transabdominal)

Question 3

Where should the uterus be at

1. 12 weeks
2. 16 weeks
3. 20 weeks

Answer 3

1. Symphysis
2. Mid-way to umbilicus
3. Umbilicus

Question 4

GTPAL

Answer 4

Gravida (number of pregnancies)
Term (number of pregnancies delivered at term)
Preterm (number of pregnancies delivered at preterm)
Abortus (prior to 20 weeks)
Living (# of living children)

Question 5

Beta hCG is made by __ and its function is __

Answer 5

Made exclusively like syncytiotrophoblasts
Role is to rescue and maintain corpus luteum and therefore production of progesterone until placenta takes over progesterone production

Question 6

Ultrasound is used for… (4)

Answer 6

Dating pregnancy
Confirming viability
Assess for early complications
Assess for multiple gestations

Question 7

What is transvaginal ultrasound good for?

Answer 7

Early pregnancy assessment (under 10 weeks)

Obese women

Question 8

What is the gold standard for dating a pregnancy?

Answer 8

Ultrasound

Unless IVF!

Question 9

Dating ultrasound

Answer 9

First scan after 7 weeks
Do before 14 weeks because thats when we start our own individual growth potential
Asses crown rump length
Also gestation sac, yolk sac, fetal cardiac activity

Question 10

Are yeast infections risky in pregnancy?

Answer 10

No!!

Question 11

Is it normal to have bleeding in early pregnancy?

Answer 11

Yes
But these signs/symptoms will likely need investigation
To assess viability and rule out ectopic pregnancy

Question 12

Abnormal rise of beta hCG is suggestive of…

Answer 12

Non-viable pregnancy

Does not distinguish location of pregnancy

Question 13

Who should be offered genetic screening?

Answer 13

All patients!

Question 14

Difference between SIPS and IPS

Answer 14

IPS has nuchal translucency scan (for downs and cardiac abnormalities)

Question 15

Screening programs integrate what various components? (6)

Answer 15

Maternal age
Maternal medical conditions
Maternal ethnicity
Gestational age
Serum analytes
Ultrasound

Question 16

5 analytes produced by fetal-placental unit

Answer 16

PAPP-A
AFP
hCG
Estriol
DIA

Question 17

Nuchal translucency scan

Answer 17

Thickness of tissue in nuchal area between 11-14 weeks

Increased NT with aneuploidy and cardiac anomalies

Question 18

What is the second trimester ultrasound looking for?

Answer 18

Structural abnormalities, growth, fluid, placenta

Ex: congenital heart anomaly, GI anomalies

Question 19

NIPT

Answer 19

Non-invasive prenatal testing
Detection of cell free fetal DNA in maternal serum
Abnormal results should be confirmed with a diagnostic test
Only covered if you have a positive SIPS and IPS

Question 20

Amniocentesis

Answer 20

Ultrasound guidance, needle procedure
Amniotic fluid contains fetal cells
> 15 weeks gestation
Risk 1/200 spontaneous abortion

Question 21

Chorionic villus sampling

Answer 21

Ultrasound guidance, needle or biopsy forceps
Chorionic villi = placenta
11-13 weeks
Risk 1/100 of spontaneous abortion

Question 22

How can the patient measure fetal well being?

Answer 22

Fetal movement counting

After ~26 weeks expect consistent fetal movement 6X in 2 hours

Question 23

4 methods care providers can use

Answer 23

Fetal movement counting
Non-stress test
Contraction stress test
Ultrasound/biophysical profile

Question 24

Non-stress test

Answer 24

Very common use in obstetrics
Continuous monitor of fetal HR over 20-40 mins
During period of non-stress (no induced contractions)
Assess multiple parameters
Indirect assessment of fetal oxygenation and well being

Question 25

Contraction stress test

Answer 25

Assesses similar patterns as NST but during contractions

Induce contractions by administering IV oxytocin or endogenous oxytocin

Question 26

How can ultrasound assess fetal well being?

Answer 26

Assesses growth, amniotic fluid volume, anatomy