Antenatal Assessment & Care

Question 1

5 purposes of Prenatal Care

Answer 1

-Assess health status of mothers & fetus
-Monitor progress of pregnancy
-Early detection of at-risk mothers/ fetuses
-Promote self-care of pregnant women
-Provide holistic care to pregnant women & family members

Question 2

how do you calculate Expected Date of Confinement (EDC)/ Delivery (EDD)?
What is the name of rule & any limitations?

Answer 2

EDC=LMP - 3 months + 7 days
Nagele’s rule
only accurate for women with 28 days cycle

Question 3

What is the difference between Gravidity & parity?

Answer 3

Gravidity: no. of times a woman has been pregnant
Parity: no. of times a woman has given birth (alive/ dead), excluding abortions
ps 1st baby stillbirth –> G1P0+1

Question 4

What is the use of fundal height?
important landmarks in assessing gestation:

Answer 4

To estimate period of gestation
symphysis pubis: 12 weeks
umbilicus: 20 weeks
xiphisternum: 36 weeks

Question 5

Name of abdominal palpation technique

Answer 5

Leopold’s Maneuvers
(4 maneuvers in total)

Question 6

Fetal heart rate normal range

Answer 6

110-160/ min, regular

Question 7

What instruments are used for auscultation? Best position to hear fetal heart beat?

Answer 7

Doppler: 8-17 weeks
Fetal Stethoscope: 17-19 weeks
best heard at fetal spine near scapula

Question 8

types of lab tests for vaginal examination

Answer 8

• vaginal & rectal swab culture for grpB streptococcus
• pap smear for cervical cytology
• culture as indicated

Question 9

What are the things to observe at the cervix during vaginal examination?

Answer 9

• open or close? (1st time moms: oval shape; otherwise slit)
• thicken
• bluish discolouration (Chadwick’s sign)
• increased mucus
• any abnormal discharge/ bleeding

Question 10

Describe bimanual examination & possible results

Answer 10

Lubricate index & middle finger, enter with palm facing sideways then rotate so it is facing upwards;
Move along the posterior wall of the vagina and locate the cervix and feel for smoothness, clots, mobility and firmness
Place fingers in the posterior fornix to lift the uterus whilst simultaneously pushing the fundus down by placing the left hand above the symphysis pubis.

for early pregnancy: softening of cervix (Goodell’s sign), softening of isthmus (Hegar’s sign)

Question 11

List out 7 blood tests in antenatal assessment

Answer 11

CBC, ABO grouping, Rhesus factor (Rh), Rubella antibody, HepB surface antigen (HbsAg), Venereal disease (syphilis), Human Immunodeficiency Virus (HIV) antibody

Question 12

antenatal urine tests are for?

Answer 12

glycosuria
proteinuria
ketone

Question 13

What to do if anti-Rh antibodies is tested positive?

Answer 13

give Rh anti-D immunoglobulin injection (Rogan) within 12hrs after delivery
(prevents hemolysis in baby)

Question 14

5 prenatal diagnosis for congenital abnormalities/ heredity condition

Answer 14

Biochemical screening
amniocentesis
chorionic villus sampling (CVS)
cordocentesis
fetoscopy

Question 15

what is nuchal translucency

Answer 15

measure thickness of subcu translucency between skin & soft tissue overlying cervical spine
if increase in thickness (1tri: >3mm, 2tri: >6mm) –> Down’s syndrome

Question 16

1st tier non invasive screening test

Answer 16

1tri combined screening: maternal age, gestation, history of T21, nuchal translucency, PAPPA, free beta hCG
11-13 weeks; result in 2 weeks; 80-90% detection rate

2tri biochemical screening: biochemical marker: hCG, alpha-fetalprotein (AFP)
16-19 weeks; result in 2 weeks; 80% detection rate

Question 17

2nd tier non-invasive prenatal test (NIPT)

Answer 17

DNAtest of fetal chromosomal abnormalities eg trisomy 21 (Down). trisomy 18 (Edwards), trisomy 13 (Patau)
>10 weeks; result in 1 week; 90-99%

Question 18

Prenatal invasive diagnostic procedures (x3)

Answer 18

Chorionic villus sampling (CVS) –> chromosome, metabolic disorders ~11-13weeks
Amniocentesis –> AFP, Chromosome ~16-20weeks
Cordocentesis –> Chromosome, pH, anemia, infection, metabolic disorders 18-24 weeks

Question 19

Abortion definition

Answer 19

expulsion of the fetus either spontaneously or by induction
<24wks or weight <500g
10-15% abortion rates (reason unknown)

Question 20

Nursing care for threatened abortion

Answer 20

• assess amount of bleeding (if
  increase & become bright red –> inevitable abortion)
• advice high fiber diet to prevent constipation

Question 21

2 reasons to consider TOP

Answer 21

1 continuing pregnancy would risk life/ injury to the woman > than termination
2 child would suffer from physical/ mental abnormalities

Question 22

common med used in legal abortion; complications

Answer 22

mifepristone, misoprostol
bleeding, uterine cramping, n&v, headache, dizziness

Question 23

antepartum hemorrhage def

Answer 23

bleeding from genital tract after 28 wk of pregnancy

Question 24

common cause of antepartum hemorrhage

Answer 24

placenta praevia, abruptio, placenta, marginal hemorrhage, rupture of vasa praevia (fetal blood vessel lies over internal cervical os)

Question 25

determine 4 types of placenta praevia

Answer 25

I: minor/ low-lying placenta II: marginal praevia (not covering internal os) III: partial praevia (overlie os when closed, not completely when dilated) IV: total praevia

Question 26

abruptio placenta def

Answer 26

bleeding from premature separation of whole/ part of a normally situated placenta from 34 week of pregnancy

Question 27

3 types of abruptio placenta

Answer 27

mild - minimal vaginal bleeding & changes in maternal vital signs; no fetal distress/ shock moderate - concealed/ apparent bleeding, fetal distress, tense uterus & painful palpation severe - maternal hypovolemic shock, may lead to fetal death

Question 28

difference in clinical features between placentia praevia & abruptio placenta

Answer 28

placenta praevia - uterus soft, tender abruptio placenta - uterus hard, tense & tender; difficult to palpate fetal parts/ auscultate heart

Question 29

Gestational DM diagnosis (test & result)

Answer 29

Oral Glucose Tolerance Test (OGTT) Fasting - 5.1 1 hr - 10 2 hr - 8.5

Question 30

diet control for GDM

Answer 30

30 kcal/ kg/ day carb: protein: fat - 40-45%: 12-20%: 35-40% high complex carb, adequate fibre

Question 31

med & monitoring of GDM

Answer 31

metformin (oral), insulin monitor: blood sugar series, HbA1c, hstix

Question 32

GDM fetal complications

Answer 32

congenital anomalies, macrosomia, birth trauma, shoulder dystocia, neonatal jaundice,

Question 33

hypertension diagnosis

Answer 33

140/90 on 2 occasions (>4hrs apart) or 160/110

Question 34

Proteinuria diagnosis

Answer 34

dipstick analysis >= 1+ spot urine protein to creatinine ratio >30mg/mmol 24hrs urine: protein >300mg/ 24hrs

Question 35

what is pre-eclampsia & eclampsia

Answer 35

pre: proteinuria +- pathological edema eclampsia: above w/ convulsion

Question 36

complications of hypertension in pregnancy

Answer 36

eclamptic seizure, cerebral hemorrhage, pulmonary edema, renal failure, liver hemorrhage/ failure (HELLP syndrome), thrombocytopenia, disseminated intravascular coagulopathy (DIC), APH

Question 37

explain HELLP syndrome

Answer 37

Haemolysis, Elevated Liver enzymes, Low Platelet count