[CLMD] The Normal Pregnancy; Antepartum care [Moulton]

Question 1

What percent of pregnancies are unplanned?

Answer 1

49%

Question 2

What is an excellent supplementation to start at least 1 month prior to conception to prevent neural tube defects?

Answer 2

Folic acid

Question 3

What population of mothers need extra attendion prior to conception?

Answer 3

Diabetic pts

Question 4

What are some normal findings in pregnancy that would otherwise be considered pathologic?

Answer 4

• Systolic murmurs
• Palmar erythema
• Spider angiomas
• Linea nigra
• Striae gravidarum
• Chadwicks sign

Question 5

What do you give to Rh (-) patients?

When?

Answer 5

Rhogam

28 weeks

Question 6

Is pregnancy a hypercoagulable or hypocoagulable state?

Answer 6

Hypercoagulable

Question 7

What are some major things to do during the first prenatal visit?

Answer 7

• Confirm pregnancy and viability
• Estimate gestational age and due date
• Potential genetic counseling
• Discuss teratology (meds)

Question 8

When can hCG be first detected in the serum?

Answer 8

6 to 8 days after ovulation

Question 9

In the first 30 days of a normal pregnancy, hCG doubles every ____ days

Answer 9

In the first 30 days of a normal pregnancy, hCG doubles every 2.2 days

Question 10

What is the hCG level when the gestational sac is seen?

Around how many weeks?

Answer 10

hCG = 1500-2000 IU/L

5 weeks

Question 11

What is the most accurate length to measure for determining the due date?

During which trimester?

Answer 11

Crown rump length

First trimester

Question 12

Who needs genetic counseling?

Answer 12

35 or older pts.

Previous child/FH of birth defects

Multiple fetal losses

Exposure to teratogens

Abnormal ultrasound findings

Question 13

What are the two diagnostic methods for prenatal diagnosis of chromosomal abnormalities?

Answer 13

Chorionic villus sampling

Amniocentesis

Question 14

What are the two major sex linked disorders?

Answer 14

Duchenne muscular dystrophy

Fragile X syndrome

Question 15

What are the screens included in the FIRST TRIMESTER?

Answer 15

Maternal age

Fetal nuchal translucency (NT) thickness

Maternal b-hCG

PAPPA-A

*PAPPA CAN GET HER PREGNANT FIRST

Question 16

What is included in the SECOND TRIMESTER SCREENING?

Answer 16

Triple screen:

b-hCG, estriol and maternal alpha fetoprotein (AFP) markers

Question 17

What do you use to identify open neural fetal defects?

Answer 17

AFP

Question 18

What technique is HIGHLY specific and used to dectect genomic trisomies?

Answer 18

Noninvasive prenatal testing

Cell-free fetal DNA

Question 19

What is the MOST VULNERABLE stage for teratogenic effect?

Answer 19

Day 17 to day 56

Question 20

What are 6 major categories of the most common teratogenic agents?

Answer 20

Alcohol

Antianxiety

Antineoplastic

Anticoagulant

Anticonvulsants

Question 21

Which anticoagulant drug crosses the placenta?

Which anticoagulant drug does NOT cross the placenta?

Answer 21

Coumadin

Heparin

Question 22

What is the rule of thumb to use for radiation exposure and risk?

Answer 22

Less than 5 rads of exposure = no risk

Question 23

Why do pregant women frequently experience N/V?

Answer 23

Relaxation of esophageal sphincter by progesterone

Question 24

How much should a baby move every 2 hours?

Answer 24

10 movements every 2 hours

Question 25

What is a **nonstress test (NST)?**

Answer 25

Either reactive or non reeactive results Reactive= 2 accelerations of at least 15 beats above baseline lasting 15 seconds during 20 min of monitoring Nonreactive = didn't not get above results

Question 26

What do you do if your pregnant pt gets a **nonreactive nonstress test (NST)?**

Answer 26

Get a **contraction stress test (CST)**

Question 27

How do you conduct a **contraction stress test (CST)?**

Answer 27

Give **oxytocin** to establish at least **3 contractions** in a 10 min period If late decelerations are noted with the majority of contractions, the test is POSITIVE and delivery is warrented

Question 28

What scores on the **components of the reassuring biophysical profile** guidelines are: Reassuring Equivocal Nonreassuring

Answer 28

Reassuring = 8-10 Equivocal = 6 Nonreassuring = 4 or less

Question 29

What biophysical variables are included in the components of biophysical profile?

Answer 29

1. Non stress test 2. Fetal breathing movements 3. Fetal movement 4. Fetal tone 5. Amniotic fluid volume