Module 01: Antenatal Care

Question 1

This is known as the comprehensive health supervision of a pregnant woman before delivery. It is planned examination, observation and guidance given to the pregnant woman from conception until the time of delivery.

Answer 1

Antenatal Care

Question 2

What are the importance of antenatal care?

Answer 2

(1) To ensure that the pregnant woman and her fetus are in the best possible health.
(2) To detect early and treat properly complications.
(3) Offering education for parenthood.
(4) To prepare the woman for labor, lactation, and care for her infant.
(5) To reduce the maternal and perinatal mortality and morbidity rates.
(6) To improve the physical, emotional, and mental health of women and children
(A) Stress = cortisol release = higher BP = vasoconstriction = fetal demise

Question 3

When is the first schedule of antenatal care?

Answer 3

The first visit should be made as early is pregnancy made possible. This is essential for early assessment and planning.

Question 4

What are the number of return visits for antenatal care?

Answer 4

(1) Once every month until 28 weeks
(2) Once every two weeks until 36 weeks
(3) Once every week until labor

DOH : 6 visits within pregnancy
WHO: 8 visits within pregnancy

Question 5

What constitutes assessment in antenatal care?

Answer 5

(1) History
(2) Examination
(3) Investigation

Question 6

What should the nurse take note of when obtaining data regarding patient history?

Answer 6

(1) Personal history
(2) Family history
(3) Medical and surgical history
(4) Menstrual history
(5) Obstetrical history
(6) History of present pregnancy

Question 7

What tool is utilized when obtaining in the obstetrical history of the patient?

Answer 7

OB SCORE: GT PALM
(Gravida, Term, Preterm, Abortion, Live, Multiple Pregnancies)

(A) Gravida: Number of pregnancies
(B) Term: Full term pregnancies (37 to 40 weeks)
(C) Preterm deliveries: 20 to 36 weeks)
(D) Abortions and miscarriages (before 20 weeks)
(E) Living Children
(F) Multiple pregnancies

Question 8

What tools are utilized when obtaining the age of gestation (AOG) in weeks?

Answer 8

(1) Bartholomew’s rule
(2) Mc Donald’s rule

Question 9

Based on Bartholomew’s rule. the age of gestation is concluded to be three months assuming that the case is normal when?

Answer 9

Above the symphysis 1/2 from the umbilicus.

Question 10

Based on Bartholomew’s rule. the age of gestation is concluded to be four months assuming that the case is normal when?

Answer 10

3/4 from the umbilicus

Question 11

Based on Bartholomew’s rule. the age of gestation is concluded to be five months assuming that the case is normal when?

Answer 11

Level of the umbilicus.

Question 12

Based on Bartholomew’s rule. the age of gestation is concluded to be six months assuming that the case is normal when?

Answer 12

1/4 from the umbilicus to the xyphoid process

Question 13

Based on Bartholomew’s rule. the age of gestation is concluded to be seven months assuming that the case is normal when?

Answer 13

1/2 from the umbilicus to the xyphoid process

Question 14

Based on Bartholomew’s rule. the age of gestation is concluded to be eight or ten months assuming that the case is normal when?

Answer 14

3/4 from the umbilicus to the xyphoid process

Question 15

This rule utilized to attain the patient’s age of gestation (AOG) in weeks focuses on the level of fundus uteri at different weeks.

Answer 15

McDonald’s rule

Question 16

Based on Bartholomew’s rule. the age of gestation is concluded to be nine months assuming that the case is normal when?

Answer 16

Just at the xiphoid process

Question 17

How is fundal height measured?

Answer 17

From the pubic symphysis to the top most portion of the uterus (measured in centimeters).

Question 18

How do you compute for the number of months under the McDonald’s rule?

Answer 18

Fundic height in cm/3.5 = months

Question 19

Based on physical examination under antenatal care, what height is an indication of an average sized pelvis?

Answer 19

Height of over 150cm

Question 20

What is the approximate weight gain during pregnancy?

Answer 20

20kg
(A) 2kg in the first 20 weeks
(B) 10kg in the remaining 20 weeks
(C) 1.5kg per week until term

Question 21

The fundal height should be measured and recorded at each antenatal appointment from how many weeks?

Answer 21

24 weeks (Should be recorded at each antenatal appointment to check along with the Mcdonald’s rule. If no weight gain, the baby may not be growing or malnourished, it can be genetics or unwanted pregnancy)

Question 22

Fetal presentation should be assessed by abdominal palpation at how many weeks?

Answer 22

36 weeks

Question 23

Under physical examination, fetal heart sounds should be heard as early as which week of pregnancy?

Answer 23

10th week of pregnancy (using a sonicaid or a doppler)

Question 24

Under physical examination, fetal heart sound should be heard by a Pinard’s heart stethoscope after what week of pregnancy?

Answer 24

20th week of pregnancy

Question 25

How many fetal kick count should a pregnant woman report in 12 hours?

Answer 25

At least 10 movements in 12 hours

Question 26

What happens when there is an absence of fetal movement?

Answer 26

Absence of fetal movements precedes intrauterine fetal death by 48 hours.

Question 27

The mother's urine should be tested for what?

Answer 27

Urine should be tested for ketones and protein.

Question 28

What does the WHO ANC guideline state?

Answer 28

An ultrasound scan before 24 weeks of gestation is recommended for all pregnant woman.

Question 29

Why is an ultrasound scan before 24 weeks of gestation recommended for all pregnant woman?

Answer 29

(1) Estimate gestational age (2) Detect fetal anomalies and multiple pregnancies (3) Enhance the maternal pregnancy experience

Question 30

When is an ultrasound scan after 24 weeks of gestation (late gestation) is not recommended for pregnant women?

Answer 30

When the pregnant woman already conducted an early ultrasound scan. (Early stakeholders should consider offering a late ultrasound scan to pregnant women who have not hand an early ultrasound scan)

Question 31

What should be included under the nurse's health teaching during the first trimester?

Answer 31

(1) Physiological changes during pregnancy (2) Weight gain (3) Fresh air and sunshine (4) Rest and sleep (5) Diet (6) Daily activities, exercises, and relaxation (7) Hygiene and teeth (8) Bladder and bowel (9) Sexual counseling (10) Smoking (11) Medications (12) Infection and Irradiation (13) Occupational and environmental hazards (14) Travel (15) Follow-up (16) Minor discomforts and signs of potential complications

Question 32

This is known as the abdominal palpation for the fetal position. This is a systematic method of observation and palpation to determine fetal presentation and position and are done as a part of physical examination during the prenatal period.

Answer 32

Leopold's Maneuver

Question 33

What does the Leopold's maneuver determine?

Answer 33

(1) Fetal position (2) Fetal presentation (3) Engagement (4) Number of fetuses

Question 34

What consists the Leopold's maneuver?

Answer 34

It consists of four distinct actions that determine the position and estimate the birth weight of a fetus inside the uterus, and the shape of the maternal pelvis. It can also indicate whether the delivery is going to be complicated, or whether a caesarean section is necessary.

Question 35

What are the purpose of the Leopold's maneuver?

Answer 35

(1) Determine the position of the baby in the uterus. (2) Determine the expected presentation during labor and delivery. (3) To aid in location of fetal hear rates. (4) TO aid in assessment of fetal size. (5) To determine a single vs multiple gestation.

Question 36

This is known as the relationship between the long (cephalocaudal) axis of the feal body and the long axis of the woman's body. In other words, this states whether the fetus is lying horizontal (transverse) or vertical (longitudinal).

Answer 36

Fetal Lie

Question 37

This type of fetal lie is when the long axis of the baby is parallel to the long axis of the woman. This is the only normal position

Answer 37

Longitudinal (These are commonly classified as cephalic, which means that the fetal head will be the first part to be contact to the cervix, or breech, with a foot or buttocks as the first portion to contact the cervix)

Question 38

This type of fetal lie is when the log axis of the fetus is perpendicular to that of the mother's.

Answer 38

Transverse

Question 39

This type of fetal lie is when the long axis of the fetus is 0 to 90 degrees (or 90 to 180 degrees) to that of the mother's.

Answer 39

Oblique

Question 40

This denotes the body part that will first contact the cervix or be born first and is determined by the COMBINATION OF FETAL LIE AND THE DEGREE OF FETAL FLEXION (ATTITUDE).

Answer 40

Fetal Presentation

Question 41

This type of presentation is the most frequent type of presentation, occurring as often as 96% of the time. With this type of presentation, the fetal head is the body part that first contacts the cervix.

Answer 41

Cephalic Presentation

Question 42

What are the four (4) types of cephalic presentation?

Answer 42

(1) Vertex (2) Brow (3) Facial (4) Mentum

Question 43

Why is vertex presentation known as the most ideal?

Answer 43

Because the skull bones are capable of effectively molding to accommodate the cervix. This exact fit may actually aid in cervical dilatation as well as prevent complications such as a prolapsed cord.

Question 44

This condition is characterized when a portion of the cord passes between the presenting part and the cervix and enters the vagina before the fetus.

Answer 44

Prolapsed Cord

Question 45

This type of cephalic presentation occurs when the head is sharply flexed, making the parietal bones or the space between the fontanelles (the vertex) the presenting part.

Answer 45

Vertex (allows the suboccipitobregmatic diameter to present to the cervix)

Question 46

This type of cephalic presentation occurs when the head is only moderately flexed, the brow or sinciput becomes the presenting part.

Answer 46

Brow or Sinciput

Question 47

This type of cephalic presentation may occur when the fetus has extended the head to make the face the presenting part. From this position, extreme edema and distortion of the face may occur.

Answer 47

Facial

Question 48

This type of cephalic presentation occurs when the fetus has highly extended the head to make the chin the presenting part.

Answer 48

Mentum

Question 49

This condition occurs when the fetal skull that contacts the cervix becomes edematous from the continue pressure.

Answer 49

Caput succedaneum

Question 50

This type of presentation means that either the buttocks or the feet are the first body parts that will contact the cervix. AFFECTED BY FETAL ATTITUDE OR VERTEX PRESENTATIONS.

Answer 50

Breech Presentations

Question 51

What does a good attitude bring or mean in breech presentation?

Answer 51

A good attitude brings the fetal knees up against the fetal abdomen.

Question 52

What does a poor attitude bring or mean in breech presentation?

Answer 52

A poor attitude means the knees and legs are extended.

Question 53

This type of breech presentation occurs when the fetus has the thighs tightly flexed on he abdomen; both buttocks and the tightly flexed feet present to the cervix.

Answer 53

Complete Breech Presentation

Question 54

This type of breech presentation occurs when neither the thighs nor lower legs are flexed. One or both feet extended downward and may enter the birth canal

Answer 54

Footling (If one foot presents, it is a single-footling breech; if both present, it is a double- footling breech.)

Question 55

This type of breech presentation occurs when the the hips are flexed, but the knees are extended to rest on the chest. The buttocks alone present to the cervix.

Answer 55

Frank Breech Presentation

Question 56

This pertains to the relationship of the fetal parts to each other.

Answer 56

Attitude (May be flexed or extended)

Question 57

This is known as the relationship of the presenting part to a specific quadrant and the side of a woman's pelvis.

Answer 57

Fetal position (Four parts of a fetus are typically chosen as landmarks to describe the relationship of the presenting part to one of the pelvic quadrants.)

Question 58

In the vertex presentation, the _______ is the chosen point.

Answer 58

Occiput (O)

Question 59

In a face presentation, it is the _______ known as the chosen point.

Answer 59

Chin (mentum [M])

Question 60

In a breech presentation, it is the ______ known as the chosen point.

Answer 60

Sacrum (Sa)

Question 61

In a shoulder presentation, it is the ____________ known as the chosen point.

Answer 61

Scapula or the acromion process (A).

Question 62

What does the first and last letter denote under fetal position?

Answer 62

(1) The first letter defines whether the landmark is pointing to the mother’s right (R) or left (L). (2) The last letter defines whether the landmark points anteriorly (A), posteriorly (P), or transversely (T).

Question 63

What are the two (2) most common fetal positions?

Answer 63

(1) Left Occipitoanterior (LOA) position (2) Right Occipitoanterior (ROA) position

Question 64

This is usually determined by the amount of head that is above or below the pelvic floor.

Answer 64

Engagement

Question 65

How is engagement determined?

Answer 65

This is usually done by dividing the head into fifths. If the head is still palpable abdominally, it is 2/5 or less engaged.

Question 66

What should you do to your patient prior to executing the Leopold's maneuver?

Answer 66

Explain the procedure and instruct the patient to empty their bladder. (Explanation reduces anxiety and enhances cooperation. Am empty bladder promotes comfort and allows for more productive palpation because fetal contour will not be obscured by distended bladder)

Question 67

Why should the nurse wash their hands using warm water and provide privacy prior to the procedure?

Answer 67

Handwashing prevents the spread of infection. Using warm water aids in patient comfort and prevents tightening of abdominal muscles during palpation.

Question 68

What is the rationale of positioning the patient supine with knees slightly flexed and placing a small pillow or rolled towel under their left side?

Answer 68

Flexing the knees relaxes the abdominal muscles. Using a pillow or a towel tilts the uterus off the vena cava, preventing supine hypertension syndrome

Question 69

What is the rationale of observing the woman’s abdomen as to which is the longest diameter and where fetal movement is apparent?

Answer 69

The longest diameter is the length of the fetus. The location of activity most likely reflects the position of the effect.

Question 70

How should the first maneuver be executed?

Answer 70

Stand at the foot of the woman, facing her, and place both hands flat on her abdomen. Palpate the superior surface of the fundus.

Question 71

What should you determine during the first maneuver?

Answer 71

Fetal presentation (Consistency, shape and mobility) Head: Round, Hard, and Firm Buttocks: Soft Shoulder: Flattened, broad mass

Question 72

This maneuver determines whether the fetal head or breech is in the fundus. A head is more firm and is round and hard, and move independently of the body while the breech feels softer and moves in conjunction with the body.

Answer 72

First maneuver

Question 73

How should you execute the second maneuver?

Answer 73

Face the woman, hold the left hand stationary on the left side of the uterus while you palpate with the right hand on the opposite side of the uterus from top to bottom. Repeat palpation using the opposite side.

Question 74

What does the second maneuver locate?

Answer 74

The second maneuver locates the back of the fetus. The fetal back feels like a smooth, hard and resistant surface.

Question 75

This maneuver locates the back of the fetus. The fetal back feels like a smooth, hard, and resistant surface; the knees and elbows of the fetus on the opposite side feel more like a number of angular bumps or nodules.

Answer 75

Second Maneuver

Question 76

How should you perform the third maneuver

Answer 76

Gently grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and fingers and try to press the thumb and finger together. Determine any movement and whether the part feels firm or soft.

Question 77

What does the third maneuver determine?

Answer 77

This maneuver determines which part of the fetus is at the inlet and its mobility.

Question 78

Under the third maneuver, what does it indicate when the presenting part moves upward so your fingers and thumb can be pressed together?

Answer 78

The presenting part is not engaged (not firmly settled into the pelvis).

Question 79

Under the third maneuver, what does it indicate if the part is firm?

Answer 79

If the part is firm, it is the head; if soft, then it is the breech.

Question 80

How do you execute the fourth maneuver?

Answer 80

Place fingers on both sides of the uterus approximately 2 in. above the inguinal ligaments, pressing downward and inward in the direction of the birth canal. Allow fingers to be carried downward.

Question 81

The fourth maneuver can only be executed when the fetus is in what presentation?

Answer 81

In a cephalic presentation because it determines fetal attitude and degree of fetal extension into the pelvis. (The position of the fetal brow should correspond to the side of the uterus that contained the elbows and knees of the fetus.)

Question 82

Under the fourth maneuver, what does it indicate if the fetus is in a poor attitude?

Answer 82

The examining fingers will meet an obstruction on the same side as the fetal back; that is, the fingers will touch the hyperextended head.

Question 83

Under the fourth maneuver, what does it indicate if the brow is very easily palpated?

Answer 83

The fetus is probably in a posterior position (the occiput is pointing toward the woman’s back).

Question 84

What is the normal duration for pregnancy?

Answer 84

Normal Duration: 38 weeks to 40 weeks Concern: Pregnancies before 37 weeks or beyond 40 weeks may indicate complications.

Question 85

This is characterized as the first pregnancy with an uncomplicated pregnancy.

Answer 85

Nulliparous (first time pregnant women) with a schedule of 10 appointments to monitor and ensure a healthy pregnancy as this is their first experience.

Question 86

This is characterized as multiple pregnancies or women who have not pregnant before with an uncomplicated pregnancy.

Answer 86

Parous (women who have been pregnant before) with a schedule of 7 appointments to monitor pregnancy (which often lead to fewer complications).

Question 87

This data includes the general health information, lifestyle factors and any other personal data relevant to pregnancy.

Answer 87

Personal history. (e.g. Age, allergies, past medications, gender, race, blood type, anthropometric, income and employment)

Question 88

This data includes any information on genetic conditions, inherited disorders, and any significant familial health issues.

Answer 88

Family history

Question 89

This data includes details on past medical conditions, surgeries, and any treatments that might impact pregnancy.

Answer 89

Medical and surgical history (e.g incisions, respiratory problems)

Question 90

This significant data includes information regarding the woman's menstrual cycle patterns, last menstrual period, and any abnormalities.

Answer 90

Menstrual History

Question 91

This significant data includes information on the woman's previous pregnancies, outcomes, and any complications experienced, and the details of childbirth.

Answer 91

Obstetrical History (e.g. pregnancies, abortion, and OB score)

Question 92

This significant data includes information on the current pregnancy details, any complications so far, and how the pregnancy went.

Answer 92

History of Present Pregnancy

Question 93

This is known as the death or loss of a baby before or during delivery.

Answer 93

Stillbirth

Question 94

What happens when a mother is due and has not conducted any physical examination or antenatal appointment at 37 weeks?

Answer 94

An emergency C section will be performed if there are no antenatal appointments at 37 weeks.

Question 95

What should occur at 41 weeks time span?

Answer 95

Prior to the formal induction of labor, the woman should be offered a vaginal examination for membrane sweeping or cervix stimulation.

Question 96

What should occur at 42 weeks time span?

Answer 96

Check the meconium stain which is indication that fluids are infected with fecal discharges

Question 97

This pertains to the orientation of the fetus in the uterus (e.g. transverse or longitudinal).

Answer 97

Fetal Position

Question 98

This pertains to whether the fetal head or the other presenting part is engaged in the pelvic inlet.

Answer 98

Engangement

Question 99

This pertains to the part of the fetus that is presenting in the pelvic inlet (e.g. head or breech).

Answer 99

Fetal presentation

Question 100

What are the different types of fetal attitude?

Answer 100

(A) Flexed (B) Deflexed (C) Extended

Question 101

This fetal attitude occurs when the fetal head is flexed with the chin near the chest. This is the most favorable attitude for delivery.

Answer 101

Flexed

Question 102

This fetal attitude occurs when the head is neither fully flexed nor extended. It can be more challenging for delivery.

Answer 102

Deflexed

Question 103

This fetal attitude occurs when the fetal head is extended backward, with the face or brow presenting. This is characterized to be complicated for delivery.

Answer 103

Extended

Question 104

This type of breech presentation occurs when one or both legs are extended and the buttocks are presenting in the pelvis. The fetal position is not fully flexed.

Answer 104

Incomplete Breech