Module 4 Unit B

Question 1

What do you expect for a second-trimester blood pressure compared with the person’s baseline: higher, lower, or unchanged?

What is the physiologic reason?

Answer 1

The arteries continue to be relaxed and peripheral vascular resistance continues to be lower than nonpregnant people so decreased blood pressure is normal until about 32 weeks gestation

Thus throughout the second trimester, you should continue to expect blood pressure to be a bit lower than the person’s normal.

Question 2

How will you assess maternal weight gain in the second trimester

what factors will you consider

Answer 2

1. Check the prepregnancy BMI and determine if it was underweight, normal weight overweight or obese
2. Check the amount of weight gain during the first trimester and compare it to the recommended amount for the BMI category
3. Check the total weight gain (current weight-pregnant weight) to gauge whether the person is on track given the current gestational age for the BMI category
4. Check the amount of weight gain since the last visit to gauge pattern, rather than focusing just on weight gain since the last visit, for example

Question 3

How will you convey your assessment of weight gain, using principles of respectful patient-centered care?

Answer 3

clinicians have a responsibility to assess weight gain and provide information and counseling about the relationship between weight gain patterns and optimal perinatal outcomes.

Question 4

what elements of a urine dip will you assess?

what are some common variations of normal you might see

Answer 4

Protein/Glucose

Protein:
little bit of protein can be due to the presence of vaginal secretions in the urine or just an isolated finding

Glucose: unlikely to be a significant finding on a urine dip.
Note: Glycosuria during pregnancy does not correlate with abnormal glucose tolerance or altered carbohydrate metabolism

Question 5

How do clinicians manage common discomforts in the second trimester, including subjective and objective data collection, ( should be able to navigate that process for each of the common discomforts listed below)

Answer 5

Round ligament pain
constipation
GERD
Hemorrhoids
Striae
Hyperpigmentation: Chloasma, linea nigra
Nasal congestion
Flatulence
Leukorrhea

Question 6

Which labs will you order in the late second trimester?

whis is each of them done at this point in pregnancy?

Answer 6

CBC
Gestational diabetes screen
Repeat antibody screen for Rh-negative individuals (and sometimes Rh-positive individuals)

CBC (H&H): rule out anemia
Gestational diabetes screen: Normally 24 (or 26) and 28 weeks. to r/u gestational diabetes
Repeat antibody screen: to determine if the patient has developed any antibodies since the initial antibody screen in early pregnancy

Question 7

How will you interpret and follow up on those labs results?

Answer 7

H&H
2nd trimester: <10.5/<32%

Gestational diabetes screen:

Question 8

Who needs RhoGAM in the late second trimester

Why

Answer 8

Antepartum prophylaxis at 26-28 weeks of gestation…Rh negative pregnant women

Question 9

What should you do if its unclear whether a person needs RhoGAM

Answer 9

Give rather than not.

Question 10

Prepregnancy body mass index < 18.5

Answer 10

Category: Underweight

Total weight gain: 28-40 lbs

Gain in 1st trimester: 5

Gain in 2nd and 3rd trimester: 1lb/week

Question 11

Prepregnancy body mass index 18.5-24.9

Answer 11

Category: Normal weight

Total weight gain: 25-35 lbs

Gain in 1st trimester: 2-5 lbs

Gain in 2nd and 3rd trimester: 1 lb/wk

Question 12

Prepregnancy body mass index 25.0-29.9

Answer 12

Category: Overweight

Total weight gain: 15-25lbs

Gain in 1st trimester: 0-2 lbs

Gain in 2nd and 3rd trimester: 0.6 lbs/wk

Question 13

Prepregnancy body mass index > 30

Answer 13

Category: obese

Total weight gain: 11-20 lbs

Gain in 1st trimester: 0-1

Gain in 2nd and 3rd trimester: 0.5 lb/wk

Question 14

what can you access on urine dip stick if patient is experiencing nausea and vomiting

Answer 14

Specific gravity and ketones

Question 15

What can you access on urine dip stick if patient is experiencing dysuria, urinary urgency, or frequency

Answer 15

nitrites and leukocyte esterase

Question 16

What other condition other then UTI can leukocyte indicate on urine dip stick

Answer 16

vaginitis.

Question 17

Abnormal Hemoglobin

Answer 17

1st trimester: < 11

2nd trimester < 10.5

3rd trimester < 11

Question 18

Abnormal Hematocrit

Answer 18

1st trimester: < 33%

2nd trimester < 32%

3rd trimester < 33 %

Question 19

What are the cut offs for GTT

Answer 19

> 130, 135, 140

Question 20

Why are there 3 different cutoffs for GTT

Answer 20

A lower cutoff will lead to more false positive screens but there will be few false-negative screens.

A higher cutoff will lead to fewer false positive screens but there will be more false negative screens

Question 21

What is the physiology of normal insulin resistance in pregnancy and why we generally screen for GDM at 24-28 weeks

Answer 21

An expected and normal aspect of pregnancy is that from 20 weeks onward, pregnant people produce more insulin but a variety of placental hormones such as estrogen, cortisol and human placental lactogen cause the pregnant persons tissues to become more resistant to that insulin.

This insulin resistance is beneficial to the fetus because it promotes nutrient passage to the fetus. However, if a pregnant woman’s pancreas is not able to raise her insulin secretion to overcome the normal pregnancy-related insulin resistance, her blood glucose will rise and become apparent as gestational diabetes.

Question 22

Candidates for RHoGAM

Answer 22

Antepartum prophylaxis at 26-28 weeks of gestation

Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure or abdominal trauma

Actual or threatened pregnancy loss at any stage of gestation

Ectopic pregnancy

After the birth of an Rh-positive baby