Normal Pregnancy, Prenatal care, and Lab changes (Moulton)

Question 1

__1__ refers to the number of times a woman has been pregnant.

__2__ refers to the number of pregnancies led to a birth at or beyond 20 weeks or an infant weighing more then 500 grams.

Answer 1

1) Gravidity

2) Parity

Question 2

What does G1P1002 mean?

What does G4P1123 mean?

Answer 2

1) A woman who has given birth to 1 set of twins at term and both are living
2) A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriages and 1 ectopic pregnancy. She has 3 living children.

Question 3

____ patients receive Rhogam at 28 weeks and anytime sensitization may occur.

Answer 3

Rh negative

Question 4

What should you vaccinate against postpartum if not already immune?

Answer 4

Rubella

Question 5

With a prenatal visit, what should you screen for if the patient presents as obese?

Answer 5

Diabetes

Question 6

Gestational age is the number of weeks that have elapsed between the __1__ and __2__.

Answer 6

1) First day of the LMP

2) The date of delivery

Question 7

With a transvaginal ultrasound, the __1__ is seen around 5 weeks.

__2__ is seen at 6 weeks.

__3__ is seen at 7 weeks.

Answer 7

1) Gestational sac
2) Fetal pole
3) Cardiac activity

Question 8

When estimating gestation age/due date, what is Naegele’s rule based on?

How is it calculated

Answer 8

1) Regular 28 day menstrual cycle

2) Add 7 days from LMP and subtract 3 months

Question 9

____ between 6-11 weeks can determine due date within 7 days.

Answer 9

Crown rump Length

Question 10

____ can be diagnosed if CRL > 5mm w/ absence of fetal cardiac activity.

Answer 10

Fetal demise

Question 11

Children born to women that are 35 yrs and older are at increased risk of?

Answer 11

The autosomal trisomies (13, 18 or 21)

Question 12

95% of Downs Syndrome cases are due to meiotic nondisjunction events leading to __1__ chromosomes with an extra copy of chromosome __2__.

Answer 12

1) 47

2) 21

Question 13

Most common class of spontaneous abortions are the __1__.

__2__ is the most common one.

Answer 13

1) Autosomal trisomies

2) Trisomy 16

Question 14

Most common single chromosomal abnormality found in spontaneous abortions is?

Answer 14

45XO

Question 15

____ couples are at increased risk for having a child who is homozygous for recessive gene

Answer 15

Consanguineous

Question 16

Carrier screening programs focus on high-risk populations because the frequency of __1__ is greater than that of the general population.

For example, Tay-Sachs should be screened for in __2__.

Answer 16

1) Heterozygotes

2) Eastern European Jewish

Question 17

__1__ is the most common gene carried in North America whites, frequency is 1 in 25.

__2__ is important for CF screening because 15% of carriers are undetected.

Answer 17

1) Cystic Fibrosis

2) Genetic counseling

Question 18

Sex linked disorders primarily affect which sex?

Which sex are usually the unaffected carriers?

This is due to?

Answer 18

1) Males
2) Females
3) Recessive genes located on the X chromosomes

Question 19

What is the most common form of inherited mental retardation and the second most common form of mental retardation after Trisomy 21?

Answer 19

Fragile X syndrome

Question 20

Many sex linked disorders can be diagnosed prenatally by __1__ sampling or __2__.

Answer 20

1) Chorionic villus

2) Amniocentesis

Question 21

Cleft lip or palate, congenital heart defects, pyloric stenosis and neural tube defects are all examples of birth defects inherited in what fashion.

Answer 21

Multifactorially (both genetic and environmental factors)

Question 22

Why should women with an affected child for neural tube defect take 4 mg of folic acid in subsequent pregnancies before conception?

Answer 22

Since neural tube closure is complete at 28 days post conception

Question 23

First trimester screening can assess increased ____ thickness which is associated with both chromosomal and congenital anomalies.

Answer 23

Fetal nuchal translucency (echo free area at the back of the fetal neck between 10 and 14 weeks)

Question 24

With first trimester screening, elevated Beta hCG and low Pregnancy associated plasma protein-A (PAPP-A) associated with?

Answer 24

Down’s syndrome

Question 25

What is the triple screen associated with second trimester screening which occurs between 16 and 20 weeks and can detect Trisomy 21?

What is added to make it a quadruple screen and increase the detection rate of Trisomy 21?

Answer 25

1) b-hCG, estriol, and maternal serum alpha fetoprotein

2) Inhibin A

Question 26

The non invasive prenatal testing that occurs around 9-10 weeks tests cell free fetal DNA, thought to be derived apoptosis of __1__ cells that have entered the maternal circulation.

It has extremely high detection rates for __2__, __2__, and __2__.

It does not test for ____ defects.

Answer 26

1) Trophoblastic
2) Trisomy 21, 18, and 13
3) Neural tube

Question 27

Cell free fetal DNA tests should only be ordered in high risk patients, including one or more of the following:

__1__ maternal age.

History of prior pregnancy with a __2__.

Family history of __3__ abnormalities.

Fetal ultrasound abnormalities suggestive of __4__.

Answer 27

1) Advanced
2) Trisomy
3) Chromosomal
4) Aneuploidy

Question 28

When can an amniocentesis be performed?

When can chorionic villi sampling be performed?

What risk do both carry?

Answer 28

1) 16-20 weeks
2) 11 weeks
3) Miscarriage

Question 29

The most vulnerable stage of teratogen exposure is from day __1__ to day __1__ post conception period known as __2__.

Answer 29

1) 17 to 56

2) Organogenesis

Question 30

There is a critical period between ___ and ___ weeks post conception for a lethal effect due to radiation exposure.

Answer 30

2 and 6

Question 31

Heartburn affects about 2/3 of pregnancies due to relaxation of esophageal sphincter by what hormone?

Answer 31

Progesterone

Question 32

What other GI complaints are common unpleasant symptoms of pregnancy?

Answer 32

1) Constipation

2) Hemorrhoids

Question 33

What MSK complaint is a common unpleasant symptom of pregnancy especially at night?

What MSK complaint is common especially in late pregnancy?

Answer 33

1) Leg cramps

2) Back pain

Question 34

BMI < 19 recommended weight gain is ____ lbs.

BMI 19-25 recommended weight gain is ____ lbs.

BMI > 25 recommended weight gain is ____ lbs.

Answer 34

1) 28-40
2) 25-35
3) 15-25

Question 35

The first sensation of movement is known as quickening and occurs on average at ___ weeks.

Answer 35

20

Question 36

What routine screening should be performed at 20 weeks?

Answer 36

Fetal survey ultrasound

Question 37

What routine screening/procedures should be performed at 28 weeks?

Answer 37

1) Gestational diabetes
2) Rhogam injection to Rh negative patients
3) Tdap (Tetanus, diphtheria, & acellular pertussis)

Question 38

What routine screening should be performed at 36 weeks?

Answer 38

Screening for group B strep carrier with vaginal culture

Question 39

Reactive nonstress test should reveal __1__ accelerations of at least __2__ beats above baseline lasting at least __3__ seconds during 20 minutes of monitoring.

Answer 39

1) 2
2) 15 beats
3) 15

Question 40

With the Contraction stress test, you want to give __1__ to establish at least __2__ contractions in a 10 min period. If late decelerations are noted with the majority of contractions the test is positive and __3__ is warranted

Answer 40

1) Oxytocin
2) 3
3) Delivery