Normal Pregnancy, Prenatal care, Labs - Moulton

Question 1

Never had a baby with neural tube defect…recommended folic acid dose?

If you HAVE had a child with a neural tube defect…recommended folic acid dose?

Answer 1

0. 4 mg

4. 0 mg

Question 2

Normal potential PE findings associated w/ pregnancy

Answer 2

• Systolic murmurs (splitting, S3)
• Palmar erythema
• Spider angiomas
• Linea nigra
• Striae gravidarum
• Chadwicks sign (blueish hue of vagina/cervix
• Abdominal striae

Question 3

If nothing happens where RH sensitization would occur, when is RhoGAM normally given?

Things that could result in sensitization?

Answer 3

28 weeks

Threatened abortion, amniocentesis, abdominal trauma

Question 4

Which has a higher risk of coagulation…pregnancy or OCP?

Labs that show this?

Answer 4

Pregnancy

High fibrinogen and clotting factors

Question 5

A patient has regular 28 day cycles and is pregnant. How to calculate expected delivery date?

Answer 5

LMP - 3 months + 7 days

Question 6

Ultrasound measuring of baby is MOST accurate in terms of estimating due date when?

Answer 6

6-11 weeks (off by only 7 days)

Question 7

Pregnant woman ultrasound shows crown-rump length (CRL) > 5mm w/ no fetal cardiac activity. Dx?

Answer 7

Missed abortion (100%)

Question 8

Flattened nose and face, upward slanting eyes, palmar crease, spaced 1st-2nd toes

Most common molecular cause?

Answer 8

Down syndrome (trisomy 21)

Meiosis error

Question 9

***When should a couple do chromosomal karyotyping?

Answer 9

3 or more spontaneous abortions

Question 10

Cystic fibrosis has what inheritance pattern?

Answer 10

Autosomal recessive

Question 11

Most common X-linked diseases

Answer 11

Duchenne muscular dystrophy

Fragile X syndrome

Question 12

Elongated face, prominent ears, flat feet, seizure activity, broad forehead

Answer 12

Fragile X syndrome

Question 13

3 tests for fetal aneuploidy (abnormal # of chromosomes) in FIRST trimester

Answer 13

• ***Pregnancy-associated plasma protein A (PAPP-A)
• Nuchal translucency (ultrasound)
• b-hCG

Question 14

2nd trimester – tests for fetal aneuploidy

Answer 14

Quadruple screen

• b-hCG
• Estriol
• AFP
• ***INHIBIN A

Question 15

MOST accurate test for fetal aneuploidy today

What is NOT tested for?

***ONLY in who?

Answer 15

MaterniT 21 plus

Neural tube defects (keep checking AFP)

HIGH RISK PATIENTS

Question 16

Test for neural tube defects

Answer 16

AFP

Question 17

If positive MaterniT 21 Plus, what next?

Answer 17

Verify w/ amniocentesis or chorionic villi sampling

Question 18

Flipper-like limbs (phecomelia)

Answer 18

Thalidomide in utero

Question 19

***Most CRUCIAL period of development for teratogens to cause major issues

Only things that can be majorly affected after this

Answer 19

Day 17 - 56

Brain and gonads

Question 20

Teratogenic drugs

Answer 20

• Alcohol
• Anti-anxiety
• Anti-neoplastic (ex. MTX)
• Anti-coagulants (Coumadin)
• Anti-convulsants

Question 21

Smooth philtrum, thin upper lip, underdeveloped jaw, short nose, epicanthal folds, low nasal bridge, small head

Answer 21

Fetal alcohol syndrome

Question 22

Proptosis, depressed nasal bridge, triangular mouth

Answer 22

CMV teratogenesis

Question 23

How much radiation is considered a risk for issues in pregnancy?

Answer 23

More than 5 rads (total)

Question 24

Pregnant woman has N/V. How to “treat”? (5)

Answer 24

• Small frequent meals
• No greasy/fried foods
• Room temp sodas and saltines
• Accupuncture
• Meds (antiemetics, other)

Question 25

Pregnant woman has heartburn. Why?

How to “treat”? (5)

Answer 25

Relaxed esophageal sphincter by progesterone

• Don’t lie down after meals
• Elevate head of bed
• Small frequent meals
• Antacids
• H2 blockers

Question 26

Pregnant woman w/ constipation. Treatment? (2)

Answer 26

• More water, fiber, fruits, veggies

- Stool softener

Question 27

Pregnant woman w/ hemorrhoids. Treatment?

Answer 27

Rest, stool softeners, elevate legs, avoid constipation

Question 28

Pregnant woman w/ leg cramps. Treatment?

Answer 28

Massage, stretching

Question 29

Pregnant woman w/ backache. Treatment?

Answer 29

Avoid excess weight gain, exercise/stretching, comfy shoes, good pillow use, heat/massage

Question 30

Frequency of prenatal office visits

Answer 30

q4wks until 28
q2wks until 36
qWk until delivery

Question 31

Things done at routine pregnancy office visit?

Answer 31

BP, weight, urinalysis, uterine measurement, fetal HR, fetal movement, education, lifestyle situations

Question 32

At 20 weeks, do what? (1)

Answer 32

Fetal survey ultrasound (anatomy, etc.)

Question 33

At 28 weeks, do what? (3)

Answer 33

Screen for GDM, check H&H, RhoGAM if Rh-

Question 34

At 35 weeks, do what? (1)

Answer 34

Screen for group B strep via vaginal culture

Question 35

****Kick counting (normal)

Answer 35

10 movements in 2 hours

Question 36

If abnormal kick/movement count, then what?

****What is a REACTIVE (good) nonstress test?

Answer 36

Nonstress test

2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes of monitoring

Question 37

**If NONREACTIVE nonstress test, then what? What is it?

**BAD (positive) test result?

If positive, do what?

Answer 37

Contractions stress test (CST) - give oxytocin to get 3+ contractions in 10 min period

LATE decelerations are noted w/ most of them

DELIVER

Question 38

**Components of biophysical profile (5)

Answer 38

• NST
• Fetal breathing mvmts
• Fetal movement
• Fetal tone
• Amniotic fluid volume

Question 39

• ***Good values for…
  
  • Fetal breathing mvmts
  • Fetal movement
  • Fetal tone
  • Amniotic fluid volume

Answer 39

• 30 sec of rhythmic breathing in 30 minutes
• 3+ discrete movements in 30 minutes
• 1+ extremity extension and flexion or hand open/close in 30 minutes
• A pocket that is 2+ cm in 2 planes perpendicular to each other

Question 40

***How to score biophysical profile?

***Meanings of scores?

Answer 40

2 pts for every positive sign

8-10 = GOOD
6 = Deliver IF at term
0-4 = Deliver