Pregnancy & Prenatal Care (Moulton)

Question 1

How soon should you recommend starting folic acid to someone who is planning to get pregnant?

Answer 1

at least 1 month before conception; reduces neural tube defects (NTDs)

Question 2

Gravidity

Answer 2

the number of times a woman has been pregnant

Question 3

Parity

Answer 3

number of pregnancies/deliveries that led to a birth; FPAL (full, preterm, abortions, living) twins count as one pregnancy and delivery

Question 4

A woman has given birth to one term infant, and one set of preterm twins, and has had 1 miscarriage and 1 ectopic pregnancy. She has 3 living children.

Answer 4

G4P1123

Question 5

Normal physical findings of pregnancy

Answer 5

systolic murmurs; exaggerated splitting of S3
palmar erythema
spider angiomas
linea nigra
striae gravidarum
chadwicks sign

Question 6

When should a RH negative mom get Rhogam

Answer 6

at 28 weeks and/or anytime sensitization occurs (threatened abortion, amniocentesis, abd trauma/MVA)

Question 7

Gestational age

Answer 7

the number of weeks that have elapsed between the first day of the last missed period and the date of delivery

Question 8

When can serum hCG be first detected?

Answer 8

6 to 8 days after ovulation; a level above 25 IU/L is positive (less than 5 IU/L is negative)

Question 9

Naegel’s rule

Answer 9

minus 3 months + 7 days = expected date of delivery; only useful w regular periods

Question 10

Crown rump length (CRL)

Answer 10

US taken in the first trimester (best time to determine due date); can determine due date within 7 days

Question 11

What patients needs genetic counseling?

Answer 11

35 yrs +; previous baby w birth defects/known genetic disorder/mental disorder; exposure to teratogens

Question 12

What is the most common sex chromosome aneuploidy?

Answer 12

Turner’s syndrome 45 XO

Question 13

What is the risk of a couple who previously had a child with Downs syndrome have another one?

Answer 13

1% risk of giving birth to another affected child

Question 14

When should chromosomal studies be considered?

Answer 14

couples after 3 or more spontaneous abortions

Question 15

Most common cause of spontaneous abortions?

Answer 15

Trisomy 16 - most common

Question 16

What is the most common form of inherited mental retardation?

Answer 16

Fragile X syndrome; located on X chromosome; no male to male transmission

Question 17

First trimester screenings

Answer 17

1. Fetal nuchal translucency (NT)
2. b-hCG
3. PAPP-A (pappa got her pregnant first)

Question 18

Second trimester screenings

Answer 18

1. b-hCG
2. maternal alpha-fetoprotein (AFP)
   Quadruple screen: b-hCG, AFP, estriol and inhibin A (higher detection rate for trisomy 21)

Question 19

Noninvasive prenatal testing

Answer 19

Cell-Free Fetal DNA; 9-10 weeks; tests free fetal FNA through the maternal circulation; does NOT test for NTDs - will need to get serum AFP or US

Question 20

Teratology definition

Answer 20

abnormal fetal development

Question 21

Teratogen definition

Answer 21

any agent or factor that can cause abnormalities of form or function in an exposed fetus

Question 22

Thalidomide

Answer 22

teratogen that caused phocomelia in newborns; given to moms for n/v

Question 23

What are the 4 principles of teratology?

Answer 23

1. Fetal susceptibility (genetic make-up of mother and fetus)
2. Dose (low dose vs high dose)
3. Timing (day 17 to 56 post-conception - organogenesis)
4. Nature of teratogenic agent

Question 24

When is the most vulnerable stage to be exposed to a teratogen?

Answer 24

day 17 to 56 post-conception - the period of organogenesis

Question 25

What is the most common teratogen that is exposed to a fetus?

Answer 25

Alcohol

Question 26

Fetal alcohol syndrome

Answer 26

most common teratogen exposed to a fetus; growth restriction; facial abnormalities - low set ears, smooth philtrum, thin upper lip; CNS dysfunction - microcephaly/mental retardation

Question 27

Heparin

Answer 27

category B; does NOT cross the placenta; can be given during pregnancy

Question 28

Fetal hydantoin syndrome (FHS)

Answer 28

teratogen; Diphenylhydantoin (Dilantin); category D; craniofacial abnormalities, limb reduction defects; growth restriction; mental deficiency

Question 29

Retinoids (Accutane)

Answer 29

teratogen; CNS - hydrocephaly, facial nerve palsies and cortical blindness; risk of spontaneous abortion or congenital malformation is 50%

Question 30

Rule of thumbs for radiation exposure

Answer 30

less than 5 rads of exposure = no risk

Question 31

Frequency of prenatal visits

Answer 31

Every 4 weeks until 28 weeks Every 2 weeks from 28 - 36 weeks Weekly until delivery

Question 32

When does a mother typically start to feel fetal movements?

Answer 32

first sensation occurs around 20 weeks

Question 33

Routine screening throughout pregnancy

Answer 33

20 weeks - US 28 weeks - Rhogram, screening for diabetes, hematocrit and hemoglobin, and given Tdap 36 weeks - screening for GBS

Question 34

Kick counting

Answer 34

you want 10 movements in 2 hours

Question 35

Nonstress test (NST)

Answer 35

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

Question 36

Contraction stress test (CST)

Answer 36

given oxytocin; at least 3 contractions in 10 min period