Prenatal and postpartum care

Question 1

when is the uterus enlarged enough to be palpable in the lower abdomen?

Answer 1

12 weeks

Question 2

what is the chadwick sign?

Answer 2

bluish discoloration of vagina

Question 3

what is the hegar sign?

Answer 3

softening of the cervix

Question 4

why is a serum pregnancy test more specific and sensitive?

Answer 4

detects unique beta subunit of HCG

Question 5

when is it possible to detect fetal heart tones? what techniques?

Answer 5

• at or beyond 18-20 weeks gestation (traditional acoustic fetoscope)
• 12 weeks (electronic doppler)

Question 6

how is gestational age determined?

Answer 6

number of weeks that have elapsed between 1st day of LMP (not presumed day of conception) and date of delivery

Question 7

what is the naegele rule?

Answer 7

add 1 year + 7 days to first day of LMP and subtract 3 months

Question 8

how is gestational age determined if the LMP date is questionable?

Answer 8

ultrasounded dated pregnancy

Question 9

when does abdominal US detect pregnancy? transvaginal?

Answer 9

• abdominal: 5-6 weeks

- transvaginal: 3-4 weeks

Question 10

the embryo and cardiac activity should be seen when HCG is at what level?

Answer 10

4000 mIU/mL or greater

Question 11

abortions / miscarriages / ectopics correspond to lesser than what week gestation?

Answer 11

under 20 weeks

Question 12

what are the normal pregnancy intervals for normal prenatal care?

Answer 12

Q4w until 28 weeks then
Q2w until 36 weeks then
Q1w until delivery

Question 13

at 20 weeks where is the uterine fundus?

Answer 13

umbilicus

Question 14

what are leopold maneuvers?

Answer 14

used to identify fetal position

Question 15

at what week does the uterus emerge from the pelvis?

Answer 15

12 weeks

Question 16

when is group B strep screening done?

Answer 16

35-37 weeks

Question 17

when is gestational diabetes screening done?

Answer 17

24-28 weeks

Question 18

what is “threatened abortion”?

Answer 18

1st trimester bleeding

Question 19

what is included in the quad screen? when is it done?

Answer 19

• HCG
• estriol
• inhibin A
• AFP
• second trimester (16-20 weeks)

Question 20

when is fetal movement felt in a nulliparous woman?

Answer 20

18-20 weeks

Question 21

when is fetal movement felt in a multiparous woman?

Answer 21

16 weeks

Question 22

what tests are done in 3rd trimester?

Answer 22

• rhogam if Rh negative (28 weeks)
• glucola GDM screen (even if neg earlier)
• repeat H&H
• repeat antibody screen

Question 23

if there is bleeding in the 3rd trimester what should you check?

Answer 23

Rh status

Question 24

is placental abruption painful or painless?

Answer 24

painful

Question 25

placental abruption is usually associated with what condition(s)?

Answer 25

hypertensive disease or trauma vs. possible abuse

Question 26

when does placenta previa present?

Answer 26

32-34 weeks

Question 27

is placenta previa bleeding painful or painless?

Answer 27

painless

Question 28

caloric requirement should increase by how much in the 3rd trimester?

Answer 28

340-450 kcal

Question 29

folate supplementation during what time prevents neural tube defects?

Answer 29

4 weeks preconception to 12 weeks gestation

Question 30

what are the features of pregnancy induced HTN?

Answer 30

- segmental arteriolar narrowing with wet, glistening appearance indicative of edema - hemorrhages and exudates RARE

Question 31

maternal blood volume increases by what % over pre-pregnancy levels?

Answer 31

40-50%

Question 32

what is braxton hicks?

Answer 32

uterine contractions that occur as early as third month of gestation

Question 33

what hormones are responsible for softening of the pelvic cartilage, and increased mobility?

Answer 33

- relaxin | - progesterone

Question 34

what is the puerperium?

Answer 34

first 6 weeks after delivery

Question 35

what occurs during puerperium?

Answer 35

- instruction about care of the neonate, breastfeeding, physical limitations, emotional support - discharge instructions - vaccinations for Tdap, MMR, influenza

Question 36

what is wound separation? what is dehiscence?

Answer 36

- would separation: skin separates, underlying adipose separates - dehiscence: skin separates, underlying adipose separates, AND fascial layer separates

Question 37

what are the 5 Bs of the immediate postpartum period?

Answer 37

- brain - breast - bladder - bleeding - birth control

Question 38

when does baby blues start and end?

Answer 38

- start: within first week | - end: by day 10

Question 39

what is the onset for postpartum depression? how long does it last?

Answer 39

- within 4 weeks | - up to 7 months

Question 40

when can postpartum contraception be started?

Answer 40

- at least 3 weeks postpartum | - benefits of contraception outweigh the risk of VTE