Prenatal Care

Question 1

When is cessation of menses a reliable sign of pregnancy?

Answer 1

10 days after the expected time of menses

Question 2

During pregnancy, there are changes inn cervical mucus, (1) what are the two patterns (2) what hormone causes each of the respective patterns (3) for each hormone, which day in the menstrual period do they occur.

Answer 2

1. fern pattern due to estrogen and beaded patterns due to progesterone
2. Fern pattern happens on the 7th to 18th day of the menstrual cycle while progesterone happens on the 21st. why?

fern pattern happens in the 7th to 18th day because in the menstrual cycle, the dominant follicle will produce estrogen, causing positive feedback leading to the recruitment of LH and LSH which stimulate the ovaries to produce more estrogen.

Progesterone or beaded pattern occurs in the 21st day and above for PREGNANT women because it is produced by the placenta once the corpus luteum involutes (produces progesterone before the placenta). Mostly found on pregnant women

Question 3

What is the Chadwick sign? Is it a definitive sign of pregnancy? Why?

Answer 3

Bluish discoloration of the vaginal mucosa due to increased vascularization

It is NOT a definitive sign of pregnancy, this is because OCPs can bring about this change.

Question 4

Name the changes in the cervix during pregnancy (1)

Answer 4

Softening

Question 5

Name the changes in the skin during pregnancy (3)

Answer 5

Increased pigmentation (melasma, linea nigra, abdominal striae

Question 6

Name the changes in the uterus
1, at the first few weeks
2. at 8 weeks
3. at 12 weeks

Answer 6

first few weeks -> increased uterine size

6-8 weeks -> hegar’s sign – softening of the isthmus (junction of the internal os and corpus of uterus)

• -non-pregnant patient isthmus is <1cm
• -pregnant patient – isthmus becomes lower uterine segment

12 weeks -> Uterus almost becomes globular and becomes an ABDOMINAL organ

Question 7

What do you call the soft blowing sound synchronous with maternal pulse?

What is the sound synchronous with fetal pulse?

what causes it?

Answer 7

Uterine souffle for mother

Funic souffle for fetus

rush of blood through the uterine ARTERIES (constricted nga so malakas pressure)

Question 8

What are the changes in the breasts? And do the changes revert back after pregnancy?

Answer 8

Increase in breast size, tenderness.

No these do not revert back, once it happens in the first pregnancy it will stay that way

Question 9

What do you call the perception of fetal movements? And when do they happen for primigravida and multigravida

Answer 9

Quickening

for primigravida - 18-20th week
for multigravida - 16-18th week

Question 10

When can you start hearing fetal heart tones with:

1. Standard non-amplified stethoscope
2. Doppler
3. transvaginal ultrasound

What is the normal range?

Answer 10

1. Standard non-amplified stethoscope -> 17-19 weks
2. doppler -> 10 weeks
3. Transabdominal US -> 8 weeks with MSD 25
4. Transvaginal US -> 5 weeks (according ro doc magpale 6-6.5weeks aog) eith MSD 13-18

Normal range for fetal heartbeat is 110-160 ON AVERAGE

at 6 weeks -> normal is 100-115
at 8 weeks -> 144-170
at 9 weeks and above 137-144

Question 11

What is the basis of pregnancy tests?

How many days after ovulation does this hormone appear?

What is its doubling time?

When is its peak?

What is its function?

Which hormones have similar subunits to this hormone?

Answer 11

Human Chorionic Gonadotropin

9 days after ovulation

1.4-2 days

60-70 days which is the 8th to 10th week AOG

Its function is to prevent the involution of the corpus luteum because CL only has a lifespan of 14 days. the placenta produces this to keep the CL “alive” to produce progesterone

LH, TSH, FSH

Question 12

How many weeks does it take before the placenta takes over the corpus luteum in production of progesterone?

Answer 12

Approximately 6 weeks

Question 13

What are possible causes of FALSE POSTIVE pregnancies via pregnancy test? (4)

Answer 13

Exogenous HCG injection for weight loss
Renal failure leading to impaired HCG clearance
Physiological pituitary HCG
HCG producing tumors

Question 14

When is Gestational Sac seen in ultrasound?

Yolk sac?

Crown rump length? and what is its significance?

Answer 14

GS seen in US in 5 weeks

YS seen in 6 weeks

at 12 weeks, measuring CRL is accurate in predicting the AOG

Side note: this is the formula for calculating AOG with CRL: Weeks = 5.2876 + (0.1584 * Crown_Rump_Length) - (0.0007 * Crown_Rump_Length2)

Question 15

What are the 3 goals in maternal prenatal care?

Answer 15

To define the health status of baby and mother
To estimate the age of gestation
To initiate the plan for continuing obstetrical care

Question 16

What are the typical components of routine prenatal care? (3)

What are the divisions between the visits? (4)

Answer 16

1. History, Physical Examination, Laboratory Tests

2. First Visit, 15-20 weeks, 24-28 weeks, 29-41 weeks

Question 17

True or False, Only in the first visit is the complete prenatal check=up done with the rest of the checkups being updates

Answer 17

True

Question 18

Which Tests should you perform in Physical Examination (5)?

Answer 18

1. Blood Pressure
2. Maternal Weight
3. Pelvic/Internal exam
4. . Fundic Height
5. Fetal heart and position (leopolds)

Question 19

How often is Psychosocial Screening performed?

Answer 19

once per trimester

Question 20

In History Taking, Why is Obstetrical History Important?

What about menstrual history? (hint, something about AOG)

What about Contraceptive use?

Answer 20

1. Because previous complications tend to recur
2. Because AOG cannot be accurately determined if menses are irregular because ovulation is not easily predictable. need early ultrasound
3. May lead to ectopic pregnancy for failed methods, Or, ovulation may not have resumed and may have been mistaken for cessation of menses.

Question 21

What do you call the syndrome when a mother drinks too much alcohol?

What are its effects?

Answer 21

Fetal alcohol syndrome:

1. Growth restriction
2. Facial Abnormalities
3. CNS dysfunction

(Small body, small head, small brain)

Question 22

What are the effects of illicit drug use?

differentiate from consumption of alcohol (the effects)

Answer 22

1. Fetal Growth restriction (same)
2. Low birthweight (different)
3. Drug withdrawal soon after birth (Different)

Question 23

What are possible outcomes of intimate partner violence?

Answer 23

1. Preterm birth
2. Fetal Growth Restriction (same)
3. Perinatal death

Question 24

What are the 5 components of the physical exam and which of those must only be done on the first visit if there are no complications?

Answer 24

1. Maternal Blood Pressure
2. Fetal Heart and Position
3. Maternal Weight
4. Fundic Height
5. Pelvic/Cervical Internal Examination

Of the five, only pelvic and cervical internal examination must be done once (on first visit)

Question 25

What do you perform in a pelvic exam? Describe each one.

Answer 25

1. Speculum exam 2. Bimanual exam 3. Measuring the Fundic Height 4. Fetal Position 5. Fetal Heart tone

Question 26

At what weeks is the height of the fundus (in cm) approximately the gestational age?

Answer 26

20-34 weeks AOG

Question 27

``` For laboratory tests in the prenatal examination, what does: 1. a 2. b 3. A 4. B 5. C 6. D 7. E mean in terms of visits? ```

Answer 27

``` a = first trimester aneuploidy screening may be offered at 11-14 weeks b = Screening with mantoux test at any visit if indicated A = Performed a 28 weeks if indicated B = Test can be offered C = High risk women should be RETESTED beginning of third trimester D = High risk woman should be screened at initial visit and re-screened at third trimester E = rectovaginal culture obtained between 35-37 weeks ```

Question 28

List down all 18 laboratories before prenatal checkup. Hint: 3 blood test, 1 cervical test, 1 screen for DM, 3 congenital screening tests, 1 test for preeclampsia, and 8 tests for infection.

Answer 28

Blood tests: Hematocrit + hemoglobin, Rh factor and blood type, Antibody screening test 1 pap smear test Glucose tolerance test Aneuploidy screening, neural tube defect, cystic fibrosis screening Urine protein assessment Urine culture, rubella serology, syphilis serology, gonococcal culture, chlamydial culture, Hepatitis B serology, HIV serology, Group B streptococci culture (rectovaginal at 35-37 weeks)

Question 29

Give 10 risk factors that may classify a pregnant woman as high-risk

Answer 29

``` Cardiac disease Uncontrolled DM Family or Personal History of genetic abnormalities hemoglobinopathy Chronic hypertension Renal insufficiency (with proteinuria >500mg/24h and serum creatinine >1.5) Pulmonary disease HIV DVT Epilepsy Cancer RH alloimmunization Prior fetal abnormality Periconceptional exposure to teratogens Exposure to infections Severe amniotic fluid disorders Higher order multifetal pregnancies ```

Question 30

Give the time of subsequent visits for low risk, high-risk, and during the pandemic visits

Answer 30

Low risk: every 4 weeks till 28, every 2 weeks till 36, then weekly thereafter Highrisk: every 1-2 weeks intervals Covid: face to face is rare, so first visit is at 11-13 weeks, then 20 or 22 or 24 weeks for fetal anomaly scans, then 32 weeks, 36 weeks, then weekly thereafter.

Question 31

When pregnant can a woman eat whatever she wants to eat? what are the conditions?

Answer 31

Yes, but has to be a well balanced diet Give IRON tablets, FOLATE supplementation, and IODINE supplementation in endemic areas.

Question 32

Give the expected weight gains per weight category

Answer 32

Underweight 28-40 Normal weight 25-35 Overweight 15-25 Obese 11-20

Question 33

Hoe much additional k/cal per day should a woman consume?

Answer 33

100-300 kcal/day

Question 34

How much additional protein (in grams) should a woman take if she is pregnant?

Answer 34

5-6 grams in the second half of pregnancy

Question 35

What is the iron requirement per day for pregnant women? what is the RDA?

Answer 35

7mg daily is needed | 27 is the recommended dietary allowance

Question 36

When should you increase the Iron intake to 60-100mg?

Answer 36

``` Large woman Late supplementation Anemia Multiple Fetus Irregular intake ```

Question 37

What is the RDA of Iodine in pregnant women?

Answer 37

220mcg/day

Question 38

For Zinc, what is the RDA? What happens if you don't fulfill the requirements?

Answer 38

12mg consequences are: Poor appetite, suboptimal growth, impaired healing (obviously)

Question 39

What is the only vitamin that needs supplementation? what is the RDA?

Answer 39

Folic acid RDA is 400mcg during PERICONCEPTIONAL period during PREGNANCY, increased to 4mg/day

Question 40

What are the contraindicated vaccines in pregnant women? Which vaccine should the women take?

Answer 40

Contraindicated: MMR, Varicella, Smallpox Must take: Flu shots

Question 41

How would you address nausea in pregnant women?

Answer 41

Small frequent meals at frequent intervals Vit B6 if with mild symptoms

Question 42

Excessive intake of caffeine (500mg) may cause what?

Answer 42

ABORTION. take 200-300mg daily

Question 43

What triggers PICA in babies?

Answer 43

Severe Iron deficiency. needless to say the above condition also leads to anemia and preterm birth

Question 44

How would you treat: 1. Headache 2. Heartburn 3. Backache 4. Varicosities 5. Hemorrhoids 6. Sleeping and Fatigue

Answer 44

For Headache -> acetaminophen For Heartburn -> frequent meals + antacids For backache -> positioning + analgesics For Varicosities -> elevated leg position For hemorrhoids -> warm sitz bath For Sleeping and fatigue -> mild sedatives such as diphenhydramine