Prenatal Care

Question 1

What are complications with adolescent pregnancy?

Answer 1

Poor compliance
Poor nutrition
Pre-eclampsia
Preterm delivery
STDs
Increased perinatal morbidity and mortality

Question 2

What are complications of an advanced maternal age?

Answer 2

increased frequency of medical illnesses (gestational diabetes and chronic HTN)
Increased frequency of karyotype abnormalities

Question 3

What is the age specific risk of a karyotype abnormality of a 45 year old mother?

Answer 3

trisomy- 1:30

all abnormalities: 1:15

Question 4

What are several prenatal care effects of race?

Answer 4

Access to care
Medical conditions (sickle cell, thalassemia, CF)

Question 5

What are several prenatal care effects of religion?

Answer 5

Genetics disorders (Tay-Sachs in Jews)
Transfusion (Jehovah’s Witnesses)
Abortion (Catholics and Evangelical Christians)

Question 6

Gravidity

Answer 6

number of pregnancies

Question 7

Parity

Answer 7

number of birth events

Question 8

What goes into an prenatal abortion history?

Answer 8

Type of abortion
Trimester
Complications

Question 9

In the assessment of menstrual pattern in prenatal care we need to look at:

Answer 9

LMP
Regularity
OC use
Timing of intercourse

Question 10

What are common prenatal care childhood illnesses?

Answer 10

CHD

Viral illnesses

Question 11

What is the most common type of connective tissue disease in the prenatal setting?

Answer 11

SLE- lupus

Question 12

What previous surgeries should we be aware of in prenatal care?

Answer 12

Tubal surgery- possible risk of ectopic pregnancy

Uterine surgery- possible risk of uterine rupture

Question 13

What can valproic acid cause?

Answer 13

Spina bifida

Question 14

What can carbamazepine cause?

Answer 14

Spina bifida, facial malformations

Question 15

What can antineoplastic agents cause?

Answer 15

Varied defest

Question 16

What can warfarin cause?

Answer 16

facial deformity, intracranial bleeding

Question 17

What can lithium cause?

Answer 17

cardiac malformation

Question 18

What can tetracycline cause?

Answer 18

straining of teeth

Question 19

What can quinolones cause?

Answer 19

cartilage injury

Question 20

What can ace inhibitors and ARBs cause?

Answer 20

Renal injury

Question 21

What can beta blockers cause?

Answer 21

growth restriction

Question 22

What can isotretinoin cause?

Answer 22

brain, face, thymus, heart defects

Question 23

What can topiramate cause?

Answer 23

facial cleft

Question 24

What can NSAIDs cause?

Answer 24

premature stricture of the ductus arteriosus and oligohydramnios

Question 25

What can excess heat cause?

Answer 25

Neural tube defects

Question 26

What can excess radiation cause?

Answer 26

Neural tube defects

Question 27

When taking a family history in prenatal care we have to look into these 3 big topics.

Answer 27

Mental retardation Genetic disorders Birth defects

Question 28

What factors determine if a particle can cross the barrier to the fetus?

Answer 28

charge size soluability

Question 29

What effects does smoking have on the fetus?

Answer 29

low birth weight greater chance of a pre term birth placental abortion inhibited growth

Question 30

What aspects of social history impact the fetus and its development?

Answer 30

smoking occupation drug use

Question 31

What special laboratory studies do we need to look at during the prenatal care?

Answer 31

HBsAG PPD CXR HIV serology

Question 32

What tests screen for aneuploidy?

Answer 32

Nucal translucent screening (US and blood test)- checks for trisomy 18 and 21 Quadscreen- NTD, trisomy 18 and 21 US- NTD, trisomy 13, 18, 21 Cell free fetal DNA- trisomy 13, 18, 21 and sex chromosomes

Question 33

What are two specialized laboratory tests for aneuploidy?

Answer 33

CVS (chronic villus sampling, biopsy of placenta)- 10-12 weeks - karyotype abnormalities Amniocentesis - 15-16 weeks, chromosome abnormalities and genetic disorders (sickle cell and CF) low risks of loss

Question 34

When do you look at the hematocrit and hemeglobin?

Answer 34

3rd trimester

Question 35

what does the glucose screen test for?

Answer 35

gestational DM

Question 36

What encompasses the prenatal focused examination?

Answer 36

BP Wt gain Uterine size

Question 37

What is the average total weight gain during pregnancy?

Answer 37

22lbs

Question 38

What is the recommended wt gain of an underweight patient?

Answer 38

28-40

Question 39

What is the recommended wt gain of an normal patient?

Answer 39

25-30

Question 40

What is the recommended wt gain of an overweight patient?

Answer 40

15-25

Question 41

What is the recommended wt gain of an obese patient?

Answer 41

11-20

Question 42

What are the perinatal care nutritional considerations?

Answer 42

approx 30-35 cal/kg of ideal body weight avoid alcohol avoid tobacco well balanced diet, including dairy

Question 43

What is the distrinbution of calories?

Answer 43

50%- CHO 25%- Fat 25%- Protein

Question 44

Determination of gestational age by examination?

Answer 44

weeks = cm +/- 2

Question 45

What test can help determine size vs date discrepancy?

Answer 45

US

Question 46

What are the landmarks for the determination of gestational age?

Answer 46

FHT- doptone: 10-12 weeks Fetal motion: 16-20 FHT- fetoscope: 18-20 weeks

Question 47

What is the frequency of routine apts for perinatal care?

Answer 47

monthly until 36 weeks and then every week from 36 weeks to delivery

Question 48

What is the single most important intervention in improving maternal and perinatal outcome?

Answer 48

early and consistent perinatal care

Question 49

What are the most common medical diseases that complicate pregnancy?

Answer 49

``` HTN DM Connective tissue disease Acquire heart disease STD ```

Question 50

When testing for HBsAG if it comes back that the mom is sero + what do you do?

Answer 50

start vaccine at birth and have them come back for follow up

Question 51

What is the purpose of a quad screen test?

Answer 51

2nd trimester test | look for NTD, trisomy 18, 21