Prenatal care

Question 1

When should women start taking folic acid?

Answer 1

Prior to conception

Question 2

How much folic acid should women start taking?

Answer 2

0.4mg daily as soon as pregnancy is diagnosed

Question 3

How often should patients be seen in the first trimester?

Answer 3

every 4-6 weeks

Question 4

What testing is done in the 1st trimester?

Answer 4

US to confirm gestational age
Blood tests, Pap smear, Gonorrhea/chlamydia tests
Screenings for fetal aneuploidy
maternal b-hCG, maternal PAPPA-A, nuchal traslucency
-combined first trimester test 11-14 weeks

Cell-free DNA testing as early as 7 weeks

Question 5

What is the combined first trimester test?

Answer 5

Maternal b-hCG
Maternal PAPP-A
Nuchal Translucency

Question 6

When is the combined first trimester test performed?

Answer 6

11-14 weeks

Question 7

How early can Cell-Free dna testing be performed?

Answer 7

7 weeks

Question 8

What are visits in the 2nd trimester used for?

Answer 8

Screen for genetic and congenital problems

Question 9

What tests are used to screen in the 2nd trimerster?

Answer 9

Triple or quad screen at 15-23 weeks

Question 10

When do you perform a 2nd trimester triple or quad screen?

Answer 10

15-23 weeks

Question 11

What are the components of the triple screen?

Answer 11

Maternal Serum Alpha Fetoprotein (MSAFP)
Beta-hCG
Estriol

Question 12

What are the components of the quad screen?

Answer 12

Maternal Serum Alpha Fetoprotein (MSAFP)
Beta-hCG
Estriol
Inhibin A: increases sensitivity

Question 13

What does an increase in MSAFP suggest?

Answer 13

Dating error, neural tube defect or abdominal wall defect

Question 14

What can a decrease in MSAFP suggest?

Answer 14

chromosomal abnormalities

Question 15

What is the defective chromosome in Patau syndrome?

Answer 15

Chromosome 13

Question 16

What is the defective chromosome in Edwards syndrome?

Answer 16

Chromsome 18

Question 17

What is the defective chromosome in Down Syndrome?

Answer 17

Chromsome 21

Question 18

What does the Quad screen show for patau Syndrome (Trisomy 13)?

Answer 18

AFP: increased
Estriol: unchanged
hCG: unchanged
Inhibin A; unchanged

Question 19

What happens to AFP in Patau syndrome (Chr. 13)?

Answer 19

Increased

Question 20

What happens to Estriol in Patau Syndrome (chr 13)?

Answer 20

unchanged

Question 21

What happens to hCG in Patau Syndrome (chr 13)?

Answer 21

unchanged

Question 22

What happens to Inhibin A in Patau Syndrome (chr 13)?

Answer 22

Unchanged

Question 23

What does the quad screen show for Edwards syndrome (Chr. 18)?

Answer 23

AFP: unchanged
Estriol: decreased
hCG: decreased
inhibin A: unchanged

Question 24

What happens to AFP in Edwards syndrome (Chr. 18)?

Answer 24

Unchanged

Question 25

What happens to Estriol in Edwards syndrome (Chr. 18)?

Answer 25

Decreased

Question 26

What happens to hCG in Edwards syndrome (Chr. 18)?

Answer 26

Decreased

Question 27

What happens to Inhibin A in Edwards syndrome (Chr. 18)?

Answer 27

Unchanged

Question 28

What does the Quad screen show in Down Syndrome (Chr. 21)?

Answer 28

AFP: decreased Estriol: Decreased hCG: increased Inhibin A: increased

Question 29

What happen to AFP in Down Syndrome (Chr. 21)?

Answer 29

decreased

Question 30

What happens to Estriol in Down Syndrome (Chr. 21)?

Answer 30

decreased

Question 31

What happens to hCG in Down Syndrome (Chr. 21)?

Answer 31

Increased

Question 32

What happens to Inhibin A in Down Syndrome (Chr. 21)?

Answer 32

Increased

Question 33

When can you start to auscultate the fetal HR and feel quickening of the HR?

Answer 33

16-20 weeks

Question 34

When do you perform a routine 2nd trimester US for fetal anatomy?

Answer 34

18-20 weeks

Question 35

How often are visits in the 3rd trimester?

Answer 35

Every 2-3 weeks until 36 weeks then weekly

Question 36

What testing is done in week 27?

Answer 36

CBC Syphillis Screen

Question 37

When do you replace iron orally?

Answer 37

if Hgb <11

Question 38

What testing is done between 24-28 weeks?

Answer 38

1-hour glucose challenge test (GCT)

Question 39

When indicates the need to perform an oral glucose tolerance test?

Answer 39

Glucose >130-140 at one hour in glucose challenge test

Question 40

What testing is performed at 36 week?

Answer 40

Cervical Cx for Chlamydia and Gonorrhea STD testing if (+) during pregnancy or high risk Rectovaginal Cx for Group B strep

Question 41

What are Braxton-Hicks contractions?

Answer 41

Sporadic contractions without cervical dilation in the 3rd trimester

Question 42

What should be done if Braxton-Hicks contractions become regular?

Answer 42

Check the cervix to rule-out preterm labor: preterm labor opens the cervix

Question 43

When is Chorionic Villus sampling performed?

Answer 43

10-13 weeks: if genetic aneuploidy screening test is positive

Question 44

What does a chorionic villus sample provide?

Answer 44

Fetal Karyotype

Question 45

How is a chorionic villus sample performed?

Answer 45

Catheter inserted into intrauterine cavity to aspirate chorionic villi from the placenta

Question 46

When is Amniocentesis performed?

Answer 46

15-17 weeks: if genetic aneuploidy screening test is positive

Question 47

What does amniocentesis provide?

Answer 47

Fetal Karyotype

Question 48

How is amniocentesis performed?

Answer 48

Needle inserted transabdominally into the amniotic sac to withdraw amniotic fluid