Prenatal Care

Question 1

What are things you should do preconception?

Answer 1

1. assess woman’s medical and obstetrical risk
2. modify risk and start education before pregnancy
3. be away of LMP before any testing or new medication
4. be on folate supplementation
5. rubella/VZV vaccine
6. smoking cessation
7. decrease alcohol
8. diabetes care
9. consider epilepsy meds

Question 2

What are the facial characteristics for FAS?

Answer 2

epicanthal folds
flat nasal bridge
small palpebral fissues
railroad track ears
upturned nose
smooth philtrum
thin upper lip

Question 3

what are the risks that can come with smoking during pregnancy?

Answer 3

SMOKING-Increased risk of placenta previa, placenta abruption, ectopic pregnancy and preterm premature rupture of membranes. Maternal smoking increases the risk of stillbirth, intrauterine growth retardation and sudden infant death syndrome (SIDS). Estimated that smoking cessation would reduce all infant deaths by 10%

Question 4

How long is gestation typically

Answer 4

40 weeks plus or minus 2 weeks

Question 5

Pre-terms is…

Answer 5

less than 37 weeks

Question 6

Term is…

Answer 6

37-42 weeks

Question 7

Post-term is…

Answer 7

over 42 weeks

Question 8

First trimester goes from when to when

Answer 8

LMP to 12 weeks

Question 9

Second trimester…

Answer 9

13 -27 weeks

Question 10

third?

Answer 10

28-term

Question 11

What is EDD?

Answer 11

estrimated date of delivery or estimated due date

Question 12

What is Naegle’s rule for determining the EDD?

Answer 12

First day of LMP-3 months + 7 days + 1 year

(implied with a normal 28 day cycle) fairly accurate

Question 13

Besides Naegle’s rule, what are some other ways we can determine EDD?

Answer 13

An ultrasound during the first trimester

you can also use clinical judgement based on when you can ear heart tones (10-12 weeks) or when the woman feels quickening (18-19 weeks if primigravida, 16-17 if multigravida)

Question 14

Talk throguh gravity and parity….

Answer 14

Gravity = how many times patient has been pregnancy including current pregnancy

Parity - results of previous pregnancies
F - # of full term
P = # of pre-term births
A = # abortions - elected or spontaneous, ectopics included
L - # of living children

(Florida Power and Light)

Question 15

What would be the GPfpal in a new first pregnancy?

Answer 15

G1P000

Question 16

What about after that baby is delivered?

Answer 16

G1P1001

Question 17

In general, wha tare the drug classifications during pregnancy?

Answer 17

category A - studies in humans show no risk
B - studies in animals show no risk
C - no adequate studies
D - evidence of fetal risk, but benefit may outweigh the risk
X - fetal risk clearly outweight benefit

Question 18

What is an example of a category A?

Answer 18

prenatal vitamin

Question 19

WHat is an example of category B?

Answer 19

azithromycin, cephalosporins, erythromycin, penicillins, sulfonamides

Question 20

What is an example of category C?

Answer 20

aminoglycosides, fluoroquinolones, trimethroprim, vancomycin

Question 21

What are examples of category D?

Answer 21

streptomycin, tetracyclines

Question 22

What is an example of category X?

Answer 22

acutane

methotrexate, warfarin, DES, thalidomide, ACE inhibitors

Question 23

What is the typical prenatal visit scheudle?

Answer 23

every 4 weeks starting at 6
every 2 weeks from 28-36
weekly from 36 weeks til delivery

Question 24

What are some typical first trimester symptoms?

Answer 24

Nausea and vomiting
Ptyalism (increased salivation)
Fatigue
Increased urination
Swollen breasts
Dizziness
Food aversions and cravings
Heartburn and constipation

Question 25

What are two pelvi signs that a woman is pregnant?

Answer 25

Chadwick's (dark bluish coloration of the vulva, vagina and cervix) Hegar's sign (uterine and cervical consistency become softer)

Question 26

Typical what should you do on the initial prenatal visit?

Answer 26

lab testing prenatal education and answer questions domestic violence screening depression screening

Question 27

WHat are some of the labs you would do on the initial visit?

Answer 27

``` CBC UA ABO and Rh with antibody screen Rubella titer RPR for syphilis HBsAg for hep B HIV antibody ```

Question 28

WHat are the three diseases you shoul dideally vaccinate for before pregnancy?

Answer 28

rubella varicella influenza

Question 29

During general prenatal visits, what should you do for exam?

Answer 29

``` ask symtoms check weight blood pressures fundal height fetal heart tones abdominal palpation evaluation for edema ```

Question 30

About how many extra calories does a woman need to eat when pregnancy

Answer 30

about 150 kcal/day in first trimester and extra 35 kcal/day during the last two trimesters

Question 31

What is the typical maternal weight gain during pregnancy?

Answer 31

25-35 pounds

Question 32

Besides folic acid, what should you supplement?

Answer 32

prenatal iron if anemic - 25-30 mg/day

Question 33

What are the typical reasons to get an ultrasound?

Answer 33

``` dating dx uterine anomaly evaluation of pelvic mass size and date discrepancies suspected miscarriage suspected multiple gestation vaginal bleeding prenatal diagnostic procedure for major fetal abnormalities monitor fetal health for breathing, body movements, fetal tone and umbilical blood flow ```

Question 34

When should you push for genetic screening

Answer 34

age over 35 with singleton age over 32 with twins family history of thalassemia, sickle cells, tay-sachs, cystic fibrosis significant meds or street drug use

Question 35

What is the newer test that's noninvasive to test for Trisomy 21?

Answer 35

frgament fetal DNA in maternal circulation - super expensive still

Question 36

What are the other ways to do genetic testing/check for abnormalities?

Answer 36

chorionic villous sampling early amniocentesis ultrasound examination maternal serum screening

Question 37

When do you do the chorionic villus sampling? amnio?

Answer 37

10-12 weeks for villus | 13-18 for amnio

Question 38

What US sign do you look for to assess Down's risk?

Answer 38

nuchal lucency increased in downs

Question 39

What do you look for on the amniocentesis?

Answer 39

check amniotic fluid for alpha fetoprotein also look at the amniotic fetal cells for chromosome abnormalities or biochemical disorders

Question 40

What does the QUad screen look at?

Answer 40

maternal serum alpha fetoprotein hCG Unconjugated estriol Pregnancy associated plasma protein

Question 41

NTD

Answer 41

elevated alpha fetoprotein

Question 42

Tirsomy 18

Answer 42

decreased AFP, decreased hCG, decreased UE3

Question 43

Trisomy 21

Answer 43

Decreased AFP, increased hCG | decreased UE3

Question 44

What are the second trimester symtposm?

Answer 44

``` skin changes larger breast nasal and gum swelling leg cramps leukorrhea braxton-hicks ```

Question 45

When do you do gestational diabetes screening?

Answer 45

24-28 weeks do the 1 hour test after 50 grams of glucose confirm with a 3 hour glucose tolerance test if abnormal

Question 46

WHen do you give rhogam to an Rh- woman?

Answer 46

at 28 weeks gestation and again within 72 hours of delivery if the infant is RhD positive

Question 47

What are typical third trimester symptoms?

Answer 47

``` back ache weight gain SOB heartburn swelling varicose veins hemorrhoids frequent urination vaginal discharge braxton hicks ```

Question 48

When should you consider a Tdap in pregnancy?

Answer 48

between 27 and 36 weeks

Question 49

When should you give a Tdap to others before the expected delivery?

Answer 49

2 weeks prior to expected delivery

Question 50

When do we test for GBS?

Answer 50

35-37 weeks with vaginal, rectal swab

Question 51

How can we determine baby's position on exam?

Answer 51

Leopold's maneuvers