10. Pregnancy care, pregnancy counseling

Question 1

what are the 3 basic components of prenatal care?

Answer 1

1. early and continuous risk assessment
2. health promotion
3. medical and psychological intervention and follow up

Question 2

what should be addressed during the first prenatal visit?

Answer 2

1. safety- maternal age, genetic diseases, domestic violence
2. vitamins- folate
3. vaccinations
4. life style- smoking, alcohol, drugs, prevent radiation exposure, infections, stress, sleep counsel, diet
5. medical diseases- chronic conditions (DM, thyroid), change to non-teratogenic drugs

Question 3

what is the dosage of folic acid supplementation for a women with previous pregnancy with NTD, with an NTD in either parent or taking antifolate drugs (antiepileptics) ?

Answer 3

4mg daily

*prophylaxis 0.4 mg daily

Question 4

when is β-hCG detected in the serum and urine?

Answer 4

serum within 7-9 days of fertilization or in urine 14 days from fertilization.
a titer of > 25 IU/L is considered positive.

Question 5

what is ‘zero-US’?

Answer 5

Ultrasound used as initial confirmation of pregnancy

Question 6

how do we exclude the possibility of extrauterine gravidity?

Answer 6

intrauterine yolk sac finding during the first US

*intrauterine gestational sac may be found in the presence of ectopic implantation.

Question 7

what are the US findings supporting intrauterine pregnancy?

Answer 7

1. Embryonal sac (not on the midline, 2 surrounding layers, Doppler positive)
2. Yolk sac
3. Cardiac activity

Question 8

what are the US findings supporting extrauterine pregnancy?

Answer 8

1. Pseudo-gestational sac (midline fluid collection in the uterus, 1 surrounding layer, Doppler negative)
2. Free fluid in the abdominal cavity
3. Irregular adnexal lesion
4. Ectopic embryo

Question 9

when is the gestational age determined and why is it important?

Answer 9

first prenatal visit

important for management of preterm labor, IUGR, postdate pregnancy

Question 10

what is the Naegele’s rule?

Answer 10

The rule estimates the expected date of delivery (EDD) by

adding 1 year, subtracting 3 months, and adding 7 days to the origin of gestational age (first day of last menses).

Question 11

How do we estimate the gestational age?

Answer 11

1. clinical assessment (women with regular menstrual cycles)
   counting gestational weeks from the first day of the last menses.
   *using Naegele’s rule
2. US:
   -Measurement of crown-rump length (CRL) at 6-11 w’ gestation can define gestational age to within 7 days
   -multiple measurements (biparietal diameter, femur length, abdominal and head circumferences) at 12-20 weeks, gestational age can be determined within 10 days

Question 12

what is the estimated date of delivery based on if there’s more than a week difference between Naegele’s rule and the measured biometric parameters (during zero or 1st trimester US) ?

Answer 12

a new date of delivery should be estimated based on the ultrasonographic findings.

Question 12

what is the estimated date of delivery based on if there’s more than a week difference between Naegele’s rule and the measured biometric parameters (during zero or 1st trimester US) ?

Answer 12

a new date of delivery should be estimated based on the ultrasonographic findings.

Question 13

what should be preformed in the first prenatal visit other than counseling topics (lifestyle, vaccinations)?

Answer 13

• Patient’s history: gynecological, medical, surgical, psychosocial
• General physical examination
• Bimanual pelvic examination
• Cancer screening with Pap smear
• Blood pressure measurement
• Laboratory assessment: CBC, Hgb, glucose, lipids, LFTs
• Urinalysis and urine culture
• Blood grouping and D (Rh) typing
• Hepatitis B and Syphilis screening; consider HIV, chlamydia, and gonorrhea in high-risk patients