14: Normal Pregnancy: Antepartum Care

Question 1

Gravidity (G)

Answer 1

Number of times a woman has been pregnant

Question 2

Parity (P)

Answer 2

Refers to the number of pregnancies led to a BIRTH at or beyond 20 weeks or an infant weighing more than 500 gms

Question 3

Parity - FPAL

Answer 3

F = Full term (37-42 weeks)
P = Preterm (20-36+6)
A = Abortions-include all pregnancy losses <20 wks
L = Living

Question 4

A woman who has given birth to 1 set of twins at term and both are living - Gs and Ps?

Answer 4

G1P1002

Question 5

A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriage and 1 ectopic pregnancy. She has 3 living children. Gs and Ps?

Answer 5

G4P1123

Question 6

Normal physical exam findings associated with pregnancy

Answer 6

Systolic murmurs, exaggerated splitting and S3, palmar erythema, spider angiomas, linea nigra, striae gravidarum, Chadwicks sign

Question 7

Prenatal labs at first visit

Answer 7

CBC, type and screen (Rh), rubella titer, STIs, cervical cytology, diabetes, urine culture

Question 8

Effect of pregnancy on hematocrit and hemoglobin

Answer 8

Decreased by 30-34 weeks - increase in plasma volume causes a physiologic anemia

Question 9

Gestational age

Answer 9

Number of weeks that have elapsed between the first day of LMP and date of delivery

Question 10

hCG levels for positive pregnancy test

Answer 10

25 IU/L

Question 11

Rate of hCG increase in first 30 days during a normal pregnancy?

Answer 11

hCG level doubles every 2.2 days

Question 12

When can pregnancy be verified with gestational sac? hCG level at this point?

Answer 12

Gestational sac seen around 5 weeks

Mean hCG 1500-2000 IU/L

Question 13

Naegels rule

Answer 13

LMP minus 3 months + 7 days in patients with regular 28 day cycles

Question 14

Crown Rump Length (CRL)

Answer 14

Visualized on ultrasound between 6-11 weeks and can determine due date within 7 days

Question 15

Most common chromosomal disorders

Answer 15

Aneuploidy; Turner’s and Klinefelter’s

Question 16

Most common risk factor for autosomal trisomies?

Answer 16

Advanced maternal age (35+ yrs)

Question 17

Most common class of spontaneous abortions

Answer 17

Autosomal trisomies

Question 18

Most common single chromosomal abnormality found in spontaneous abortions

Answer 18

Turner’s syndrome (45XO)

Question 19

Most common gene carried in North American whites?

Answer 19

CFTR gene; cystic fibrosis

Question 20

What is the most important way to lower risk of neural tube defects?

Answer 20

Folic acid supplementation

Question 21

First trimester screening

Answer 21

Maternal age, fetal NT thickness, b-hCG, PAPP-A

Question 22

Second trimester screening

Answer 22

Triple screen: b-hCG, estriol, maternal serum AFP

Quad screen: b-hCG, estriol, AFP and inhibin A

Question 23

Amniocentesis

Answer 23

Diagnostic procedure at 16-20 weeks

Question 24

Chorionic villi sampling

Answer 24

Diagnostic procedure at 11 weeks

Question 25

Teratogen

Answer 25

Any agent or factor that can cause abnormalities of form/function in exposed fetus (often pharmaceutical)

Question 26

Most vulnerable stage to teratogens

Answer 26

Organogenesis - day 17-56 post-conception

Question 27

Most common teratogen to which a fetus is exposed

Answer 27

ALCOHOL (FAS)

Question 28

Symptoms of Fetal Alcohol Syndrome

Answer 28

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

Question 29

Effect of tobacco smoking on fetus

Answer 29

IUGR, low birth weight, increased risk of spontaneous abortion, fetal death, neonatal death and prematurity

Question 30

Effect of radiation on fetus

Answer 30

Dose dependent effects during critical period (2-6 wks)
Exposure before 2 weeks - all or none effect
Less than 5 rads exposure = no risk

Question 31

Frequency of office visits during pregnancy

Answer 31

4 weeks until 28 weeks
2 weeks from 28-36 weeks
weekly 36 weeks until delivery

Question 32

When does screening via fetal survey US occur

Answer 32

20 weeks

Question 33

When does screening for GDM, hemoglobin and hematocrit occur?

Answer 33

28 weeks

Question 34

When do you give Rhogam to Rh- patients, as well as Tdap vaccine?

Answer 34

28 weeks

Question 35

When do you screen for Group B strep carrier with vaginal culture?

Answer 35

35 weeks

Question 36

Normal fetal movement

Answer 36

10 movements in 2 hours

Question 37

Reactive NST

Answer 37

2 accelerations of at least 15 beats above baseline lasting at least 15 seconds during 20 minutes monitoring

Question 38

Positive CST

Answer 38

If late decels noted with contractions, delivery is warranted