Antenatal care

Question 1

What is the WHO’s recommendation on counseling about healthy eating and physical activity during pregnancy?

Answer 1

Counseling about healthy eating and keeping physically active during pregnancy is recommended for pregnant women to stay healthy and prevent excessive weight gain.

Question 2

What nutritional education is recommended in undernourished populations?

Answer 2

Nutrition education on increasing daily energy and protein intake is recommended for pregnant women in undernourished populations to reduce the risk of low-birth-weight neonates.

Question 3

What dietary supplementation is recommended in undernourished populations to reduce the risk of stillbirths and small-for-gestational-age neonates?

Answer 3

Balanced energy and protein dietary supplementation is recommended for pregnant women in undernourished populations.

Question 4

Is high-protein supplementation recommended for pregnant women in undernourished populations?

Answer 4

High-protein supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.

Question 5

What daily supplementation is recommended for preventing maternal anemia, puerperal sepsis, low birth weight, and preterm birth?

Answer 5

Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) of folic acid is recommended for pregnant women.

Question 6

When is intermittent oral iron and folic acid supplementation recommended?

Answer 6

Intermittent oral iron and folic acid supplementation is recommended if daily iron is not acceptable due to side effects and in populations where the prevalence of anemia among pregnant women is less than 20%.

Question 7

What is the recommendation for calcium supplementation in populations with low dietary calcium intake?

Answer 7

Daily calcium supplementation (1.5–2.0 g oral elemental calcium) is recommended for pregnant women in populations with low dietary calcium intake to reduce the risk of pre-eclampsia.

Question 8

What is recommended for pregnant women with high daily caffeine intake?

Answer 8

For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low-birth-weight neonates.

Question 9

When does most normal gestational weight gain occur?

Answer 9

Most normal gestational weight gain occurs after 20 weeks of gestation

Question 10

What is the recommended weight gain for underweight women at the start of pregnancy?

Answer 10

Women who are underweight at the start of pregnancy (BMI < 18.5 kg/m²) should aim to gain 12.5–18 kg.

Question 11

What is the recommended weight gain for women with normal weight at the start of pregnancy?

Answer 11

Women who are normal weight at the start of pregnancy (BMI 18.5–24.9 kg/m²) should aim to gain 11.5–16 kg.

Question 12

What is the recommended weight gain for overweight women during pregnancy?

Answer 12

Overweight women (BMI 25–29.9 kg/m²) should aim to gain 7–11.5 kg during pregnancy.

Question 13

What is the recommended weight gain for obese women during pregnancy?

Answer 13

Obese women (BMI ≥ 30 kg/m²) should aim to gain 5–9 kg during pregnancy.

Question 14

What is the hemoglobin (Hb) threshold for diagnosing anemia in the first trimester of pregnancy?

Answer 14

In the first trimester, the Hb threshold for diagnosing anemia is 110 g/L.

Question 15

What is the hemoglobin (Hb) threshold for diagnosing anemia in the second trimester of pregnancy?

Answer 15

In the second trimester, the Hb threshold for diagnosing anemia is 105 g/L.

Question 16

What is the hemoglobin (Hb) threshold for diagnosing anemia in the third trimester of pregnancy?

Answer 16

In the third trimester, the Hb threshold for diagnosing anemia is 110 g/L.

Question 17

What is the recommended daily elemental iron dose if a pregnant woman is diagnosed with anemia?

Answer 17

If a woman is diagnosed with anemia during pregnancy, her daily elemental iron should be increased to 120 mg until her Hb concentration rises to normal (110 g/L or higher).

Question 18

What is the iron dosage used in intermittent iron and folic acid supplementation during pregnancy?

Answer 18

120 mg of elemental iron.

Question 19

What is the folic acid dosage used in intermittent iron and folic acid supplementation during pregnancy?

Answer 19

2800 µg (2.8 mg) of folic acid.

Question 20

How often should intermittent iron and folic acid supplementation be taken during pregnancy?

Answer 20

Once weekly.

Question 21

In what context is intermittent iron and folic acid supplementation recommended during pregnancy?

Answer 21

It is recommended if daily iron is not acceptable due to side effects, and in populations with an anemia prevalence among pregnant women of less than 20%.

Question 22

What is the primary purpose of maternal blood pressure measurement during antenatal care?

Answer 22

Measuring maternal blood pressure during antenatal care is essential for screening and managing hypertensive disorders, such as pre-eclampsia, which are major causes of maternal and perinatal morbidity and mortality.

Question 23

How is fetal growth assessed through symphysis-fundal height (SFH) measurement?

Answer 23

Symphysis-fundal height (SFH) is measured using a tape to assess fetal growth, with the measurement in centimeters generally corresponding to the number of weeks of gestation, with a 2 cm allowance either way from 24 weeks of gestation onwards.

Question 24

What is daily fetal movement counting and when is it recommended?

Answer 24

Daily fetal movement counting is when a pregnant woman counts and records her baby’s movements to monitor fetal health. It is only recommended in the context of rigorous research.

Question 25

What are the benefits of an ultrasound scan before 24 weeks of gestation?

Answer 25

One ultrasound scan before 24 weeks of gestation is recommended to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labor for post-term pregnancy, and improve a woman’s pregnancy experience.

Question 26

What is the role of Doppler ultrasound examination in pregnancy?

Answer 26

Doppler ultrasound evaluates fetal well-being by assessing blood flow in fetal vessels, particularly useful in high-risk pregnancies, but routine Doppler ultrasound is not recommended for all pregnancies.

Question 27

How should hyperglycemia first detected during pregnancy be classified?

Answer 27

Hyperglycemia first detected during pregnancy should be classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to WHO criteria.

Question 28

What are the WHO criteria for diagnosing gestational diabetes mellitus (GDM)?

Answer 28

GDM should be diagnosed at any time in pregnancy if one or more of the following criteria are met:

Fasting plasma glucose: 5.1–6.9 mmol/L (92–125 mg/dL)
1-hour plasma glucose: ≥10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load
2-hour plasma glucose: 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load

Question 29

What are the WHO criteria for diagnosing diabetes mellitus in pregnancy?

Answer 29

Diabetes mellitus in pregnancy should be diagnosed if one or more of the following criteria are met:

Fasting plasma glucose: ≥7.0 mmol/L (126 mg/dL)
2-hour plasma glucose: ≥11.1 mmol/L (200 mg/dL) following a 75 g oral glucose load
Random plasma glucose: ≥11.1 mmol/L (200 mg/dL) in the presence of diabetes symptoms

Question 30

What are the adverse pregnancy outcomes associated with hyperglycemia during pregnancy?

Answer 30

Women with hyperglycemia (GDM or diabetes mellitus) detected during pregnancy are at greater risk of adverse pregnancy outcomes, including macrosomia, pre-eclampsia, hypertensive disorders, and shoulder dystocia.

Question 31

What is the general management approach for gestational diabetes mellitus (GDM)?

Answer 31

The management of GDM usually involves a stepped approach of lifestyle changes (nutritional counseling and exercise), followed by oral blood-glucose-lowering agents or insulin if necessary, to reduce poor outcomes.

Question 32

During which weeks of gestation is GDM usually diagnosed?

Answer 32

The usual window for diagnosing GDM is between 24 and 28 weeks of gestation.

Question 33

What risk factors may indicate the need for a 2-hour 75 g oral glucose tolerance test (OGTT)?

Answer 33

Risk factors include a BMI of greater than 30 kg/m², previous GDM, previous macrosomia, family history of diabetes mellitus, and ethnicity with a high prevalence of diabetes mellitus.

Question 34

What is recommended for pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth, and low birth weight?

Answer 34

A seven-day antibiotic regimen is recommended for all pregnant women with ASB.

Question 35

Is antibiotic prophylaxis recommended to prevent recurrent urinary tract infections during pregnancy?

Answer 35

Antibiotic prophylaxis is only recommended in the context of rigorous research for preventing recurrent urinary tract infections in pregnant women.

Question 36

What is recommended for Rh-negative pregnant women to prevent RhD alloimmunization?

Answer 36

Antenatal prophylaxis with anti-D immunoglobulin at 28 and 34 weeks of gestation is recommended for non-sensitized Rh-negative pregnant women, but only in the context of rigorous research.

Question 37

What is the recommendation for preventive anthelminthic treatment in endemic areas?

Answer 37

Preventive anthelminthic treatment is recommended for pregnant women after the first trimester in endemic areas as part of worm infection reduction programs. - Albendazole 400mg/ Mebendazole 500mg

Question 38

What is the WHO guideline regarding pre-exposure prophylaxis (PrEP) for HIV prevention in pregnant women?

Answer 38

Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for pregnant women at substantial risk of HIV infection as part of combination prevention approaches.

Question 39

What is the recommendation for malaria prevention in pregnancy in malaria-endemic areas?

Answer 39

In malaria-endemic areas in Africa, intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for all pregnant women, starting in the second trimester, with doses given at least one month apart, aiming for at least three doses.

Question 40

What is the dose of SP in IPT?

Answer 40

3 tablets of 500 mg sulfadoxine - 25 mg pyrimethamine (SP), to be given monthly at the beginning of the 2nd trimester of pregnancy until delivery

Question 41

What is the dosing schedule for a pregnant woman who has not previously been vaccinated against tetanus?

Answer 41

She should receive two doses of a tetanus toxoid-containing vaccine (TT-CV) one month apart, with the second dose given at least two weeks before delivery. A third dose is recommended six months after the second dose.

Question 42

How many doses of tetanus toxoid vaccine are recommended for women who have previously received 1-4 doses?

Answer 42

Women who have had 1-4 doses of a TT-CV in the past should receive one dose of a TT-CV during each subsequent pregnancy, up to a total of five doses.

Question 43

What is the duration of protection provided by the recommended doses of tetanus toxoid vaccine?

Answer 43

Two doses protect against tetanus for 1-3 years, while a third dose extends protection to at least five years. Five doses protect throughout the childbearing years.

Question 44

Why is tetanus toxoid vaccination important in the context of maternal and neonatal health?

Answer 44

Tetanus vaccination and clean delivery practices are major components of the strategy to eradicate maternal and neonatal tetanus globally.

Question 45

How are recurrent urinary tract infections (RUTIs) defined during pregnancy?

Answer 45

RUTIs are defined as symptomatic infections of the urinary tract that follow the resolution of a previous UTI, generally after treatment. They include two UTIs within the previous six months or a history of one or more UTIs before or during pregnancy.

Question 46

What are the potential pregnancy complications associated with recurrent urinary tract infections?

Answer 46

RUTIs in pregnancy are associated with adverse outcomes, including preterm birth and small-for-gestational-age newborns.

Question 47

What are the recommended interventions for nausea and vomiting in early pregnancy?

Answer 47

Ginger, chamomile, vitamin B6, and/or acupuncture are recommended for the relief of nausea, based on a woman’s preferences and available options.

Question 48

What is recommended to prevent and relieve heartburn in pregnancy?

Answer 48

Advice on diet and lifestyle is recommended to prevent and relieve heartburn. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification.

Question 49

What can be used for the relief of leg cramps in pregnancy?

Answer 49

Magnesium, calcium, or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options.

Question 50

What is recommended to prevent low back and pelvic pain during pregnancy?

Answer 50

Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. Treatment options such as physiotherapy, support belts, and acupuncture can be used based on a woman’s preferences and available options.

Question 51

What interventions are recommended for constipation during pregnancy?

Answer 51

Wheat bran or other fiber supplements can be used to relieve constipation if the condition fails to respond to dietary modification, based on a woman’s preferences and available options.

Question 52

What non-pharmacological options are recommended for the management of varicose veins and edema during pregnancy?

Answer 52

Compression stockings, leg elevation, and water immersion can be used based on a woman’s preferences and available options.

Question 53

What is the WHO-recommended number of antenatal care (ANC) contacts?

Answer 53

A minimum of eight ANC contacts are recommended to reduce perinatal mortality and improve women’s experience of care.

Question 54

When should the first ANC contact occur according to the WHO 2016 guidelines?

Answer 54

The first ANC contact should occur in the first trimester, up to 12 weeks of gestation.

Question 55

How many ANC contacts are recommended during the second trimester?

Answer 55

Two ANC contacts are recommended during the second trimester, at 20 and 26 weeks of gestation.

Question 56

How many ANC contacts are recommended during the third trimester?

Answer 56

Five ANC contacts are recommended during the third trimester, at 30, 34, 36, 38, and 40 weeks of gestation.