Antenatal Care

Question 1

Listeria infection is a problem if contracted, with fetal

mortality being _______

Answer 1

30–50%.

Question 2

Folic acid (0.5 mg tablets) is now generally
recommended to commence about\_\_\_\_\_\_\_\_ preconception and \_\_\_\_\_\_\_post concepcion

Answer 2

3 months prior to conception, continuing to 12 weeks postconception

Question 3

Rubella serology should be estimated and, if
required, immunisation_______ prior to conception
should be initiated

Answer 3

4 weeks

Question 4

When to test for seroconversion for rubella

Answer 4

Test for seroconversion 6–8

weeks late

Question 5

Rubella Vaccination should be avoided in early
pregnancy, and pregnancy avoided for ________after
rubella vaccination.

Answer 5

28 days

Question 6

if vaginal bleeding: if Rh negative, send blood
sample for Rh antibodies—if absent, give one
ampoule ______ within
72 hours of first bleed

Answer 6

anti-D gammaglobulin

Question 7

Perform the four classic techniques of palpation

(applies to later visits):

Answer 7

1 Fundal palpation
2 Lateral abdominal palpation
3 Pawlik palpation
4 Deep pelvic palpation

Question 8

When to do Maternal serum screening (MSST)

Answer 8

(9–13 weeks, 11 is ideal):

Question 9

MSST tests

Answer 9

— Free β -hCG

— PAPP-A

Question 10

If MSST performed at 11 weeks and combined
with NT one week later, it enables the risk of
_____ and _________ to be defined and
compared with age-related risk

Answer 10

trisomy-21 and trisomy-18

Question 11

Nuchal translucency (NT) ultrasound (usually
\_\_\_\_\_\_\_\_

Answer 11

12–13 weeks)

Question 12

Second trimester MSST

• performed at ________ (if desired)

Answer 12

15–16 weeks

Question 13

Second trimester MSST

Genetic testing for recessive disorders
such as ________ and ________ can be
discussed at this time.

Answer 13

cystic fibrosis

thalassaemia

Question 14

Recently, free fetal DNA testing has been available
in Australia and overseas. It is performed on a
maternal blood sample taken at about_______

Answer 14

10–12 weeks

Question 15

If positive free fetal DNA testing, _______ or __________would usually be required for
confirmation

Answer 15

amniocentesis or

chorionic villus biopsy

Question 16

A common routine schedule (if all appears normal)

• Initial in first trimester: _______
• Up to 28 weeks: every _______
• Up to 36 weeks: every _____
• 36 weeks–delivery:_____

Answer 16

8–10 weeks

4–6 weeks

2 weeks

weekly

Question 17

Guidelines for OGTT

Answer 17

• First visit—if previous gestational diabetes or
strong family history
• About 20 weeks—as above + normal initial test
• About 26 weeks—for all other patients

Question 18

The average number of visits is 12 but the need
for this number is being questioned, with some
authorities recommending as few as______

Answer 18

six visits

Question 19

urinalysis (protein and sugar)—many clinics
repeat at each visit only if there is _______at
the first visit or if signs of hypertension, kidney
disease or pre-eclampsia develop.

Answer 19

proteinuria

Question 20

Record day of first fetal movements (i.e.
‘quickening’) (ask patient to write down the dates):
• primigravida: ______
• multigravida:______

Answer 20

17–20 weeks

16–18 weeks

Question 21

Causes of proteinuria in pregnancy

Answer 21

Urinary tract infection
Contamination from vaginal discharge
Pre-eclampsia toxaemia
Underlying chronic kidney disease

Question 22

The uterus is a pelvic organ until the ______ of pregnancy

Answer 22

twelfth week

Question 23

At about _______weeks it
has reached the level of the umbilicus and reaches
the xiphisternum between ________ weeks

Answer 23

20–22

36 and 40

Question 24

If the symphysis fundal height is more than ____ different
from that expected for the gestation, the cause of
this should be evaluated by ultrasound examination

Answer 24

2 cm

Question 25

______ and ________ helps prevent constipation of | pregnancy

Answer 25

Bran with cereal

Question 26

It is usual to gain about ______ during pregnancy

Answer 26

12 kg

Question 27

Smoking, alcohol and other drugs 1 standard drink of ______ • 1 cup of _____ or 2 cups of tea

Answer 27

alcohol | coffee

Question 28

There is convincing evidence that promotion of smoking cessation programs during pregnancy is effective, with improved outcomes, including reduction in_______ and _______

Answer 28

preterm birth rates and low birthweight rate

Question 29

Mothers taking illicit drugs, especially opioids and amphetamines, require identification, counselling, treatment and surveillance for the __________

Answer 29

neonatal abstinence syndrome in the newborn child

Question 30

Coitus should be encouraged during pregnancy but | with appropriate care, especially in the _______

Answer 30

4 weeks before | delivery

Question 31

They should avoid international air travel after ______ weeks and travel after 34 weeks is usually not permitted.

Answer 31

28

Question 32

Normal weight gain is minimal in the first 20 weeks, resulting in a _____weight gain in the first half of pregnancy

Answer 32

3 kg

Question 33

From 20 weeks onwards there is an average weight gain of _____ kg per week. From 36 weeks the weight gain usually levels off.

Answer 33

0.5

Question 34

if the movements drop to fewer than ______ per day, the patient should be referred to hospital for fetal monitoring

Answer 34

10

Question 35

Possible exposure to rubella If her immune status is unknown, perform a _______ and repeat titres in 2–3 weeks

Answer 35

rubella IgG titre and IgM and repeat the IgG and IgM

Question 36

Vaginal bleeding <6 weeks: Do _________ (ultrasound usually unhelpful).

Answer 36

serial quantitative HCG levels, | which should double every 2 days

Question 37

Vaginal bleeding 6–8 weeks:________

Answer 37

Ultrasound will define an intrauterine | pregnancy and exclude an ectopic.

Question 38

Vaginal bleeding >8 weeks: Normal ultrasound is reassuring since miscarriage rate is only ________ unless the amount of intrauterine blood is large

Answer 38

3%

Question 39

T or F Rest is not necessary for threatened miscarriage

Answer 39

T

Question 40

A small bleed between 18–24 weeks indicates possible ________ and warrants a speculum or vaginal examination plus fetal assessment

Answer 40

cervical ‘weakness’

Question 41

Be aware that an incomplete abortion can cause | ___________

Answer 41

cervical shock (pelvic pain and fainting).

Question 42

If a threatened miscarriage occurs, check the blood | group and test for________

Answer 42

rhesus antibodies in maternal | serum.

Question 43

``` If the mother is Rh-negative and no antibodies are detected, give one ampoule of __________ intramuscularly if the woman actually miscarries (not for threatened abortion). ```

Answer 43

anti-D | gammaglobulin

Question 44

Medication for Nausea and vomiting during pregnancy

Answer 44

— pyridoxine 25–50 mg bd or tds | — if still ineffective add metoclopramide 10 mg tds

Question 45

This is severe vomiting in pregnancy, which may result in severe fluid and electrolyte depletion. It occurs in about 1 in 100 pregnancies

Answer 45

Hyperemesis gravidarum

Question 46

Hyperemesis gravidarum association

Answer 46

* Normal complication * Hydatidiform mole * Multiple pregnancy * Urinary infection

Question 47

________ is the basis of the cramps

Answer 47

Prolonged plantar | flexion

Question 48

There is no evidence that __________ help cramps during pregnancy

Answer 48

calcium supplements

Question 49

Painful haemorrhoids may be eased by the application of __________or perhaps haemorrhoidal ointments containing local anaesthetic

Answer 49

packs soaked in warm saline

Question 50

Exercise guidelines during pregnancy

Answer 50

• avoid overheating and dehydration • allow for a long warm-up before exercise and a long cool-down • choose low-impact or water exercise

Question 51

If desperate for CTS, what to do?

Answer 51

an injection of corticosteroid into the carpal tunnel can be very effective (check drug category for risk relative to dates

Question 52

Cause of hypotension during pregnancy

Answer 52

This is due to increased peripheral circulation and | venous pooling

Question 53

Generalised itching (pruritus gravidarum) is usually associated with ________ due to oestrogen sensitivity in the third trimester

Answer 53

cholestasis

Question 54

Obesity is associated with increased obstetric | morbidity, including_____ and ______

Answer 54

difficult labour and potential | anaesthetic risks

Question 55

T or F Iron is not routinely recommended for pregnant women who are healthy, following an optimal diet and have a normal blood test

Answer 55

T

Question 56

_________ is essential for the developing fetus and if deficiency is known or suspected (e.g. vegetarian/ vegan diet)

Answer 56

Vitamin B12

Question 57

It is recommended, for pregnant and lactating women and those planning a pregnancy, to take _______of supplementary iodine as soon as possible by using iodised salt for cooking and a multivitamin that includes iodine

Answer 57

150 | mcg