Antepartum Care

Question 1

Preconception Care

Answer 1

goal to reduce risk of adverse effects by optimizing ps health b/f conception

• risk assessment
• health promotion
• medical intervention (diabetes management, folic acid supplementation)
• psychosocial intervention (stress reduction)

Question 2

G and P

Answer 2

• gravidity- number of times pregnant
• parity- number of births (>20 wks or >500 gms)
• FPAL:
• full term (37-42 wks)
• preterm (20-36)
• abortions (< 20 wks)
• living

Question 3

normal PE findings assoc with pregnancy

Answer 3

• systolic murmurs
• palmar erythema
• spider angiomas
• linea nigra
• striae gravidarum
• chadwicks sign

Question 4

confirming pregnancy and viability

Answer 4

• HCG

- TVUS- gestational sac seen around 5 wks (HCG 1500-2000), fetal pole at 6 wks, cardiac activity at 7 wks

Question 5

estimating gestational age and due date

Answer 5

• LMP minus 3 months + 7 days= expected date of delivery

- crown rump length b/w 6-11 wks can determine due date within 7 days

Question 6

chromosomal disorders

Answer 6

• 0.5% of all live births
• spontaneous abortions- 50%
• > 35 yo- inc risk of autosomal trisomies or sex chrom abnormalities

Question 7

Down syndrome

Answer 7

• 95% of cases due to meitotic nondysjxnal events- 47 chrom with an extra copy of chrom 21
• 4% due to unbalanced translocations
• a couple with a child with Downs syndrome- has 1% risk of giving birth to another child with Downs syndrome

Question 8

chromosomal studies done when?

Answer 8

• in couples after 3 or more spontaneous abortions- 3% will e dx with a balanced translocation
• most common class of SABs- autosomal trisomies (16 most common)
• most common single chrom abnormality in SABs- 45XO

Question 9

most common gene carried in N Am whties

Answer 9

CF- 1 in 25

Question 10

sex linked disroders

Answer 10

• primarily affects males
• recessive genes on X chromosomes
• ex- Duchenne muscular dystrophy, Fragile X syndrome

Question 11

multifactorial disorders

Answer 11

-Neural tube defects- folic acid supplementation lowers risk

Question 12

first trimester screening

Answer 12

-maternal age
-fetal nuchal translucency thickness
-HCG
-PAPP-A (pregnancy assoc plasma protein-A)
(elevated HCG and low PAPP-A- down syndrome)

Question 13

second trimester screening

Answer 13

• HCG, estriol, AFP- b/w 16-20 wks- 70% detection rate of trisomy 21
• HCG, estriol, AFP, inhibin A- 80% detection of trisomy 21

Question 14

free fetal DNA testing

Answer 14

• 9-10 wks
• detects trisomy 21, 18, 13, sex chromosomes (95% detection)
• doesnt test for open neural fetal defects
• order only in high risk pts

Question 15

second trimester testing- dx procedures

Answer 15

• amniocentesis- 16-20 wks

- chorionic villi sampling- 11 wks

Question 16

teratogenic agents

Answer 16

• drugs
• infectious agents
• radiation

Question 17

teratogenic agents- Drugs

Answer 17

• alcohol- most common- Fecal alcohol syndrome
• antianxiety- Fluoxetine drug of choice during pregnancy
• antineoplastic- Aminopterin and methotrexate are folic acid antagonists; Alkylating agents
• anticoagulants- coumadin (crosses placenta), heparin doesnt cross placenta
• anticonvulsants- diphenylhydantoin- fetal hydantoin syndrome

Question 18

fetal alcohol syndrome

Answer 18

• growth restriction
• facial abnormalities- low set ears, smooth philtrum, thin upper lip, shortened palpebral fissures, flat midface
• CNS dysfxn- microcephaly, mental retardation, behavior disorders

Question 19

Fetal hydantoin syndrome

Answer 19

-anticonvulsant- Diphenylhydantoin

Question 20

Anticonvulsants

Answer 20

• Diphenylhydantoin
• valproic acid- open spina bifida
• carbamazepine
• phenobarbital

Question 21

Hormones

Answer 21

DES- T-shaped uterus, vaginal cell cancer, cervical and uterine malformations

Question 22

radiation

Answer 22

• dose dependent
• critical period- 2-6 wks postconception
• most cases- diagnostic levels of radiation dont have a teratogenic risk
• rule of thumb- <5 rads of exposure = no risk

Question 23

unpleasant sx’s of pregnancy

Answer 23

• N/V- eat small meals, avoid greasy foods, room T sodas and saltine crackers, acupuncture, meds (antihistamines, vit B6, antiemetics)
• heart burn- relaxation of esophageal sphincter by progesterone
• constipation- dec in colonic activity
• hemorrhoids
• leg cramps
• backache

Question 24

prenatal office visits- freq of visits

Answer 24

• every 4 wks until 28 wks
• every 2 wks from 28-36 wks
• weekly until delivery
• BP, weight, urine protein, uterine size, fetal heart rate, fetal movement

Question 25

20, 28, 35 wks- routine screening

Answer 25

• 20- fetal survey US
• 28- screen for gestational diabetes, rhogram injection to Rh neg parents, Tdap
• 35- screen for group B strep carrier with vaginal culture

Question 26

assessment of fetal well being

Answer 26

• kick counting
• nonstress test
• contraction stress test