Assessment of Antenatal Risks

Question 1

When is Nuchal Translucent Screening done during pregnancy?

Answer 1

11-14 wks of prego

Question 2

What is Nuchal Translucent Screening?

Answer 2

• US that checks the thickness of the nuchal fold
• done at 11-14 wks of prego
• thicker fold = increased risk of genetic anomalies

Question 3

Reasons for an early US?

Answer 3

Nuchal Transulency Screening, early prego confirmation and accurate dating of pregnancy (date of delivery)

Question 4

The sex of the child can be determined at how many wks?

Answer 4

18-20 wks

Question 5

Why are late prego US usually done?

Answer 5

to monitor high-risk preggos

Question 6

What does Quad testing screen for?

Answer 6

risks of down syndrome (trisomy 21)

Question 7

What substances does Quad testing measure?

Answer 7

AFP, hCG, estriol and inhibin A

Question 8

What is alpha-fetoprotein (AFP) and where is it produced?

Answer 8

is a protein that is produced by the fetus

Question 9

What is estriol and where is it produced?

Answer 9

an estrogen produced by both the fetus and the placenta

Question 10

What is hCG and where is it produced?

Answer 10

a hormone produced within the placenta

Question 11

What is inhibin A and where is it produced?

Answer 11

a protein produced by the placenta and ovaries

Question 12

When is the Quad Screen done during pregnancy?

Answer 12

1st (1-13 wks) or 2nd trimester (13-28 wks)

Question 13

High levels of AFP suggests what about the developing fetus?

Answer 13

may have a neural tube defect

Question 14

When in the pregnancy are fetal kick counts begun?

Answer 14

28-30 wks

Question 15

Explain the fetal kick count.

Answer 15

• measures how long it takes the baby to kick 10x, want within 2

Question 16

When is Amniocentesis done during pregnancy?

Answer 16

15-20 wks

Question 17

Where are the cells for CVS taken from?

Answer 17

the cells are taken from the placenta

Question 18

When is CVS done during pregnancy?

Answer 18

10-14 wks

Question 19

What should a woman do if she feels < 10 movements within 2 hrs of fetal kick counting?

Answer 19

take a walk, drink something sweet and make sure to be in a quiet environment

Question 20

When should a woman see her provider after when performing fetal kick counts?

Answer 20

if < 10 fetal movements within 2 hrs after taking a walk, drinking something sweet and make sure to be in a quiet environment

Question 21

When during the pregnancy are non-stress tests (NST) begun?

Answer 21

26-28 wks, only useful during the 3 trimester

Question 22

What is a normal (“Reactive”) NST?

Answer 22

≥ 2 heart rate accelerations periods of ≥ 15 BPM for ≥ 15 secs within a 20 min period

Question 23

What to do if specified HR criteria are not met within for NST?

Answer 23

wait another 20 mins (making 40 mins total), to account for fetal sleep time

Question 24

How long does the typical fetal sleep period last?

Answer 24

about 40 mins

Question 25

Why should a prego woman not smoke prior to having a non-stress test?

Answer 25

it could cause a false positive

Question 26

Contra-indications for Contractions Stess Test?

Answer 26

hx of preterm labor, previous classical/vertical incision c-section, placenta previa (placenta lies low, near cervix)

Question 27

Drug of choice for contraction stress test?

Answer 27

Pitocin

Question 28

Number of contractions and length wanted during a contraction stress test?

Answer 28

3 contractions, lasting ≥ 40 secs in 10 mins

Question 29

What is a (1) positive and (2) negative contraction stress test interpretation?

Answer 29

1) repetitive late decelerations or drop in HR

2) no decelerations or drop in HR

Question 30

Fluid amount for the below:

1) oligohydramnios
2) normal AFI
3) polyhydramnios

Answer 30

1) ≤ 4 cm
2) 5-19 cm
3) ≥ 20 cm

Question 31

What test(s) are an alternative to a complete Biophysical Profile?

Answer 31

NST with AFI

Question 32

Interpret the results and determine whether a complete BPPis needed:

1) Reactive NST and AFI of 3
2) Reactive NST and AFI 23
3) Reactive NST and AFI 16

Answer 32

• 1 & 2: perform full BPP

- 3: normal results, no BPP needed

Question 33

Interpret the NST results (normal or not normal):

1) 3 periods of acceleration (20, 15, 20 BPM), (20, 25, 15 secs), within 12 minutes
2) 4 periods of acceleration (20, 15, 20 BPM), (20, 25, 15 secs), within 25 minutes
3) 2 periods of acceleration (24, 12, 22 BPM), (20, 25, 15 secs), within 10 minutes

Answer 33

1) normal
2) non-normal (timeframe is longer than 20 mins)
3) non-normal (12 BPM is < 15)

Question 34

BPP Scoring and interpretation:

1) 8-10/10
2) 6/10
3) 4/10
4) 2/10
5) 0/10
6) <6/10

Answer 34

1) low risk for perinatal asphyxia
2) Probable perinatal asphyxia
3) high risk for perinatal asphyxia
4) perinatal asphyxia almost certain
5) perinatal asphyxia certain
6) plan will be to deliver if the fetus is mature

Question 35

Components of the BPP include?

Answer 35

1) Nonstress test: reactive = 2 points, non=0
2) Fetal breathing:
- 2points: ≥20 secs of rythmic breathing ≤ 30 mins
- 0 points: other
3) Fetal Activity
- 2 points: ≥ 2 torso/limb movements
- 0 points: < 2 movements
4) Muscle tone
- 2 points: ≥ flexion and extension of limb or trunk
- 0 points: poor/none
5) Qualitative Amniotic Fluid volume
- 2 points: ≥ 1 vertical pockets with ≥ 2 cm of AF
- 0 points: < 2 cm of AF

Question 36

Infections associated with Congenital Disorders in the Fetus/Neonate?

Answer 36

TORCH:

• Toxoplasmosis
• Other (chlamydia, syphilis, varicella)
• Rubella
• Cytomegalovirus
• Herpes Simplex

Question 37

Adolescent Pregnancies (phase of adolescence)

1) early
2) mid
3) late

Answer 37

1) 10-13
2) 14-16
3) 17-20