Bates Chapter 19 - The Pregnant Woman

Question 1

List the functions of estrogen in pregnancy:

Answer 1

1) Promotes endometrial growth
2) Stimulates prolactin output (readys breast tissue for lactation)
3) Contributes to hypercoagulable state

Question 2

List the functions of progesterone in pregnancy:

Answer 2

1) Increases tidal volume and minute ventilation
2) Lowers esophageal sphincter tone
3) Relaxes tone in the ureters and bladder

Question 3

List the functions of HCG in the pregnant female:

Answer 3

1) Supports progesterone synthesis in the corpus leuteum

Question 4

List the functions of relaxin in the pregnant female:

Answer 4

1) Promotes ligamentous laxity in the sacroiliac joints and pubic symphysis

Question 5

List the functions of erythropoietin in the pregnant female:

Answer 5

1) Raises erythrocyte mass

Question 6

Where is the uterus located in each trimester?

Answer 6

1) First - in the pelvis
2) Second - Above umbilicus
3) Third - Xiphoid process

Question 7

What is the term for the bluish color of the vagina and cervix noted during pregnancy?

Answer 7

Chadwick’s sign

Question 8

What lowers the pH of the vagina which may help to protect against vaginal infections?

Answer 8

Lactobacillus acidophilus

Question 9

What is the term for the palpable softening of the cervical isthmus?

Answer 9

Hegar’s sign

Question 10

What is the official term for “stretch marks”?

Answer 10

Striae gravidarium

Question 11

What do you call a brown/black stripe along the midline skin?

Answer 11

Linea nigra

Question 12

What is the term for separation of the rectus abdominis muscle at the midline?

Answer 12

Diastasis recti

Question 13

What are some of the common concerns of pregnancy?

Answer 13

1) Confirmation
2) Symptoms
3) Concerns about/attitudes toward PG
4) Current health and PMH
5) Past obstetric hx
6) Risk factors
7) Family hx
8) Plans for breast feeding
9) Gestational age and EDD

Question 14

How do you calculate gestational (menstrual) age?

Answer 14

Count the number of weeks and days from the LMP

Question 15

How do you calculate the conception age?

Answer 15

Two weeks prior to the menstrual age

Question 16

How do you calculate the expected date of delivery (EDD) using Nagle’s Rule?

Answer 16

1) Determine the LMP
2) Add 7 days
3) Subtract 3 months
4) Add one year

Question 17

What is the schedule for prenatal visits?

Answer 17

1) Monthly until 30 weeks gestation
2) Biweekly until 36 weeks
3) Weekly until delivery

Question 18

What 4 things should be in the history at every visit?

Answer 18

1) Fetal movement (reported by patient)
2) Contractions
3) Leakage of fluids
4) Vaginal bleeding

Question 19

What 4 things should be in the PE at every visit?

Answer 19

1) Vital signs
2) Fundal Height
3) FHR
4) Position and activity

Question 20

What two vitamins should be included in a prenatal vitamin?

Answer 20

Folate 0.4-0.8 mg

Iron 30 mg

Question 21

What tests does the standard prenatal screening panel include?

Answer 21

1) Blood type
2) Rh
3) Antibody screen
4) CBC
5) Rubella titer
6) Syphilis test
7) Hep B surface antigen
8) HIV
9) STI screen for G/C
10) UA with culture

Question 22

When is oral glucose tolerance testing done?

Answer 22

24 weeks

Question 23

When do you swab for group B strep (GBS)?

Answer 23

35-37 weeks

Question 24

What immunizations can be given during pregnancy?

Answer 24

1) Influenza (second or third trimester in flu season)
2) Pneumococcal
3) Meningococcal
4) Hep B

Question 25

Which vaccines are NOT safe during pregnancy?

Answer 25

1) Measles, mumps, rubella
2) Polio
3) Varicella

Question 26

Who gets RhoGAM immunoglobulin?

Answer 26

All Rh negative women at 28 weeks gestation and again within 3 days of delivery to prevent sensitization to an Rh-positive infant

Question 27

What is the term for brownish patches around the forehead, cheeks, nose and jaw?

Answer 27

Chloasma or melasma

Also the “mask of pregnancy”

Question 28

What is the name of the common cardiac sound heard during pregnancy?

Answer 28

Mammary soufffle

Question 29

When can fetal movement be detected?

Answer 29

By mother at 18-24 weeks, externally around 24 weeks

Question 30

What is the term for fetal movement?

Answer 30

Quickening

Question 31

When measuring fundal height, where is the “0” placed?

Answer 31

On the pubis symphysis

Question 32

Where should the fundus be around 20 weeks?

Answer 32

At or near the umbilicus

Question 33

When can FHT be auscultated by doppler?

Answer 33

At or around 10 weeks

Question 34

What is a normal FHR?

Answer 34

120-160 BPM

Question 35

The Leopold Maneuver is used to assess what?

Answer 35

1) The adequacy of fetal growth

2) Readiness for vaginal birth

Question 36

What is the presentation of the fetus when the head is the presenting part?

Answer 36

Vertex or cephalic

Question 37

What is the presentation of the fetus when parts other than the head present?

Answer 37

Breech