Chapter 5: Antenatal Care And Common Conditions In Pregnancy Flashcards
You are a trainee intern in general practice seeing Annie, an 18 year old primigravid Pākehā woman, after she has had a positive urine pregnancy test. The pregnancy was not planned and she has not used any hormonal contraception in her six month relationship. Annie is unsure when she became pregnant and her periods have always been quite irregular, occurring every two to three months. She thinks her last period was at least four months ago. On abdominal examination, the uterus is not palpable. She asks “how far pregnant am I?” Of the following statements, which is the MOST correct regarding correctly dating Annie’s pregnancy?
“Based on my examination, you are 16 weeks pregnant”
“Because of your irregular periods, we need to measure your blood HCG level levels to estimate how far pregnant you are”
“Because of your irregular periods, we need to measure your blood progesterone level to estimate how far pregnant you are”
“Because of your irregular periods, we need to arrange an ultrasound to estimate how far pregnant you are”
“Based on your last period date, you are four months pregnant”
“Because of your irregular periods, we need to arrange an ultrasound to estimate how far pregnant you are”
You are a trainee intern in a general practice with Bernie, a 26 year old NZ European woman who has just attended for a cervical screening test. Bernie states she is planning to stop her pill next month and to try for a pregnancy. There are no medical contraindications to pregnancy, and Bernie’s BMI is 24. You advise Bernie to start folic acid, 0.8mg daily. From the following options, what is the most important reason to advise her to start the folic acid?
Prevention of microcytic anaemia in pregnancy
Prevention of megaloblastic anaemia in pregnancy
Prevention of a neurodevelopment deficit in the baby
Prevention of an exomphalos (omphalocoele) in the baby
Prevention of a neural tube defect in the baby
Prevention of a neural tube defect in the baby
You are a trainee intern in a general practice with Rangi, a 21 year old wahine Māori whois planning to get pregnant soon. Rangi is a healthy woman with a BMI of 22. Rangi’s sister has just had a termination of pregnancy after the fetus was diagnosed with anencephaly. You advise Rangi to start folic acid, 5mg daily..
From the following options, what is the most important reason for Rangi to take folic acid 5mg daily?
Prevention of maternal cytochrome P450 enzyme induction
Prevention of a cleft lip or palate in the baby
Prevention of maternal megaloblastic anaemia in pregnancy
Rangi’s BMI means that a 5mg dose of folic acid is indicated
The family history of a neural tube defect
The family history of a neural tube defect
You are a trainee intern at an antenatal clinic seeing Cathy, a 30 year old G3 P1 Pakeha woman who is 11 weeks pregnant.
Cathy’s first pregnancy was an ectopic pregnancy when she was 18 and she had a salpingectomy. When she was 24 she had a 3900g healthy baby boy via normal vaginal birth.
After her son was born, Cathy used Depo-Provera for contraception and was amenorrhoeic on it. Cathy’s last Depo-Provera injection was five months ago and Cathy has not had a period since then.
Cathy’s GP arranged an ultrasound for dating and when performed 5 weeks ago, the scan showed a live single intra-uterine pregnancy at 6 weeks gestation.
Two years ago Cathy had a cone biopsy of her cervix for adenocarcinoma in situ (AIS). Her follow up smears and HrHPV test have been normal.
Cathy lives with her partner of 10 years, Sandeep, who is 42 years old. She is a non smoker and consumes no alcohol. Cathy has been taking folic acid and iodine for the last 4 months.
Cathy is 165cm tall and weighs 69kg. Her BP is 110/70.
Of the following options, which aspect of Cathy’s history places her at increased risk of a pregnancy complication in this pregnancy?
Cathy’s history of a cone biopsy
Cathy’s last baby weighed 3900g
Cathy’s age of 30yrs, with a birth interval >5yrs
Cathy’s history of an ectopic pregnancy
Cathy’s partner is aged 42
Cathy having used Depo-Provera for five years
Cathy’s history of a cone biopsy
You are a trainee intern at an antenatal clinic with Rewa, a 35 year old primigravid wahine Māori who is happily hapū with a planned pregnancy. You are calculating Rewa’s EDD using a pregnancy wheel. Rewa is certain of her LMP and has 35 day cycles. Her period lasts for four days. Her GP confirmed pregnancy with a urine HCG test. Which of the following describes how you should estimate her EDD?
Enter the last day of the LMP into the pregnancy wheel and subtract 7 days from the EDD
Enter the first day of the LMP into the pregnancy wheel and add 7 days to the EDD
Enter the last day of the LMP into the pregnancy wheel and add 7 days to the EDD
Enter the first day of the LMP into the pregnancy wheel and obtain the EDD
Enter the first day of the LMP into the pregnancy wheel and subtract 7 days from the EDD
Enter the last day of the LMP into the pregnancy wheel and obtain the EDD
Enter the first day of the LMP into the pregnancy wheel and add 7 days to the EDD
You are a trainee intern in general practice seeing Leigh, a 24 year old nulliparous Pākehā woman who suspects she is pregnant. Leigh stopped the combined oral contraceptive pill 10 weeks ago as she didn’t like the side effects of it. She had a withdrawal bleed when she stopped the pill and hasn’t had a period since then. Prior to starting on the COC pill she had regular periods every 4 weeks. You do a urine HCG which is positive. You are unable to palpate the uterus abdominally. You explain to Leigh that because she has not had a period since the last pill withdrawal bleed, her estimated date of delivery cannot be calculated with accuracy using that period date.
You arrange her an ultrasound scan to date the pregnancy.
Which of the following is correct regarding calculating Leigh’s EDD?
Determination of the EDD will depend on an ultrasound measurement of the yolk sac
Given the positive pregnancy test, the baby’s due date can be regarded as being 40 weeks from the first day of the last withdrawal bleed
Determination of the EDD will depend on an ultrasound measurement of the crown-rump length
Determination of the EDD will depend on an ultrasound measurement of the biparietal diameter
Determination of the EDD will depend on an ultrasound measurement of the femur length
Determination of the EDD will depend on an ultrasound measurement of the crown-rump length
You are a trainee intern at an antenatal clinic seeing Ana, a 24 year old primigravid Samoan woman who has a planned, welcome pregnancy. She stopped using condoms for contraception 3 months ago. Her periods are regular, every 28 days. Her LMP was exactly 10 weeks ago. Ana asks you when the baby is due. From the following options, how will you estimate her EDD?
Her baby is due 40 weeks from the first day of her LMP
A bimanual examination is required to estimate her EDD
An ultrasound of the gestational sac size is required to estimate her EDD
An ultrasound of crown-rump measurement is required to estimate of her EDD
An ultrasound of femur length measurement is required to estimate her EDD
Her baby is due 40 weeks from the first day of her LMP
You are a Trainee Intern in antenatal clinic seeing Cindy, a 22 year old Pākehā woman in her first pregnancy. This is Cindy’s first antenatal appointment. Cindy missed her earlier antenatal clinic appointments Cindy has a 28 day menstrual cycle and the first day of her LMP was exactly 16 weeks ago. She remembers the date well as it was her sister’s birthday. Cindy can’t feel any fetal movements yet.
On clinical examination the uterine fundus is palpable half way between the public bone and the umbilicus. The fetal heart is heard with a Sonicaid Doppler. Cindy asks you when her baby is due.
Of the following options, which is the correct response?
By your period dates you are 16 weeks pregnant, but this must be wrong because you haven’t started to feel baby move yet.
It is not possible to work out when your baby is due without an ultrasound scan.
From your period date you are 16 weeks pregnant, and the examination findings are consistent with that. The baby’s due date is 40 weeks from the first day of your last period.
Dating a pregnancy is not important, and the baby will come when it is ready
By your period dates you are 16 weeks pregnant, but your examination findings are consistent with you being only 12 weeks pregnant.
From your period date you are 16 weeks pregnant, and the examination findings are consistent with that. The baby’s due date is 40 weeks from the first day of your last period.
You are a trainee intern in a general practice seeing Daisy, a 39 year old nulliparous New Zealander of Indian ethnicity who is planning to get pregnant. She is currently taking iodine 150 mcg daily and folic acid 0.8 mg daily. You take a medical and family history. Which of the following situations would result in you advising Daisy to increase her folic acid to 5mg daily?
Daisy’s husband takes valproate for epilepsy
Daisy is on fluoxetine for depression
Daisy’s mother has had surgery for a spinal stenosis
Daisy has a BMI of 36
She is taking metformin for PCOS
Daisy has a BMI of 36
You are a trainee intern in a general practice seeing Izzy, a 25 year old Pākehā woman who is planning pregnancy and wishing further advice about folic acid supplementation. You recommend that she takes folic acid 0.8mg od. When should Izzy be taking the folic acid?
From a month prior to conception until conclusion of breast feeding
From diagnosis of pregnancy until conclusion of breast feeding
From diagnosis of pregnancy until delivery
From diagnosis of pregnancy until end of the first trimester
From a month prior to conception until term
From a month prior to conception and then until 12 weeks’ gestation
From a month prior to conception and then until 12 weeks’ gestation
You are a trainee intern in general practice seeing Kylie, a 31 year old Pākehā person who is 16 weeks pregnant in her first pregnancy.
Kylie was diagnosed with PCOS as a teenager. She needed to take letrozole to conceive. Kylie had a colposcopy when she was 28 after 2 low grade smears. A cervical biopsy showed CIN1.
Kylie’s BP is 120/70. Her BMI is 35. The fetal heart is heard with a Sonicaid Doppler.
She conceived after clomiphene and FSH therapy as her periods were infrequent after stopping the combined contraceptive pill Ginet (contains cyproterone acetate) and she was not ovulating. She had originally been advised to start this contraceptive pill because of infrequent periods with acne when aged 19 years. Kylie required a colposcopy when aged 27 years because of an abnormal cervical screening test - the histological diagnosis was CIN1 and she did not require any treatment for this. Abdominal examination correlates with her dates, and viable fetal heart activity is confirmed at clinic.
Which of the following complications is Kylie MOST likely predisposed to?
Gestational diabetes
Premature labour
Prolonged pregnancy
Antepartum haemorrhage
Severe pre-eclampsia
An ectopic pregnancy
Gestational diabetes
Diabetes of PCOS + obesity
You are a trainee intern in an antenatal clinic with Leila, a 32 year old primigravid woman of Tongan ethnicity. She is at 30 weeks by dates. You have just advised her of your examination findings which are all normal except you note the baby’s lie is transverse. Her previous antenatal course, including the first and second trimester scans had also been normal. She asks about this abnormal finding, and is anxious because she lives at least one hour from the hospital should a problem arise. From the following options, what is the most accurate comment about the baby’s lie at this gestation?
You need hospitalisation, because your membranes can rupture anytime from now, and if the cord then prolapses, you will need an urgent caesarean section
As neither the baby’s head nor buttocks are presenting, but the cord probably is, you will need a caesarean section
Your baby’s spine is parallel to your spine
The lie of a baby is normally longitudinal with the head presenting
This finding is within normal limits for this gestation, but if the transverse lie persists, the management plan will need review
This finding is within normal limits for this gestation, but if the transverse lie persists, the management plan will need review
You are a trainee intern at an antenatal clinic seeing Melissa, a 26 year old primigravid NZ European woman at 39 weeks’ gestation. She complains of various symptoms that have developed over the last three weeks. Which of the following symptoms is more likely to suggest an underlying medical problem rather than be a distressing (but non-pathological) symptom of late pregnancy?
A clear, non-irritant vaginal discharge
Palmar paraesthesia and numbness
Lower back pain
Heartburn
Pain and swelling in one leg
Painful cramps in leg muscles
Nocturia
Difficulty sleeping
Pain and swelling in one leg
DVT
You are a trainee intern at an antenatal clinic with Maria, a 29 year old primigravid Samoan woman at 32 weeks’ gestation. You are concerned that Maria is measuring small for dates as her fundal height is 28 cm. Maria’s early pregnancy care was in Samoa. She recently returned to New Zealand and has not had any ultrasound scans during her pregnancy. Maria is 165 cm tall and weighs 65kg. Which of the following is a possible cause for Maria’s fundal height measuring less than what you would expect?
Gestational diabetes
Fibroid uterus
Anemia
Multiple pregnancy
Oligohydramnios
Oligohydramnios
You are a trainee intern seeing in Krishna, a 28-year-old primigravid New Zealander of Indian ethnicity for a booking visit. She had an ultrasound yesterday showing a single live intrauterine pregnancy at 8 weeks gestation. Krishna has no significant past medical or family history. Examination is also normal. Krishna had a normal cervical smear 6 months ago.
Of the following options, which should be arranged now?
FBC, Blood Group & Antibody screen, HIV, Hepatitis C, Syphilis and Rubella serology, , HBA1C
FBC, Ferritin, Blood Group & Antibody screen, HIV, Hepatitis B and C, Syphilis and Rubella serology, Mid-stream urine (MSU)
FBC, Blood Group & Antibody screen, HIV, Hepatitis B, Syphilis and Rubella serology, HbA1C, Mid-stream urine (MSU)
FBC, Blood Group & Antibody screen, HIV, Hepatitis B, Syphilis and Rubella serology, Glucose Tolerance Test, Mid-stream urine (MSU)
FBC, BHCGi
FBC, Blood Group & Antibody screen, HIV, Hepatitis B, Syphilis and Rubella serology, HbA1C, Mid-stream urine (MSU)
Hep B not C, need a MSU. Do hba1c not gtt
