Childbearing

Question 1

Full term vs early term vs late term vs post-term

Answer 1

Full term → 39 - 40 weeks 6 days

Early term → 37 weeks - 38 weeks 6 days

Late term → 41 weeks - 41 weeks 6 days

Post-term → after 42 weeks

Question 2

Common signs occurring at 8 weeks of pregnancy

Answer 2

• Hegar sign: softening of uterine isthmus
• Goodell sign: softening of vaginal portion of cervix
• Chadwick sign: blue-violet vaginal color

Question 3

Common signs occurring at 10 weeks of pregnancy

Answer 3

First fetal heart tone can be heart via abdominal US at 10-12 weeks

Question 4

Common signs occurring at 12 weeks of pregnancy

Answer 4

Uterine fundus palpable through abdominal wall as it rises above symphysis pubis

Question 5

Common signs occurring at 16 weeks of pregnancy

Answer 5

• Uterine fundus halfway between symphysis pubis and umbilicus
• Quickening (fetal movement) during weeks 16 and 17 if second pregnancy
  
  • Week 18 if first pregnancy

Question 6

Common signs occurring at 20-36 weeks of pregnancy

Answer 6

• 1 cm gain in fundal height per week
• Uterine fundus at umbilicus at 20 weeks

Question 7

CDC recommendation of folic acid intake/supplementation during pregnancy

Answer 7

400 mcg supplementation daily

• 4 mg/day for one month before pregnancy and during first 3 months of gestation if previous history of neural tube defect

Question 8

Recommended range of total weight gain during pregnancy

• Underweight vs normal vs overweight vs obese

Answer 8

Underweight (BMI <18.5) - 28-40 lb

Normal (BMI 18.5-24.9) - 25-35

Overweight (BMI 25-29.9) - 15-25

Obese (BMI >30) - 11-20

Question 9

Frequency of prenatal visits

• Up to 28 weeks, 28-36 weeks, 36 weeks or more

Answer 9

Up to 28 weeks → every 4 weeks

28-36 weeks → every 2 weeks

36 weeks or more → every week

Question 10

Prenatal care - testing at 10-13 weeks

Answer 10

• First trimester screen with plasma protein A (PAPP-A)
• hCG
• US nuchal translucency for trisomy

Can proceed with Quad screening at 15-21 weeks (

Question 11

Prenatal care - testing at 15-21 weeks (ideally 16-18 weeks)

Answer 11

• Quad screen/AFP4/tetra marker for trisomy or neural tube defect
• US to detect physical defects

Question 12

Prenatal care - testing at 24-28 weeks

Answer 12

• One hour glucose tolerance test
• If Rh-neg, will need antibody screen and given RhoGAM at 28 weeks

Question 13

Prenatal care - testing at 28-32 weeks

Answer 13

• Hemoglobin
• STIs
• Administer RhoGAM, if needed, at 28 weeks

Question 14

Prenatal care - testing at 32-36 weeks

Answer 14

• Fetal presentation
• Kick count
  
  • 4+ in 1 hour
  • 10+ in 2 hours

Question 15

Prenatal care - testing at 35-37 weeks

Answer 15

• Group B strep culture (rectal and vaginal)

Question 16

Prenatal care - testing at 40-42 weeks

Answer 16

• Vaginal examination to assess cervical ripeness
• Fetal station

Question 17

Prenatal care - testing at 41+ weeks

Answer 17

• Nonstress test and BPP to check fetal status
• BPP consists of five components:
  
  • Fetal breathing movements
  • Gross body movements
  • Tone
  • Amniotic fluid index
  • Nonstress test

Question 18

Instead of a Quad screen, when can the provider offer a cell-free fetal DNA test for pregnant mothers?

Answer 18

• Maternal age 35+ years
• Fetal US findings indicating increased risk of aneuploidy
• History of prior pregnant with trisomy
• Positive test result for aneuploidy
• Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or 21

Question 19

Diagnostic criteria for preeclampsia

Answer 19

• Elevated BP diagnosed after 20th week of pregnancy
• 140/90 or greater on two readings at least 4 hours apart
• 160/110 or higher for one reading)
• Proteinuria
  
  • >300 mg per 24 hour urine collection
  • Protein/creatinine ratio of 0.3 mg/dL or more
  • Dipstick of 2+

Other findings:

• Thrombocytopenia (less than 100,00 platelets)
• Renal insufficiency
• Impaired liver function
• Pulmonary edema
• New onset headache unresponsive to medication and not accounted for by another diagnosis

Question 20

What syndrome can preeclampsia progress to?

Answer 20

HELLP syndrome

• Elevated lactate dehydrogenase
• Elevated AST/ALT
• Platelets less than 100,000

Question 21

Preeclampsia treatment and management

Answer 21

• Definitive treatment = birth
  
  • Considered after 34 weeks gestation
• Referral to expert obstetrics
• Supportive → rest, ongoing maternal and fetal monitoring
• Antihypertensives and/or anticonvulsants

Question 22

GBS treatment

Answer 22

Intrapartum IV antibiotics (PCN) - beings at onset of labor and continues through delivery

Question 23

Stages of labor: early labor (also called latent phase of labor)

Answer 23

• Longest part (lasts 2-3 days)
• Mild to moderate contractions lasting 30-45 seconds, 5-20 minutes apart
• Cervix dilates to 3 cm
• Membranes intact

Question 24

Stages of labor: active labor

Answer 24

First stage

• Cervix dilates to 3-4 cm or more
• Contractions every 2-3 minutes and last 50-70 seconds or more
• Go to hospital or birthing center when contractions are every 5 minutes apart and last 1 minute

Final stage

• Cervix dilates to 7-10 cm

Question 25

Stages of labor: second stage of labor

Answer 25

Actual birth

Question 26

Stages of labor: third stage of labor

Answer 26

Placenta detaches and expelled from uterus

Question 27

When can labor inductions occur?

Answer 27

No sooner than 39 weeks or if pregnancy goes beyond 41 weeks

Question 28

When does postpartum blues typically resolve?

Answer 28

Beings a few days after giving birth and goes away after 14 days