L&D

Question 1

How can you measure gestational age using ultrasonography?

Answer 1

Measure crown-rump length (CRL) at 6-12 weeks

Measure biparietal diameter (BPD), femur length, and abdominal circumference from 13 weeks

Question 2

When is ultrasound most reliable for measuring gestational age?

Answer 2

During first trimester

Question 3

When are fetal heart tones detected?

Answer 3

17-18 weeks at the earliest

Question 4

What is the main difference between urine and serum B-hcg?

Answer 4

Serum B-hcg is more sensitive and preferred if menstrual period is <1 week late

Question 5

Where is B-hcg produced and at what level does it peak?

Answer 5

Produced by the placenta; peaks at 100,000 mIU/ml by 10 weeks GA

Question 6

Describe the levels of B-hcg throughout pregnancy

Answer 6

Peaks at 10 weeks, decreases during the second trimester and levels off during the third trimester

Question 7

Approximately how long should you expect B-hcg to double in a normal pregnancy?

Answer 7

every 48 hours

Question 8

Describe the stages of labor.

Answer 8

Stage I: 0-10cm. separated into latent and active. Latent is 0-6cm and active is >6-10cm

Stage II: 10cm to delivery

Stage III: post deliver to placental delivery

Question 9

What is the most common cause of low back pain during the third trimester?

Answer 9

increased pressure from uterus and laxity of muscles and joints

Question 10

Pregnancy causes a hypercoagulable state. What level of Fibrinogen should you expect?

Answer 10

Fibrinogen should be elevated in pregnancy. If it is “normal”, suspect DIC!

Question 11

What are the appropriate weight gains per BMI?
Underweight, BMI<19.8
Acceptable, BMI 19.8-26.0
Overweight, BMI 26.1-29.0
Severely overweight, BMI>29.0

Answer 11

Underweight, BMI<19.8 - 12-18kg
Acceptable, BMI 19.8-26.0 - 11-16kg
Overweight, BMI 26.1-29.0 - 7-11kg
Severely overweight, BMI>29.0 - 5-9kg

Question 12

Which Immunoglobulins cross the placenta?

Answer 12

IgG

Question 13

Name 9 organisms that cross the placenta?

Answer 13

Toxoplasma gondii
Rubella
HIV
Varicella-zoster virus
CMV
Enteroviruses
Treponema pallidum
Listeria monocytogenes
Parvovirus B19

Question 14

How often should prenatal visits be per gestational age?

Answer 14

Weeks 0-28: q4wks
Weeks 29-35: q2wks
Weeks 36-birth: q1wk

Question 15

TORCHeS pathogens

Answer 15

Toxoplasmosis
Other (parvovirus, varicella, Listeria, TB, malaria, fungi)
Rubella
CMV
Herpes simplex virus
Syphilis

Question 16

What fetal defects are associated with ACEIs?

Answer 16

fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IUGR, lack of cranial ossification

Question 17

What fetal defects are associated with Alcohol?

Answer 17

Fetal alcohol syndrome (growth restriction before and after birth, mental retardation, mid facial hypoplasia, smooth philtrum, renal and cardiac defects)

Question 18

What fetal defects are associated with Amphetamines

Answer 18

Preterm delivery, placental abruption, preeclampsia, IUGR, fetal demise

Question 19

What fetal defects are associated with Androgens

Answer 19

Virilization of female fetus; advanced genital development of male fetus.

Question 20

What fetal defects are associated with Carbamazepine

Answer 20

Neural tube defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR

Question 21

What fetal defects are associated with Cocaine

Answer 21

Bowel atresia, congenital malformations of the heart, limbs, face and GU tract; microcephaly; IUGR; cerebral infarctions

Question 22

What fetal defects are associated with DES

Answer 22

Clear cell adenocarcinoma of the vagina or cervix, vaginal adenosine, abnormalities of the cervix and uterus or testes, possible infertility

Question 23

What fetal defects are associated with Lead

Answer 23

Increased SAB rate, stillbirth