module 12 prenatal care

Question 1

Barriers to care

Answer 1

physically accessible
financially accessible
culturally accessible
temporally accessible
practically accessible

Question 2

nageles rule

Answer 2

LNMP - 3 months + 7 days

Question 3

prenatal visit schedule

Answer 3

before 28 weeks: monthly
28-36 weeks: every 2 weeks
36 weeks - birth: weekly

Question 4

initial prenatal visit labs

Answer 4

BHCG
US
Blood type, Rh
Rubella titer
CBC (Hgb/Hct)
UA 
Pap if indicated
RPR, VDRL 
HepBsAG
HIV
antibody screen
CF screen 
Varicella titer
TB
GC/chlamydia

Question 5

done at prenatal visit

Answer 5

BP 
Wt
FHT
UA
fundal height
GBS screen 
vaccines

Question 6

prenatal vaccines: during preg

Answer 6

Flu

Tdap: between 27-36 weeks

Question 7

vaccines contraindicated during preg

Answer 7

HPV
Live flu
MMR
Varicella

Question 8

genetic testing in the 1st trimester

Answer 8

US for size and dates (8-12wks)
Non-invasive prenatal testing (10 wks)
Nuchal translucency US (11-13 wks)
CVS (11-13 wks)

Question 9

Genetic testing in the 2nd trimester

Answer 9

Quad screen (15-18wks)
Amnio (15-19 wks)
Anatomy scan US (18-20 wks)

Question 10

gestational DM screening

Answer 10

OGTT 24-26wks

• 50g check serum 60 minutes later
• • > 130 mg/dl need to have 100g OGTT

Question 11

Nutrition during preg

Answer 11

1800-2400kcal/day
protein intake of 60-75g/day 
folic acid
Vit B12
Iron
Calcium
Vit D

Question 12

Wt gain during pregnancy by BMI

Answer 12

< 18.5: 28-40lb total (1lb/week 2/3 trimester)
18.5-24.9: 25-35 total 1lb/week 2/3 trimester)
25-29.9: 15-25 total 0.5lb/week 2/3trimester)
>30: 11-20 total (0.5lb per week 2/3trimester)

Question 13

postpartum visit

Answer 13

4-6 weeks PP 
physical
emotional 
contraception
breastfeeding
infant

Question 14

physically accessible

Answer 14

located on bus routes

no parking fees

Question 15

financially accessible

Answer 15

acceptance of a variety of payment options

low out-of-pocket costs

Question 16

culturally accessible

Answer 16

immigration status blind

multiple languages spoken

Question 17

temporally accessible

Answer 17

evening appointments
reasonable wait times
initial appointments soon after first contact

Question 18

practically accessible

Answer 18

safe play areas for children

Question 19

centering pregnancy

Answer 19

10, 2-hour group sessions with the same cohort
Self monitoring
- BP
- wt
- fundal ht
Participation in group discussion and edu

Question 20

gravidity

Answer 20

total number of pregnancies

Question 21

parity

Answer 21

total number of pregnancies progressed beyond 20 weeks

Question 22

TPAL

Answer 22

T: number of term deliveries (>37)
P: number of preterm (<37)
A: abortion (elective or spontaneous) before 20 weeks
L: living children

Question 23

poor wt gain and preg

Answer 23

associated with fetal undernutrition
-> affects survival and poor health outcomes later in life
Evaluate for food security

Question 24

excessive wt gain and preg

Answer 24

associated with

• miscarriage
• preeclampsia
• GDM
• perinatal depression
• LGA babies
• further excess wt gain
• risk of preterm birth
• still birth
• birth inj
• neural tube defects
• postpartum hemorrhage
• delayed lactogenesis
• need for induction and operative birth

Question 25

overwt women 1st visit

Answer 25

1 hour OGTT and repeat at 24-28wks
UA at every visit
- glucose and protein