NCM 109 PRELIM LEC

Question 1

All pregnancies and deliveries are potentially at risk.

Answer 1

HIGH-RISK PRENATAL

Question 2

About 20 to 30 percent pregnancies belong to this category.

Answer 2

HIGH-RISK PRENATAL

Question 3

HIGH-RISK PRENATAL
At risk people: (9)

Answer 3

18 yrs old below
*nullipara 35 yrs old and over
*multipara 40 yrs old and over
*high parity - 5 or more
*pregnancy occuring less than 3 months after pregnancy
*non-marital pregnancy
*PIH
*Kidney diseases
*Pre-eclamptic women

Question 4

Specific factors that might contribute to a high-risk pregnancy include: (3)

Answer 4

● Advanced Maternal age. Pregnancy risks are higher for mothers older than age 35.
● Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
● Maternal health Problems. High blood pressure obesity, diabetes, epilepsy, thyroid disease, heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risk

Question 5

PREGNANCY COMPLICATIONS

Answer 5

an abnormal placenta position, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and rhesus (Rh) sensitization - a potentially serious condition that can occur when the mother’s blood group is Rh negative and the baby’s blood group is Rh positive.

Question 6

A history of pregnancy-related hypertension disorders, such as preeclampsia, increases the risk of having this diagnosis during the next pregnancy. If the mother gave birth prematurely in the
last pregnancy or had multiple premature births, incredsed risk of an early delivery in your next pregnancy.

Answer 6

PREGNANCY HISTORY:

Question 7

SCREENING OF HIGH-RISK CASE: (4)

Answer 7

● The cases are assessed at the initial antenatal examination, preferably in the first trimester of pregnancy.
● This examination may be performed in a big institution (teaching or non-teaching) or in a peripheral health center.
● Some risk factors may later appear and are detected at subsequent visits.
● The cases are also reassessed near term and again in labour for any new risk factors.

Question 8

Screening/ Assessment (16)

Answer 8

● Initial screening History
● Maternal age
● Reproductive history
● Pre-eclampsia, eclampsia
● Anemia
● Third stape abnormality
● Previous infant with Rh-isoimmunization or ABO incompatibility
● Medical or surgical disorders
● Psychiatric illness
● Cardiac disease
● Viral hepatitis
● Previous operations
● Myomectomy
● Repair of complete perineal tear
● Repair of vesico-vaginal fistula
● Family history

Question 9

It is a test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test).

Answer 9

Diagnostic test

Question 10

NON-INVASIVE DIAGNOSTIC TEST (basaha lang)
Fetal ultrasound or ultrasonic testing (7)

Answer 10

■ Fetal ultrasound is a test done during pregnancy that uses reflected sound waves to produce a picture of a fetus camera.gif, the organ that nourishes the fetus (placenta), and the liquid that surrounds the fetus /amniotic fluid).
■ The picture is displayed on a TV screen and may be in black and white or in color.
■ The pictures are also called a sonogram, echogram, or scan, and they may be saved as part of baby’s record.
■ Fetal ultrasound camera is done to learn about the health of the fetus
■ Different information is gained at different times (trimesters) during pregnancy.
■ This exam is typically dore between weeks 18 and 20 of pregnancy However, the timing of this ultra sound might be altered for reasons such as obesity or prior surgical incision at the scanning site, which could limit visualization of the foetus.
■ Most women get an ultrasound in their second trimester at 16 to 20 weeks of pregnancy. Some also get a first-trimester ultrasound (also called an early ultrasound) before 14 weeks of pregnancy.

Question 11

1st-trimester fetal ultrasound is done to: (5)

Answer 11

● Determine how pregnancy is progressing.
● Find out if female is pregnant with more than 1 fetus.
● Estimate the age of the fetus (gestational age).
● Estimate the risk of a chromosome defect, such as Down syndrome
● Check for birth defects that affect the brain or spinal cord.

Question 12

2nd-trimester fetal ultrasound is done to: (4)

Answer 12

● Estimate the age of the fetus (gestational age).
● Look at the size and position of the fetus, placenta, and amniotic fluid
● Determine the position of the fetus, umbilical cord, and the placenta during a procedure, such as an amniocentesis camera.gif or umbilical cord blood sampling.
● Detect major birth defects, such as a neural tube defect or heart problems.

Question 13

3rd-trimester fetal ultrasound is done to: (2)

Answer 13

● Make sure that a fetus is alive and moving.
● Look at the size and position of the fetus, placenta, and amniotic fluid.

Question 14

Cardiotocography(CTG)

Answer 14

● It is a technical means of recording (-graphy),
● the fetal heartbeat (cardio) and the uterine contractions (toco-)
● during pregnancy, typically in the third trimester. The machine used to perform the monitoring is called a
● cardiotocograph, more commonly known as an electronic fetal monitor (EFM).

Question 15

Interpretation of a CT tracing requires both qualitative and quantitative description of: (3)

Answer 15

● Uterine activity (contractions)
● Baseline fetal heart rate (FHR)
● Baseline FHR variability

Question 16

Non-stress test (NST)

Answer 16

● A nonstress test is a common prenatal test used to check on a baby’s health.
● During a nonstress test, also known as fetal heart rate monitoring, a baby’s heart rate is monitored to see how it responds to the baby’s movements.
● Typically, a nonstress test is recommended for women at increased risk of fetal death. A nonstress test is usually done after week 26 of pregnancy. Certain nonstress test results
might indicate that client and baby need further monitoring. testing or special care.

Question 17

Non-Stress Test Example

Answer 17

Example of a reactive non-stress test (NST). Accelerations of 15 beats per minute lasting 15 seconds with each fetal movement (FM). Top of strip shows FHR; bottom of strip shows uterine activity tracing. Note that FHR increases (above the baseline) at least 15 beats and remains at that rate for at least 15 seconds before returning to the former baseline

Question 18

Contraction stress test(CST)

Answer 18

sIt is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth.

The aim is to induce contractions and monitor the fetus to check for heart rate abnormalities using a cardiotocograph.

Question 19

CONTRACTION STRESS TEST (CST)

Answer 19

● Rarely used today
● Measures the response of Fetal HR to contractions 1
● The test requires 3 contractions in 10 mins
● A positive or Abnormal test results in decelerations in more than half of the contractions
● Negative result: no deceleration with the contractions
● Contraindication: Any case where labour not allowed

Question 20

INVASIVE DIAGNOSTIC TESTS:
A chronic virus sampling

Answer 20

● Chorionic villi are small structures in the placenta that act like blood
● These structures contain cells from the developing fetus. A test that removes a sample of these cells through a needle is called chorionic villus sampling CVS!
● CVS is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus.

Question 21

Chorionic Villi

Answer 21

● It entails sampling of the chorionic villus (placental tissue) and testing it for chromosomal
abnormalities.
● CVS usually takes place at 10-12 weeks’ gestation, earlier than amniocentesis or
percutaneous umbilical cord blood sampling.
● “It is the preferred technique before 15 weeks.

Question 22

Chorionic Villi
This includes women who:

Answer 22

Will be 35 or older when they give birth
Had a screening test result that shows there may be a birth defect or other problem.
Have had babies with birth defects in other pregnancies
Have a family history of genetic disorders it may choose genetic counseling before the
procedure.

Question 23

Embryoscopy

Answer 23

● it is the examination of the embryo at 9-10 weeks’ gestation through the intact membranes by introducing an endoscope into the exocoelomic space/cavity transcervically. or transabdominally.
● This is likely to remain confined to the management of earty pregnancy in selected families affected by recurrent genetic syndromes with recognizable external fetal abnormalities.
● The procedure-related risk of fetalloss is around 12 per cent.

Question 24

Fetoscopy

Answer 24

● Fetoscopy is the examination of the fetus after 11 weeks’ gestation.
● “This is performed transabdominally in the amniotic fluid.
● ‘The technique has evolved with the miniaturization of the optical device by using fibre-optics technology.
● This procedure is likely to find new applications with the development of ultrasound examination at 10-14 Weeks gestation in order to, either confirm, or rule out suspected
external fetal abnormalities.

Question 25

Percutaneous umbilical cord blood sampling/ Cordocentesis

Answer 25

● Cordocentess, also sometimes called Percutorioa Umbilical Cord Biood Sampling (PUB5) 14 a darronie test that examines blood from the fetus to desecifes abnormalities.
● An advancedimatinedraatnedpceuhnesane location where the umbilical cord insert into the placenta
● “The ultrasound guides a thin needie through the abdomen and uterine walls to the umbilical cord
● The needle is inverted into the umb/licateord to retrieve a smal sample of feta blood.
● The sample is sent to the laboratory for analysis, and results are usually available within 72 hours
● The procedure is similar to amniocentesis except the objective is to retrieve blood from the fetus versus amniotic fluid.
● Cordocentesis is usually done when diagnostic information cannot be obtained through amniocentesis, CVS, ultrasound or the results of these tests were inconclusive.
● Cordocentesis is performed after 17 weeks into pregnancy.
● Cordocentesis detects chromosome abnormalities (i.e. Down syndrome) and blood disorders (i.e. fetal hemolytic disease.)

Question 26

Cordocentesis may be performed to help diagnose any of the following concerns: (5)

Answer 26

● Malformations of the fetus
● Fetal infection (Le. toxoplasmosis or rubella)
● Fetal platelet count
● Fetal anemia
● Rh-Isoimmunization