normal pregnancy

Question 1

what is gravida and what is parity?

Answer 1

gravida = total number of pregnancies 
parity = number of births beyond 24 weeks gestation, including live and stillbirths

Question 2

when does the uterus

a) become palpable?
b) reach umbilicus?
c) reach xiphisternum?

Answer 2

a) 12 weeks
b) 20 weeks
c) 36 weeks

Question 3

what is normal fetal presentation?

Answer 3

• cephalic

- occiput anterior (facing backwards)

Question 4

what are the changes to blood in pregnancy?

Answer 4

• plasma volume increases (oedema)
• red cell volume increases
• Hb remains the same (‘physiological anaemia’)
• WCC increases (neutrophilia in labour)
• platelets drop slightly
• fibrinogen + other clotting factors increase (‘hypercoagulable state’)

Question 5

cardiovascular changes in pregnancy?

Answer 5

• cardiomegaly
• CO increases
• LV hypertrophy
• peripheral resistance decreases
• BP drops mid-pregnancy, then rises to pre-preg levels by term

Question 6

respiratory changes in pregnancy?

Answer 6

• diaphragm rises
• intercostal angle increases
• tidal volume increases
• breathlessness is common

Question 7

what is the supplementary dose of folic acid:

a) normal pregnancy?
b) high risk pregnancy?

Answer 7

a) 400 micrograms / day

b) 5 mg / day if prev. affected child or Hx of epilepsy

Question 8

which vitamin is teratogenic and should be avoided in pregnancy? where is it found?

Answer 8

Vitamin A, liver and pate

Question 9

which foods should be avoided due to Listeria monocytogenes?

Answer 9

undercooked meat, pate, soft cheeses, shellfish

Question 10

what antenatal care is done at 8-12 weeks gestation?

Answer 10

booking visit:

• give lifestyle advice on pregnancy
• check BP, urine dipstick, BMI

booking bloods/urine:

• FBC, blood group, rhesus status, haemoglobinopathies
• hep B, syphilis
• HIV test
• urine culture

Question 11

what antenatal care is done at 10-13+6 weeks gestation?

Answer 11

• early scan to confirm dates

- exclude multiple pregnancy

Question 12

what antenatal care is done at 11-13+6 weeks gestation?

Answer 12

Down’s screening - includes a nuchal scan

Question 13

what antenatal care is done at 16 weeks gestation?

Answer 13

• blood results

- BP, urine dipstick

Question 14

what antenatal care is done at 18-20+6 weeks gestation?

Answer 14

anomaly scan

Question 15

what antenatal care is done at 25 weeks gestation?

Answer 15

• BP
• urine dipstick
• symphysis-fundal height (SFH)

Question 16

what antenatal care is done at 28 weeks gestation?

Answer 16

• routine care (see 25 weeks)
• 2nd screen for anaemia and atypical red cell alloantibodies
• 1st dose anti-D prophylaxis for all rhesus -ve women

Question 17

what antenatal care is done at 34 weeks gestation?

Answer 17

• routine care
• 2nd dose of anti-D prophylaxis if rhesus -ve
• info about labour and birth plan

Question 18

what antenatal care is done at 36 weeks gestation?

Answer 18

• routine care
• presentation checked
• external cephalic version done if needed
• info on breastfeeding, vit K and baby blues

Question 19

what antenatal care is done at 40 weeks gestation?

Answer 19

• routine care

- possibility of induction of labour discussed

Question 20

standard folic acid guidance in pregnancy?

Answer 20

400mcg OD until 12th week gestation

Question 21

folic acid guidance for woman at higher risk of neural tube defect in pregnancy?

Answer 21

5mg OD from before conception until 12 weeks gestation

Question 22

risk factors for foetal neural tube defect?

Answer 22

• parental NTD
• prev pregnancy NTD
• maternal AED (e.g. phenytoin)
• maternal coeliac, DM, obesity or thalassaemia trait