Normal Pregnancy, Prenatal care, and Lab changes (Moulton) Flashcards
Starting __1__ supplementation at least 1 month before conception reduces the incidence of __2__ such as spina bifida and anencephaly.
1) Folic acid
2) Neural tube defects
__1__ refers to the number of times a woman has been pregnant.
__2__ refers to the number of pregnancies led to a birth at or beyond 20 weeks or an infant weighing more then 500 grams.
1) Gravidity
2) Parity
What does G1P1002 mean?
What does G4P1123 mean?
1) A woman who has given birth to 1 set of twins at term and both are living
2) A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriages and 1 ectopic pregnancy. She has 3 living children.
____ patients receive Rhogam at 28 weeks and anytime sensitization may occur.
Rh negative
What should you vaccinate against postpartum if not already immune?
Rubella
With a prenatal visit, what should you screen for if the patient presents as obese?
Diabetes
Gestational age is the number of weeks that have elapsed between the __1__ and __2__.
1) First day of the LMP
2) The date of delivery
hCG can be first detected in serum ____ to ____ days after ovulation.
6 to 8
hCG less than ____ IU/L is negative.
Level above ____ IU/L considered positive.
A level of about ____ IU/L is reached by time of expected menses.
1) 5
2) 25
3) 100
In the first 30 days of a normal pregnancy hCG __1__ every 2.2 days.
This is used to evaluate for early intrauterine pregnancy vs __2__.
1) Doubles
2) Ectopic pregnancy
With a transvaginal ultrasound, the __1__ is seen around 5 weeks.
__2__ is seen at 6 weeks.
__3__ is seen at 7 weeks.
1) Gestational sac
2) Fetal pole
3) Cardiac activity
When estimating gestation age/due date, what is Naegele’s rule based on?
How is it calculated
1) Regular 28 day menstrual cycle
2) Add 7 days from LMP and subtract 3 months
____ between 6-11 weeks can determine due date within 7 days.
Crown rump Length
____ can be diagnosed if CRL > 5mm w/ absence of fetal cardiac activity.
Fetal demise
Children born to women that are 35 yrs and older are at increased risk of?
The autosomal trisomies (13, 18 or 21)
95% of Downs Syndrome cases are due to meiotic nondisjunction events leading to __1__ chromosomes with an extra copy of chromosome __2__.
1) 47
2) 21
Most common class of spontaneous abortions are the __1__.
__2__ is the most common one.
1) Autosomal trisomies
2) Trisomy 16
Most common single chromosomal abnormality found in spontaneous abortions is?
45XO
With autosomal dominant disorders, the affected individual has a ____ chance of passing the gene and disorder to the offspring.
50%
____ couples are at increased risk for having a child who is homozygous for recessive gene
Consanguineous
Carrier screening programs focus on high-risk populations because the frequency of __1__ is greater than that of the general population.
For example, Tay-Sachs should be screened for in __2__.
1) Heterozygotes
2) Eastern European Jewish
__1__ is the most common gene carried in North America whites, frequency is 1 in 25.
__2__ is important for CF screening because 15% of carriers are undetected.
1) Cystic Fibrosis
2) Genetic counseling
Sex linked disorders primarily affect which sex?
Which sex are usually the unaffected carriers?
This is due to?
1) Males
2) Females
3) Recessive genes located on the X chromosomes
What is the most common form of inherited mental retardation and the second most common form of mental retardation after Trisomy 21?
Fragile X syndrome
Many sex linked disorders can be diagnosed prenatally by __1__ sampling or __2__.
1) Chorionic villus
2) Amniocentesis
Cleft lip or palate, congenital heart defects, pyloric stenosis and neural tube defects are all examples of birth defects inherited in what fashion.
Multifactorially (both genetic and environmental factors)
Why should women with an affected child for neural tube defect take 4 mg of folic acid in subsequent pregnancies before conception?
Since neural tube closure is complete at 28 days post conception
First trimester screening can assess increased ____ thickness which is associated with both chromosomal and congenital anomalies.
Fetal nuchal translucency (echo free area at the back of the fetal neck between 10 and 14 weeks)
With first trimester screening, elevated Beta hCG and low Pregnancy associated plasma protein-A (PAPP-A) associated with?
Down’s syndrome
What is the triple screen associated with second trimester screening which occurs between 16 and 20 weeks and can detect Trisomy 21?
What is added to make it a quadruple screen and increase the detection rate of Trisomy 21?
1) b-hCG, estriol, and maternal serum alpha fetoprotein
2) Inhibin A
The non invasive prenatal testing that occurs around 9-10 weeks tests cell free fetal DNA, thought to be derived apoptosis of __1__ cells that have entered the maternal circulation.
It has extremely high detection rates for __2__, __2__, and __2__.
It does not test for ____ defects.
1) Trophoblastic
2) Trisomy 21, 18, and 13
3) Neural tube
Cell free fetal DNA tests should only be ordered in high risk patients, including one or more of the following:
__1__ maternal age.
History of prior pregnancy with a __2__.
Family history of __3__ abnormalities.
Fetal ultrasound abnormalities suggestive of __4__.
1) Advanced
2) Trisomy
3) Chromosomal
4) Aneuploidy
When can an amniocentesis be performed?
When can chorionic villi sampling be performed?
What risk do both carry?
1) 16-20 weeks
2) 11 weeks
3) Miscarriage
__1__ is defined as any agent or factor that can cause abnormalities of form or function in an exposed fetus.
For example, ____ which was used in the 50s caused phocomelia (short limbs).
1) Teratogen
2) Thalidomide
The most vulnerable stage of teratogen exposure is from day __1__ to day __1__ post conception period known as __2__.
1) 17 to 56
2) Organogenesis
What is the most common teratogen to which a fetus is exposed?
Alcohol
____ is drug of choice for anxiety and depression during pregnancy.
Fluoxetine
The antineoplastic drugs aminopterin and methotrexate have been established as teratogens because they are both ____ antagonists.
Folic acid
What teratogen causes a syndrome of growth restriction, low set ear, smooth philtrum, thin upper lip, microcephaly and mental retardation?
Alcohol (Fetal alcohol syndrome)
Which of the following alkylating agents, busulfan, chlorambucil, and cyclophosphamide are not teratogenic agents?
They all are
What anticoagulant crosses the placenta and cause spontaneous abortion, intrauterine growth restriction, and central nervous system defects like mental retardation?
Which anticoagulant is the drug of choice because it does not cross the placenta?
1) Warfarin (Coumadin)
2) Heparin
Which anticonvulsant causes a syndrome of craniofacial abnormalities, limb reduction defects, prenatal onset growth restriction, mental deficiency, and cardiovascular anomalies?
Diphenylhydantoin (Phenytoin)
Which anticonvulsants have an increased risk for spina bifida?
1) Valproic acid
2) Carbamazepine
Exposure to what hormone causes an increased risk for vaginal cell cancer and can cause a T shaped uterus?
Diethylstilbestrol (DES)
The risk of spontaneous abortion or congenital malformations is as high as 50% in women who take what vitamin A derivative drug used for severe acne in the first trimester?
Isotretinoin
What interferes with fetal growth- weight, length, and head circumference?
Tobacco smoking
Exposure to what infectious agent in early pregnancy can result in proptosis, depressed nasal bridge and triangular mouth?
CMV
There is a critical period between ___ and ___ weeks post conception for a lethal effect due to radiation exposure.
2 and 6
Heartburn affects about 2/3 of pregnancies due to relaxation of esophageal sphincter by what hormone?
Progesterone
What other GI complaints are common unpleasant symptoms of pregnancy?
1) Constipation
2) Hemorrhoids
What MSK complaint is a common unpleasant symptom of pregnancy especially at night?
What MSK complaint is common especially in late pregnancy?
1) Leg cramps
2) Back pain
BMI < 19 recommended weight gain is ____ lbs.
BMI 19-25 recommended weight gain is ____ lbs.
BMI > 25 recommended weight gain is ____ lbs.
1) 28-40
2) 25-35
3) 15-25
The first sensation of movement is known as quickening and occurs on average at ___ weeks.
20
What routine screening should be performed at 20 weeks?
Fetal survey ultrasound
What routine screening/procedures should be performed at 28 weeks?
1) Gestational diabetes
2) Rhogam injection to Rh negative patients
3) Tdap (Tetanus, diphtheria, & acellular pertussis)
What routine screening should be performed at 36 weeks?
Screening for group B strep carrier with vaginal culture
Reactive nonstress test should reveal __1__ accelerations of at least __2__ beats above baseline lasting at least __3__ seconds during 20 minutes of monitoring.
1) 2
2) 15 beats
3) 15
With the Contraction stress test, you want to give __1__ to establish at least __2__ contractions in a 10 min period. If late decelerations are noted with the majority of contractions the test is positive and __3__ is warranted
1) Oxytocin
2) 3
3) Delivery
