Normal Pregnancy, Prenatal care, and Lab changes (Moulton)

Question 1

What is Gravidity?

What is Parity?

What is acronym for Parity?

Answer 1

1) Number of times a woman has been pregnant
2) Number of pregnancies led to a birth at or beyond 20 weeks or an infant weighing more than 500 grams

FPAL

Question 2

What does G1P1002 mean?

What does G4P1123 mean?

Answer 2

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.

Question 3

1) What do Rh Negative patients get?
2) When?
3) FPAL Length

Answer 3

1) Rhogam
2) 28 weeks and anytime sensitization occurs

3)
Full term 37-42 weeks
Preterm 20-36+6
Abortion: <20 weeks

Question 4

What should you vaccinate against postpartum if not already immune?

With a prenatal visit, what should you screen for if the patient presents as obese?

Answer 4

Rubella

Diabetes

Question 5

Gestational age is the number of weeks that have elapsed between when?

Answer 5

1) First day of the last menstrual period

2) The date of delivery

Question 6

hCG can be first detected in serum when after ovulation?

Answer 6

6 to 8 days

Question 7

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.

Answer 7

1) 5
2) 25
3) 100

Question 8

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__.

Answer 8

1) Doubles

2) Ectopic pregnancy

Question 9

With a transvaginal ultrasound, what is seen around 5 weeks.

What is seen at 6 weeks.

What is seen at 7 weeks.

Answer 9

1) Gestational sac
2) Fetal pole
3) Cardiac activity

Question 10

When estimating gestation age/due date, what is Naegele’s rule based on?

How is it calculated

Answer 10

1) Regular 28 day menstrual cycle

2) Last menstrual period - 3 months + 7 days + 1 year

Question 11

At 6-11 weeks how can due date be determined within 7 days?

Answer 11

Crown Rump Length

Question 12

How can Fetal demise be calculated?

Answer 12

Crown Rump Length >5mm

With Absence of Fetal Cardiac Activity

Question 13

Child born to women that are 35 yrs and older are at increased risk of?

Answer 13

The autosomal trisomies (13, 18 or 21)

Question 14

Downs Syndrome cases are due to meiotic nondisjunction events leading to __1__ chromosomes with an extra copy of chromosome __2__.

Answer 14

1) 47

2) 21

Question 15

1) What is the most common class of spontaneous abortions?
2) What is the most common one?
3) What is the most common SINGLE chromosomal abnormality found in spontaneous abortions is?

Answer 15

1) Autosomal trisomies
2) Trisomy 16
3) Turner 45XO

*Can also use Chorionic Villi sampling and amniocentesis

Question 16

With autosomal dominant disorders, the affected individual has a ____ chance of passing the gene and disorder to the offspring.

Answer 16

50%

Question 17

Consanguineous couples are at an increased risk of what?

What is important for CF screening?

Answer 17

Child homozygous for recessive gene

Genetic Counseling

Question 18

1) High Risk populations have higher frequency of what compared to general population?
2) Tay-Sachs should be screened in Who?

Answer 18

1) Heterozygotes

2) Eastern European Jewish

Question 19

1) Sex linked disorders primarily affect which sex?
2) Which sex are usually the unaffected carriers?
3) What is the most common form of inherited mental retardation?

4) How are sex linked disorders diagnosed?
5) When can they be performed?
6) When is the risk of this diagnosis method?

Answer 19

1) Males
2) Females
3) Fragile X syndrome

4) Chorionic Villus sampling: 11 weeks
Amniocentesis: 16-20 weeks

6) Miscarriage

Question 20

Cleft lip or palate, congenital heart defects, pyloric stenosis and neural tube defects are all examples of birth defects inherited in what fashion.

Answer 20

Multifactorially (both genetic and environmental factors)

Question 21

Why should women with an affected child for neural tube defect take 4 mg of folic acid in subsequent pregnancies before conception?

Answer 21

Since neural tube closure is complete at 28 days post conception

Question 22

What is Fetal Nuchal Translucency thickness associated with?

Answer 22

Chromosomal and congenital abnormalities

Question 23

What does first trimester screening include? (Week 1-12)

What is seen with Down syndrome?

Answer 23

1) Maternal Age
2) Nuchal Translucency
3) b-hCG
4) Pregnancy Associated Plasma Protein-A (PAPP-A)

Elevated b-hCG and Low PAPP-A

*BNPM (Barnes and Noble in the PM) during first trimester

Question 24

1) What is Second Trimester Screen (13-26)
2) What is added to make it Quadruple Screen?
3) What can it help detect?

Answer 24

1) b-hCG, estriol, and maternal serum alpha fetoprotein

2) Inhibin A
BEM(i)

3) Down syndrome

Question 25

1) The non invasive prenatal tests what?
2) Derived from where that enters where?
3) It has high detection rates for what?
4) What does it not test for?

Answer 25

1) Free fetal DNA
2) Apoptosis of trophoblastic cells that entered maternal circulation

2) Trisomy 13, 18, 21
3) Neural tube Defects

Question 26

Cell free fetal DNA tests should only be ordered in high risk patients, including one or more of the following:

Answer 26

1) History of Trisomy pregnancy
2) Old Age
3) FH of Chromosomal abnormalities
4) Fetal US showing Aneuploidy

HOFF

Question 27

__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).

What is the most Vulnerable time of teratogenesis?

What occurs during this period?

Answer 27

1) Teratogen
2) Thalidomide
3) First trimester
4) Organogenesis

Question 28

1) What is the most common teratogen to which a fetus is exposed?
2) What is the drug of choice for anxiety and depression during pregnancy.
3) Why are the antineoplastic methotrexate and aminopterin teratogen?

Answer 28

1) Alcohol
2) Fluoxetine
3) They are folic Acid Antagonist

Question 29

What teratogen causes a syndrome of

• growth restriction
• Low set ear
• Smooth philtrum
• Thin upper lip
• Microcephaly
• Mental retardation?

Answer 29

Alcohol (Fetal alcohol syndrome)

Question 30

Which of the following alkylating agents, busulfan, chlorambucil, and cyclophosphamide are not teratogenic agents?

Answer 30

They all are

Question 31

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?

Answer 31

1) Coumadin

2) Heparin

Question 32

Which anticonvulsant causes a syndrome of

• Craniofacial abnormalities
• Limb reduction defects
• Prenatal onset growth restriction
• Mental deficiency
• Cardiovascular anomalies?

Answer 32

Diphenylhydantoin

Question 33

Which does Valproic and Carbamazepine cause?

Answer 33

Spina Bifida

Question 34

Exposure to what hormone causes an increased risk for vaginal cell cancer and can cause a T shaped uterus?

Answer 34

Diethylstilbestrol (DES)

Question 35

What drug can cause spontaneous abortion or congenital malformation for severe acne in first trimester?

Answer 35

Isotretinoin

Question 36

What interferes with fetal growth- weight, length, and head circumference?

Answer 36

Tobacco smoking

Question 37

Exposure to what infectious agent in early pregnancy can result in

• Proptosis (displacement of eye)
• Depressed nasal bridge
• Triangular mouth?

Answer 37

CMV

Question 38

When is the critical period for lethal effect from radiation exposure?

Answer 38

2 and 6 weeks

Question 39

What drug induces Heartburn in pregnancies?

What other GI complaint is a common unpleasant symptom of pregnancy?

Answer 39

Progesterone

2) Constipation and Hemorrhoids

Question 40

What MSK complaint is a common unpleasant symptom of pregnancy especially at night?

What MSK complaint is common especially in late pregnancy?

Answer 40

1) Leg cramps

2) Back pain

Question 41

BMI < 19 recommended weight gain is ____ lbs.

BMI 19-25 recommended weight gain is ____ lbs.

BMI > 25 recommended weight gain is ____ lbs.

Answer 41

1) 28-40
2) 25-35
3) 15-25

Question 42

The first sensation of movement is known as what and occurs when?

Answer 42

1) Quickening

2) 20 weeks

Question 43

What routine screening should be performed at 20 weeks?

Answer 43

Fetal survey ultrasound

Question 44

What routine screening/procedures should be performed at 28 weeks?

Answer 44

1) Gestational diabetes
2) Rhogam injection to Rh negative patients
3) Tdap

28 is GRT

Question 45

What routine screening should be performed at 36 weeks?

Answer 45

Screening for group B strep

GBS=36

Question 46

Reactive Non-Stress Tests shows what normally?

Answer 46

2 acceleations
15 beats above baseline
Lasting 15 seconds

Question 47

1) What do you give with Contraction stress test
2) Why?
3) What should happen if late decelerations are noted?

Answer 47

1) Oxytocin
2) To give at least 3 contractions in 10 minutes
3) Delivery