Normal Pregnancy - Routine Prenatal, Labor, and Delivery Care

Question 1

Methods to Determine Due Date

Answer 1

Naegele’s Rule = LMP + 9 months + 7 days

Crown-rump length 7-13 weeks

Biparietal Diameter and Femur length 13-25 weeks

Question 2

Maternal Serum Alpha Fetal Protein (MSAFP)

Answer 2

Detect Fetal abnormalities

Low = Down Syndrome

High = neural tube defect, anencephaly, multiple gestations

Question 3

Prenatal Visit Schedule and Vitals

Answer 3

Every 4 weeks until 28 weeks

Then every 2 weeks until 34-36 weeks

Then every week until delivery

Get Maternal weight, BP, uterine growth, UA, fetal activity and FHR

Question 4

1st Trimester Bleeding

Answer 4

r/o ectopic, threatened abortion

ABCs, cardiovascular stability

If unstable: think ruptured ectopic - fluids and OR ASAP

Question 5

2nd Trimester

Answer 5

Fundal height - 20 weeks, should grow ~1cm each week until 36 when baby drops into the pelvis

Fetal Movement (quickening) - 18-20 weeks

Question 6

Risk in 2nd Trimester; Vaginal bleeding indicates:

Answer 6

Premature labor/rupture of membranes, HTN/preeclampsia

Vaginal bleeding: usually placenta previa or placental abruption

Question 7

3rd Trimester labs

Answer 7

Screen for gestational DM @ 28 weeks

-Glucose challenge >130 -> GTT >180,155,140

Rhogam @ 28 weeks

32-36: CBC, US, HIV, Depression screen

35-37: Group B strep

Question 8

Fetal Monitoring

Good Tracing

Variable Tracing

Late Decelerations

Sinusoidal Pattern

Answer 8

110-160 good

Good Tracing: variability and accelerations

Variable Tracing: associated w/ umbilical cord compression - baby recovering well

Late Decelerations: Decreased oxygen to baby - deliver w/in 15 minutes or crash C

Sinusoidal Pattern: Acidotic baby - get out now

Question 9

1st Stage of Labor

Answer 9

Latent phase - cervix effacement and dilation

Active phase - 3-4 cm dilated

-Contraction onset to complete dilation and effacement

Question 10

Labor Induction

Answer 10

Cervical ripening: Misoprostol, prostaglandin E2, Laminaria (seaweed)

Pitocin drip once cervix is dilated to stimulate contractions