Normal Prenatal Care

Question 1

when do most of severe birth defects happen?

Answer 1

within the first 8wks

Question 2

what things are emphasized in pre-conception health?

Answer 2

folate supplementation - prevent neural tube defects
optimization of medical conditions
transition from teratogenic meds to pregnancy-safe
improved lifestyle - smoking/alcohol cessation crutial

Question 3

risk addressed in prenatal care of: safety and risk

Answer 3

genetic disease
carrier states
domestic violence
maternal complications

Question 4

risk addressed in prenatal care of: folic acid

Answer 4

neural tube defects

Question 5

risk addressed in prenatal care of: vaccinations

Answer 5

influenza
Hep B
MMR (live attenuated)

Question 6

risk addressed in prenatal care of: lifestyle

Answer 6

smoking cessation
alcohol cessation
exercise
sleep
stress management

Question 7

risk addressed in prenatal care of: optimize pre-existing disease

Answer 7

diabetes
hypertension
thyroid

Question 8

when is the first visit for pregnancy?

Answer 8

10wks

Question 9

what tests done at first visit

Answer 9

urine screen
U/S confirms
ß-HCG rarely needed
establish baseline for vitals and weight
bimanual exam

Question 10

what is ultrasound used for

Answer 10

confirm IUP, assess gestational age, assess for aneuploidy

Question 11

(G) TPAL

Answer 11

(G) = # pregnancies
T = term; # births after 37wks
P = preterm; # births before 37wks
A = abortion; # pregnancies resulting in any outcome for any reason that did not count as a live birth (<20wks)
L = living; # humans birthed alive

Question 12

GPA nomenclature

Answer 12

Gravid = # pregnancies
Para = # pregnancies brought to viable gestational age
Abortus = # pregnancies that ended before viable gestational age for any reason

Question 13

when is viability

Answer 13

<20wks

Question 14

what labs at first visit?

Answer 14

immunity - rubella, varicella, Hep B
maternal anemia
alloimmunization - ABO type; Rh Ag
infection (UTI/STI)
baseline hemoglobin - Identify correctable anemia
HIV - confirm and viral load if positive
RPR - syphilis screen
Hep B - antigen status; antibody status
urine proteinuria baseline

Question 15

how to handle asymptomatic bacteriuria

Answer 15

actively screen and treat

Question 16

MMRV vaccine

Answer 16

live attenuated, so not given during pregnancy

know titers, specifically rubella and varicella

Question 17

gonorrhea, chlamydia, and syphilis

Answer 17

assessed and treated if positive

Question 18

HIV

Answer 18

confirmatory viral load/CD4 count
HAART as soon as possible - AZT is right in pregnancy
(ziduvidine)

Question 19

Hep B status

Answer 19

can lead to vertical transmission

Question 20

cytology at first visit

Answer 20

Pap if indicated by age and history

Question 21

urine at first visit

Answer 21

urinalysis, culture - screen for and treat asymptomatic bacteriuria
protein - confounds eclampsia picture
GC/Chla - treat both if find one

Question 22

genetic testing at first visit

Answer 22

Cystic Fibrosis (caucasians) and Sickle Cell (African Americans)

Question 23

first trimester screens

Answer 23

nuchal translucency
serum HCG
PAPP-A levels

Question 24

follow up appointments

Answer 24

q4 wks until 28wks
q2 wks until 36wks
q1 wk until birth