Ob/Gyn- Normal pregnancy- Dr. Moulton Flashcards
women with no history of Neural Tube Defect should be given what to reduce the incidence of NTD? how much?
Folic acid. 0.4 mg
women with history of NTD increase dose to?
4.0 mg of folic acid
Gravidity and parity of a women who has birthed 1 term, 1 pre term twins and one failed ectopic.
G3P1113
What is a difficult but very important question to ask during the first prenatal visits if patient presents with re-occuring injuries?
abuse, sexual abuse
Normal heart finding w/ pregnancy?
systolic murmurs, exaggerated splitting and S3
What is striae gravidum?
stretch marks on stomach, purple, bruising looking. its a normal finding associated w/ pregnancy
Rh negative pts recieve Rhogam at 28 weeks & anytime ______________
sensitization occurs (threatened abortion, amniocentesis, abdominal trauma)
Common lab value in preggos of Hematocrit? (increased or decreased)
decreased (4-7% by 30 weeks)
What modality can you use to lock down their due date during their first prenatal visit. earlier in pregnancy the better when using this modality
Ultrasound
what week and hCG levels is the gestational sac seen at?
5 weeks. 1500-2000 IU/L
what is Crown rump Length?
use ultrasound to measure fetus from head to bottom. if done btw 6-11 wks can determine due date w/ in 7 days
fetal demise can be diagnosed if CRL > what?
5mm w/ absence of fetal cardiac activity
the number one reason for genetic counseling?
advanced maternal age ( 35 years and older)
most common sex chromosome aneuploidy?
turners 45XO
for a couple who already had a child with Downs syndrome, what is the risk that the couple has another Downs child?
1% risk
physical features of Down’s babies
flattened nose, facies; upward slanting eyes
what should be done on couples after 3 or more spontaneous abortions?
Karyotype (chromosomal studies)
Most common gene carried in North american Whites, frequency 1 in 25? is genetically screened for. Autosomal recessive
Cystic Fibrosis
Can fragile X syndrome be passed down from male to male?
no. caused by recessive genes on X chromosome. primarily affects males
most common form of inherited mental retardation?
Fragile X syndrome
why should women who have already had a child with a NTD take 4 mg of folic acid in all subsequent pregnancies?
the neural tube closure is complete at 28 days post conception
Increased thickness of what in First trimester screening is assoc. w/ chromosomal & congenital abnormalities?
Nuchal Translucency
what is the triple screen done in the second trimester?
b-hCG, estriol and alpha fetoprotein ( wks 16-20)
what if triple screen comes back elevated, all of them. what most likely happened?
false positive due to improper timing, intervals and cycle is off. (marker meant for 16-20 weeks)
What does MaterniT21 plus test for?
test cell free fetal DNA for trisomies and chromosomal abonormalites. DOES NOT TEST FOR NTD
what risk patients should MaterniT21 only be ordered in?
HIGH risk. (ex: old maternal age)
what weeks can you perform an Amniocenteisis test on the fetus?
16-20 weeks. NOT 11 weeks, cause a deformed extremity.
exposure to what teratogen causes phocomelia?
Thalidomide
why are more than category A drugs prescribed to pregnant women?
not that many category A drugs. only < 5% of medicines are Cat. A
most vulnerable stage for teratogens on fetus?
3-8 weeks
A child born with a small head, low nasal bridge, small eyes, thin upper lip was exposed to what common teratogen?
alcohol (fetal alcohol syndrome)
fetus exposure to Diethylstilbestrol (DES) ?
t-shaped uterus, vaginal cell carcinoma, testicular abnormalities, infertility, malignancy
what is heartburn in pregnant women due to?
progesterone- relaxation of esophageal sphincter
what frequency should prenatal office visits occur?
every 4 weeks until 28 weeks
every 2 weeks from 28 to 36 weeks
weekly until delivery
what is quickening?
first sensation of movement (baby kicking). avg at 20 weeks
at what week should you obtain fetal survey ultrasound?
20 weeks
what week should one be screened for gestational diabetes and repeat hemoglobin and hematocrit
28 weeks
what week screen for group B strep carrier w/ vaginal culture?
35 weeks
what is a reactive Nonstress test (NST) finding?
2 accelerations of at least 15 beats above baseline for at least 15 seconds during 20 mins of monitoring
what is a positive finding of the Contraction stress test?
late decelerations are noted w/ majority of contractions. delivery is warranted
