OB Lecture 3- Keppler

Question 1

What is the timing of visits throughout pregnancy? How often should the patient be seen?

a. Through 1st and 2nd trimesters
b. starting at 32 wks
c. term
d. after 40 wks

Answer 1

● Monthly visits through first and second trimesters
● Every two weeks starting ~32 weeks
● Weekly starting at term
● More frequent after 40 weeks (9 months)

Question 2

When do you expect to see fetal heart tones?

Answer 2

○ After 10-13 weeks

Question 3

When can you measure fundal height?

Answer 3

○ After 18-20 weeks

Question 4

WHen can you see fetal movement?

Answer 4

○ Fetal movement (after 18-20 weeks)

Question 5

What’s the earliest gestational age that fetal heart tones can be heard by doppler?

A. 6 weeks
B. 20 weeks
C. 16 weeks
D. 10 weeks

Answer 5

D. 10 weeks ← 10-13 weeks. I usually don’t even try before 13 weeks

Question 6

True or False: Measuring fundal height estimates fetal size, and the distance should be within about 2-3 cm of the patients gestational age, in weeks?

Answer 6

A. True ← Obesity will usually overestimate fetal size

Question 7

What meds should be started in the first trimester?

Answer 7

Prenatal vitamins and folate supplements

Question 8

What OTC meds are safe in pregnancy?

Answer 8

○ Acetaminophen
○ Antihistamines (2nd generation)
○ H2 blockers (famotidine)
○ Most medications (OTC and Rx) are category C

Question 9

This type of screening checks this DNA to find out if the baby is more likely to have Down syndrome or another disorder caused by a trisomy

Answer 9

Prenatal cell-free DNA (cfDNA)

Question 10

What is the risk of having a baby with down syndrome?

Answer 10

○ Risk increases with age: 1:1000 in early 20s, 1:100 at 40 y/o
○ Majority of Down Syndrome babies are born to patients < 35 y/o

Question 11

True or False: Diagnostic tests like CVS and Amniocentesis are rarely performed currently given the increased accuracy of screening tests like cell-free DNA?

Answer 11

A. True ← Usually reserved for patients making decisions about pregnancy termination

Question 12

Which of these is NOT a common indication for obtaining an obstetric ultrasound?
A. Dating
B. Evaluate fetal anatomy
C. Evaluate fetal wellbeing
D. Check amniotic fluid volume
E. Follow up of an abnormal screening test
F. Check fetal presentation
G. Evaluate vaginal bleeding
H. Check placental location
I. None of the above

Answer 12

I. None of the above

Question 13

True or False: low risk patients do not need to be screened for gestational diabetes in the 2nd trimester?

Answer 13

A. True ← But - most practices will screen all patients universally

Question 14

In the second and third trimesters you should check for what at every visit?

Answer 14

Fetal heart tones

Question 15

In the third trimester, what should you check for at every visit?

Answer 15

● Fetal heart tones, fundal height at every visit

Question 16

What is the timing for induction or cesarean delivery?

Answer 16

○ >= 39 weeks for most indications

○ >= 37 weeks for more serious complications

Question 17

True or False: GBS (group B strep) carrier screening should be done for all patients at 36 weeks?

Answer 17

B. False← Somewhat of a trick question. Offer to everyone unless already colonized, or if they merit treatment regardless, based on history

Question 18

Uncomplicated patients should be seen every ______ wks through 32 weeks gestation.

Answer 18

4 wks

Question 19

FHTs should be heard by doppler starting _____ - ____weeks gestation.

Answer 19

10 to 13

Question 20

Diagnostic tests for Down Syndrome are _______% accurate and do/don’t carry risk of pregnancy loss.

Answer 20

100& and do not carry risk or pregnancy loss

Question 21

T/F: Most elective or medical inductions are offered starting 37 wks GA?

Answer 21

False - 39 wks

Question 22

At a recent holiday gathering, you learn that your great, great, great, great grandmother was a G20 P10 4 6 13. How many of her pregnancies ended prior to 20 weeks gestation?

1. 5
2. 6
3. 7
4. 2

Answer 22

2. 6

G= gravita= # births total 
P= term, preterm 
C= abortion 
D= living

Question 23

The provision of routine prenatal care includes offering patients numerous screening and diagnostic tests. Which of the following tests is considered a diagnostic test?

1. Checking a fundal height at each prenatal visit after 20 weeks gestation to evaluate risk of fetal growth abnormalities
2. The Quad Screen, a maternal serum test evaluating 4 analytes to determine the risk of aneuploidy, for example Down Syndrome
3. Amniocentesis to extract amniotic fluid to determine the fetal karyotype to confirm whether a fetus has Down Syndrome
4. A 1-hour 50g glucose challenge test to evaluate the risk of gestational diabetes

Answer 23

3. Amniocentesis to extract amniotic fluid to determine the fetal karyotype to confirm whether a fetus has Down Syndrome