Pre-partum OB

Question 1

Explain GPtpal

Answer 1

Gravida: how many times you were pregnant
Para: how many times you have given birth
term: # of full term babies, 37-42 weeks
preterm: # of deliveries 20-36 weeks
abortion: spontaneous or induced prior to 20 wks
live: # of living kids (if twins, 2)

Question 2

A fetus is considered viable at

Answer 2

> 23 weeks or >500 g

Question 3

What are the stages of a baby from conception

Answer 3

Embryo: fertilization-8 wks 
Fetus: 9 wks-birth 
Preterm: born prior to 37 wks 
Neonate: birth-28 days 
Infant: 28d- 1 y/o 
Post-term: live born after 42 wks (increased perinatal mortality)

Question 4

What is Nagele’s rule

Answer 4

a way to determine the due date! 
Date of LMP + 7 days - 3 months 
ex: LMP was on 2/20/2018 
20+7=27 
Due date= Nove,ber 27, 2013

Question 5

Standard pregnancy is

Answer 5

280 days (40 weeks)

Question 6

Explain gestational age vs fetal age

Answer 6

Gestational: age of fetus is calculated from 1st day of LMP and includes 2 weeks that woman is not pregnant
Fetal: age of fetus is calculated from implantation (2 weeks less than G age)

Question 7

What are the trimesters in pregnancy

Answer 7

First: 1-12 weeks
Second: 13-28 weeks
Third: 29-40 weeks

Question 8

How does mom’s physiology change with pregnancy (by system)

Answer 8

• Skin: melasma, linea nigra, striae
• Resp: increased VT and O2, decreased ERV and CO2
• Cardio: increased CO and SV, decreased systemic vascular resistance
• GI: slow motility, delayed gallbladder emptying
• GU: increased GFR
• Heme: increased plasma volume and WBC

Question 9

How much folic acid do moms need

Answer 9

Low risk: 0.4mg (400 mcg)

High risk: 4mg (4000 mcg)

Question 10

How does a home pregnancy test work

Answer 10

measures HCG (picks up level of 25) 
most are + by the time of missed menses

Question 11

Where is HCG made

Answer 11

By the placenta!
It rises exponentially for the first 10 weeks, then plateaus (doubles every 48 hours)
-HCG and progesterone are what cause morning sickness usually

Question 12

Where is progesterone made

Answer 12

By the corpus luteum until 6 weeks post-fertilization

Then placenta takes over

Question 13

Sypmtoms of pregnancy include

Answer 13

amenorrhea 
n/v 
breast tenderness 
fatigue 
urinary frequency/nocturia 
increased incidence of UTI
Linea nigra (umbilicus-pubis) 
Melasma (at 16+ weeks) 
Leukorrhea (white discharge) 
Striae

Question 14

PE findings in pregnancy include

Answer 14

Systolic ejection murmur
Goodell’s sign (cervical softening at 4-6 wks)
Hegar’s sign (uterine isthmus softening at 6-8 wks gestation)
Chadwick’s sign (cervix looks blue from 8-12 wks gestation)

Question 15

At your initial OB visit, these labs should be done

Answer 15

CBC
blood type and Rh 
Ab screen 
Rubella immunity 
Syphilis testing 
Hep B antigen testing 
HIV 
UA C&S 
Chlamydia/gonorrhea 
Pap (if they fall into guidelines)

Question 16

At the first OB appointment, docs should get this confirmation test

Answer 16

US!

can detect a fetal heart (but not get a full heart tone) at 5-6 weeks gestation

Question 17

What genetic screening is available in the first trimester (11-13 wks)

Answer 17

US for nuchal translucency (if thick, trisomy 21) and fetal nasal bone
Maternal blood (very high hCG, trisomy 21) (low plasma protein A, trisomy 21)
-Chorionic villus sampling at 10-12 weeks, extract cells from placenta

Question 18

What genetic screening is available in second trimester (16-18 wks)

Answer 18

Quad screen: maternal blood + AFP, HCG, Estriol, and inhibin A
AFP (increase if w/ neural tube defects or twins)
-Amniocentesis: 15-20 weeks, extract amniotic fluid

Question 19

How often do pregnant women go to visits

Answer 19

First: 6-8 weeks after LMP
Monthly until 28 weeks (7 months)
2x month from 28-36 weeks
weekly from 36 weeks-delivery

Question 20

How much weight should mamas gain

Answer 20

1st trimester: 1.5-3 lbs
2nd trimester: 0.8lb x week
Total pregnancy weight gain: 25-35 lbs

Question 21

Prenatal monitoring tests

Answer 21

Fetal heart tone (handheld doppler): start at 10-12 wks (120-160 is NL)
Fundal height: start at 20 wks
Cervical exams: start at 37 wks

Question 22

What is “quickening”

Answer 22

first perception of fetal movement by mama
Primigravida: 18-20 wks
Multigravida: 16-20 wks

Question 23

What is the count to 10 method

Answer 23

Should have 10 fetal movements over 2 hours OR 4 over 1hr while mom rests
(activity is higher at night)

Question 24

What are normal fundal height measurements

Answer 24

12 weeks: pubic symphysis
20 weeks: umbilicus
ad 1cm for each week after 20 wks
DROP: 36-38 weeks

Question 25

When do you do specific prenatal screenings

Answer 25

24-28 wk: Gestational diabetes
26-28 wk: Repeat Ab test if Rh negative
35 wk: H&H
35-37: GB strep

Question 26

How do you screen for gestational diabetes

Answer 26

50g 1 hr glucose challenge test. If >130, do the 3hr
100g 3 hr glucose test; get BG at fasting, 1, 2, and 3hr
2+ abnormal results= GD!

Question 27

How does antibody screening work

Answer 27

If mom is Rh NEGATIVE, repeat screen at 26-28 weeks
If Ab test is still negative, give RhoGAM at 28 weeks (it attaches to the Rh+ antigen to prevent mom from recognizing an intruder)

Question 28

If (+ for group b strep, how do you proceed

Answer 28

mom needs IV Abx if a vaginal delivery is planned (do NOT need if c-section is planned)

• Ampicillin 2g initially, then 1g q4 hrs until delivery
• Clinda 900mg q 8 hrs (allergic to penicillin)
• If you have NOT had a GBS screen prior to delivery, you get empiric Tx

Question 29

MCC of bacterial illness in neonates are

Answer 29

Sepsis
PNA
Meningitis

Question 30

How should nutrition change in pregnancy

Answer 30

\+ 350 kcal/day 
1g/kg/d of protein extra 
175g CHO x day 
30mg iron x day 
250mg calcium x day 
0.4mg folic acid x day 
600IU vitamin D 
If vegan/vegetarian, increase calcium, B12, iron, and zinc

Question 31

Diet restrictions in pregnancy

Answer 31

• Avoid high mercury contect fish (shark, swordfish, marlin, bigeye tuna)- 8-12 oz x wk of acceptable fish (crab, salmon, lobster, scallop, tilapia, canned light tuna)
• <200mg caffeine x day (can do decaf)- high caffeine= high risk spon. abortion, premie, or low birth weight
• Unpasteurized dairy, undercooked meat (hot dogs, deli meat, soft cheeses, smoked seafood)- listeria monocytogenes, toxoplasmosis (meat). brucellosis (raw milk/cheese)

Question 32

What is a good exercise regimen in pregnancy

Answer 32

continue what you are currently doing!
30 min x day on most days
20+ weeks: avoid lying on back
STOP if you are fatigued, uncomfortable, dehydrated, or overheated

Question 33

What vaccines should pregnant women get

Answer 33

Updated Tdap and INACTIVE flu shot

-Avoid all live vaccines; wait until postpartum to give MMR, varicella, and live flu, even if mom is due for them

Question 34

Travel restrictions in pregnancy

Answer 34

Avoid known Zika virus areas (if you do, wait 90 days to conceive for women, 9-12 months for men)
Avoid travel >35 weeks