Pregnancy 101

Question 1

Pre-Conception Counseling

Answer 1

o Drug use; 800mg folic acid intake for one month (decreases risk of neural tube defect)
o Ideal body weight; exercise minimum of 30 minutes a day
o Family history, drug history, genetic screening

Question 2

Smoking During Pregnancy

Answer 2

– congenital anomalies, intrauterine growth restriction (IUGR) or fetal growth restriction (FGR), prematurity, still birth, sudden infant death

Question 3

FGR

Answer 3

– fetal weight in utero or after delivery as %ile for their gestational age
o 90% = large gestational age = macrosemia

Question 4

Fetal Alcohol Spectrum Disorder

Answer 4

o	FGR (<10%ile)
o	Microcephaly and central nervous system dysfunction
o	Facial anomalies (thin upper lip, elongated/poorly formed philtrum (vertical groove in upper lip), short palpebral fissures, flat nasal bridge, short nose

Question 5

Risk of Obesity in Pregnancy

Answer 5

o Difficult to become pregnant (under 35 try for 1 year; over 35 try for 6 months before IVF)
o Gestational diabetes
o Hypertensive disorders of pregnancy
o Deep venous thrombosis, pulmonary embolism
o Preterm delivery
o Increase risk of C-section
o Increased risk of shoulder dystocia (can cause permanent injury to baby)

Question 6

Teratogens

Answer 6

o Warfarin (Coumadin) – blood thinner
o Valproic acid (valproate) – for seizures
o Carbamazipine (Tegretol) – for seizures
o Isotretinoin (RetinA) – for acne
o ACE inhibitors (Lisinopril, captopril, enalapril) – for high blood pressure

Question 7

Highest Risk Time for Malformations

Answer 7

o 0-3 weeks: death of embryo may occur
o 3-8 weeks: malformations of embryo may occur; maximal sensitivity to abnormal development
o 8-38 weeks: functional disturbance of fetus may occur; growth and maturation of organ systems

Question 8

Preconception Medical Consultation

Answer 8

– diabetes, seizure disorders, thyroid disease, phenylketonuria, chronic hypertension, thrombophilias (clotting disorders), hemoglobinopathies (ex: sickle cell)

Question 9

Fetal Complications of Uncontrolled Pre-gestational Diabetes

Answer 9

– hypoglycemia/hypoxia, polyhydramnios, preterm delivery, neonatal respiratory distress syndrome, stillbirth

Question 10

Menstrual Dating of Pregnancy

Answer 10

o Ovulation occurs day 14
o Implantation 5 days after conception
o Obstetricians – pregnancy = first day of last normal menstrual period; including 2 weeks when woman was not pregnant
o Embryologists – pregnancy = time from fertilization

Question 11

Abortion

Answer 11

– any pregnancy loss before 20 weeks; includes miscarriages, induced abortions, ectopic pregnancies, and “molar pregnancy”

Question 12

Preterm, Term, Postterm

Answer 12

• Preterm – between 20-36 weeks 6 days;
• Term – between 37 weeks and 41 weeks 6 days
o 37-38.6 weeks = early term
o 39-40.6 weeks = full term
o 41-41.6 weeks = late term
• Post-term – 42+ weeks – increased risk of stillbirth and cerebral palsy

Question 13

Diagnosis of Pregnancy

Answer 13

o Symptoms: nausea/vomiting, tender breasts, fatigue, urinary frequency
o Blood pregnancy test – diagnostic as early as 8 days past conception
o Urine pregnancy test – may be positive on day of anticipated menses
o Ultrasound may detect cardiac motion 6 weeks after last menstrual period

Question 14

Recommendation for Nutrition in Pregnancy

Answer 14

– folic acid, calcium, vitamin D, iron, protein

Question 15

Foods to avoid in pregnancy

Answer 15

– alcohol, soft cheeses from unpasteurized milk, unpasteurized milk/juice, raw/undercooked fish/poultry/meat, mercury containing fish, deli meat, hot dog, salads made in store

Question 16

1st Trimester Complications

Answer 16

o Pregnancy of unknown location – time of conception until implantation can be identified
o Missed abortion (blighted ovum) – pregnancy loss without an embryo present
 Managed expectantly (wait), medically (misoprostol), surgically (Dilation & Curretage)
o Ectopic pregnancy in fallopian tube, ovary, or abdomen
 Major cause of maternal death in 1st trimester
 Treat medically with methotrexate or surgically via laparotomy/laparoscopy

Question 17

2nd and 3rd trimester complications

Answer 17

– preterm labor and delivery (45%), preterm rupture of membranes (25%), obstetric intervention for maternal or fetal problems (30%)

Question 18

Preterm labor and delivery

Answer 18

o Premature activation of maternal or fetal hypothalamic-pituitary-adrenal (HPA) axis
o Exaggerated inflammatory response or infection
o Abruption-premature separation of normally implanted placenta
o Pathologic uterine over distension (multiple gestation, polyhydramnios, macrosemia)
o Treatment: steroid given to mother help fetal lung maturity; magnesium sulfate given to mother to help protect brain of fetus;
 Can only prevent delivery for one or two days

Question 19

Preterm Premature Rupture of Membranes

Answer 19

• rupture of membranes more than 1 hour before onset of labor along with pregnancy between 20-37 weeks
  o Prior to 34 weeks try to delay birth; after 34 weeks induce labor to prevent infection

Question 20

Placenta previa

Answer 20

– placenta implants in lower part of uterus and covers the cervix so the placenta comes out before the baby
 Up to 24 weeks of pregnancy many placentas are in lower part of uterus but many times the placenta moves away from cervix as the uterus grows (self resolves)
 Treatment: C-section

Question 21

Placental abruption

Answer 21

– premature separation of normally implanted placenta; associated with bleeding either visible or hidden; spectrum of changes depending on how much of placenta is interrupted
 Can cause stillbirths

Question 22

Gestational hypertension

Answer 22

• new onset of BP >140/90 at least twice with 4+ hours between after 20 weeks gestation
  • Becomes chronic hypertension if not resolved by 6 weeks post-partum

Question 23

Pre-eclampsia

Answer 23

– hypertension diagnosed AFTER 20 weeks gestation plus 1 of following:
• Platelet count <100k; impaired liver function; new development of renal insufficiency; pulmonary edema; new onset cerebral or visual disturbances
• May result in: pulmonary edema, heart attack, stroke, kidney failure, retinal injury/blindness, death-leading cause of maternal&perinatal morbidity& mortality
• Eclampsia - presence of new seizures; treatmen – magnesium sulfate parenterally

Question 24

Chronic hypertension with superimposed pre-eclampsia

Answer 24

– PRIOR to 20 weeks

Question 25

Gestational Diabetes

Answer 25

• develops in response to hormone from placenta; often resolves postpartum – does NOT increase risk of birth defects
   Mother at increased risk of developing diabetes w/ other pregnancies and in life
   Risks: fetal macrosemia; risk of shoulder dystocia, need for C-section, stillbirth
   Treatment: check glucose 4x day; diabetic diet; oral medication or insulin if needed; weekly monitoring of fetus

Question 26

Fetal Growth Restriction

Answer 26

 Risk Factors: chromosomal abnormalities, congenital anomalies, congenital infections (rubella, CMV, syphilis, toxoplasmosis), chronic hypertension, multiple gestation, smoking, drug addiction, malnutrition