Pregnancy

Question 1

• Amenorrhea
• N&V
• Breast changes
• Fatigue
• Urinary frequency
• Increase in body
  temperature
• Quickening

Answer 1

Presumptive signs of pregnancy

Question 2

• Goodell’s sign (cervix softening)
• Chadwick’s sign (increased blood flow to vagina/ cervix)
• Hegar’s sign (softening of cervix & isthmus)
• Enlarged uterus
• Ballottement ( a technique of feeling for a movable object in the body)
• • hCG (urine or
    blood)

Answer 2

probable signs of pregnancy

Question 3

Positive signs of pregnancy

Answer 3

• Palpation of fetus by
  health care provider
• Visualization of fetus
  on US
• Fetal heart tones
  auscultated by heath
  care provider

Question 4

GTPAL

Answer 4

Gravida G # of pregnancies
Term T # deliveries after 37 weeks
Preterm P # delivers after 20 weeks
Abortion A # of deliveries before 20 weeks (induced or spontaneous)
Living L # of living children

Example: G1P1002
G: 1 pregnancy
T: 1 full term
P: 0 preterm
A: 0 abortions
L: 2 (twins)

Question 5

Negele’s Rule

Answer 5

LMP – 3 months + 7 days

Question 6

Where will fundal height be at 38 weeks?

Answer 6

Xyphoid process

Question 7

Where will fundal height be at 12 weeks?

Answer 7

Pubic Symphisis

Question 8

Where will fundal height be at 20 weeks?

Answer 8

Umbilicus

2cm or more in uterine size form the # of weeks gestation.

Question 9

Normal pregnancy lab changes

Answer 9

• ↑ alkaline phosphatase: due to fetal bones growth.
• ↑ WBC (leukocytosis), as high as 16K
• ↓ Hgb & Hct: rule out IDA by checking MCV
• ↑ ESR
• • Gold standard test for genetic disorders is testing of fetal chromosomes/DNA

Question 10

10-12 weeks, tests for
fetal abnormalities.

Answer 10

Amniocentesis and Chorionic Villus Sampling

Question 11

When and what to test pregnant women vaginal cultures

Answer 11

Group B strep by 35-37 weeks. + Tx PCN.

Question 12

When to check HCG ?

Answer 12

Pregnancy week 8

Question 13

Pregnancy CAT A drugs

Answer 13

Prenatal vitamins,
insulin,
levothyroxine,
senna, folic acid

Question 14

Pregnancy Cat X Drugs

Answer 14

Lupron,
methotrexate,
tetracyclines,
Accutane, Proscar,
misoprostol. All
hormonal drugs,

Question 15

Category B avoid in 3rd trimester due to increased risk of neonatal hemolytic anemia.

Answer 15

*Nitrofurantoin (Macrobid):

Question 16

Antihypertensives used in pregnancy

Answer 16

Methyldopa (Aldomet), Beta-Blocker (Labetalol)
Calcium Channel Blockers (Procardia),

Question 17

*Drugs to avoid in 3rd trimester

Answer 17

NSAIDs, Aspirin, Bismuth, Sulfa drugs.

Question 18

*Drugs to avoid in 3rd trimester

Answer 18

NSAIDs, Aspirin, Bismuth, Sulfa drugs.
+ Nitrofurantoin (Macrobid)

Question 19

Vaccines not to get during pregnancy

Answer 19

MMR
Oral polio
VZV
FluMist

Question 20

Placenta is attached to uterus in an abnormal position near
or over the cervical opening.

Answer 20

Placenta Previa

Question 21

S&S: painless bleeding, soft uterus*

Risk factors: older age, smoking, multiparity, prior Csection,
labor induction or termination of pregnancy
Dx: US
Tx: Strict bed rest. If uterine contractions, administer magnesium sulfate

Answer 21

Placenta Previa

Question 22

When the placenta separates early from the
uterus.
S&S: sudden vaginal bleeding** , lower abdominal pain/contractions, dangerously low bloodpressure, hypertonic uterus**

Risk factors: smoking pre-eclampsia, prior
abruption, trauma during pregnancy, cocaine
use, previous c-section.
Tx: Bed rest, delivery*.

Answer 22

Placenta Abruption

Question 23

The onset of hypertension in pregnancy after 20 weeks gestation with proteinuria.
BP at least 140/90 mm Hg, urine protein 1+ or higher, oliguria, N&V. (If seizures =
eclampsia)

Answer 23

Severe Preeclampsia

Question 24

S&S: severe headache, visual abnormalities (blurred vision), pitting edema (face/eyes and fingers)*, sudden weight gain (1-2 days >2-4lbs), new RUQ abdominal pain,
Risk factors: hx of preeclampsia, pregnant with more than one baby, chronic HTN,
DM 1 or 2, autoimmune disorders, kidney disease, in vitro fertilization.
Tx: delivery. Mg sulfate.

Answer 24

Severe Preeclampsia

Question 25

associated with pre-eclampsia or eclampsia.
S&S: fatigue, fluid retention, HA, nausea, upper R abdominal /mid-epigastric*, N&V,
blurred vision, nose bleeds, seizures.

Labs: Elevated LFTs, hyperbilirubinemia, thrombocytopenia*.

Risk factors: older age, multiparity.
Tx: child delivery, blood transfusions, antihypertensives

Answer 25

HELLP Syndrome
(Hemolysis, Elevated Liver Enzymes, and Low Platelets)

Question 26

(detects presence of Rh antibodies)
indirect vs direct

Answer 26

Indirect Coombs test: mother
Direct Coombs test: infant

Question 27

How to tx Rh incompatibility

Answer 27

Tx: RhoGAM (gamma globulin) to all pregnancies, including terminations and
miscarriages.

Question 28

Oligohydramnios vs. Polyhydramnios

Answer 28

Oligohydramnios: too little amniotic fluid during pregnancy (Normal is
5-25 cm)
Polyhydramnios: Too much amniotic fluid.

Dx: with US and refer to OB

Question 29

how to tx UTI in pregnant women?

Answer 29

Nitrofurantoin (Macrobid) BID x 5-7 days. Other options include Augmentin, Amoxicillin, Cephalexin and Fosfomycin. Bactrim

NO sulfas in pregnancy
AVOID Bactrim (Trimethoprim-Sulfamethoxazole) and Nitrofurantoin (Macrobid) in 3rd trimester.

Question 30

Diabetes that develops during pregnancy.
Higher rates for neural tube defects, congenital heart disease, birth trauma, preeclampsia, neonatal hypoglycemia.
Risk Factors: history of GDM, obesity, ethnicity (Asian, American Indian, Pacific Islander African American, Hispanic), macrocosmic infant, >age 35.

Answer 30

Gestational DM

Question 31

How to tx mastitis?

Answer 31

Tx: (low risk S. aureus resistance) Dicloxacillin or cephalexin (Keflex).
AVOID Sulfas.

Tx: (high risk S. aureus resistance) Trimethoprim-sulfamethoxazole
(Bactrim) or clindamycin.

Question 32

Hyperpigmentation due to ↑ estrogen in pregnancy , usually face.

Answer 32

Chloasma (Melasma)