Pregnancy and Prenatal Care

Question 1

What is included in the obstetrics hx?

Answer 1

1. General medical, obstetric and family hx
2. Menstrual hx
   A. LMP
3. Sxs of current pregnancy
4. Previous pregnancies
   A. Vaginal vs c-section
   B. Complications
5. Medical hx
   A. Cardiovascular
   B. Asthma
   C. SLE
   D. Bleeding disorders
   E. Seizure disorders
6. Surgical hx
   A. Abdominal surgery
7. Family Hx
   A. Chromosomal abnormalities
   B. Mental retardation
   C. Diabetes
8. Social Hx
   A. Alcohol
   B. Drugs
9. Diet

Question 2

What are the subjective sxs of pregnancy?

Answer 2

1. Amennorhea
2. Nausea/vomiting
3. Breast tenderness
4. Quickening (fetal movement)
   A. Nullipara: 18-20 weeks
   B. Multipara: 14-16 weeks
5. Easy fatigability
6. Urinary freq, nocturia

Question 3

What are the objective sxs of pregnancy?

Answer 3

1. (+) pregnancy test
2. Increased basal body temp
3. Skin changes
   A. Melasma/chloasma
   B. AKA “mask of pregnancy”
   C. Linea nigra
4. Chadwick’s sign

Question 4

What is melasma/cloasma?

Answer 4

1. Inc melanocyte-stimulating hormone by placenta, causes melasma & darkened nipples
2. AKA chloasma, “mask of pregnancy”

Question 5

Define linea nigra

Answer 5

1. Inc melanocyte-stimulating hormone by placenta

2. Darker pigmented greater than fair-skinned women

Question 6

Define Chadwick’s sign

Answer 6

Blueish tinge to cervix

Question 7

How is the expected date of delivery calculated?

Answer 7

1. Patient’s due date (EDC)
2. Estimated w/ “Pregnancy Wheel”
3. Calculated using Nagle’s or McDonald’s rule:
   A. 1st day of LMP – 3 months + 7 days
   B. Based on a 28 day menstrual cycle
   C. If irregular, use USN

Question 8

How fast does the uterus grow during pregnancy?

Answer 8

1. Growth approximately two finger’s breaths every two weeks until 20 wks
2. Growth approximately one finger’s breadth every 2 weeks form 20 weeks to birth

Question 9

Define gravida

Answer 9

Gravida: G = total # of pregnancies

Question 10

Define Parity

Answer 10

1. Parity: P = # of deliveries
2. Sequence of 4 digits (P 1001)
   A. 1st number → # of term deliveries
   B. 2nd number → # of premature deliveries (20-36 wk gestation)
   C. 3rd number → # of abortions (therapeutic &/or spontaneous by 20 wk)
   D. 4th number → # of living children

Question 11

When are the usual prenatal visits scheduled?

Answer 11

1. Initial visit 6-8 wk after LMP
2. Exam q 4 wk until 28th wk of gestation
3. 29 – 36 wk, visits q 2-3 wk
4. 37 wk on, visits weekly

Question 12

What is included in prenatal visits?

Answer 12

1. After initial visit, ALL visits include:
   A. Focused Hx & exam
   B. Wt gain, edema, fetal movement, BP, fundal height, fetal heart tones UA for glucose & protein
   C. Vaginal exam 1st & ≥ 37 weeks to assess for cervical dilation

Question 13

When does quickening occur?

Answer 13

1. 18-20 weeks in primigravida

2. 14-18 weeks in multigravida

Question 14

What are common complaints of pregnancy?

Answer 14

1. Backache
2. Varicose veins
3. Heartburn
4. Hemorrhoids
5. Fatigue

Question 15

When are fetal heart tones audible?

Answer 15

Audible (Doptone) @ 10-12 weeks gestation

Question 16

What is the normal fetal hr?

Answer 16

Normal fetal HR 120-160 bpm

Question 17

When is the uterine growth at the umbilicus?

Answer 17

1. 20 wks: at umbilicus

2. After 20 weeks: Ht of fundus should correlate roughly (+/- 2 cm) to # of weeks gestation