Pregnancy and Prenatal Care Flashcards

Question

physiological changes in preganancy gastrointestinal

Answer 1

* ↑ Salivation * ↓ Motility (due to progesterone) → constipation * Hemorrhoids (uterus presses against the pelvic veinsand vena cava, impairing venous return)

Answer 2

Increased lumbar lordosis and relaxation of the ligaments supporting the joints of the pelvic girdle can cause lower back pain

Answer 3

* Spider angioma * Palmar erythema * Striae gravidarum * Hyperpigmentation: chloasma, linea nigra, hyperpigmentation of the nipples

Answer 4

Progesterone and estrogen increase vaginal blood supply, thereby increasing Bartholin gland secretions= increased vaginal discharge

Answer 5

The recommendations are determined by the BMI prior to the pregnancy: * BMI \< 18.5 (underweight): 28–40 lb (12–18 kg) * BMI 18.5–24.9 (normal weight): 25–35 lb (11–16 kg) * BMI 25–29.9 (overweight): 15–25 lb (7–11 kg) * BMI ≥ 30 (obese): 11–20 lb (5–9 kg)' Approx. 2 lb in the first trimester and up to 1 lb per week in the second and third trimesters

Answer 6

1. weight control, 2. improved or maintained physical fitness, 3. ↓ risk of gestational diabetes, 4. ↓ risk of operative delivery, 5. ↓ risk of eclampsia, 6. improved psychological wellbeing 7. ↓ postpartum recovery time

Answer 7

1. Walking 2. Running or jogging\*\*\* 3. Swimming 4. Stationary cycling 5. Pilates 6. Yoga\*\* 7. Racquet sports\*\*\* 8. Strength training\*\*\* \* Avoid positions associated with ↓ venous return \*\*\* May be considered safe in women who took part in these exercises before

Answer 8

1. Contact sports (e.g., soccer, basketball) 2. Activities associated with a high risk of falling (e.g., snow skiing, water skiing, gymnastics, surfing) 3. Hot yoga 4. Hot Pilates 5. Skydiving 6. Scuba diving

Answer 9

8-18 = normal, AFI ≤5 cm = oligohydramnios, AFI ≥24 cm = polyhydramnios.

Answer 10

amount of amniotic fluid \< 500 mL in the third trimester Complications * Intrauterine growth restriction * Intrauterine compression and decreased amniotic fluid ingestion → **Potter sequence:** pulmonary hypoplasia (cause of death due to severe neonatal respiratory insufficiency), craniofacial abnormalities, limb anomalies

Answer 11

excessive amniotic fluid volume (\> 2000 mL in the third trimester) Complications * Fetal malposition * Umbilical cord prolapse * Premature rupture of membranes * Premature uterine contractions * Premature birth

Answer 12

1. Urethral obstruction (e.g., posterior urethral valves) 2. Bilateral renal agenesis 3. Autosomal recessive polycystic kidney disease (ARPKD) 4. Chromosomal aberrations (e.g., trisomy 18) 5. Intrauterine infections (e.g., congenital TORCH infections) 6. In multiple pregnancies: twin-to-twin transfusion syndrome

Answer 13

1. Late or post-term pregnancies (\> 42 weeks of gestation) 2. Placental insufficiency 3. Preeclampsia 4. Premature rupture of membranes

Answer 14

1. Gastrointestinal anomalies (e.g., esophageal atresia, duodenal atresia and stenosis) 2. CNS anomalies (e.g., anencephaly , meningomyelocele ) 3. Chromosomal aberrations 4. Intrauterine infections (e.g., congenital TORCH infections) 5. Multiple pregnancy: twin-to-twin transfusion syndrome

Answer 15

1. Diabetes mellitus (increased fetal glucose levels, resulting in polyuria) 2. Rhesus incompatibility: hemolytic disease of the newborn

Answer 16

* Advanced maternal age (\> 35 years) * Previous multiple pregnancy * Use of fertility enhancing treatments * Maternal family history of dizygotic twins

Answer 17

* 1/3 twin pregnancies * division of fertilized oocyte * **genetically identical**

Answer 18

* 2/3 of twin pregnancies * two oocyted with two spermatozoa * **genetically different** * **Dichorionic- diamniotic**

Answer 19

Each twin has an individual amniotic sac and placenta.

Answer 20

The twins **share a placenta** and have individual amniotic sacs. (twin-to-twin transfusion syndrome)

Answer 21

The twins **share both** the placenta and amniotic sac.

Answer 22

* Fundal height and abdominal girth are unusually large for the gestational age * Two or more fetal heart rates can be heard on auscultation

Answer 23

* Dichorionic twins: lambda sign * Separation of the chorionic and amniotic sacs resembles the Greek symbol "λ = lambda" * Monochorionic twins: T-sign * Separation of the amniotic sacs resembles a "T" on ultrasound.

Answer 24

1. Hyperemesis gravidarum and gestational diabetes 2. preeclampsia 3. **Cervical incompetence, premature birth, preterm labor, premature rupture of membranes** 4. Placental insufficiency 5. Uterine atony

Answer 25

* Blood is continuously shunted from one twin to the other through vascular anastomoses on the shared placenta * Recipient twin: **polycythemia; polyhydramnios** in diamniotic pregnancies * Donor twin: **anemia**, dehydration, **growth retardation; oligohydramnios i**n diamniotic pregnancies

Answer 26

a pregnancy in which the fertilized egg attaches in a location other than the endometrium * Tubal pregnancy: occurs within the fallopian tube- most common * Complicated ectopic pregnancy: associated with severe bleeding, rupture, or hemodynamic compromise. * Interstitial pregnancy: within the interstitial portion of the fallopian tube (connects the tube to the endometrial cavity)

Answer 27

1. Fallopian tube (96% of cases): ampulla \>\> other 2. Ovary (3% of cases) 3. Abdomen (1% of cases) 4. Cervix (very rare)

Answer 28

Anatomic alteration of the fallopian tubes: * A history of PID * Previous ectopic pregnancy * Past surgeries involving the fallopian tubes * Endometriosis Non‑anatomical risk factors * History of infertility * IUD (implantations outside uterus)

Answer 29

* 4–6 weeks after their last menstrual period * Lower abdominal pain and guarding * **Vaginal bleeding** (mistaken for menstrations) * **Signs of pregnancy**: amenorrhea, nausea, breast tenderness, frequent urination * Tenderness in the area of the ectopic pregnancy * Cervical motion tenderness, **closed cervix** * **Enlarged uterus** * Interstitial pregnancies tend to present late, at 7–12 weeks of gestation, because of myometrial distensibility

Answer 30

* Acute course with sudden and severe lower abdominal pain (acute abdomen) * Signs of hemorrhagic shock: e.g., tachycardia, hypotension, syncope * More common in interstitial pregnancy

Answer 31

Serial β-hCG measurements(48 hours) * Intrauterine pregnancies: β-hCG increases by ≥ 50% in 99% of patients. * **Ectopic pregnancies:** Approx. 70% of patients show an insufficient increase or decrease of β-hCG.

Answer 32

**Transvaginal ultrasound (TVUS)** * best initial imaging test * Empty uterine cavity in combination with a thickened endometrial lining * Possible free fluid within the pouch of Douglas * Tubal ring sign * Interstitial line sign * A thin myometrial layer (\< 5 mm) surrounding the gestational sac

Answer 33

an echogenic ring that surrounds an unruptured ectopic pregnancy

Answer 34

an echogenic line that extends from the gestational sac into the upper uterus

Answer 35

* uncomplicated: methotrexate * hemodynamically unstable or signs or rupture 1. fluid resuscitation normal saline or lactated Ringer's solution * Hgb \>10 no blood even if in shock 2. salpingostomy

Answer 36

1. Ectopic pregnancy * Lower unilateral abdominal pain and guarding * Positive pregnancy test * Ultrasound shows echogenic mass. 2. Benign neoplasms * chronic pelvic or back pain/discomfort * irregularly enlarged uterus, infertility 3. Ovarian cyst rupture * Sudden onset of unilateral abdominal pain * Onset usually during physical activity 4. Infection/Inflammation (PID, cervicitis) * lower bilateral abdominal pain/ lower abdominal or pelvic pain * fever, dyspareunia, purulent cervical discharge 5. Endometriosis * Chronic pelvic pain that worsens before the onset of menses * Dysmenorrhea Dyspareunia 6. Trauma * Pelvic pain

Answer 37

1. PCOS * _Amenorrhea, oligomenorrhea_ * _Hirsutism, obesity, acne vulgaris, infertility_ * Ultrasound shows _enlarged ovaries_ with numerous anechoic cysts. 2. Endometrial hyperplasia * Constant bleeding * Ultrasonography- _endometrial thickening._ 3. Endometrial polyp * Irregular menstrual bleeding 4. Malignant neoplasms * _Cervical cancer:_ menometrorrhagia, postcoital spotting, _abnormal vaginal discharge_ * _Endometrial cancer:_ metrorrhagia, menometrorrhagia

Answer 38

1. Until the 28th week of pregnancy: monthly 2. From the 28th week until the 36th week: every two weeks 3. From the 36th week until birth: every week

Answer 39

1. Personal and family history, previous pregnancies 2. Gynecological examination 3. Laboratory analysis 4. Ultrasound assessment

Answer 40

* HIV (using 3rd or 4th generation ELISA), * syphilis(using nontreponemal tests such as VDRL or RPR), * hepatitis B infection (using HBsAg). * \< 25 years, have risk factor: Chlamydia and N. gonorrhea infection by PCR of vaginal swabs

Answer 41

1. CBC 2. Anemia 3. Blood typing (ABO and rhesus) 4. Proteinuria 5. Asymptomatic bacteriuria 6. Screening for STIs * HIV testing * Syphilis screening * Hepatitis B surface antigen testing * Chlamydia testing: * \< 25 years of age and ≥ 25 years with high risk of infection 7. Rubella and varicella antibody testing

Answer 42

1. Blood pressure monitoring: early detection of pregnancy-induced hypertension 2. First-trimester screening: screening of chromosomopathies 3. Physical examination * Leopold's maneuver * Fetal heart monitoring 4. Laboratory

Answer 43

1. Group B streptococcus screening performed between **36 0/7 and 37 6/7 weeks** of gestation 2. Repeat Hb from the **24th week** 3. 50-g, one-hour oral glucose challenge test (initial screening) at **24–28** weeks gestation * 100-g, three-hour oral glucose tolerance test to confirm diagnosis 4. Repeat rhesus screening

Answer 44

* vaginal and rectal swab for culture and gram staining * colonization by this bacteria may cause chorioamnionitisand neonatal infection.

Answer 45

1. First: bimanual examination of the **fetal position** (longitudinal/oblique/transverse) and **fundal height** 2. Second: bimanual examination of the **location of the fetal back** (i.e., either on the mother's left or right side) 3. Third: One hand **grasps above the symphysis** in an attempt to **determine if the presenting part of the fetus is engaged.** 4. Fourth: Bimanual determination of the location of the fetal brow and the degree of flexion of the fetus's head. when the fetus has entered the pelvic inlet.

Answer 46

increases ∼ 1 cm/week in the second and third trimester. * Week 12 = Just above the symphysis * week 20 = Between the symphysis and navel * week 24 = Navel * week 32 = Between the navel and xiphoid * week 36 = Peak: at the costal arch * week 40 = Two finger widths below the costal arch

Answer 47

All pregnant women (regardless of age) should be offered noninvasive aneuploidy screening tests (before 20 weeks gestation) * Possible tests: * Testing maternal serum; specific biomarkers and ultrasound * Cell-free fetal DNA testing * invasive genetic testing; amniocentesis or CVS

Answer 48

* Sonographic nuchal translucency (NT) * β-HCG in maternal serum * PAPP-A in maternal serum Detects: 1. **Down syndrome/Trisomy 21**: ↑ HCG, ↓ PAPP-A, ↑NT 2. Trisomy 18 & 13: ↓ HCG, ↓↓ PAPP-A, ↑ NT 3. Molar pregnancy: ↑↑ HCG 4. Ectopic pregnancy: ↓ HCG 5. **Neural tube defects**: ↑ HCG

Answer 49

* based on maternal age and ultrasound * HCG * Alpha-fetoprotein(AFP) * Estriol Diagnoses: 1. **Trisomy 21:** ↑ β-HCG, ↓ AFP, ↓ free estriol, ↑ Inh A 2. Trisomy 18: ↓↓ β-HCG, ↓ AFP, ↓↓ free estriol,↔︎ or ↓ Inh A 3. Molar pregnancy: ↑↑ HCG 4. Ectopic pregnancy: ↓ HCG, ↓ AFP, ↓ free estriol 5. **Neural tube defects:** ↔︎ HCG, ↑ AFP, ↔︎ free estriol, ↔︎ inh A 6. Abdominal wall defects: ↔︎ HCG, ↑ AFP, ↔︎ free estriol, ↔︎ inh A

Answer 50

* based on maternal age and ultrasound * HCG * Alpha-fetoprotein(AFP) * Estriol * Inhibin A (Inh A) Diagnoses: 1. **Trisomy 21:** ↑ β-HCG, ↓ AFP, ↓ free estriol, ↑ Inh A 2. Trisomy 18: ↓↓ β-HCG, ↓ AFP, ↓↓ free estriol,↔︎ or ↓ Inh A 3. Molar pregnancy: ↑↑ HCG 4. Ectopic pregnancy: ↓ HCG, ↓ AFP, ↓ free estriol 5. **Neural tube defects:** ↔︎ HCG, ↑ AFP, ↔︎ free estriol, ↔︎ inh A 6. Abdominal wall defects: ↔︎ HCG, ↑ AFP, ↔︎ free estriol, ↔︎ inh A

Answer 51

1. Frist trimerster combined (10-13 wks) 2. Quad screen test (15-20 wks)

Answer 52

* Fetal DNA is isolated from a maternal blood specimen for genetic testing' Detects: 1. Identifies chromosomal aberrations * (high specificity and sensitivity for trisomy 21 \> trisomy 18 \>trisomy 13) 2. Determine the sex of the fetus 3. high sensitivity (\> 99%) and specificity (\> 99%) for Down syndrome

Answer 53

* removal of chorionic tissue under sonographic guidance * Analysis of DNA for genetic diagnosis in early pregnancy * preferred testing method before 15wks for prenatal genetic diagnosis (conformatory) * perform after 1st trimester screening Complications: 1. Miscarriage(approximate risk: 2–3%) 2. Limb defects

Answer 54

* AF is extracted under sonographicguidance via transabdominal puncture Comlications 1. Miscarriage(approximate risk: 0.5–1%) 2. **Premature rupture of the membranes** 3. Infection

Answer 55

* Fetal blood sampling via ultrasound-guided transabdominal needle insertion into the umbilical cord * dentify the type of fetal hemoglobinand to assess the severity of fetal anemia Complications 1. miscarriage 2. infection

Answer 56

* Suspected intrauterine growth restriction * Suspected fetal deformities * Growth discordance in multiple pregnancies

Answer 57

1. Uterine artery * Early diastolic notch * risk of preeclampsiaand/or fetal growth restriction 2. Umbilical artery * Decline or loss of end diastolic flow velocity or negative flow * increased resistance to the placentalvascular bed 3. Fetal middle cerebral artery * Increased diastolic flow velocity * centralization ("brain sparing effect") in fetal hypoxia

Answer 58

1. Nonstress Test (NST) 2. Contraction stress test (CST) 3. Biophysical Profile (BPP)

Answer 59

* a noninvasive test cardiotography (CTG) that measures FHR reactivity to fetal movements * Indications: * maternal medical conditions (e.g., gestational diabetes, preeclampsia) * fetal conditions (e.g., fetal heart defects, fetal growth restriction) * performed in the third trimester

Answer 60

1. A normal NST would show ≥ 2 FHR accelerations. 2. Reactive nonstress test: normal 3. Non-reactive nonstress test: \<2 FHR accelerations 1. Perform vibroacoustic stimulation 2. If the NST is still non-reactive: check the biophysical profile (BPP) or perform contraction stress test

Answer 61

* measures FHR reactivity in response to uterine contractions * contractions are stimulated with oxytocin administration.

Answer 62

evaluates the risk of antenatal fetal death. Ultrasound exam. Measured parameters: 0 (abnormal) or 2 (normal) 1. Fetal movement 2. Fetal tone 3. Fetal breathing 4. Amniotic fluid volume ≥ 8 points: no signs of fetal compromise at the time of testing ≤ 4 points: potential fetal compromise → **delivery is indicated**

Answer 63

1. Fetal movement * ≥ 3 body or limb movements within a 30-minute period 2. Fetal tone * ≥ 1 episodes of a fetal extremity or fetal spine extension with return to flexion 3. Fetal breathing * ≥ 1 rhythmic breathing episode(s) ≥ 30 seconds within a 30-minute period 4. Amniotic fluid volume * A single deepest vertical pocket ≥ 2 cm 5. Nonstress test * ≥ 2 episodes of FHR accelerations

Answer 64

* Highest risk during birth (perinatal vertical transmission) * Prenatal transmission is possible * **Risk depends on maternal viral load**

Answer 65

1. Combined antiretroviral therapy (cART) is recommended throughout pregnancy 2. Delivery method Viral load \> 1,000 copies/mL: increased risk of HIV transmission * Cesarean delivery should be scheduled at 38 weeks * post-exposure prophylaxis with **zidovudine, lamivudine and nevirapine OR zidovudine and nevirapine** 3. Viral load ≤ 1,000 copies/mL and mother has received cART * HIV post-exposure prophylaxis with **zidovudine** for the newborn * vaginal delivery considered 4. Breastfeeding should generally be avoided , because risk of transmission is 5–20%

Answer 66

if \< 18 months, diagnosis is confirmed via PCR, not ELISA

Answer 67

* An antibody against the rhesus D antigen that is used as prophylaxis against hemolytic disease of the fetus and newborn in Rh(D) negative mothers. * Anti-D prophylaxis protects newborns in subsequent pregnancies. * Only indicated in unsensitized mothers

Answer 68

Anti-D prophylaxis should be administered during the **28th week** of gestation and **within 72 hours** following the birth of an Rh-positive baby. Further indicaitons: 1. Following a miscarriage, ectopic pregnancy, or termination of pregnancy 2. Bleeding during pregnancy 3. Following invasive procedures (e.g., amniocentesis, chorionic villus sampling

Answer 69

1. No anti-D antibodies (**unsensitized** mothers): antibody screening repeated at 28 weeks' gestation and at delivery. 2. Anti-D antibodies manifest with an anti-D antibody titer \> 1:8, which indicates maternal sensitization to fetal Rh antigens (**sensitized** mothers). * Further monitoring with amniocentesis and imaging is required for evidence of hemolysis.

Answer 70

1. Conduct a rosette test (initial test of choice). This is a qualitative test that assesses whether fetomaternal hemorrhage has occurred. 2. If the rosette test is positive, conduct a Kleihauer-Betke test. * The amount of fetal hemoglobin determines the amount of Anti-D immunoglobulin necessary.

Answer 71

Maternal Rh-negative blood is incubated with Rho(D) immunoglobulin, which binds to fetal Rh-positive erythrocytes. The addition of an indicator causes these erythrocytes to form a rosette pattern

Answer 72

maternal blood smear is exposed to acid and then stained. Adult hemoglobin is removed by the acid whereas fetal hemoglobin (HbF) is not, thus, cells appear pink on a positive test for fetal hemoglobin

Answer 73

* very low 1000-1499 * low: \<2500g * Normal: 2500-4000g * Macrosomic: 4500g