Pregnancy care in community Flashcards
With regard to SGA pregnancies, which of the following statements is true?
a) SGA babies who have had normal umbilical Doppler studies do not require monitoring for hypoglycaemia after birth
b) Fetal abnormalities are more likely when the fetus is symmetrically small
c) 5-10% of SGA pregnancies have umbilical Doppler waveforms with absent end-diastolic velocity
d) The majority of SGA babies are born at <36 weeks
e) Chromosomal abnormality can be excluded if umbilical Doppler waveforms are normal
b) Fetal abnormalities are more likely when the fetus is symmetrically small
With regard to SGA pregnancies which of the following statements is true?
a) Cessation of smoking in the first trimester has no impact on birthweight
b) A woman who has previously delivered a baby weighing 2300g at 39 weeks should be prescribed aspirin 300mg/day from the first trimester in her next pregnancy
c) SGA babies born at term have an increased risk of diabetes in adult life
d) About 20% of SGA babies have evidence of chromosomal or congenital abnormality at birth
e) About 80% of SGA babies are detected antenatally
c) SGA babies born at term have an increased risk of diabetes in adult life
A 40-year-old woman G1 P0 attends your practiceat 20 weeks following a morphology scan. The ultrasound report mentions a low lying placenta. Which of the following is the best answer?
a) The diagnosis of low lying placenta can only be established by transvaginal scan
b) An amniocentesis is recommended because placenta praevia is associated with an increased risk of fetal anomalies
c) If the placenta is located more than 2 cm away from the internal os at 36 weeks, vaginal delivery is possible.
d) If the placenta is located 1 cm from the internal os on transvaginal scan at 36 weeks gestation, this is called a placenta praevia major and delivery at 37 weeks by caesarean section is indicated
e) This is likely to represent a placenta praevia and a repeat scan is indicated at 32-34 weeks.
c) If the placenta is located more than 2 cm away from the internal os at 36 weeks, vaginal delivery is possible.
A healthy 30 year old primigravid woman with no relevant past medical or family history attends your practice at term (40 weeks by early ultrasound) for a routine antenatal check. Her pregnancy has so far been completely unremarkable. She appears well and reports normal fetal movements. However she mentions that her friends all mention that she is “big” and she is worried that “baby will not fit”. Her symphysial-fundal height is 40 cm and the fetal head is palpable 2/5ths above the pelvic brim. An ultrasound shows an estimated fetal weight of 4200g, (on the 85th customised centile) with normal liquor volume. Maternal weight is 80 Kg and height 172 cm. Which of the following is true?
a) This woman should have a glucose tolerance test tomorrow
b) Elective caesarean section should be recommended
c) This pregnancy should be considered normal and it is best to await spontaneous labour
d) Induction of labour in this situation is associated with decreased obstetric intervention
e) If the baby weighs over 4000g, there is a 15% risk of shoulder dystocia
c) This pregnancy should be considered normal and it is best to await spontaneous labour
Regarding prescribing in pregnancy – which of the following is true:
a) Warfarin is always contraindicated in the first trimester
b) Prednisone can be prescribed for exacerbations of asthma in pregnancy
c) Thyroxine dosage for hypothyroidism should be doubled in pregnancy
d) Manic-depressive patients who are stable should have their lithium treatment stopped before pregnancy
e) Chlamydia should not be treated in the first trimester because of the risk of teratogenesis with antibiotics
b) Prednisone can be prescribed for exacerbations of asthma in pregnancy
With regard to hyperemesis which of the following statements is true:
a) Vitamin B6 200mg TDS reduces nausea
b) Hospitalisation is not necessary unless weight loss exceeds 5kg
c) Maternal ketonuria is best treated with 10% IV dextrose
d) May persist throughout pregnancy
e) Occurs in 60% of multiple pregnancies
d) May persist throughout pregnancy
With respect to perinatal deaths in New Zealand, which of the following answers is true:
a) Neonatal death is twice as common as stillbirth
b) Approximately 50% of stillborn babies are SGA
c) The rate of perinatal death in New Zealand is approximately 2/1000 births
d) A stillbirth is defined as the birth of a baby with no signs of life delivered at >24 weeks gestation
e) The rate of stillbirth amongst Maori mothers is the same as in European mothers
b) Approximately 50% of stillborn babies are SGA
Which of the following statements about advice in pregnancy is true?
a) Long haul travel is contraindicated after 28 weeks as it increases the risk of preterm birth
b) Women should routinely be tested for toxoplasmosis at the start of their pregnancy
c) Influenza vaccination is recommended in any trimester in pregnancy
d) Suspected appendicitis should be treated with antibiotics after 28 weeks to avoid the risk of surgical complications
e) If booking BMI is 30 a weight loss of 4kg during pregnancy is associated with the best pregnancy outcome
c) Influenza vaccination is recommended in any trimester in pregnancy
A 30 year old primagravid woman has premature rupture of the membranes at 18 weeks. She has no uterine contractions. An ultrasound confirms a live fetus with size compatible with dates and anhydramnios. Which of the following is the best answer?
a) This woman is at high risk of a miscarriage
b) Termination of pregnancy is not an option
c) After PPROM and anhydramnios, membranes often seal spontaneously
d) With bed rest and treatment with erythromycin, the most likely outcome of this pregnancy is delivery near 37 weeks
e) The most likely cause for PPROM in this case is Bacterial Vaginosis
a) This woman is at high risk of a miscarriage
With regards to fetal growth, what is the most likely cause of a fetus with asymmetry on scan where the abdominal circumference is disproportionately smaller than the other measurements?
a) Congenital infection
b) Placental insufficiency
c) Inadequate maternal nutrition
d) Chromosomal abnormality
e) Misleading results on population chart due to maternal ethnicity
b) Placental insufficiency
Which is true with regards to air travel in pregnancy?
a) The safest time is the second trimester
b) You can travel after 36 weeks on any airline if you have a letter from your lead maternity carer
c) Long distance flights should be avoided in the first trimester due to radiation levels
d) Due to increased blood volume in pregnancy dehydration is not likely
e) The seat belt should be buckled over the uterus to protect the baby
a) The safest time is the second trimester
A 31y G3P0 presents for a pregnancy test as her LMP was 7 weeks ago. She has a history of moderately severe asthma for which she takes on average three courses of oral prednisone per year and a booking BMI of 42. Which of the following is CORRECT?
a) As she’s had 2 spontaneous 1st trimester miscarriages, she is at increased risk of miscarriage in this pregnancy and should be investigated for causes of recurrent miscarriage
b) She is at high risk for developing gestational hypertension/pre-eclampsia so should be started on aspirin
c) According to NZ Clinical practice guidelines, she should have an HbA1c at booking and if normal (<40mmol/L) a glucose challenge test (Polycose) at 24-28 weeks’ gestation
d) Prednisone is contraindicated in the first trimester due to the increased risk of cleft lip/palate.
e) In order to reduce her risk of pregnancy and birth complications she should be advised that her optimal gestational weight gain is 7-12kg
c) According to NZ Clinical practice guidelines, she should have an HbA1c at booking and if normal (<40mmol/L) a glucose challenge test (Polycose) at 24-28 weeks’ gestation
