Prenatal

Question 1

Red flags in pregnancy?

Answer 1

Bleeding with cramping
Excessive swelling
HTN
Decreased fetal mvmt between 26-32wks (at least 6x in 2hrs)
Unstable mental health

Question 2

How to diagnose pregnancy

Answer 2

Beta Hcg 12-14d after conception
Serum beta 11d after conception

Expected to double q2d x4 wks

Question 3

How to date pregnancy

Answer 3

Naegels Rule: from the first day of the LMP, add 1 year, subtract 3m and add 7 days

Otherwise dating U/S - if it gives a different date from Naegels rule >5day difference Naegels Rule trumps

Question 4

What should be done at every antenatal visit

Answer 4

BP, urine for protein, weight, FHR, ask about spotting and bleeding

Question 5

What is the gold standard testing for genetic screening

Answer 5

IPS of eFTS

Question 6

What is the IPS test?

Answer 6

Integrated Prenatal Screening (IPS)
Step 1: US looking at the fold of the back of the baby’s neck, assessing for nuchal translucency and BW @ 11-13 + 6wks (risk for down syndrome)
- Results will not come back to you

Step 2: Maternal Serum Screen @ 15-20wks (looking for probability of Trisomy 18 & 21, neural tube defects)
- Step 1 & 2 results will come back together as a probability factoring in the patient’s age

Question 7

What is the eFTS?

Answer 7

Enhanced First Trimester Screen (eFTS)
- Essentially step #1 of IPS that is more enhanced and results are back by week 13-14 and has now replaced IPS for the most part

Question 8

What is the NIPT?

Answer 8

Non-Invasive Prenatal Testing:
analyses maternal blood for circulating cell-free fetal DNA (ccffDNA) at 10 wk GA onwards. Requires
dating U/S for accuracy
*not OHIP covered unless you have screened + for the above or >40yrs of age
- Done after 9-10wks, it is a blood test done that measures circulating cell-free fetal DNA in maternal blood
- Cons: expensive

Question 9

What if your patient presents to you after 15 weeks, what testing can you offer?

Answer 9

Maternal Serum Screen - essentially step #2 of IPS
& NIPT if they are willing to pay

Question 10

If abnormalities are found on genetic screening what happens next?

Answer 10

Genetic testing through:
Chorionic Villus Sampling: done at 10-14wks, U/S guided catheter that takes a sample of the placenta, fetal loss risk of 1-2%

Amniocentesis: done at 15-20wks, U/S guided catheter that takes a sample of the amniotic fluid, fetal loss risk of 0.5-1%

Question 11

What does GTPAL stand for?

Answer 11

Gravida
Term
Preterm
Abortions
Live

Question 12

What are some contraindications to sex and exercise in pregnancy?

Answer 12

• Hx of incompetent cervix (no sex or exercise, typically on bed rest)
• PROM (risk of infection to baby
• Placenta Previa (no sex once diagnosed, no vigorous exercise at all but can do light >28wks)
• Vaginal Bleeding (No sex or exercise if consistence bleeding)

Question 13

Who gets Rhogam and when is it given?

Answer 13

Rh - Mom
Given at 28wks and 72 hrs post delivery if babe is Rh +

Question 14

What is placenta previa?

Answer 14

Completely overlying placenta over Os, Defined by U/S, special considerations for care. No internal checks until after 12wks confirming no previa

Question 15

What are the risk factors for gestational diabetes?

Answer 15

 Age >25yrs
 Obesity
 Ethnicity/Fhx of DM
 Prev hx of GDM
 Prev child with macrosomia BW >4.0kg
 PCOS
 Current use of glucocorticoids
 Essential HTN or pregnancy-related HTN

Question 16

What are some complications of GDM?

Answer 16

Increased risk of: stillbirth, shoulder dystocia, preeclampsia, c-section, LGA infant, later development for T2DM

Question 17

When do we screen for GDM

Answer 17

24-28 wks with the OGTT

Question 18

What screening tool can be used to screen for PPD?

Answer 18

Edinburgh PP Depression Scale

Question 19

What are some differentials for spotting with pregnancy?

Answer 19

Ectopic Pregnancy
Post Sex
Pregnancy with normal spotting
Placental previa (painless bright red bleeding)
Placental Abruption
Miscarriage
STI

Question 20

Screening tests for HTN in pregnancy

Answer 20

Symptomatic?
Take BP, weight
Urine for protein

Question 21

Why are we concerned about HTN in pregnancy

Answer 21

Eclampsia
HELLP

Question 22

For how long should the pregnant patient be seen primarily by PCP?

Answer 22

Up to 28 weeks and should have OB involved

Question 23

What do each trimester translate into weeks?

Answer 23

the first trimester: from the first day of LMP-13 weeks the second trimester: from about 14-27 weeks
third trimester: from about 28 weeks until birth.

Question 24

What are the first S/S of pregnancy?

Answer 24

Breast tenderness (4-6wks), nausea (starts at 6-8wks), perceived fetal movement (starts at 16-20wks), wt gain

Question 25

When can an external doppler pick up a HB?

Answer 25

14-16 wks

Question 26

How long does nausea in pregnancy last for?

Answer 26

Typically will start to decrease after 20wks

Question 27

What initial investigations are you doing in the first prenatal visit?

Answer 27

HB, ABO/Rh, MCV, Antibody screen, platelets, rubella immune, HBsAg, syphillis, HIV, GC, Chlamydia, Urine C&S

Other additional as needed: TSH, ferritin, B12, infectious disease screening (Hep C, Parvo B19

Question 28

Define preeclampsia

Answer 28

PIH + new proteinuria, and/or + adverse condition and/or + severe complication (see table on next slide)
- Can occur up to 6 weeks PP!!
- may get: Anti-HTNs, calcium, ASA