Prenatal 2

Question 1

When should Gestational Diabetes screening take place?

Answer 1

at 26 weeks

Question 2

What is the screening test for GDM (gestational DM)?

Answer 2

Glucose Challenge Test (GCT) - 50 grams oral glucose given, and serum glucose is measured 1 hour later

Question 3

What is a positive result of the GCT?

Answer 3

serum glucose > 140 mg/dL

Question 4

At what level is the GCT diagnostic of GDM?

Answer 4

at > 200 mg/dL (no need to perform GTT)

Question 5

What is the diagnostic test for GDM?

Answer 5

Glucose Tolerance Test (100g oral glucose is measured at 1- 2- and 3- hours later)

Question 6

What are the two standards for the GTT?

Answer 6

Carpenter and Coustan (fasting 95, 180, 155, 140), and the National Diabetes Data Group (fasting 105, 190, 165, 145)

Question 7

When is the GTT diagnostic for GDM?

Answer 7

When two or more values are elevated

Question 8

How is latent TB in pregnancy treated?

Answer 8

delay tx until 3 months postpartum, if no risk factors for active disease

Question 9

How is active TB in pregnancy treated?

Answer 9

Isoniazid, Rifampin, and Ethambutol

Pyrazinamide has unknown teratogenicity

Question 10

Why should Aminoglycosides (i.e. Gentamycin) be avoided in pregnancy?

Answer 10

to avoid fetal ototoxicity

Question 11

What are the MCC of Asymptomatic bacteriuria?

Answer 11

E. coli, Proteus, Klebsiella

Question 12

What are some options for treating asymptomatic bacteriuria?

Answer 12

Nitrofurantoin, Amoxicillin, Augmentin (amoxicillin-clavulante), Cephalexin, Fosfomycin

Question 13

How can an ectopic pregnancy be medically managed?

Answer 13

Methotrexate (folic acid antagonist)

50 mg/ square meter of body surface area; up to three doses

Question 14

What conditions are required for Methotrexate use in ectopic pregnancy?

Answer 14

hCG < 5000
no fetal heart rate
embryo < 3 cm

Question 15

What is the Ultrasound EDD margin of error in the 1st trimester?

Answer 15

+/- 3 to 5 days
(If the EDD calculated by LMP is outside this range, use the EDD by US.
If LMP date is within this range, use the EDD by LMP)

Question 16

What is the Ultrasound EDD margin of error from 14-26 weeks?

Answer 16

+/- 2 weeks

Question 17

What is the Ultrasound EDD margin of error after 26 weeks?

Answer 17

too large to be useful (don’t date the EDD by US at this time)

Question 18

When is genetic testing suggested?

Answer 18

maternal age > 35

Question 19

What does GBS in pregnancy cause?

Answer 19

UTI, upper genital tract infection, intraamniotic infection, endometritis, bacteremia

Question 20

When is flu season?

Answer 20

October 1 - May 1

Question 21

When can TdaP be administered in pregnancy?

Answer 21

2nd or 3rd trimester, or delay until postpartum

Question 22

When can the gestational sac be seen on trans-vaginal US?

Answer 22

5 weeks

Question 23

When can the yolk sac be seen on trans-vaginal US?

Answer 23

5.5 weeks

Question 24

When can cardiac activity be seen on trans-vaginal US?

Answer 24

6 weeks

Question 25

When does the fetal neural tube close?

Answer 25

~ 6 weeks

Question 26

How can neural tube defects be prevented?

Answer 26

Take 0.4 to 1 mg Folic Acid per day for 3 months before conception

Question 27

Causes of Intrauterine Growth Restriction? (IUGR)

Answer 27

Genetics, Congenital anomalies, Multiple gestation, Infection (CMV),
Ischemic placenta, Maternal factors (DM, HTN, low maternal weight, cocaine, alcohol, smoking)

Question 28

When should Rhogam be administered?

Answer 28

at 28 weeks, and Postpartum.

Also if abdominal trauma, chorionic villous sampling, or amniocentesis occurs.

Question 29

When is Rhogam indicated?

Answer 29

Rh negative mothers (with possibly Rh positive fetus) who have not yet formed antibodies to Rh antigen (AKA D antigen).

Question 30

What is the MOA of Rhogam?

Answer 30

Rhogam (Anti-D IgG) binds to fetal RBCs with the D antigen, and clears them from circulation. (this prevents maternal antibodies to D antigen from forming)

Question 31

What is the standard dose of Rhogam?

Answer 31

300 micrograms (adjusted based on Kleihauer-Betke test, which estimates # of fetal RBCs in maternal blood)