Prenatal Care

Question 1

Increased caloric intake in pregnancy

Answer 1

1st tri: no additional cals
2nd tri: + 350 cals
3rd tri: + 450 cals

Question 2

Incidence of obesity in pregnancy

Answer 2

31%

Overweight + obese = 58%

Question 3

BMI Categories

Answer 3

Normal: 18-24.9
Overwieght: 25-29.9
Class 1 Obesity: 30-34.9
Class 2 Obesity: 35-39.9
Class 3 Obesity: > 40

Question 4

Recommended wt gain for underweight (BMI < 20)

Answer 4

28-40 lbs

1 lb/wk in 2/3rd tri

Question 5

Recommended wt gain for normal BMI (20-25)

Answer 5

25-35 lbs

1 lb/wk in 2/3 tri

Question 6

Recommended wt gain for overweight (BMI 25-30)

Answer 6

15-25 lbs

0.6 lb/wk in 2/3 tri

Question 7

Recommended wt gain for Obese (BMI > 30)

Answer 7

11-20 lbs

0.5 lb/wk in 2/3 tri

Question 8

Classification of Anemia in pregnancy

Answer 8

1st tri < 11
2nd tri < 10.5
3rd tri < 11

Question 9

What test has the highest sensitivity and specificity for diagnosing Fe deficiency in anemic pts?

Answer 9

Serum Ferritin

< 30 micrograms/L confirms Fe deficiency anemia

Question 10

Fe deficiency is associated with what?

Answer 10

Low birth weight
preterm birth
perinatal mortality
Postpartum Depression

Question 11

Who needs Hgb ELP at new OB visit?

Answer 11

Everyone planning pregnancy or at the initial prenatal visit if preiovus testing not completed. Can be done using hemoglobin electrophoresis or molecular genetic testing

Question 12

What hemoglobinopathy often causes fetal hydrops and intrauterine fetal demise?

Answer 12

Alpha Thal Major (deletion of all 4 genes)

Barts disease

Question 13

Sickle cell disease is a mutation in which gene? how is it inherited?

Answer 13

Autosomal Recessive disorder caused by a mutation in the B globin gene

Question 14

Should you treat a non-pregnant woman with asymptomatic bacteriuria?

Answer 14

Nope!

Question 15

What percentage of pregnant women will develop cystitis or pyelo from asymptotic bacteriuria?

Answer 15

20-35%

Risk is reduced by 70-80% with treatment

Asympomatic bacteriuria is also associated with preterm birth and low birth weight

Question 16

Most common organism for UTI?

Answer 16

E. Coli (70%)
Klebsiella (3%)
Enterobacter (2%)
Gram Positive Organisms (like GBS) (10%)

Question 17

Diagnostic Criteria for Asymptomatic Bacteriuria?

Answer 17

Isolation of same bacteria strain 10^5 (100K) in two consecutive voided urine samples

OR

Single catheterized specimen with 100 CFU/mL

Question 18

Risk of developing ARDS with pyelonpehritis?

Answer 18

20%!!!

Question 19

F/up for asymptomatic bacteriuria or acute cystitis?

Answer 19

30% of women will fail abs w// asymptomatic bacteriuria

Repeat Cx 1 weeks after completion of antibiotics (for either group)

Question 20

Who are candidates for antibiotic ppx for UTI?

Answer 20

2 or more episodes of cystitis in pregnancy OR 1 episode of pyelo

Question 21

Abs for UTI PPx in pregnancy?

Answer 21

Macrobid (Nitrofurantin) 50-100 mg qHS

Cephalexin 250-500 mg 1HS

Question 22

Pyelo treatment in pregnancy?

Answer 22

IV abs until afebrile 24-48h

Ceftriaxone

Question 23

First line treatment for complicated urinary tract infection (not pregnant)?

Answer 23

Ciprofloxacin 500 mg PO BID 7-14 days

Question 24

Does treatment of BV in asymptomatic women reduce their risk of preterm birth?

Answer 24

Nope!!! Asymptomatic women should NOT be screened, and treatment is NOT recommended in patients without a hx of preterm birth

Question 25

Amsel's Criteria

Answer 25

Grayish Vaginal Discharge pH > 4.5 Positive Whiff test > 20% clue cells on wet mount

Question 26

What is the most common complication that can occur from untreated pyelonephritis in pregnancy?

Answer 26

Anemia

Question 27

Prevention of UTI in women?

Answer 27

1. PPx antibitoics 2. Increased fluid intake (1.5L) 3. Vaginal estrogen in postmenopausal women

Question 28

Most common cause of UTI/pyelonephritis?

Answer 28

E. Coli

Question 29

When can you use Bactrim in pregnancy?

Answer 29

Second trimester ONLY

Question 30

Is gadolinium MRI contrast safe to use in preganncy?

Answer 30

Gadolinium - concern that this can enter fetal circulation and become unbound (which is toxic) **Can use in lactation Limit its use to cases where there is an absolute clear benefit to its administration

Question 31

Should breastfeeding be interrupted after gadolinium contrast MRI?

Answer 31

No!! Safe to use during lactation

Question 32

Radiation at 0-2 weeks post fertilization?

Answer 32

All or none effect (either miscarriage or no consequence at all)

Question 33

Radiation exposure 2-8 weeks post fertilization?

Answer 33

Can see congenital anomalies or growth restirction

Question 34

Worst time to have radiation exposure during prengancy?

Answer 34

8-15 weeks Has the highest risk of severe intellectual deficit or microcephaly

Question 35

Is Technetium-99 safe to use in pregnancy (NM scan for thryoid, bone, or VQ scan)

Answer 35

Yes! Short half life

Question 36

What is the difference between a prenatal vitamin and a multi-vitamin?

Answer 36

Prenatal vitamin often has more folic acid, DHEA, and iron Multi-vitamin has higher dose of Vit A (fat soluble) which you want to avoid

Question 37

Common genetic conditions assocaited with ashkenazi jewish patient?

Answer 37

Cystic fibrosis Tay Sachs - fatal disease that destroys nerve cells in the brain and spinal cord Familia dysautonomia Canavan Disease - fatal Gaucher's most common* but treatable

Question 37

For preconception counseling.... what titers would you obtain? | If she needed vaccination, how long should she wait prior to conception?

Answer 37

Rubella and Varicella | 1 month (however, if pregnant two weeks later, nothing changes)