Prenatal Care

Question 0

Physiologic changes in pregnancy – respiratory?

Answer 0

1. Tidal volume increased
2. Increase in TV increases minute ventilation
3. Respiratory rate unchanged

Question 1

Physiologic changes in pregnancy – cardiovascular?

Answer 1

1. 50% increase in Cardiac output and plasma volume
2. Decrease in Systemic vascular resistance
3. Normal/low mean arterial pressure

Question 2

Physiologic changes in pregnancy – ABG?

Answer 2

1. PH 7.45 (increased)
2. PCO2 28 (decreased)
3. HCO3 18 (decreased)

primary respiratory alkalosis with partial metabolic compensation

Question 3

Physiologic changes in pregnancy – renal?

Answer 3

1. 50% increase in GFR
2. Decreased serum creatinine (Increased creatinine clearance)
3. Dilated ureters
4. Glucosuria

Question 4

Physiologic changes in pregnancy – hematologic?

Answer 4

1. Decreased hemoglobin
2. Decreased platelets
3. Slightly increased leukocytes

Question 5

Physiologic changes in pregnancy – gastrointestinal?

Answer 5

1. Decreased LES tone
2. Delayed stomach emptying
3. Decreased gut motility

Question 6

Isoimmunization?

Answer 6

Development of antibodies due to stimulation from another’s RBCs

Question 7

Asymptomatic bacteriuria?

Answer 7

Urine culture of 100,000+ in mid stream specimen

Question 8

antenatal testing – goal?

Answer 8

Determine risk for uteroplacental insufficiency and perinatal death (NST and BPP)

Question 9

PCO2 of 40 in the pregnant patient indicates?

Answer 9

Significant CO2 retention and possible impending respiratory

Question 10

Dating via LMP and fundal height – discrepancy if?

Answer 10

3 cm or more difference in fundal height as what would be expected based on LMP

Question 11

Anemia in pregnancy? Complication if untreated? Next steps?

Answer 11

Hemoglobin <10.5

Preterm delivery

Trial of iron, ferritin studies, hemoglobin electrophoresis

Question 12

Patient nonimmune to rubella – when to vaccine?

Answer 12

Postpartum

Question 13

If Rh antibody screen is negative?

If negative but baby is Rh positive?

Answer 13

Rhogam at 28 weeks

Rhogam at 28 weeks and also after delivery

Question 14

Positive antibody screen suggests?

Answer 14

Lewis lives, Kell kills, Duffy dies

Lewis antibodies are IgM and do not cross placenta

Question 15

Pregnant patient with positive HIV ELISA?

Answer 15

Western blot or PCR – if positive:

1. anti-HIV medicines
2. offer C-section or give IV ZDV is labor

Question 16

Pregnant patient positive for syphilis – tx?

Answer 16

If less than one year – penicillin x1

If unknown/over one year – IM penicillin x3

Question 17

Pregnant Patient positive for gonorrhea – complications? Next step?

Answer 17

Preterm labor, blindness

Ceftriaxone IM

Question 18

Pregnant Patient positive for chlamydia – complications? Next step

Answer 18

Neonatal blindness, pneumonia

Azithromycin or amoxicillin orally

Question 19

Pregnant Patient positive for Hepatitis B surface antigen – complications? Next step

Answer 19

Check LFTs and hepatitis serology to determine if chronic carrier or active hepatitis

Baby needs HB IG and hepatitis B vaccine

Question 20

Pregnant Patient positive for urine culture but asymptomatic – complications? Next step

Answer 20

Asymptomatic bacteriuria leads to Pyelonephritis 25%

treat and recheck; if positive for GBS, give penicillin in labor

Question 21

Pregnant Patient with abnormal Pap smear – Next steps?

Answer 21

Alter management only if invasive cancer

If ASC-US – re-PAP postpartum
If LGSIL or HGSIL – Colposcopy

Question 22

Pregnant Patient positive for nuchal translucency – complications? Next step

Answer 22

May indicated trisomy

Offer karyotype and follow-up ultrasounds

Question 23

Pregnant Patient positive for trisomy screen – complications? Next step

Answer 23

At risk for trisomy or neural tube defect

Ultrasound for dates. If confirmed, offer genetic amniocentesis

Question 24

Glucose tolerance test positive it?

Answer 24

2 normal values

Question 25

Pregnant patients with previous placental abruption – management?

Answer 25

Induction slightly before time of last abruption