Prenatal Care

Question 1

Know the guidelines for prevention of neonatal GBS disease

Answer 1

2011 AAP Guidelines:

1. Onset of labor is at 35W and GBS screening is negative –> no ppx
2. Onset of labor is at 32W, GBS positive. –> tocolytic drugs to stop labor. Labor resumes at 35W and mother delivers.

Question 2

True or False? Women with GBS bacteriuria at any time during the current pregnancy or who previously gave birth to an infant with GBS disease, should receive intrapartum antimicrobial ppx whether currently colonized or not?

Answer 2

True

Question 3

Do you prophylax a woman with GBS colonization who is going for a scheduled c-section and has intact membranes?

Answer 3

No

Question 4

Describe the management of PROM based on gestational age.

Answer 4

Membrane rupture prior to onset of uterine contractions; Preterm PROM (PPROM) occurs at <37W

> 34W and delivery if lung maturity is confirmed –> Deliver
<34W and lung maturity confirmed –> expectant management (ppx abx, corticosteroids, tocolytics

Question 5

How is most pre-E identified in the prenatal period?

Answer 5

Monitoring BPs and proteinuria in later 2nd and 3rd trimesters

Question 6

Which agent is given to a mother with pre-E to prevent seizures?

Answer 6

Magnesium sulfate

Question 7

In DM, the incidence of malformations most closely correlates with what finding?

Answer 7

Degree of hyperglycemia PRIOR to conception

Question 8

What is the simplest screening method for IUGR?

Answer 8

Fundal height measurements

Question 9

Define nonstress testing.

Answer 9

Detecting FHR by external methods and reactivity in response to fetal movements, noting the presence of FHR variability with fetal movement

Question 10

What is the contraction stress test?

Answer 10

Notes changes in FHR in response to bresat stimulation or oxytocin

Question 11

Describe an example of a Category 1 FHR pattern.

Answer 11

FHR 110-160 bpm and good beat-to-beat and baseline variability –> moderate baseline FHR variability of 6-25 bpm and no late or variable decelerations.

Question 12

Maternal fever in association with fetal tachycardia >180bpm should make you suspect what diagnosis?

Answer 12

Chorioamnionitis

Question 13

If fetal scalp stimulation does not give an appropriate response, what should you do next?

Answer 13

Fetal scalp sampling for pH

Question 14

What value of a scalp pH would make you suspect that immediate delivery was necessary?

Answer 14

pH <7.20

Question 15

Define fetal bradycardia.

Answer 15

Baseline HR of <120 bpm

Question 16

What does a FHR less than or equal to 80 bpm signifiy?

Answer 16

Congenital heart abnormalities or myocardial conduction defects –> significant hypoxia

Question 17

What is the likely cause of early decelerations? Late decelerations?

Answer 17

Early: fetal head compression during uterine contractions –> vagal stimulation and slowing of HR

Late: uteroplacental insufficency, “unmasked” by uterine contractions

Question 18

Describe what causes variable decelerations.

Answer 18

Compression of umbilical cord, which initially occludes the umbilical vein resulting in an acceleration.