Prenatal care - Hx, PE and Dx

Question 1

System for measuring prenatal care adequacy

Answer 1

Kessner index

Question 2

Time frame for the three trimesters

Answer 2

• First – first 14 weeks
• Second – through 28 weeks
• Third – 29^th to 42^nd week

Note: 3 periods of 14 weeks each

Question 3

Frequency of prenatal check-up

Answer 3

• Monthly until 28 weeks (1^st two trimesters)
• Every 2 weeks until 36 weeks
• Weekly > 36 weeks (near term)

Question 4

Initial prenatal work-up

Answer 4

• CBC
• Blood typing
• Urine culture
• OGTT
• HBsAg
• RPR
• Pap smear
• Rubella IgG
• Biometry
• BPP

Question 5

75 g OGTT is best done when? Why?

Answer 5

• When
  
  • At 24-28 weeks
• Why
  
  • HPL is produced at this time which causes insulin resistance, lipolysis and increased fatty acids

Question 6

UTZ work-up schedule

Answer 6

• < 12 weeks
  
  • TVS
• 12 to 28 weeks
  
  • Biometry
• 28 to 34 weeks
  
  • Biometry, BPP
• > 34 weeks
  
  • Biometry, BPP, NST (closed cervix), IPM (open cervix)

Question 7

10 danger signs of pregnancy

Answer 7

1. Headache
2. Blurring of vision
3. Prolonged vomiting
4. Epigastric pain
5. Nondependent edema
6. Fever
7. Dysuria
8. Watery discharge
9. Blood discharge
10. Decreased fetal movement

Question 8

T/F. Twin gestation count as 2 parity

Answer 8

• False
  
  • Count multiples as 1 parity, but TPAL is affected

Question 9

T/F. Stillbirths is counted as parity

Answer 9

True

Question 10

T/F. Twin abortion is counted as 1 A in TPAL

Answer 10

True

Question 11

Women with complicated pregnancies often require return visits at ___ intervals.

Answer 11

1- to 2-week

Question 12

What if OGTT finding is elevated? What if normal?

Answer 12

• One positive, take note of the level (manage)
• If negative, repeat at 28 and 32 weeks

Question 13

Timing for the following tests

• Fetal aneuploidy screening
• Serum screening for neural-tube defects
• Vaginal and rectal GBS cultures

Answer 13

• Fetal aneuploidy screening
  
  • 11 to 14 weeks and/or at 15 to 20 weeks
• Serum screening for neural-tube defects
  
  • 15 to 20 weeks
• Vaginal and rectal GBS cultures
  
  • 35 to 37 weeks

Question 14

Source of swab for GBS

Answer 14

Rectovaginal

Question 15

In DM, laboratory testing between ___ is the most sensitive approach

Answer 15

24 to 28 weeks

Question 16

Age

• Young primigravida
• Elderly primigravida

Answer 16

• Young primigravida
  
  • ≤ 17 y/o
• Elderly primigravida
  
  • ≥ 35 y/o

Question 17

High risk pregnancy patients

Answer 17

• Extreme of age
• Pregnant with medical complications
• Poor OB history
• Placenta previa
• Pregnant with gynecologic tumors
• Pregnant with coexisting trophoblastic disease or had trophoblastic disease within the last year
• Patients with problems with fetal aging, structure, and size
• Poly- or oligohydramnios

Question 18

Who are considered to have poor OB history?

Answer 18

• 2 consecutive abortions
• 3 or more repeated abortions
• History of preterm delivery
• History of term/preterm fetal death in utero
• History of term/preterm neonatal death
• Previous baby with congenital anomaly

Question 19

Smoking increases risk for:

Answer 19

1. Placenta previa
2. Abruptio placenta
3. PROM
4. Preterm delivery
5. SGA neonate
6. Spontaneous abortion
7. Fetal death
8. Fetal anomalies

Question 20

Illicit drug increases risk for:

Answer 20

1. IUGR
2. SGA

Question 21

Partner violence increases risk for:

Answer 21

1. Preterm delivery
2. IUGR
3. Perinatal death

Question 22

Leopolds maneuver grips

Answer 22

• L1 - Fundal grip
• L2 - Umbilical grip
• L3 - Pawlick’s grip
• L4 - Pelvic grip
• Memory aid:*
• FUPP

Question 23

The uterus becomes an abdominal organ at what AOG?

Answer 23

12 weeks

Question 24

Fundal grip findings

Answer 24

• What fetal pole occupies the fundus?
  
  • Irregular. nodular
    
    • Feet (cephalic presentation)
  • Hard, round, ballotable, mobile
    
    • Head (breech presentation)

Question 25

Umbilical grip findings

Answer 25

• On which side is the back?
  
  • Linear, convex, bony ridge
    
    • Back
  • Numerous nodulation
    
    • Extremities

Question 26

Pawlick’s grip findings

Answer 26

• What fetal part lies above the pelvic inlet?
  
  • Head engaged
    
    • Feel shoulder, fixed, knob-like
  • Head not engaged
    
    • Feel round, ballotable mass

Question 27

Pelvic grip findings

Answer 27

• On which side is the cephalic prominence?
  
  • Opposite side as the back
    
    • Head is flexed
  • Same side as the back
    
    • Head is extended
• Engaged or not
  
  • Engage if hands are parallel and does not meet
  • Not engaged if hands converge

Question 28

Tdap vaccine

• Route
• Dose
• When given

Answer 28

• Route
  
  • IM
• Dose
  
  • 3 doses at 0, 1 and 6–12 months plus booster every 10 years or once per pregnancy
• When given
  
  • Between 27–36 weeks

Question 29

Influenza vaccine

• Route
• Dose
• When given

Answer 29

• Route
  
  • IM
• Dose
  
  • Once a year
• When given
  
  • preferably between February to June

Question 30

Hepatitis B vaccine

• Route
• Dose
• When given

Answer 30

• Route
  
  • IM
• Dose
  
  • 3 doses
• When given
  
  • 0, 1 and 6 months

Question 31

Safe or contraindicated?

• Rabies
• MMRV
• Meningococcus
• Varicella
• HPV
• Pneumococcus
• Hepatitis A

Answer 31

• Rabies
  
  • Safe
• MMRV
  
  • Contraindicated
• Meningococcus
  
  • Safe (given in outbreak)
• Varicella
  
  • Ig (post-exposure)
• HPV
  
  • Contrainficated
• Pneumococcus
  
  • If asplenic or with cardiac disease
• Hepatitis A
  
  • Pre- or post-exposure