Prenatal Care/Normal Pregnancy part 2

Question 1

Monozygotic twins

Answer 1

Twins formed by the fertilization of one egg by one sperm

Question 2

Dizygotic twins

Answer 2

Twins formed by the fertilization of two eggs by two sperm

Question 3

Chorionicity

Answer 3

The number of placentas in a twin or higher order gestation; in monozygotic twins, can either be monochorionic or dichorionic. Dizygotic twins are always dichorionic

Question 4

Amnionicity

Answer 4

The number of amniotic sacs in a twin or higher order gestation; monozygotic twins may be monoamniotic or diamniotic whereas dizygotic twins are always diamniotic

Question 5

What is associated with an increased incidence of twinning?

Answer 5

Slowed tubal motility

OCPs can slow tubal motility, so ask a woman if she has used OCPs within 3 mos of becoming pregnant

Question 6

When is there an increase of a twin pregnancy?

Answer 6

Rate increases with maternal age and peaks at 37 yrs
Also increased when the mother is a dizygotic twin
Fertility tx are also responsible for many twin gestations

Question 7

Presentation in multiple gestation

Answer 7

Increased maternal serum alpha fetoprotein
Nausea and vomiting increased more than single gestation
Blood and stroke volume increased more than single gestation
Red cell mass increases proportionately less
Greater increase in size and wt of the uterus

Question 8

Maternal complications in multiple gestation

Answer 8

Preeclampsia
Gestational diabetes
Anemia
DVT
Postpartum hemorrhage
The need for caesarean delivery

Question 9

Fetal complications in multiple gestation

Answer 9

Preterm delivery
IUGR
Polyhydramnios
Stillbirth
Fetal abnormalities
Placenta previa
Abruption
Twin-twin transfusion syndrome

Question 10

Apgar score: appearance

Answer 10

0: blue or pale
1: acrocyanotic
2: completely pink

Question 11

Apgar score: pulse

Answer 11

0: absent
1: <100/minute
2: >100/minute

Question 12

Apgar score: grimace

Answer 12

0: no response
1: grimace
2: cry or active withdrawal

Question 13

Apgar score: activity

Answer 13

0: limp
1: some flexion
2: active motion

Question 14

Apgar score: respirations

Answer 14

0: absent
1: weak cry, hypoventilation
2: good, crying

Question 15

What is the most accurate means to date a pregnancy?

Answer 15

1st trimester transvaginal u/s

Question 16

Initial labs of pregnancy

Answer 16

CBC
Blood type
Rh
Antibody titer
RPR or VDRL
Hep B
Rubella titer
Varicella titer
HIV
HgbA1c if diabetic
Hgb electrophoresis if possibility of sickle cell trait
Offer CF screening

Question 17

What should be done on any new OB pt?

Answer 17

Wet prep

Question 18

Education for pregnant pt

Answer 18

Ok to keep doing almost anything she is USED to doing for physical activity, providing it doesn’t cause extreme temp. Sex OK unless told not to. Many times sex will cause some spotting
Use gloves with cat litter, no raw meat, good handwashing
Small frequent meals work best. Need about 300 extra calories/day in early pregnancy
Avoid unpasteurized milk products and cheeses
Limit tuna, shark, swordfish to 6 oz per wk
No safe amount of alcohol, no smoking
Avoid situations which can cause rise in the core temp

Question 19

What does the triple screen measure?

Answer 19

AFP, beta-hCG, and unconjugated estriol

Question 20

What does the quad screen measure?

Answer 20

Triple screen plus inhibin-A

Question 21

What is one of the number one reasons for false pos triple or quad screen results?

Answer 21

Inaccurate dating of the pregnancy

Question 22

What do high levels of alpha fetoprotein suggest?

Answer 22

The developing baby has a neural tube defect

Question 23

What do low levels of AFP and abnormal levels of hCG and estriol suggest?

Answer 23

May indicate chromosomal abnormality

Question 24

What does elevated inhibin A indicate?

Answer 24

Down syndrome but low with the other trisomies

Question 25

When should an u/s be done to check for anomalies?

Answer 25

Around 20 wks

Question 26

When is glucose screening done?

Answer 26

26-28 wks

Question 27

When should a 3-hr GTT be done?

Answer 27

If >140 or if >130 plus risk factors

Question 28

Normal values of GTT

Answer 28

Fasting: <95 mg/dL 1 hr: <180 mg/dL 2 hr: <155 mg/dL 3 hr: <140 mg/dL

Question 29

Non stress test

Answer 29

Electronic fetal monitoring of fetal heart rate Reactive: baby's heart rate increases when it moves Non-reactive needs prompt further workup

Question 30

Contraction stress test

Answer 30

Evaluates fetal response to contractions

Question 31

Biophysical profile

Answer 31

U/s evaluation of fetal well-being

Question 32

Endocrine changes in pregnancy

Answer 32

Postprandial hyperglycemia ensures adequate glucose for fetus Insulin resistance promotes hyperglycemia Estrogen and progesterone may also have anti-insulin effects Placental lactogen increases tissue resistance to insulin

Question 33

Thyroid changes in pregnancy

Answer 33

Estrogen stimulates increase in thyroid binding globulin formation and increases its 1/2 life, peaking at 20 wks Total T3 and T4 increased TSH low to nl in early pregnancy, normal mid-pregnancy and reduced later

Question 34

Genital tract changes in pregnancy

Answer 34

``` Increased vascularity Increased secretions Softening of the cervix (Goodell's sign) Violet color to vagina (Chadwick's sign) Size of the uterus can compress veins within the abdomen and impede venous return thereby decreasing CO ```

Question 35

Gallbladder changes in pregnancy

Answer 35

``` Impaired contraction High residual volumes Bile of thicker consistency Promotion of stasis and increased likelihood of stone formation Retained bile salts can cause itching ```