Prenatal Diagnosis/Care

Question 1

recommended prenatal care schedule

Answer 1

• 4-28 weeks: monthly
• 28-36 weeks: biweekly
• after 36 weeks: weekly
• 38-40 weeks: delivery

Question 2

2 supplements all prenatal women should take

Answer 2

folic acid
prenatal vitamin

Question 3

folic acid recs prior to conception vs for secondary prevention

Answer 3

prior to conception: 0.4 - 0.8 mcg
secondary prevention: 4 mg

Question 4

indications for prenatal Ca supplementation (2)

Answer 4

-high risk for gestional HTN
-low Ca intake

1,200-1,300 mg/day

Question 5

vitamin A should be limited to _ during prenatal period

Answer 5

< 5,000 IU/day

Question 6

full PE should be performed at the first prenatal visit

what should be done at each subsequent prenatal visit (7)

Answer 6

weight
BP
UA
fundal height
fetal heart rate
fetal position
+/- cervical exam

Question 7

pregnancy weight gain recs for obese women

Answer 7

< 15 lb

Question 8

gs (but impractical) test for proteinuria in pregnancy

Answer 8

24 hour protein excretion

Question 9

fetal HR is usually audible by

Answer 9

12 weeks

Question 10

fetal position by palpation can usually be determined at _ weeks

Answer 10

36

Question 11

advanced maternal age

Answer 11

35 yo

Question 12

consideration for advanced maternal age

Answer 12

offer genetic testing

Question 13

expectant date of confinement (EDC) - due date can be calculated using

Answer 13

naegele’s rule:

1st day of LMP + 7 days - 3 mo + 1 year

Question 14

initial prenatal visit should take place _ weeks after LMP

Answer 14

6

Question 15

ACOG defines HTN as

Answer 15

SBP > 140
OR
DBP > 90

Question 16

triple screen

Answer 16

AFP
HCG
estriol

Question 17

quad screen

Answer 17

AFP
HCG
estriol
inhibin A

Question 18

when should corionic villus sampling occur

Answer 18

10-12 weeks (end of 1st trimester)

Question 19

when should amniocentesis occur

Answer 19

15-18 weeks (beginning of 2nd trimester)

Question 20

when should 75 g 2 hour glucose tolerance test be done

Answer 20

26-28 weeks

Question 21

when should group B strep test be done

Answer 21

35-37 weeks

Question 22

estimated gestational age by uterine size schedule

Answer 22

-12 weeks: pubic symphysis
-16 weeks: midway from symphysis to umbilics
-20 weeks: at umbilicus
-20-36 weeks: height in cm above pubic symphysis = weeks gestation

Question 23

prenatal screening tests: first trimester

Answer 23

11-14 weeks:

-US for nuchal transucency
-PAPP-A and hCG
-chronic villus sampling (CVS)

Question 24

elevated levels of PAPP-A and hCG are seen with

Answer 24

chromosomal abnormalities

Question 25

low levels of PAPP-A can be associated w.

Answer 25

Down's syndrome

Question 26

prenatal screening test: 10 weeks

Answer 26

cell free fetal DNA (fetal DNA in maternal blood)

Question 27

what does cell free DNA test for

Answer 27

-trisomies of 13, 18, 21 -if positive -> amniocentesis

Question 28

what does chronic villus sampling test

Answer 28

placental tissue for chromosomal/genetic abnormalities

Question 29

prenatal screening test: 16-18 weeks

Answer 29

quadruple screen

Question 30

elevated AFP indicates

Answer 30

neural tube or abdominal wall defects

Question 31

quad screen indicative of down syndrome

Answer 31

elevated hcg and inhibin PLUS decreased AFP and estradiol

Question 32

quad screen indicative of edwards syndrome

Answer 32

elevated AFP, Hcg, and estradiol

Question 33

prenatal screening test: 15-20 weeks

Answer 33

amniocentesis

Question 34

prenatal screening test: 24-28 weeks

Answer 34

1. 1 hr glucose challenge test 2. if abnormal: glucose tolerance test

Question 35

prenatal screening test: 35-37 weeks

Answer 35

lower genital swab for GBS

Question 36

6 symptoms of pregnancy

Answer 36

amenorrhea increased urinary frequency breast engorgement nausea hyperpigmentation cervical softening

Question 37

urine pregnancy test detects _ (2) and is sensitive starting at _ weeks pregnancy

Answer 37

hCG OR beta subunit 1-2 weeks

Question 38

most accurate method to detect fetal size

Answer 38

US

Question 39

US detection can detect the following at what gestational ages: gestational sac: fetal image: cardiac activity:

Answer 39

gestational sac: 5 weeks fetal image: 6-7 weeks cardiac activity: 8 weeks

Question 40

procedure where small samples of placenta are acquired to perform prenatal genetic analysis

Answer 40

chronic villus sampling

Question 41

5 indications for chronic villus sampling

Answer 41

-maternal age > 35 yo -prior child w. genetic d.o -parents are carriers of genetic d.o -1st trimester US suggestive of congenital anomaly -abnormal aneuploidy screening result

Question 42

2 risks of chronic villus sampling

Answer 42

-maternal alloimmunization -vertical transmission of infxn (ex HIV)

Question 43

2 complications associated w. chronic villus sampling

Answer 43

miscarriage amniotic fluid leakage

Question 44

2 routine 3rd trimester tests

Answer 44

UA BG

Question 45

when should RhoGAM be given if indicated

Answer 45

28-30 weeks

Question 46

mothers w. pre gestational DM should undergo twice weekly non stress testing until delivery between _ weeks

Answer 46

28-32

Question 47

when should cervical chlamydia and gonorrhea cultures be done if indicated

Answer 47

36-40 weeks