Prenatal / Normal pregnancy 2

Question 1

postterm infants

Answer 1

Infants born at > 42 weeks gestation

Question 2

Risk factors for postterm birth

Answer 2

primigravidity, prior postterm pregnancy, maternal obesity, older maternal age, male fetal gender, and certain congenital conditions (e.g., adrenal gland hypoplasia, congenital adrenal hyperplasia, placental sulfatase deficiency)

Question 3

Macrosomia

Answer 3

infant weight > 4,500 grams

Question 4

common finding in post-term neonates

Answer 4

macrosomia

Question 5

Complications associated with macrosomia

Answer 5

prolonged labor, clavicular fracture, brachial plexus palsy, cephalopelvic disproportion, and shoulder dystocia

Question 6

physical findings in post term neonates

Answer 6

Physiological desquamation of the skin may be seen at 1 week of age
Meconium staining
Vernix caseosa and lanugo hair are typically decreased or absent
Dry and parchment-like peeling skin
Loose skin
Scalp hair is increased and the nails are usually long
Alert/Wide eyed appearance

Question 7

Naegele rule

Answer 7

method of dating the pregnancy and helping to calculate the estimated due date

Naegele rule calculates the estimated due date by establishing the last menstrual period, subtracting 3 months, and adding 7 days

Question 8

Limitations of Naegele rule

Answer 8

It assumes a 28-day menstrual cycle with ovulation on day 14

Question 9

when can doppler US detect fetal heart tones

Answer 9

10 weeks

Question 10

initial lab tests at first prenatal visit

Answer 10

A Pap smear should be taken at the initial visit if this has not been performed in the past year
ABO and Rh typing and antibody screen
immunoglobulin testing for varicella and rubella immunity if not otherwise documented
human immunodeficiency virus testing
RPR
Hep B
chlamydial testing for patients under 25 or those over 25 years with risk factors for sexually transmitted infection

Question 11

when is a fetal US first performed

Answer 11

20 weeks

Question 12

Pregnant uterus on PE

Answer 12

typically soft and globular

Question 13

how long does the uterus remain in the pelvis during pregnancy

Answer 13

until about 12 weeks

Question 14

where can the fundus be palpated at 12 weeks

Answer 14

pubic symphysis

Question 15

where can the fundal height be palpated at 20 weeks

Answer 15

umbilicus

Question 16

where can the fundus be palpated at 36 weeks

Answer 16

xiphoid process

Question 17

What factors reduce the diagnostic accuracy of physical exam-based gestational age assessment?

Answer 17

Leiomyoma, obesity, and pregnancies of multiple gestation

Question 18

lab findings in hyperemesis gravidarum

Answer 18

weight loss, dehydration, starvation ketosis, hypochloremic metabolic alkalosis, hypokalemia, and transient liver enzyme elevation

Question 19

in what population is hyperemesis gravidarum MC

Answer 19

multiple fetuses
hydatidiform molar pregnancy
hyperthyroidism

Question 19

tx hyperemesis gravidarum

Answer 19

Hydration and electrolytes should be maintained through parenteral fluids and vitamin supplementation (if hospitalized)
Administer antiemetics

After discharge - eat small meals

Question 19

Common antiemetics for pregnancy

Answer 19

promethazine
metoclopramide
ondansetron

Question 20

at what level can serum tests detect pregnancy

Answer 20

1–2 mIU/mL

Question 21

at what level can urine tests detect pregnancy

Answer 21

20–50 mIU/mL

Question 22

when do hCG values double

Answer 22

every 29–53 hours during the first 30 days following implantation of a normal intrauterine pregnancy

Question 23

hCG levels that are rising slowly suggest

Answer 23

either an ectopic pregnancy or an early embryonic death

Question 24

when are hCG levels useful in estimating fetal gestational age

Answer 24

the first 1 to 3 weeks postconception

Question 25

The range of normal hCG at 8–10 weeks of gestation

Answer 25

5,000 to 150,000 mIU/mL

Question 26

when do hCG levels decline

Answer 26

following 8–10 weeks

Question 27

when do hCG levels plateau

Answer 27

20 weeks

Question 28

hCG levels remain relatively constant between _______ from 20 weeks-term

Answer 28

2,000–50,000 mIU/mL

Question 29

Fetal quickening

Answer 29

the perceived fetal motion by the mother

Question 30

when is fetal quickening first noted - primiparity vs prior pregnancies

Answer 30

It is often first detected in primiparous women at 18–20 weeks gestation. In women with prior pregnancies, fetal quickening can be felt much earlier, as early as 14 weeks gestation

Question 31

Unilateral lower abdominal pain that transpires early in pregnancy is often caused by

Answer 31

round ligament pain

Question 32

leukorrhea

Answer 32

Clear or thick white vaginal secretions

Question 33

when do Braxton hicks contractions usually occur

Answer 33

after 28 weeks

Question 34

What is the Chadwick sign?

Answer 34

bluish discoloration of the vulva, vagina, and cervix that occurs as the result of increased blood flow around 8–12 weeks gestation

Question 35

Hegar sign

Answer 35

characterized by a softening of the uterus

Question 36

Osiander sign

Answer 36

Pulsations felt through the lateral vaginal fornices Occur around 8 weeks Associated w lateral implantation

Question 37

Goodell sign

Answer 37

softening of the cervix occurs around 4-6 weeks

Question 38

Piskacek sign

Answer 38

Asymmetrical enlargement of uterus in case of lateral implantation

Question 39

drugs that are C/I in pregnancy

Answer 39

angiotensin-converting enzyme inhibitors androgens carbamazepine phenytoin valproic acid cyclophosphamide diethylstilbestrol methimazole misoprostol oral retinoids tetracycline thalidomide warfarin methotrexate

Question 40

Ophthalmia neonatorum is also known as

Answer 40

neonatal conjunctivitis

Question 41

when does neonatal conjunctivitis often occur

Answer 41

within 4 weeks of life

Question 42

MC cause of neonatal conjunctivitis

Answer 42

Neisseria gonorrhoeae

Question 43

what can neonatal conjunctivitis ultimately lead to

Answer 43

blindness

Question 44

prevention neonatal conjunctivitis

Answer 44

erythromycin ointment to both eyes within 2 hours of birth

Question 45

Routine procedures for newborns

Answer 45

erythromycin ointment on both eyes within 2 hours of birth vitamin K1 to prevent vitamin K deficiency bleeding hep B vaccine umbilical cord care to prevent infection monitoring for hyperbilirubinemia and hypoglycemia

Question 46

When is ophthalmia neonatorum most likely to appear in a newborn?

Answer 46

2-5 days after birth

Question 47

untreated infections in pregnancy increase the risk of

Answer 47

neonatal infection (e.g., conjunctivitis, pneumonia), preterm birth, low birth weight, and congenital defects

Question 48

should you screen for chlamydia and gonorrhea in pregnancy

Answer 48

Screening for chlamydia and gonorrhea with nucleic acid amplification testing is recommended in all pregnant women < 25 years of age and pregnant women ≥ 25 years of age at increased risk for sexually transmitted infections

Question 49

antibiotic treatment for chlamydia in pregnancy

Answer 49

zithromycin 1 g PO in a single dose

Question 50

antibiotic tx for gonorrhea or both chlamydia and gonorrhea in pregnancy

Answer 50

azithromycin 1 g PO in a single dose and ceftriaxone 500 mg IM in a single dose Patients who weigh ≥ 150 kg should receive ceftriaxone 1 g IM in a single dose

Question 51

should you do a test of cure or repeat testing for chlamydia or gonorrhea

Answer 51

a test of cure is indicated in all pregnant women 3–4 weeks after treatment is completed repeat testing for chlamydia and gonorrhea is recommended 3 months after the test of cure

Question 52

Routine vaccinations during pregnancy

Answer 52

tetanus, diphtheria, acellular pertussis (Tdap) vaccine, and the influenza vaccine

Question 53

when should pregnant person get the flu vaccine

Answer 53

should be given in the first trimester if the patient is pregnant during the flu season,

Question 54

when should pregnant person get Tdap

Answer 54

between 27–36 weeks gestation

Question 55

what additional vaccines can be given in pregnancy but are not given routinely

Answer 55

Pneumococcal pneumonia, meningococcal meningitis, and hepatitis A vaccines may be given as indicated during pregnancy. Patients at high risk for hepatitis B may be given the hepatitis B vaccine during pregnancy

Question 56

what types of vaccines should be avoided in pregnancy

Answer 56

live vaccines

Question 57

examples of live vaccines that should be avoided in pregnancy

Answer 57

measles, mumps, rubella, varicella, yellow fever, smallpox, Bacillus Calmette-Guéerin, the live attenuated influenza vaccine, and the live zoster vaccine

Question 58

pregnancy weight gain: BMI of 18.5–24.9 kg/m2

Answer 58

25–35 lbs over the course of the entire pregnancy

Question 59

pregnancy weight gain: BMI < 18.5 kg/m2

Answer 59

should gain 28–40 lbs during pregnancy

Question 60

pregnancy weight gain: BMI of 25.0–29.9 kg/m2

Answer 60

should gain 15–25 lbs during pregnancy

Question 61

pregnancy weight gain: BMI ≥ 30.0 kg/m2

Answer 61

should gain 11–20 lbs during pregnancy

Question 62

caloric need in second and third trimester

Answer 62

The caloric need of the mother increases by approximately 340 kcal/day in the second trimester and 450 kcal/day in the third trimester

Question 63

protein recs in pregnancy

Answer 63

1.1 g/kg/day

Question 64

carb recs in pregnancy

Answer 64

175 g/day

Question 65

fiber recs in pregnancy

Answer 65

28 g/day

Question 66

micronutrient recommendations during pregnancy

Answer 66

iron 27 mg calcium 1,000 mg vitamin D 600 IU folate 600 mcg iodine 220 mcg

Question 67

adequate intake of what micronutrient can decrease the risk of HTN in pregnancy

Answer 67

calcium

Question 68

folate intake recs for women who have had a previous neural tube defect-affected pregnancy

Answer 68

4,000 mcg of folic acid daily

Question 69

which US is preferred in pregnancy

Answer 69

TVUS

Question 70

when is the gestational sac visible on TVUS

Answer 70

4.5–5 weeks

Question 71

when can the yolk sac be visualized on TVUS

Answer 71

5–6 weeks

Question 72

when is fetal pole with cardiac activity visualized on TVUS

Answer 72

5.5–6 weeks

Question 73

what is the smallest gestational sac size that can be visualized on TVUS

Answer 73

2–3 mm

Question 74

what is the first structure to appear within the gestational sac

Answer 74

yolk sac

Question 75

what confirms intrauterine pregnancy

Answer 75

visualization of the yolk sac

Question 76

when does the yolk sac degrade

Answer 76

between 10-12 weeks

Question 77

In patients with a gestational sac but no yolk sac, what signs increase the likelihood of an intrauterine pregnancy

Answer 77

double decidual sac sign or intradecidual sign Absence of these signs does not exclude intrauterine pregnancy

Question 78

The double decidual sac sign

Answer 78

intrauterine fluid collection surrounded by two concentric echogenic rings, with the inner ring representing the decidua capsularis and the outer ring representing the decidua parietalis

Question 79

The intradecidual sign

Answer 79

intrauterine fluid collection with an echogenic rim located inside a thickened decidua on one side of the uterine cavity and deviation of the central endometrial echo

Question 80

Most accurate assessment of gestational age

Answer 80

measuring the crown-rump length of an embryo with cardiac activity