Spring 03b: Prenatal Care

Question 1

List the three main components of current prenatal care.

Answer 1

1. Screen for health/socioeconomic conditions
2. Education (for safe birth)
3. Providing therapeutic interventions

Question 2

What are the long term effects of perinatal stress?

Answer 2

Can lead to:

1. preterm delivery
2. poor fetal growth
3. low birth weight
4. infant mortality

Question 3

Preconception care: Peridontal disease is risk factor for (X). It affects (Y)% of pregnant women, more common in patients with:

Answer 3

X = pre-term birth
Y = 40
Low SES

Question 4

T/F: It’s ideal to treat periodontal disease prior to pregnancy, because it’s dangerous to treat during pregnancy (due to anesthesia).

Answer 4

False - it is ideal to treat before pregnancy, but it’s ok to treat during pregnancy too

Question 5

Ratio of 1 in (X) reproductive age women are prescribed potentially teratogenic medication. This is problematic due to the unintended pregnancy rate of (Y)%.

Answer 5

X = 6
Y = 50

Question 6

(X)% of reproductive age women in US are overweight/obese.

Answer 6

X = 50

Question 7

50-70% of neural tube defects can be prevented if Folic Acid is taken (X) (days/weeks/months) (before/after) conception.

Answer 7

X = 3

Months before and 3 months after conception

Question 8

What’s the Folid Acid requirement if woman has no prior pregnancy with NTD?

Answer 8

0.4-1 mg daily

Question 9

What’s the Folid Acid requirement if woman has prior pregnancy with NTD?

Answer 9

4 mg daily

Question 10

Which travel-related diseases would you be concerned about with your pregnant patient?

Answer 10

1. TB
2. Zika
3. Malaria

Question 11

T/F: You should address preconception care for age-appropriate women at every visit.

Answer 11

True

Question 12

T/F: One rationale for prenatal care is to reduce incidence of fetal anomalies.

Answer 12

False - preconception care (prenatal care too late)

Question 13

T/F: Prenatal care has role in screening for perinatal infection/genetic risks.

Answer 13

True

Question 14

T/F: There’s a relationship between adequate prenatal care and risk of preterm delivery.

Answer 14

True

Question 15

The results of a study that explored predictors of preterm birth found that (X) was the culprit.

Answer 15

X = stress

Question 16

At BMC, the most common indication (60%) of preterm births is associated with (X).

Answer 16

X = hypertension

Question 17

A study has shown that preterm births due to HT can be prevented by (X).

Answer 17

X = taking low-dose aspirin

Question 18

Centering pregnancy involves (X) element, which is not included in traditional prenatal care.

Answer 18

X = personal engagement in physical exam monitoring

Question 19

T/F: You’d have a breastfeeding discussion in “centering pregnancy”, but not in traditional prenatal care.

Answer 19

False

Question 20

In 2013 study of most common causes of US deaths, where does medical error fall?

Answer 20

3rd

Question 21

Which element of patient safety does National Patient Safety Foundation consider most critical in 2016?

Answer 21

Patient identification

Question 22

Use of preoperative checklist has been shown to decrease:

Answer 22

Surgical mortality and complications

Question 23

T/F: Preoperative checklist has been shown to shorten surgical time.

Answer 23

False - increases time

Question 24

Medical errors due to communication most common in (X) settings, such as (Y)

Answer 24

X = fast-paced
Y = ICU, Labor/delivery unit, ER

Question 25

What does hierarchy have to do with patient safety?

Answer 25

Analysis of medical errors shows that there's at least one person in room who is aware of error but feels unempowered to speak up

Question 26

Current resident work hour limitations:

Answer 26

80 hours per week (averaged over 2 weeks); no more than 24 hours on duty

Question 27

T/F: Including pharmacists into patient rounds is one solution to errors in safe prescribing.

Answer 27

True

Question 28

List the Hospital National Safety Goals of 2016.

Answer 28

1. ID patients correctly 2. Use meds/alarms safely 3. ID patient safety risks 4. Prevent infections/mistakes in surgery

Question 29

At BMC, we evaluate causes/prevention of error via (X) system. What are the steps?

Answer 29

X = I-PASS 1. Standardized communication 2. Frame communication with "Sender"/"Receiver"of tasks 3. End with contingency plan

Question 30

List the Six Aims of QI.

Answer 30

1. Patient-centered 2. Effective 3. Timely 4. Safe care 5. Efficient 6. Equitable

Question 31

Remember when to implement the tools.. LEAN management is all about (X) and Six Sigma about (Y).

Answer 31

``` X = saving money Y = error reduction ```

Question 32

Understanding, evaluating, using, and engaging with written text to participate in the society, to achieve one’s goals and to develop one’s knowledge and potential.

Answer 32

Literacy

Question 33

T/F: Low literacy is associated with older adults.

Answer 33

True

Question 34

T/F: Low literacy can lead to higher health care costs.

Answer 34

True

Question 35

The degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions.

Answer 35

Health literacy

Question 36

T/F: Low health literacy always overlaps with low literacy.

Answer 36

False

Question 37

The ability to access, use, interpret and communicate mathematical information and ideas, to engage in and manage mathematical demands of a range of situations in adult life.

Answer 37

Numeracy

Question 38

The limited ability to read, speak, write or understand English

Answer 38

Limited English Proficiency

Question 39

(Interpretation/Translation) is conveying the meaning of spoken word from one language to another.

Answer 39

Interpretation

Question 40

(Interpretation/Translation) converting written text from one language to another.

Answer 40

Translation

Question 41

T/F: Patients tend to convey their illiteracy to the physician.

Answer 41

False - may feel shame/stigma

Question 42

T/F: Minor children can never be interpreters for the patient.

Answer 42

False - they legally shouldn't be, but patient has autonomy to refuse interpreter and allow child to interpret

Question 43

T/F: You shouldn't assume a patient speaks English.

Answer 43

True (but it's ok to start encounter in English)

Question 44

What if your patient doesn't want interpreter, but you feel more comfortable having one?

Answer 44

Decision on you - explain to patient that you want to use interpreter to "do good job"

Question 45

Title VI of the Civil Rights Act of 1964 requires recipients of (X) to take reasonable steps to make their programs (Y). Thus, there's a legal requirement to (Z).

Answer 45

``` X = federal financial assistance Y = accessible by persons with LEP Z = provide interpretation ```

Question 46

T/F: Education tends to be a good predictor of health literacy.

Answer 46

False - not necessarily

Question 47

Best way to arrange communication with patient and interpreter is (X) set-up. And physician should direct conversation to (Y).

Answer 47

``` X = triangle; Y = patient directly ```

Question 48

T/F: During interpreter and patient conversation, the physician should avoid chunking information since it may be conveyed improperly.

Answer 48

False

Question 49

T/F: During interpreter and patient conversation, the physician should avoid excess medical terminology.

Answer 49

True

Question 50

T/F: Low health literacy always overlaps with low english proficiency.

Answer 50

False

Question 51

Bulk of US is at which level of proficiency on literacy tasks?

Answer 51

Level 2 or 3 (out of 5)

Question 52

T/F: Years of school that patient has completed tends to be good measure of his/her literacy skills.

Answer 52

False - usually read 3-5 years below completed school year

Question 53

List some tools/advantages available in US hospital birth.

Answer 53

1. Skilled attendants 2. Meds/surgical services 3. Neonatal resuscitation

Question 54

T/F: Per ACA, all qualified health plans must cover maternity care.

Answer 54

True

Question 55

T/F: Costs of care for birth are bundled into global payment for prenatal care and delivery. Post-partum care is separate.

Answer 55

False - post-partum included

Question 56

EMTALA, aka (X), is 1986 Act that states:

Answer 56

X = Emergency Med Treatment and Active Labor Act If patient comes into your L&D/ER in active labor, you must care for them (regardless of their ability to pay); can’t send them to a different hospital

Question 57

(X) serve as middle ground between hospital birth and home births. They're adjacent to hospital and attended by (physicians/nurses/midwives).

Answer 57

X = birth centers | Midwives

Question 58

T/F: At BMC, OBGYN, midwives, and family physicians all collaborate.

Answer 58

True

Question 59

T/F: About half US births are home births.

Answer 59

False - less than 1%

Question 60

T/F: Home births usually more common in minorities and young women.

Answer 60

False - white, older women (not first birth)

Question 61

Give some examples of collaborative care for birth at BMC.

Answer 61

1. Partnering with CHC 2. Centering pregnancy groups 3. Birth sisters

Question 62

C-sections are (higher/lower) today than they used to be. According to WHO, (X)% of births is ideal portion for C-sections.

Answer 62

Higher; | X = 15

Question 63

Risks of C-section

Answer 63

1. Longer hospital stay 2. Increased resp problems in infant 3. Greater complications in subsequent pregnancies

Question 64

List some factors that increase desirable birth outcome.

Answer 64

1. Continuous labor support 2. Access to meds/services 3. Skilled attendance 4. Exclusive breastfeeding for first month

Question 65

T/F: C-section causes increased risk of hemorrhage and transfusion.

Answer 65

False - decreased

Question 66

T/F: C-section causes decreased urinary incontinence in first year after birth.

Answer 66

True

Question 67

Optimal timing: C-section cannot be performed before (X) weeks of pregnancy.

Answer 67

X = 39

Question 68

Optimal time: "preterm" is anytime before (X) weeks. And "post-term" is (Y) weeks.

Answer 68

``` X = 37 Y = 42 ```

Question 69

T/F: Physician would almost never induce labor.

Answer 69

False - at 41 weeks (since "post-term" birth introduces complications)