Uncomplicated Pregnancy

Question 1

What are the trimesters?

Answer 1

Preconception: 12 weeks
1st Trimester: 1-13 weeks
2nd Trimester: 14-26 weeks
3rd Trimester: 27-40+ weeks

Question 2

When to go for your Prenatal Care visits

Answer 2

<28 weeks: q4-6 weeks
28-36 weeks: q2-3 weeks
>36 weeks: q1-2 weeks (cervix examination)

Question 3

What does Prenatal visits consists of?

Answer 3

• BP
• Weight
• Fundal Height
• Urine Dip
• FHR
• Focused Physical Assessment
• Health Teaching
• Psychosocial Assessment
• (If >36 weeks) Vaginal Exam
• GTT (@ 24-28 weeks)
• Maternal Serum, amniocenteses, Chorionic Villus sampling
• GBS screen (@35-37 weeks)
• CBC
• Group screen
• Rubella
• STIs

Question 4

What could an Ultrasound be used for/or why?

Answer 4

• Safe
• Multiple Gestation
• Anatomy and size
• Amniotic Fluid
• Blood Flow from cord
• How old
• Determine EDD @7-10 weeks
• Mandatory @18-22 weeks

Question 5

Subjective Assessment

Answer 5

• Health and medical history
• Pregnancy
• GTPAL
• Current gestation
• EDD
• Issues in current/previous pregnancy
• Review of systems
• Current Medications
• Psychosocial and Cultural Considerations

Question 6

Calculating EDD [Naegele’s Rule]

Answer 6

Obtain first day of LMP
- Subtract 3 months, add 7 days

Question 7

Objective Assessment

Answer 7

• Head to Toe assessment
• Vital Signs
• Fundal Height
• Leopold’s Maneuver
• Lab and Diagnostics Tests

Question 8

At what gestation is the fetus if fundal point is:
- Highest?
- At umbilicus point?
- 2 inches above umbilicus point?

Answer 8

• 36 weeks
• 20 weeks
• 28 weeks

Question 9

What is GTPAL

Answer 9

G: Gravida: # of pregnancies including current
P: Para: # of pregnancies carried to viable age (>20 wks)
T: Term: # of term births (>=37 wks)
P: Premature: # of premature births (20-36^6 wks)
A: Abortion: # of therapeutic or spontaneous (<20wks)
L: # of Living children

Question 10

Leopold’s Maneuvers

Answer 10

1st: Fundal Grip: to assess which part at fundus
2nd: Umbilical Grip: assess side for FHR
3rd: Pawlick’s Grip: to assess presenting part
4th: Pelvic Grip: To check for descended deeply

Question 11

What is Isoimmunization?
And Management

Answer 11

What it is:
Rh- mom and Rh+ incompatibility
Mother creating antibodies against fetus blood
Subsequent pregnancy is at risk
Risk for: Hemolytic disease and anemia: Erythroblastosis fetalis (Jaundice)

Management:
@28 weeks: WinRho (300ug anti D IgG)
Tests:
- Indirect Coomb’s (DAT): sensitized
- Kleihauer-Betke’s: fetal hemoglobin transferred from baby to mom

Question 12

What is the management for WinRho?

Answer 12

Given to Rh- Mom @ 28 wks
Given to women who haven’t been sensitized and have given birth within 72 hours
Isoimmunizaed women are high risk

Question 13

What is the risk for Group B Strep?
And Management?

Answer 13

Vaginal/Rectal Swab @ 35-37 weeks
For Babies:
- If GBS+/Mother was not covered, Monitoring for 48 hours
- Early Onset: < 7days
- Late Onset: >7days
- Risk for: Bacteremia, Meningitis, Persistent Fetal Circulation
- Risks: + prenatal culture, preterm birth, PROM, intrapartum maternal fever, early onset neonatal

Management:
- Pen G (5 mil then 2.5 mil) or Clindamycin
- SROM : start antibiotics and induction at least 4hrs of coverage
- If not covered or GBS+, monitor