Duke PA Prenatal Care
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| The only sonogram that is indicated in a normal pregnancy is done at __, it is called the anatomy ultrasound | 18 weeks
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| Two major goals of prenatal care in the last half of pregnancy are diagnosis of __ | Preeclampsia and fetal malpresentation
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| What are the routine examination pieces that are done at each prenatal visit | Measurement of blood pressure, measurement of uterine fundus to assess fetal growth, auscultation of fetal heart tones/assessment of fetal activity, (determination of fetal presentation in the third trimester)
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| What are some safe and common medications used during pregnancy | Acetaminophen, Benadryl, Claritin/Zyrtec, Sudafed (with caution/elevation of BP), Metamucil
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| Two main medications to avoid in pregnancy | NSAIDS, fluoroquinolones
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| In general what antibiotics are safe in pregnancy | Any of the penicillins
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| If the patient is allergic to penicillin what is another antibiotic that can be used during pregnancy | Clindamycin
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| Presumptive symptoms of pregnancy | Amenorrhea, N/V, breast tenderness, fatigue, urinary frequency, quickening, increased basal body temp, chloasma, linea nigra, stretch marks, spider telangiectases
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| When do most women experience quickening | 18-20 weeks primigravidas, 14-16 weeks multigravidas
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| Name the sign: Bluish or purplish discoloration of vagina and cervix | Chadwick’s sign
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| Name the sign: Softening of the uterine isthmus | Hegar’s sign
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| Name the sign: Softening of the cervix | Goodell’s sign
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| Positive manifestations of pregnancy | Fetal heart tones, palpation of fetus, ultrasound of fetus
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| When can fetal heart sounds be heard with Doppler | 10 weeks
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| When can the fetus be palpated | 22 weeks
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| When can you discover cardiac activity on ultrasound of the fetus | 5-6 weeks
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| When can you see limb buds on ultrasound of the fetus | 7-8 weeks
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| When can you see general movement on ultrasound of the fetus | 9-10 weeks
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| Serum pregnancy test can detect pregnancy as early as __ after conception | 1 week
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| When should a serum pregnancy test be done | When question of normal development, ectopic, signs of pregnancy loss, previous loss
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| hCG is produced by the placenta about __ after fertilization | 8 days
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| hCG is detectable __ after conception | 8-11 days
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| hCG doubles every __ | 48 hours
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| when does hCG peak | 10-12 weeks
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| when do hCG levels return to normal after termination or delivery | 21-24 days
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| what does a very rapid increase in hCG indicate | Multiples, or molar pregnancy
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| what does a very slow rising level of hCG indicate | Ectopic or non-viable pregnancy
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| how long does a normal pregnancy last | 280 days, 40 weeks, 10 lunar months, 9 calendar months
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| What is Nagele’s rule | From the date of the last normal menstrual period, subtract 3 months and add 7 days
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| What is the most accurate noninvasive method of finding gestational age | Ultrasound (esp early US); also is most widely used method to determine GA
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| If cardiac activity can be seen by transvaginal ultrasound by 8 weeks there is only a __% risk of pregnancy loss | 3
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| When is a transabdominal ultrasound done | Once uterus above pelvic brim, about 8-12 weeks
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| What is the window of time during which a transabdominal ultrasound can be used to evaluate fetal growth/anatomy | After 16 weeks, before 22 weeks
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| __% of pregnancies are dangerous to the health of the mother and or fetus | 5-20
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| What are some major structural anomalies that can be detected on transabdominal ultrasound | DS markers; 2 vessel cord, neural tube defect, anencephaly, hydrocephaly, cleft lip/palate, diaphragmatic hernia
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| When should prenatal care ideally start | 3 months before conception
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| A pregnant woman can get supine hypotensive syndrome after __ weeks | 20
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| The fundus of the uterus is at the pubic symphysis at __ | 8 weeks
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| The fundus of the uterus is palpable in the abdomen at __ | 12 weeks
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| The fundus of the uterus is at the midpoint between symphysis and umbilicus at __ | 16 weeks
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| The fundus of the uterus is at the umbilicus at __ | 20 weeks
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| When do you start measuring from the symphysis to fundus in centimeters | 26-34 weeks
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| When does fundal height start to decrease (as the head descends) | 36 weeks
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| What is included in the maternal blood tests | CBC, type and screen, RPR (syphilis), Rubella, Hep B, HIV, glucose tolerance test, maternal serum screen
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| When is the maternal serum screen offered | 15-20 weeks
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| What is the purpose of the maternal serum screen | Screen for open neural tube defects (spina bifida, anecephaly) and chromosomal abnormalities (trisomy 21 and 18). If the mother would not do anything different with her pregnancy regardless of results test should not be done
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| When is the 1 hour glucose challenge test done | 26-28 weeks, earlier if at high risk for gestational diabetes (by 24, ideally by 12 wk)
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| When should you check mom for group B strep | 35-37 weeks
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| What do you tell mom to do if she doesn’t feel baby move later in pregnancy | Tell her to drink some juice or water, lay on her left side and feel for movement for one hour. If there is still no movement tell her to come in for evaluation
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| What is the normal fetal heart rate | 110-160
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| What is fetal bradycardia | <110
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| What is fetal tachycardia | >160
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| What is part of the fetal biophysical profile | Non-stress test, fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume
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| What score on the biophysical profile is considered normal | 8-10
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| What score on the biophysical profile is considered abnormal and requires intervention | 4 or less
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| Fetal US: 5-13 weeks, measure: | fetal crown-to-rump length
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| Fetal US: after 13 weeks, measure: | femur length, abdominal circumference and biparietal diameter; after 30 weeks, accuracy decreases
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| Quad screen: diff btw Trisomy 21 & 18 | DS: high hCG/DIA, low AFP/uE3; Edwards: low AFP, hCG, uE3; diff is high hCG in DS
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| GDM RFs | FH, h/o previous stillbirth, h/o macrosomia (>9lbs), prenatal wt >180lbs, advanced maternal age, history of HTN
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| Antenatal visits start: | at 8-12 weeks (unless prior PG loss, fertility tx, or maternal illness)
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| Most widely used test of fetal lung maturity | Fluorescence polarization; direct measure of surfactant concentration
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| erythroblastosis fetalis = | heart failure, edema, ascites & pericardial effusion; d/t RBC destruction exceeding production
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| Screening for Down syndrome can be performed when: | 1st or 2nd trimester; 1st trimester test characteristics are better than those in 2nd trimester only
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| Follow-up antenatal visits detect __% of fetuses with growth abnormality, prevent __% of eclampsia, & uncover __% of breech presentations prior to labor | 50% of growth abnormality, prevent 70% of eclampsia, 80% of breech presentations
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