Questions with Graded A+
What is the PLLR? - ANSWER-Pregnancy & lactation labeling rule provides the
prescriber w/ relevant information for critical decision-making when treating pregnant
or lactating women
What immunizations can be administered during pregnancy? - ANSWER-Viruses
that are killed or inactivated:
Influenza
TDaP (protects infant from pertussis); given w/ q pregnancy
Which immunizations are contraindicated during pregnancy? - ANSWER-Live
attenuated vaccines; should avoid trying to get pregnant 28 d after vaccine:
Nasal spray influenza
MMR
Varicella
HPV
Pneumococcal polysaccharide (PPSV23)
Pneumococcal conjugate (PCV13)
Meningococcal conjugate (MenACW)
Meningococcal polysaccharide (MPSV4)
Smallpox
When is the TDaP administered during pregnancy? - ANSWER-Between 27-36
weeks; optimizing duration of antibody protection until after birth
Which vaccines can be given under special conditions? - ANSWER-HepB
Inactivated polio
HepA
Yellow fever
What is included in the Women's health assessment? - ANSWER-Complete PX
Past medical Hx
GYN Sx
OB Hx: menstrual, contraceptive, sexual, reproductive & complications
Nutrition
Cultural Hx
Support system
Risk Factors
Complete Genetic Hx
Immunizations
Diagnostics
,What is preventive care during pregnancy? - ANSWER-Nutrition: Maintain avg body
wt for ht
Folic acid (0.4mg/d)
Exercise
Smoking Cessation
What symptoms occur during first trimester (up to 12 weeks) of pregnancy? -
ANSWER-Amenorrhea
N/V
Fatigue
Breast tenderness (first sign)
Urinary frequency
What symptoms occur during second trimester (13-27 weeks)? - ANSWER-Fetal
movement
Abdominal discomfort (round ligament pain)
Cholasma (brown or gray-brown patches on face)
Syncopal episodes
What symptoms occur during third trimester (28-40 weeks)? - ANSWER-Abdominal
growth
Braxton-Hicks
Return of urinary frequency w/descent of presenting part
Increased respiratory effort until descent
What is expected during the first trimester PE? - ANSWER-Softening of cervix
(Goodell's sign)
Cervical cyanosis (Chadwick's Sign)
Softening of cervicouterine junction (Hegar's sign)
Breast enlargement
Fetal heart tones by 10-12 weeks
What is expected during the second trimester PE? - ANSWER-Striae
Fundus palpable at umbilicus @ 20 wks; grows 1 cm/wk
Leopold maneuvers after 20 wks
What is expected during the third trimester PE? - ANSWER-Lightening 3-4 wks prior
to delivery
Loss of mucus plug
Increase Braxton-Hicks
Contractions/rupture of membranes
What diagnostics are done first trimester? - ANSWER-Pregnancy test
CBC
UA
U-Preg
Blood type, Rh, antibody screen
, Rubella titer
Syphilis
Chlamydia
HIV
Hep B
Sickle cell
TB Skin test
Hep C & gonorrhea
Glucose screen if @ risk
Wet prep for Trich, Candida, bacterial vaginitis
PAP
US for dates
Chronic villus sampling (11-14 wks)-Downs Syndrome
TSH
What diagnostics are done during second trimester? - ANSWER-Amnio @15-20 wks
for advanced maternal age & family hx
Triple or Quad screen @16-20 wks:
hCG, Estriol, & AFP
Quad: hCG, Estriol, AFP, & Inhibin-A
US @ 8-20wks
Repeat CBC
When is DM screen done during pregnancy? - ANSWER-24-28 wks if plasma
glucose is >130-140mg/dl after 1hr 50g oral glucose test
CBC is also done
What is considered a positive gestational DM screen during pregnancy? - ANSWER-
100g glucose load w/ glucose values measured fasting @ 1hr, 2hrs, 3hrs
If two or four values abnormal dx made
What diagnostic test are done in third trimester? - ANSWER-RhoGAM for un-
sensitized Rh-Negative @ 28wks
Hgb/Hct @ 28-36 wks
US if warranted
STIs if indicated
Culture for Group A hemolytic Strep
Repeat CBC prn
How often are prenatal visits scheduled? - ANSWER-0-28 wks: q 4 wks
28-36 wks: q 2 wks
36 wks to delivery: q wk
What is Naegele's Rule - ANSWER-First day of LMP - 3 months plus 7 d