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Questions and Answers

A patient with a history of cervical dysplasia is at an increased risk for which of the following complications during pregnancy?

  • Antepartum hemorrhage and ectopic pregnancy
  • Gestational diabetes and preeclampsia
  • Pelvic inflammatory disease and ovarian cysts
  • Cervical incompetence and stenosis (correct)

A patient reports painless vaginal bleeding after 24 weeks of gestation. Which condition should be the primary concern?

  • Ectopic pregnancy
  • Cervical ectropion
  • Threatened abortion
  • Placenta previa (correct)

A patient with a history of hypertension is taking antihypertensive medications during pregnancy. What is the most important consideration regarding her medication?

  • Determining if the medication is safe for use during pregnancy. (correct)
  • Monitoring for allergic reactions.
  • Ensuring the medication does not interfere with iron absorption.
  • Checking the expiration date of the medication.

A patient reports that her 'womb went hard' during an episode of antepartum hemorrhage. What condition does this symptom suggest?

<p>Placental abruption (B)</p> Signup and view all the answers

A patient with a history of previous ectopic pregnancy is counselled about future pregnancies. What is the approximate risk of recurrence?

<p>1 in 10 (A)</p> Signup and view all the answers

When assessing a patient with antepartum hemorrhage (APH), what is the most crucial initial question to ask?

<p>“Was there pain with the bleeding, or was it painless?” (D)</p> Signup and view all the answers

Which element of a patient's history is most relevant when evaluating the cause of antepartum hemorrhage (APH)?

<p>Details of previous blood transfusions. (B)</p> Signup and view all the answers

A patient undergoing treatment for epilepsy is planning a pregnancy. What is the most important consideration regarding her anti-epileptic medication?

<p>Potential teratogenic effects of the medication. (A)</p> Signup and view all the answers

Why is it important to inquire about consanguinity in the patient's marriage during history taking?

<p>To identify potential risks of genetic disorders in offspring. (B)</p> Signup and view all the answers

A patient reports taking small yellow-colored pills. Why is it important to identify these during history taking?

<p>To determine if the patient is taking folic acid supplements. (A)</p> Signup and view all the answers

During history taking, what is the significance of asking a patient if an ultrasound was performed at 6 or 7 weeks gestation?

<p>To confirm the viability of the pregnancy and gestational age. (D)</p> Signup and view all the answers

Why is it important to distinguish between parity and gravidity when taking a patient's obstetric history?

<p>Gravidity indicates total pregnancies, while parity indicates births beyond 24 weeks, offering a comprehensive view of reproductive history. (C)</p> Signup and view all the answers

What information would be most important to gather when a patient reports a history of preterm labor (PTL) in a previous pregnancy?

<p>The gestational age at the time of PTL, interventions used, and outcomes. (D)</p> Signup and view all the answers

During history taking, a patient mentions experiencing burning micturition. Which follow-up question is most relevant?

<p>Do you have any associated symptoms such as frequency, urgency, or hematuria? (B)</p> Signup and view all the answers

A patient reports a previous pregnancy complicated by abruption. What is the most important aspect to investigate regarding this history?

<p>The gestational age at which the abruption occurred, severity, management, and fetal outcome. (A)</p> Signup and view all the answers

Why is it important to ask about exposure to harmful substances during the antenatal period?

<p>To evaluate the risk of teratogenic effects on the developing fetus. (B)</p> Signup and view all the answers

Why is it important to gather information about hereditary illnesses and congenital defects during obstetric care?

<p>To ensure adequate counseling and offer appropriate screening. (C)</p> Signup and view all the answers

A patient presents with a history of thrombophilia. Which of the following is the MOST important implication for their obstetric care?

<p>Increased risk of thromboembolic events during pregnancy. (B)</p> Signup and view all the answers

During an abdominal examination, a healthcare provider notes a dark pigmented line stretching from the xiphisternum to the suprapubic area. What is the MOST likely cause of this observation.

<p>Linea nigra. (D)</p> Signup and view all the answers

A primigravida patient at 30 weeks gestation has a symphysis-fundal height (SFH) of $27 , cm$. What is the MOST appropriate next step?

<p>Schedule a follow-up appointment in two weeks to reassess SFH. (B)</p> Signup and view all the answers

During Leopold's maneuvers, the healthcare provider palpates a fetal head or breech over the pelvic inlet. Which fetal lie is MOST likely?

<p>Longitudinal. (C)</p> Signup and view all the answers

A patient presents with silvery-white stretch marks on her abdomen. How would you document this finding?

<p>Striae albicans. (C)</p> Signup and view all the answers

During an initial prenatal visit, a patient reports a history of domestic violence. What is the MOST appropriate action for the healthcare provider?

<p>Document the disclosure and offer resources and support. (B)</p> Signup and view all the answers

A patient reports a miscarriage at 10 weeks followed by an evacuation (evac) procedure, with no reported post-operative complications. How should this be documented in her obstetrical history?

<p>Ex: 1990, Miscarriage: at 10/52, evac, no post op complications (C)</p> Signup and view all the answers

Which of the following findings during an abdominal examination would be MOST concerning and warrant immediate further investigation?

<p>Sudden, severe abdominal pain accompanied by vaginal bleeding. (D)</p> Signup and view all the answers

Which of the following birth weights would classify a baby as macrosomic?

<p>4.2 kg (A)</p> Signup and view all the answers

During history taking, what specific information should be gathered regarding a patient's menstrual cycle?

<p>Age of menarche, cycle length, and regularity, and duration of bleeding. (C)</p> Signup and view all the answers

A patient's history indicates a C-section was performed at 39 weeks due to antepartum hemorrhage (APH). How should this be correctly documented?

<p>C.S for APH 39/52 (C)</p> Signup and view all the answers

What key details, beyond just the occurrence, should be obtained when taking a patient's history of previous miscarriages?

<p>Gestational age at the time of miscarriage and if there were any post-operative complications. (C)</p> Signup and view all the answers

Why is it important to ask a patient about their contraceptive history, including the date when contraceptives were stopped?

<p>To help assess fertility and potential reasons for difficulty conceiving. (D)</p> Signup and view all the answers

A patient had a cervical smear performed 3 years ago, and you are taking her history now. What steps should you take based on this information?

<p>Inquire about the results of the smear and the reasons it was done and when was it done, and follow up according to guidelines. (C)</p> Signup and view all the answers

What information about a newborn is important to gather during history taking?

<p>The baby's gender, birth weight, and feeding method. (D)</p> Signup and view all the answers

A pregnant woman's fundal height is at the level of the umbilicus. Approximately how many weeks gestation is she?

<p>20 weeks (D)</p> Signup and view all the answers

Which of the following conditions is characterized by spoon-shaped nails?

<p>Koilonychias (D)</p> Signup and view all the answers

During a prenatal examination, a midwife uses the pelvic grip to assess the fetal presentation. What is the midwife trying to determine?

<p>The position of the fetus overlying the pelvic brim (A)</p> Signup and view all the answers

When assessing engagement using the palm width of the hand, what does it mean if five fingers are needed to cover the fetal head above the pelvic brim?

<p>The fetal head is five-fifths palpable. (A)</p> Signup and view all the answers

Why is it important to find the site to auscultate for the baby's heartbeat by noting that 75% of baby's backs are on the left?

<p>The fetal back is on the left more often, making the heartbeat easier to hear (D)</p> Signup and view all the answers

A pregnant woman has a BMI of 17. What potential risk does this indicate?

<p>Increased risk of pregnancy complications (D)</p> Signup and view all the answers

A healthcare provider uses a one-handed technique, a cupped right hand, to assess the lower pole of the uterus. What aspect of the pregnancy is the provider trying to evaluate?

<p>Engagement (B)</p> Signup and view all the answers

In a nulliparous woman, when does engagement typically occur?

<p>Around 37 weeks gestation (A)</p> Signup and view all the answers

During antenatal care, what information can be gained by determining the size, position and number of fibroids?

<p>It informs decisions about the mode and timing of delivery. (B)</p> Signup and view all the answers

Which finding during a routine obstetric examination would warrant further investigation for potential pre-eclampsia?

<p>The presence of pretibial edema. (B)</p> Signup and view all the answers

At which gestation age, can the fetal heart auscultation be performed using a Doppler ultrasound device during a routine antenatal visit?

<p>Approximately 12 weeks' gestation. (C)</p> Signup and view all the answers

Which physical assessment finding would lead you to suspect a breech presentation during a routine antenatal examination?

<p>Fetal heart sounds heard loudest at the level of the maternal umbilicus or above. (A)</p> Signup and view all the answers

A pregnant woman presents with elevated blood pressure, and her urine test reveals protein. What additional assessment should be prioritized?

<p>Examination of the fundi with an ophthalmoscope. (B)</p> Signup and view all the answers

Flashcards

Gravidity

Total number of pregnancies a woman has had, including the current one.

Parity

Number of births a woman has had beyond 24 weeks of gestation.

A (in G P A)

Miscarriages or terminations of pregnancies before 24 weeks gestation, plus ectopic pregnancies.

Abdominal/pelvic pain - key questions

Inquire about site, nature, relation to periods, aggravating and relieving factors.

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Vaginal discharge - characteristics

Amount, color, odor, blood, rash, and pain associated with the discharge.

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Labor/delivery details

Normal vaginal delivery, C-section, prolonged labor, length of labor, and place of delivery.

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Past pregnancy history

Problems during pregnancy, gestational age at time of delivery, pre-eclampsia, miscarriage, preterm labor, congenital abnormality and abruption.

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History of current pregnancy

Was the pregnancy planned and spontaneous? Any exposure to harmful substances?

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Cervical dysplasia risk?

Increased risk for cervical incompetence (weakness) and stenosis.

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Prior ectopic pregnancy risk?

Increases the risk of recurrence to 1 in 10.

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When can APH happen?

After 24 weeks gestation.

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Serious APH causes?

Abruption and Placenta Previa

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APH Pain?

Abruption is usually painful; previa often painless (maybe with a dull ache).

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APH + No fetal movement?

Could indicate abruption.

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APH + Hardening Womb?

Could indicate a contraction.

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Important question in APH?

To rule out placenta previa.

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FTND

Full Term Normal Delivery; indicates a vaginal birth without complications.

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Bleeding per vaginum

Bleeding from the vagina during pregnancy.

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Antepartum Hemorrhage (APH)

Bleeding from the vagina during pregnancy after 20 weeks gestation but before labor.

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Menarche

The age when a female experiences her first menstrual period.

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Cervical Smear (PAP Smear)

A test to screen for abnormal cervical cells.

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Macrosomic

Too large; A baby whose weight is greater than 4kg at birth (8lb 13oz).

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Puerperium

The period after childbirth when the mother's body returns to its pre-pregnancy state.

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D&E

Dilation and Evacuation; A surgical procedure involving dilation of the cervix and removal of uterine contents.

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Anemia

Pale skin, often indicating low red blood cell count.

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Jaundice

Yellowing of the skin and eyes, indicating liver issues.

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Cyanosis

Bluish discoloration of the skin, indicating low oxygen levels.

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Dehydration

Condition where the body lacks sufficient fluids.

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Edema

Swelling caused by fluid accumulation in body tissues.

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Koilonychias

Abnormal curving of the nails, often indicating underlying medical conditions.

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Engagement (pelvic grip)

Estimating how far the fetal head has descended into the pelvis.

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Symphysis-Fundal Height

Uterine size measurement from the pubic bone to the top of the uterus.

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Amniotic Fluid Assessment

Assessment of amniotic fluid involves abdominal palpation to determine ease of fetal part palpation.

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Fetal Heart Auscultation

Listening to the fetal heart using doppler (from 12 weeks) or fetal stethoscope (from 24 weeks). Rate and rhythm monitored for 1 minute.

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Vaginal Examination in Obstetrics

Not routine, but used to check for ruptured membranes or onset of labor.

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Assessing Hypertension/Pre-eclampsia

Monitor blood pressure and urine protein. Check for oedema, fundal changes and pulmonary oedema.

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Fetal Heart Location - Breech

In breech presentations, the fetal heart is often heard at or above the maternal umbilicus.

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Hereditary/congenital history

Illnesses or defects passed down through families.

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Importance of history

Ensures appropriate advice and testing are provided.

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Linea Nigra

Dark line on the abdomen during pregnancy.

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Striae Gravidarum/Albicans

Stretch marks, purplish when recent, silvery-white when old.

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Symphysis-Fundal Height (SFH)

Height measured from the top of the pubic bone to the top of the uterus, in cm after 25 weeks.

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Leopold's Maneuvers

Systematic palpation of the maternal abdomen to determine fetal position.

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Fetal Lie

Relationship of the fetal spine to the mother's spine: longitudinal, transverse, or oblique.

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Longitudinal Lie

Fetal head or breech felt over the pelvic inlet.

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Study Notes

  • The notes below are a great study guide, covering all topics from history taking, to abdominal examinations

History Taking

  • The patient's name, age, occupation (as well as her husband's), address, and time since marriage are important details
  • Note any consanguinity in the marriage
  • Note blood group, Rh factor, and the date and time of admission
  • Gravidity refers to the total number of pregnancies, inclusive of the current one
  • Parity refers to the number of births beyond 24 weeks of gestation
  • A is the number of miscarriages or terminations of pregnancies before 24 weeks gestation and ectopic pregnancies
  • Reason for coming in today
  • Any complaints, when they occurred and how long they lasted are all important
  • Note all investigations or treatments already received

Systemic Review and Current Pregnancy

  • A systemic review includes CNS, CVS, respiratory system, GIT, and the urinary system
  • Determine if the pregnancy was planned and/or spontaneous
  • How did she know she was pregnant
  • How was the pregnancy confirmed

History of the First Trimester

  • Note and record any obstetrical or medical events
  • Examples include nausea, vomiting, and/or bleeding
  • Ask about: Abdominal/pelvic/back pain; Site, Nature, Relation to periods, Aggravating and relieving factors, Burning micturition
  • Inquire about vaginal discharge: Amount, color, odor, blood, rash, or pain
  • Was an ultrasound performed around 6 or 7 weeks
  • Ask about: using folic acid tablets, antenatal period before pregnancy, exposure to any harmful substances, getting vaccinated, abdominal pain, contractions, lost fluid or blood from your vagina,
  • Inquire about: the results of all antenatal blood tests (routine and specific), any problems in antenatal care so far, or if this is a low/high-risk pregnancy

Past Obstetric History

  • Inquire about pregnancy Hx of present pregnancy (any problems during pregnancy, GA at time of delivery), e.g PE, miscarriage, PTL (preterm labor), and congenital abnormality Note: Labour/delivery history (Normal vaginal delivery, C-section, Labor- Normal, Prolonged, Length of labor, Place of delivery, at home or at the hospital and/or any other complications?)
  • Inquire about: Puerperium complications, baby gender, birth weight, age and feeding type

Past Operations and Gynecology

  • Post Op complications examples include 1990, Miscarriage at 10/52, evac, no post op complications or 1992, Miscarriage at 22/52, D&E, no post op complications
  • Obtain a gynecological History
  • Ask about: Menstrual history, Menarche age, pattern of periods, cycle length, period length and contraceptive history
  • Inquire about: Cervical smear (PAP smear, liquid bas cytology), any previous gynecological operations/conditions
  • Note any treatment for cervical changes
  • Knife cone biopsy (performed when there are abnormal cervical cells e.g. Cervical dysplasia has the potential to lead to cervical incompetence
  • Ask about: previous episodes of pelvic inflammatory disease, a previous ectopic pregnancy (increases recurrence risk to 1 in 10), recurrent miscarriage or pelvic masses

Medical, Drug, Family and Social History

  • Ask about: medical conditions (Details of any previous surgery or Blood Transfusion), current medications, drug allergies (iron tablets, folic acid, Vitamins) Ask for details on: antihypertensive, diabetic, anti-epileptic and thyroid medications issues
  • Note any family history of hereditary illnesses or congenital defects
  • Inquire about: history of breast cancer, ovarian cancer, uterine cancer, history of HTN, Diabetes and/or Familial disorders such as thrombophilia's.
  • Ask about: unemployed partners, living status, family members and domestic violence
  • Obtain personal history as to the use of: smoking, illicit drugs and or alcohol.

Special Situations and Abdominal Examination

  • Note any instances of antepartum haemorrhage (APH)
  • Differentiate a serious APH (abruption, placenta praevia) from local causes of bleeding
  • Did the baby stop moving with the bleeding
  • Remember that: abruption is more dangerous to the foetus, and praevia more dangerous to the mother
  • In abdominal examination, note apparent size and asymmetry of the abdominal distension, foetal movements and Linea nigra

Physical Examination

  • Note: striae gravidarum, flattening/eversion of umbilicus, suerficial veins and surgical scars
  • Always note patients: appearance (ill/well, obese/thin (body weight), anxious or depressed), anemia, jaundice, cyanosis, edema and clubbing
  • Monitor: BMI, vital signs, thyroid gland, breast (exclude any lumps) and auscultation of the heart and lungs
  • Assess normal uterine size to understand the level of gestation
  • Take note: of the symphysis-fundal height

Leopold's Maneuvers and Palpations

  • Use fundal grip to determine fetal lie
  • Record if Longitudinal-fetal head or breech is palpable over pelvic inlet or a Transverse positions with fetal poles felt in flanks
  • Most baby's backs are on the left which the baby needs to be placed for measuring heartbeat
  • Presentation assessment notes: Cephalic, Breech, Other(shoulder, compound).
  • In engagement the diameter of the presenting part beyond the pelvic inlet estimated with hand
  • Note if the baby shows as engaged by the 37th week

Palpation

  • If the head is only two-fifths palpable it is usally considered to be engaged
  • Compact abdomen with fetal parts easily palpable
  • Place stethoscope at the anterior shoulder.

Auscultation and Other Examinations

  • Fetal heart best heard at the anterior shoulder of fetus using a doppler from 12 weeks' gestation or a Pinard-stethoscope from 24 weeks gestation
  • Vaginal Examination using digital examination is only needed: to diagnose rupture of membranes or onset of labor
  • Check blood pressure, urine and limbs for hypertensive changes.
  • Be aware and check for pretibial/sacral oedema

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