3- Obstetric Anamnesis and Examination quiz
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Questions and Answers

What should genetic screening for conditions like SMA and CF prioritize?

  • Pregnant women regardless of risk factors
  • General population without consideration of ethnicity
  • Susceptible subgroups within the population (correct)
  • Only adolescents under the age of 20

    • Which of the following complications is NOT associated with increased maternal age?

  • Preeclampsia
  • Placenta accreta
  • Stillbirth
  • Maternal malnutrition (correct)

    • Why should both first- and second-trimester screenings not be ordered independently during a pregnancy?

  • It is irrelevant and does not provide additional information
  • It results in unacceptably high false-positive rates (correct)
  • It increases maternal anxiety unnecessarily
  • It leads to a lower detection rate for fetal anomalies

    • In the context of gravidity and parity, what does 'abortus' refer to?

    <p>The number of pregnancy losses before 20 weeks</p> Signup and view all the answers

    How is the estimated duration of pregnancy calculated from the date of fertilization?

    <p>267 days</p> Signup and view all the answers

    Which methodology is categorized as a screening test rather than a definitive test for aneuploidy?

    <p>Cell-free DNA sequencing</p> Signup and view all the answers

    What is the sum of parity and abortus equivalent to?

    <p>Gravida</p> Signup and view all the answers

    What is the correct order of calculations for estimating the estimated delivery date (EDD) based on Naegele's Rule?

    <p>Add 7 days, subtract 3 months, add 1 year</p> Signup and view all the answers

    At how many weeks gestation should the initial routine prenatal visit ideally occur?

    <p>6 to 8 weeks</p> Signup and view all the answers

    What does the McDonald Formula estimate during the second and third trimesters?

    <p>Gestational week</p> Signup and view all the answers

    What is the recommended frequency for prenatal follow-up visits from 28 weeks to 36 weeks gestation?

    <p>Every 2 weeks</p> Signup and view all the answers

    Which of the following measurements indicates that the fundal height is at the level of the umbilicus?

    <p>24 weeks</p> Signup and view all the answers

    What distinguishes the presence of a yolk sac from a pseudosac during an ultrasound?

    <p>Visualization of the yolk sac</p> Signup and view all the answers

    If there is a discrepancy of more than 5 days between the crown-rump length (CRL) measurement and the last menstrual period (LMP), what should be prioritized?

    <p>Crown-rump length measurement</p> Signup and view all the answers

    What is the purpose of laboratory testing during prenatal evaluation?

    <p>To assess maternal health</p> Signup and view all the answers

    Which measurement indicates that the fundal height is four fingers above the umbilicus?

    <p>30 weeks</p> Signup and view all the answers

    What is the purpose of measuring Rh(D) antibody levels at the initial prenatal visit?

    <p>To assess the risk of developing erythroblastosis fetalis</p> Signup and view all the answers

    What event is indicated by proteinuria after 20 weeks of gestation?

    <p>Preeclampsia</p> Signup and view all the answers

    Which factor would warrant screening for gestational diabetes in the 1st trimester?

    <p>A previous macrosomic neonate</p> Signup and view all the answers

    At what gestational weeks is routine screening for gestational diabetes typically performed?

    <p>24 to 28 weeks</p> Signup and view all the answers

    What is the significance of a family history of diabetes in a 1st-degree relative when considering gestational diabetes?

    <p>It indicates a need for early screening</p> Signup and view all the answers

    What proactive measure is given to Rh-negative women to minimize the risk of developing antibodies?

    <p>Prophylactic dose of Rh(D) immune globulin</p> Signup and view all the answers

    Which of the following is a symptom that suggests kidney disease when observed in early pregnancy?

    <p>Proteinuria before 20 weeks gestation</p> Signup and view all the answers

    What is the threshold weight for a neonate that indicates a potential risk factor for gestational diabetes?

    <p>4500 g</p> Signup and view all the answers

    When is it appropriate to repeat screening tests for gestational diabetes after an initial normal result?

    <p>At 24 to 28 weeks</p> Signup and view all the answers

    Which of the following statements regarding the risks of vaccination during pregnancy is true?

    <p>No evidence exists of risk to the fetus from inactivated virus or bacterial vaccines.</p> Signup and view all the answers

    When is it recommended for pregnant women to receive the Tdap vaccine?

    <p>At any time during pregnancy, preferably between 27 and 36 weeks.</p> Signup and view all the answers

    Which vaccines are generally contraindicated during pregnancy?

    <p>Live influenza vaccine and varicella vaccine.</p> Signup and view all the answers

    What is the recommended timeframe for getting the flu vaccine during pregnancy?

    <p>At any time during the flu season.</p> Signup and view all the answers

    Which of the following vaccines should not be given to pregnant women unless clearly needed?

    <p>Live nasal flu vaccine.</p> Signup and view all the answers

    What is the purpose of measuring Rh(D) antibody levels at 26-28 weeks in Rh-negative women?

    <p>To evaluate the risk of Rh incompatibility.</p> Signup and view all the answers

    Which of the following conditions requires cervical cultures to be repeated at 36 weeks?

    <p>High risk for gonorrhea and chlamydial infection.</p> Signup and view all the answers

    What is the ideal time frame for conducting pelvic ultrasonography during pregnancy?

    <p>18-22 weeks.</p> Signup and view all the answers

    What is indicated by a sensitivity of 79-87% in the context of dual screening?

    <p>Effectiveness in anomaly detection.</p> Signup and view all the answers

    Which of the following lab tests are ideally included during the first visit?

    <p>CBC, Ferritin, and Biochemistry tests.</p> Signup and view all the answers

    What is the recommended glucose load for the Oral Glucose Tolerance Test (OGTT) between 24-28 weeks?

    <p>75 grams.</p> Signup and view all the answers

    What type of examination should be performed to assess edema and breast health during follow-up?

    <p>Pelvic evaluation.</p> Signup and view all the answers

    Which vaccination is specifically mentioned for administration if not already given during pregnancy?

    <p>Tetanus immunization.</p> Signup and view all the answers

    What is the limitation mentioned regarding ultrasound anomaly detection?

    <p>It can only identify certain types of anomalies.</p> Signup and view all the answers

    What key counseling information should be provided at the fourth visit?

    <p>Breastfeeding and postpartum family planning.</p> Signup and view all the answers

    Study Notes

    Obstetric Anamnesis and Examination

    • Obstetric anamnesis and examination are important for minimizing maternal and infant deaths.
    • Maintaining maternal and fetal health.
    • Identifying risky pregnancies.
    • Preventing pregnancy complications.
    • Achieving early intervention.
    • Detecting smoking, alcohol use, and domestic violence.

    Etymology of Obstetrics

    • Science of midwifery.
    • Department of medicine.
    • Deals with treatment and care of women during pregnancy and childbirth.
    • Date of terminology: 1819
    • Midwife: with woman

    Antenatal Care

    • Important process to minimize maternal and infant deaths.
    • Maintaining maternal and fetal health.
    • Identifying risky pregnancies.
    • Preventing pregnancy complications.
    • Early intervention for risk factors.
    • Detecting smoking, alcohol use, and domestic violence during pregnancy.
    • Evidence-based knowledge, skills, and practices of health professionals to improve the quality of care increase awareness in care.
    • Standardization and reduce medical errors and unnecessary practices.

    Prenatal Care Purpose

    • Confirming pregnancy.
    • Determining health status of pregnant woman and fetus.
    • Determining gestational age and monitoring development.
    • Detecting risky pregnancies and taking precautions.
    • Creating an obstetric care plan.
    • Pregnant education and counseling.

    High Risk Pregnancy

    • Pregnancy complicated by a disease/disorder that endangers life or affects health.
    • Mother, fetus, and/or newborn can be affected.
    • Identification of high-risk patients is crucial for life-saving benefits.

    High Risk Pregnancy Factors

    • Poor obstetric history (recurrent miscarriages/preterm deliveries).
    • Heart disease.
    • Hypertension or preeclampsia (essential, renal or pregnancy-induced).
    • Diabetes (IDDM/NIDDM).
    • Multiple gestations.
    • Placenta previa/abruption.
    • Threatened preterm labor.
    • Cervical insufficiency.
    • Abnormal placentation(accreta, increta, percreta).
    • Anemia: Hemolytic, megaloblastic, thalassemia.
    • Bleeding disorders
    • Thrombosis/thrombophilia
    • Antiphospholipid syndrome (APS).
    • Neurological disease (epilepsy, brain hemorrhage, or tumor).
    • Malignancy (cervical, ovarian, or breast).
    • Transplant patient's pregnancy.
    • Fibroid uterus.
    • Fetal congenital malformations.

    Causes of Death in Pregnant Women

    • 28% - Pre-existing medical conditions exacerbated by pregnancy (diabetes, malaria, HIV, obesity).
    • 27% - Severe bleeding.
    • 14% - Pregnancy-induced high blood pressure (preeclampsia).
    • 11% - Infections.
    • 3% - Blood clots.
    • 8% - Abortion complications.
    • 9% - Obstructed labor and other direct causes.

    Initial Visit: History Taking

    • Personal history.
    • Medical history.
    • Obstetrical history.
    • Current pregnancy.

    Initial Visit: Physical Examination

    • Physical examination of the pregnant woman.
    • Check specific areas (including but not limited to: thyroid, heart, lungs, breasts, abdomen, extremities, and optic fundus, and ankles for edema).

    Initial Visit: Lab

    • Immunization and drug support.
    • Information and consultancy.
    • Pregnancy-related complaints.
    • General evaluation

    Initial Visit: Full Medical History

    • Previous and current disorders.
    • Drug use (therapeutic, social, and illicit).
    • Risk factors of pregnancy complications.
    • Obstetrical history.
    • Maternal/fetal complications (gestational diabetes, preeclampsia, congenital malformations, stillbirth).

    Past Medical History

    • Chronic hypertension.
    • Diabetes mellitus.
    • Thromboembolic disease.
    • Thyroid disorders.
    • Cardiac disease.
    • Renal disease.
    • Pulmonary disease (asthma, sarcoidosis).
    • Connective tissue disorders.
    • Maternal cancer.
    • Epilepsy.
    • Blood disorders (anemia, coagulopathy, hemoglobinopathy).
    • Psychiatric disorders

    Family History

    • Tay-Sachs disease.
    • Cystic fibrosis.
    • Sickle cell disease.
    • Thromboembolism.
    • Birth defects (particularly cardiac anomalies).
    • Medical history of first-degree relatives.
    • Diabetes

    Ethnic Background

    • Population screening for genetic diseases.
    • Effective cost-wise screening targeting particular ethnic groups susceptible to genetic diseases.
    • Screening for carriers of genetic diseases in susceptible subgroups.

    Diseases and Risk Groups

    • Table listing diseases (Alpha thalassemia, Beta thalassemia, Bloom’s syndrome, etc.) and populations at increased risk (Chinese, Southeast Asians, etc.) for each disease.
    • Testing method for each disease listed.
    • Method of testing includes CBC, Hemoglobin electrophoresis, Mutation analysis, Enzyme and mutation analysis .

    Maternal Age

    • Adolescents are at increased risk for preeclampsia-eclampsia, intrauterine growth restriction, and maternal malnutrition.
    • Women of increasing age are at increased risk for preeclampsia, diabetes, obesity, cesarean section, stillbirth, placenta accreta, and fetal aneuploidy.

    Fetal Aneuploidy Screening

    • Maternal age of 35 is no longer a cutoff for screening.
    • Patient counseling and options evaluation.
    • Maternal serum screening should occur.
    • First- and second-trimester screens should not be ordered independently.
    • Cell-free DNA in maternal blood for screening aneuploidy through sequencing and quantifying DNA chromosome fragments proportions.

    Gravidity and Parity

    • Gravidity is the number of confirmed pregnancies.
    • Parity is the number of deliveries after 20 weeks.
    • Muti-fetal pregnancy counts as one delivery.
    • Abortus is the number of pregnancy losses before 20 weeks.
    • Sum of parity and abortus equals gravidity.

    Calculating Estimated Delivery Date

    • Pregnancy lasts 10 lunar months or 280 days (average) .
    • Nagele's rule to calculate estimated delivery date (EDD) is used, adding 7 days to the first day of the last menstrual cycle, and subtracting three months from that date.
    • The rule gives year + 1.

    Fundal Height

    • Measuring symphysis pubis to fundus gives gestational week (cm x 8 / 7 = gestational week)
    • The fundus height is used to understand which fetal part is at the fundus during the second and third trimester
    • Fetal position and size are studied during second and third trimesters using the height of the fundus.

    Initial Routine Prenatal Visit

    • Occurs between 6 and 8 weeks gestation.
    • Follow-up visits: ~4 weeks until 28 weeks, ~2 weeks from 28 to 36 weeks, and weekly thereafter until delivery.
    • Visits may be more or less frequent depending on risk factors.

    Initial Visit: Definitive Diagnosis

    • Definitive diagnosis of pregnancy needed.
    • First transvaginal ultrasound (USG) for visualization.
    • β-hCG measurement if no visualization of gestational sac.
    • Gestational sac size bigger than 20 mm suggests anembryonic pregnancy.
    • Yolk sac presence differentiates the gestational sac from pseudosaic .
    • Ectopic pregnancy excluded

    Laboratory Testing

    • Prenatal evaluation involves testing urine and blood.
    • Repeats during follow-ups.
    • Rh-negative women and Rh-positive fathers at risk of Rh-disease.
    • Prophylactic doses of Rh(D) immune globulin may be necessary.
    • Urine tests for proteinuria (before/after 20 weeks).
    • Gestational diabetes screening (between 24 and 28 weeks with 50-g, 1-hour glucose tolerance test).
    • Thyroid disorders screening (TSH) in all trimesters.

    Risk Factors for Gestational Diabetes

    • Diagnosis factors include:
      • Gestational diabetes or macrosomic neonate (weight > 4500 g at birth) in a previous pregnancy.
      • Unexplained fetal losses
      • Strong family history of diabetes in first-degree relatives
      • History of persistent glucosuria
      • Body mass index (BMI) > 30 kg/m2
      • Polycystic ovary syndrome with insulin resistance

    Screening for Thyroid Disorders

    • Thyroid-stimulating hormone (TSH) measurement in all trimesters.
    • Risk factors for thyroid disorders:
      • Symptoms
      • Moderate to severe iodine insufficiency in an area
      • Family or personal history of thyroid disorders
      • Type 1 diabetes
      • Infertility, preterm delivery, or miscarriage history
      • Head/neck radiation therapy
      • Morbid obesity (BMI > 40 kg/m2)
      • Age > 30 years

    Initial Visit: Physical Examination

    • Height and weight measurement.
    • Blood pressure (BP) measurement.
    • Examination of thyroid, heart, lungs, breasts, abdomen, extremities and optic fundus, checking for edema.
    • Pelvic exam for determining pelvic capacity, uterus size, and fetal position..
    • Fetal heart sounds evaluation.

    Laboratory Tests

    • Complete blood count (CBC).
    • Thyroid function tests (TFT).
    • Blood typing and Rh(D) antibody level.
    • Hepatitis B serologic test.
    • HIV test.
    • Toxoplasmosis, cytomegalovirus (CMV), and varicella immunity tests.
    • Serologic test for syphilis.
    • Cervical cultures (gonorrhea and chlamydia).
    • Papanicolaou (Pap) test.
    • Urine culture.
    • Urine protein and glucose determination.
    • Tuberculosis (TB) screening (if at risk).
    • Genetic screening (including first-trimester screening for aneuploidy).

    Vaccination During Pregnancy

    • Risks to the fetus are theoretical from maternal vaccination; minimal evidence exists of risks.

    • Inactivated viral and bacterial vaccines/toxoids are safe.

    • Live-attenuated vaccines generally contraindicated.

    • CDC recommendations include the inactivated influenza vaccine (injection, not nasal) and the Tdap vaccines is recommended between 27 and 36 weeks.

    • Certain travel vaccines (yellow fever, typhoid fever) should be avoided unless benefits outweigh the risks.

    Different Guidelines Across the World

    • Varies between different countries and healthcare organizations (e.g., US, UK, Australia, Canada, Japan, WHO, and Turkey).

    Prenatal Visit Follow-Up

    • Follow-ups are based on different guidelines among organizations.
    • The most common practice includes:
      • 12-14 weeks (Nullipar 10, multipar 7 times)
      • Routine checkups for weight, BMI, fundal height, blood pressure, edema, proteinuria, educations, and consultations,

    4th Visit

    • Review of the previous visit (including the initial exam, lab tests) evaluation
    • Medication and immunization support (iron and vitamin D supplementation, tetanus immunization).
    • Information and consultations on pregnancy, childbirth, breastfeeding, postpartum family planning.
    • Ultrasound(USG) and non-stress test(NST).

    Evaluation of Fetal Presentation and Position

    • Leopold maneuvers are used to evaluate fetal presentation and position.
      • Fundal height and position of the back.
      • Presenting part and fetal engagement are used as guidelines for evaluation.

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    Obstetric Anamnesis And Examination PDF

    Description

    This quiz explores essential concepts related to genetic screening for conditions like SMA and CF, as well as the implications of maternal age on pregnancy outcomes. It covers important terminology, methodologies, and the calculation of pregnancy duration. Test your knowledge on these critical aspects of maternal and fetal health.

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