Obstetrics Fetal Positioning Quiz
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Questions and Answers

What does fetal 'engagement' refer to?

  • The transition of the fetus into the anterior position
  • The position of the fetal head in relation to the spine
  • When the widest presenting transverse diameter has passed through the pelvic brim (correct)
  • The contraction of the uterine muscles during labor
  • Which presentation indicates that the fetal head is down in the pelvis?

  • Breech presentation
  • Face presentation
  • Vertex presentation (correct)
  • Transverse presentation
  • What is the relationship of fetal head to spine termed as?

  • Engagement
  • Presentation
  • Attitude (correct)
  • Position
  • What does a normal fetal heart rate range from?

    <p>110-160 beats per minute (B)</p> Signup and view all the answers

    Which denominator corresponds to a breech presentation?

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

    What does the term 'longitudinal lie' indicate about the fetus?

    <p>The fetus is lying parallel to the mother's spine (A)</p> Signup and view all the answers

    What measurement corresponds with the palpation of the fetal head being '2/5 above the pelvic brim'?

    <p>Non-engaged fetal head (C)</p> Signup and view all the answers

    What is the significance of the fetal heart rate being regularly auscultated at 130 beats per minute?

    <p>It is within the normal range for a fetus (A)</p> Signup and view all the answers

    What is the definition of maternal mortality rate?

    <p>Number of maternal deaths that occur as a direct result of pregnancy per 100,000 live births (C)</p> Signup and view all the answers

    What is included in critical elements of prenatal assessment?

    <p>Health history, physical examination, blood and urine tests (C)</p> Signup and view all the answers

    What factors contributed to the high maternal mortality ratio in low-income countries?

    <p>Inadequate prenatal care and poor healthcare infrastructure (C)</p> Signup and view all the answers

    Which of the following statistics indicates the risk of infant mortality?

    <p>Number of deaths of infants under one year of age per 1,000 live births (D)</p> Signup and view all the answers

    At what gestational age is stillbirth defined?

    <p>After 24 weeks of pregnancy (D)</p> Signup and view all the answers

    Which condition is NOT a primary cause of maternal deaths worldwide?

    <p>Heart disease (A)</p> Signup and view all the answers

    What is the perinatal mortality rate defined by?

    <p>Stillbirths and deaths in the first week of life (B)</p> Signup and view all the answers

    Which population has the highest risk of maternal mortality?

    <p>Adolescents and women in poorer communities (A)</p> Signup and view all the answers

    What is the purpose of prenatal care?

    <p>To provide holistic care to pregnant women and their families (B)</p> Signup and view all the answers

    Which component is NOT typically included in a prenatal health history assessment?

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

    What does the term 'Gravida' refer to?

    <p>A woman who is currently pregnant (D)</p> Signup and view all the answers

    Which formula can be used to calculate the expected date of confinement (EDC)?

    <p>EDC = LMP - (3 months) + 7 days (A)</p> Signup and view all the answers

    What does 'Para' indicate in obstetrics?

    <p>The number of times a woman has given birth to a child (C)</p> Signup and view all the answers

    Which of the following statements about gravidity is correct?

    <p>G5 refers to a woman who has been pregnant five times (D)</p> Signup and view all the answers

    What is NOT typically assessed as part of a woman's psychosocial health during prenatal care?

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

    What does the term 'Nullipara' represent?

    <p>A woman who has never given birth (C)</p> Signup and view all the answers

    What is a primary focus of the WHO's 2023 publication on maternal mortality?

    <p>Trends in maternal mortality from 2000 to 2020 (A)</p> Signup and view all the answers

    Which organization provides guidelines for the management of hypertension in pregnancy?

    <p>National Institute for Health and Care Excellence (NICE) (A)</p> Signup and view all the answers

    What is the relationship between maternal age and Down syndrome according to the literature?

    <p>Increased maternal age is associated with a higher risk of Down syndrome (A)</p> Signup and view all the answers

    What document outlines diagnostic criteria for hyperglycaemia first detected in pregnancy?

    <p>WHO diagnostic criteria document (A)</p> Signup and view all the answers

    In which publication would you find information on maternal and child health nursing practices?

    <p>Maternity women’s health care (B)</p> Signup and view all the answers

    What is the primary complication associated with the medical method of legal abortion?

    <p>Uterine cramping (A)</p> Signup and view all the answers

    Which type of placenta praevia completely covers the internal os?

    <p>Type IV (Total praevia) (B)</p> Signup and view all the answers

    Which risk factor is commonly associated with abruptio placenta?

    <p>Advanced maternal age (D)</p> Signup and view all the answers

    What clinical feature might indicate a complete abruptio placenta?

    <p>Massive vaginal bleeding with tense uterus (D)</p> Signup and view all the answers

    Which of the following scenarios does NOT typically cause antepartum hemorrhage?

    <p>Normal vaginal delivery (D)</p> Signup and view all the answers

    Which ultrasound finding is associated with abruptio placenta?

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

    What is a potential long-term effect of the surgical method of abortion?

    <p>Chronic pelvic infection (A)</p> Signup and view all the answers

    What should management for antepartum hemorrhage be based on?

    <p>Amount of bleeding and maternal-fetal conditions (C)</p> Signup and view all the answers

    Which of the following describes Type I placenta praevia?

    <p>Lower placental edge encroaches onto lower segment (A)</p> Signup and view all the answers

    Which condition describes fetal blood vessels lying over the internal os?

    <p>Vasa praevia (C)</p> Signup and view all the answers

    What is assessed during the bimanual examination in early pregnancy?

    <p>Softening of the cervix (B)</p> Signup and view all the answers

    What is measured in a complete blood picture to indicate anaemia?

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

    What sign indicates a bluish discoloration of the cervix during examination?

    <p>Chadwick's sign (B)</p> Signup and view all the answers

    Which blood test is used to check for Rhesus isoimmunization?

    <p>Rhesus factor test (B)</p> Signup and view all the answers

    What precaution should be taken if the rubella antibody is negative?

    <p>Avoid contact with individuals with rubella (C)</p> Signup and view all the answers

    What condition can proteinuria during urine tests indicate?

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

    Which test helps in early detection of congenital abnormalities?

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

    What is a common method to assess fetal well-being during pregnancy?

    <p>Fetal heart rate monitoring (C)</p> Signup and view all the answers

    Which sign indicates the softening of the cervix during pregnancy?

    <p>Goodell's sign (A)</p> Signup and view all the answers

    Which condition may require testing for syphilis during blood testing?

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

    What is indicated by the presence of ketones in urine tests during pregnancy?

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

    What does the non-stress test (NST) primarily assess?

    <p>Response of fetal heart rate to movement (C)</p> Signup and view all the answers

    What clinical application does transvaginal ultrasound serve during pregnancy?

    <p>Determine fetal viability (B)</p> Signup and view all the answers

    When should Rh anti-D immunoglobulin be administered if tested positive for anti-Rh antibodies?

    <p>Within 72 hours after delivery (C)</p> Signup and view all the answers

    Flashcards

    Maternal Mortality Rate

    Number of maternal deaths per 100,000 live births due to pregnancy-related causes, including the 42-day postpartum period.

    Infant Mortality Rate

    Number of deaths of infants under one year of age per 1000 live births.

    Neonatal Mortality Rate

    Number of deaths of infants younger than 28 days old per 1000 live births.

    Stillbirth

    Birth of a baby with no signs of life after 20 weeks of pregnancy (and/or weighing at least 500 grams).

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    Perinatal Mortality

    Number of stillbirths and deaths in the first week of life.

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    Birth Rate

    Number of live births in one year per 1000 population.

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    High Maternal Mortality Risk Locations

    Rural areas, poorer communities, and adolescents have higher maternal mortality risks compared to other groups.

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    Primary Causes of Maternal Deaths

    Severe bleeding (postpartum), infections (postpartum), high blood pressure during pregnancy, and delivery complications.

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    Prenatal Care Purposes

    Assessment of mother and fetus health, monitoring pregnancy progress, early detection of risk factors, promoting self-care, and providing holistic care.

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    Expected Date of Confinement (EDC)

    Estimated date of delivery, calculated using the first day of the last menstrual period (LMP) and a 28-day cycle.

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    Gravida

    A pregnant woman; gravidity refers to the total number of pregnancies.

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    Parity

    A woman's previous deliveries of live or stillborn babies, excluding abortions.

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    Health History (Prenatal)

    Detailed information about a woman's current pregnancy, reproductive history, past medical/surgical history, family history, and psychosocial well-being.

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    Prenatal Assessment

    Evaluates maternal and fetal health through health history, physical exam, blood tests, and urine tests.

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    Nagele's Rule

    A method of calculating the estimated due date (EDD) of a pregnancy, subtracting 3 months from the first day of the last menstrual period (LMP) and adding 7 days.

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    Reproductive History

    A woman's complete history of menstrual cycles, pregnancies, live births, abortions, and previous surgeries/infections/Pap smears/contraceptive use.

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    Fetal Presentation

    The part of the fetus that is positioned at the pelvic brim or lower pole of the uterus.

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    Vertex Presentation

    The fetal head is the presenting part.

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    Breech Presentation

    The fetal buttocks or feet are the presenting part.

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    Face Presentation

    The fetal face is the presenting part.

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    Fetal Attitude

    The relationship of the fetal head to the spine.

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    Fetal Position

    The relationship between the presenting part and the pelvic brim.

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    Engagement

    The widest transverse diameter of the presenting part has passed through the pelvic brim.

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    Rule of Fifth

    A method to assess engagement - 2/5 or less of the fetal head palpable above the symphysis pubis means the head is engaged.

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    Gestational Diabetes Mellitus (GDM)

    A type of diabetes that develops during pregnancy. It usually resolves after childbirth but can increase the risk of developing type 2 diabetes later in life.

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    Hypertension in Pregnancy

    High blood pressure that develops during pregnancy and can be dangerous for both mother and baby.

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    Down Syndrome and Maternal Age

    The risk of having a baby with Down syndrome increases with the mother's age, especially after 35.

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    First Trimester Abortion

    Termination of pregnancy within the first 12 weeks of gestation.

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    Maternal Mortality

    Death of a woman during pregnancy, childbirth, or within 42 days of childbirth, from any cause related to or aggravated by the pregnancy.

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    Medical Abortion Methods

    Using medications like Mifepristone and Misoprostol to terminate a pregnancy.

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    Surgical Abortion Methods

    Procedures like aspiration, D&C, or D&E to terminate a pregnancy.

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    Antepartum Haemorrhage (APH)

    Bleeding from the vaginal tract after 24 weeks of pregnancy, before giving birth.

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    Placenta Praevia (PP)

    Placenta positioned partially or completely in the lower segment of the uterus.

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    Abruptio Placenta (AP)

    Premature separation of the placenta from the uterine wall, usually after 24 weeks.

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    Placenta Praevia Types

    Types of PP are classified based on placenta position relative to the internal os: Type I - low-lying, Type II - marginal, Type III - partial, Type IV - total.

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    Abruptio Placenta Types

    Types of AP are classified based on the degree of placental separation: Marginal (mild), Partial (concealed or apparent bleeding), Complete (massive bleeding).

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    Abruptio Placenta Classification

    AP is also classified based on the degree of placental detachment and symptoms, ranging from Grade 0 (asymptomatic) to Grade 3 (severe).

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    APH Management

    The management of APH depends on the amount of bleeding, mother and fetus's health, placenta location, and pregnancy stage.

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    APH Complications

    Complications of APH include maternal hemorrhagic shock, hypovolemia, renal failure, postpartum hemorrhage, and coagulation disorders.

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    Goodell's Sign

    Softening of the cervix during early pregnancy.

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    Hegar's Sign

    Softening of the isthmus of the uterus during early pregnancy.

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    Chadwick's Sign

    Bluish discoloration of the vaginal mucosa and cervix during pregnancy.

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    What are some tests to check for anemia?

    Haemoglobin (Hb) level, mean cell volume (MCV).

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    Why check for Rh factor?

    To detect Rhesus isoimmunization, and to check for anti-Rh antibodies in the mother's blood.

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    When should Rh anti-D immunoglobulin be given?

    Within 72 hours after delivery.

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    Why check for rubella antibody?

    To determine if the mother is immune to rubella. If not, she should avoid contact with people suffering from it and get vaccinated in the puerperium.

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    Why check for Hepatitis B surface antigen (HbsAg)?

    To identify if the mother is infected with Hepatitis B. If positive, the newborn should receive Hepatitis B immunoglobulin and vaccine soon after birth.

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    What is VDRL test used for?

    To detect any syphilis infection. It is confirmed with Fluorescent treponemal antibody-absorption test.

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    Why check for Human Immunodeficiency Virus (HIV) antibody?

    To identify if the mother is infected with HIV. Early detection and treatment can significantly reduce the risk of transmission to the child.

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    What are the common pregnancy complications?

    Abortion, antepartum hemorrhage (APH), gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH).

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    What is a non-stress test?

    It measures the fetal heart rate response to fetal movement using cardiotocography (CTG).

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    What are some prenatal diagnosis methods?

    Biochemical screening, amniocentesis, chorionic villus sampling (CVS), cordocentesis, fetoscopy.

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    What are the applications of ultrasonography in pregnancy?

    Confirming pregnancy, determining gestational age, assessing fetal well-being, evaluating fetal growth.

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    What does a fetal heart rate (FHR) monitoring test measure?

    Fetal heart rate (FHR) monitoring measures the baby's heartbeat during pregnancy.

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    Study Notes

    Antenatal Assessment & Care (Part I)

    • This is a lecture on antenatal assessment and care, part 1, for Bachelor of Science (Honours) in Nursing students.
    • The lecture date is September 13, 2024.

    Learning Outcomes

    • Students will be able to discuss current trends in maternal and child health.
    • Students will be able to describe the purposes and essential components of prenatal care.
    • Students will be able to identify critical elements of prenatal assessment, including health history, physical examination, blood, and urine tests.

    Vital Statistics

    • Birth rate: Number of live births per 1,000 population in one year.
    • Maternal mortality rate: Number of maternal deaths per 100,000 live births resulting directly from pregnancy, including the postpartum period.
    • Infant mortality rate: Number of infant deaths under 1 year of age per 1,000 live births.
    • Neonatal mortality rate: Number of infant deaths younger than 28 days per 1,000 live births.
    • Stillbirth: Birth of a baby with no signs of life after pregnancy (and/or weight ≥ 500 gm).
    • Perinatal mortality: Number of stillbirths and deaths in the first week of life.

    Maternal & Child Health

    • In 2020, approximately 800 women died each day from preventable causes related to pregnancy and childbirth.
    • Over 95% of maternal deaths occur in low- and lower-middle-income countries.
    • In 2020, the maternal mortality ratio was 430 per 100,000 live births in low-income countries compared to 12 per 100,000 in high-income countries.
    • Maternal mortality is higher in rural areas, poorer communities, and adolescents.
    • Primary causes of maternal deaths worldwide include severe bleeding (mostly after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications from delivery (e.g., obstructed labor), and unsafe abortion.

    Prenatal Care

    • Purposes: Assess health status of mothers and fetus, monitor pregnancy progress, identify at-risk mothers or fetus, promote self-care of pregnant women, and provide holistic care to pregnant women and their family members.
    • Schedule: First antenatal visit and subsequent visits.

    Prenatal Assessment

    • Key elements of prenatal assessment include health history, physical examination, blood tests, and urine tests.

    Health History

    • Current pregnancy: Signs, symptoms, urine/blood test for hCG, first day of last menstrual period (LMP).
    • Reproductive history: Menstrual history, age at menarche, menstrual cycle regularity, number of pregnancies/abortions/living children, previous experience in pregnancy, labor, and puerperium, date of last Pap smear, and contraceptive history.
    • Past medical, surgical & personal history: Medical conditions, surgeries, medications, allergies, and personal history.
    • Family history: Genetic diseases, multiple pregnancies, hypertension, diabetes mellitus, tuberculosis, and psychiatric disorders.
    • Psychosocial health assessment: Mental and emotional wellbeing.

    Physical Examination

    • Height, weight, vital signs, head-to-toe physical examination, abdominal examination, and vaginal/pelvic examination.
    • Specific measurements and findings during physical examinations are included.
    • Detailed methods of breast examination (inspection and palpation) are described.
    • Abdominal examination method (including inspection, palpation, and auscultation) is documented, alongside examples of Leopold's maneuvers for determining fetal presentation.
    • Details on how to determine fetal attitude, fetal lie, fetal position and engagement are included.

    Blood Tests

    • Complete blood picture, ABO grouping, Rhesus factor (Rh), Rubella antibody, Hepatitis B surface antigen (HbsAg), Venereal disease – Syphilis, and Human Immunodeficiency Virus (HIV) antibody.
    • Specific details of how to interpret the results of these blood tests are also detailed.

    Urine Tests

    • Glycosuria, proteinuria, and ketones.

    Prenatal Care (Subsequent)

    • Subsequent prenatal assessments, including general condition, body weight and height, blood pressure, urine tests for protein and glucose, and abdominal examination are detailed.

    Antenatal Check-up Schedule

    • A standard schedule for antenatal check-ups, including the gestational week and the frequency of routine check-ups, as well as other examinations to be performed each week is listed.

    Antenatal Assessment & Care (Part II)

    • Learning outcomes for this part include discussing common antenatal tests, identifying risk factors for high-risk pregnancies, and describing nursing assessment and management for various complications.

    Assessment of Fetal Well-being

    • Methods of assessing fetal well-being, such as fetal heart rate (FHR), non-stress test (NST), and cardiotocography (CTG), are included.
    • Additional methods and procedures for fetal wellbeing, such as ultrasonography, biochemical screening, amniocentesis, chorionic villus sampling (CVS), and cordocentesis.

    Ultrasonography

    • Methods and clinical applications of ultrasonography in pregnancy are described.

    Prenatal Diagnosis

    • Non-invasive and invasive prenatal diagnostic procedures are detailed, including methods and complications.
    • Data about gestational age, including 1st and 2nd/3rd trimesters is detailed.

    Pregnancy at Risk

    • Specific types of high-risk pregnancies, including abortion, antepartum hemorrhage (APH), gestational diabetes mellitus (GDM), and pregnancy-induced hypertension (PIH), are discussed.

    Abortion

    • Definition and classification of spontaneous and induced abortions.
    • Causes of abortion.
    • Nursing care management for threatened abortions, including bed rest, bleeding monitoring, and subsequent care.
    • Legal aspects, including management methods, and complications of induced abortions.

    Antepartum Haemorrhage (APH)

    • Various types of APH (including placenta previa and abruptio placenta), causes, clinical features, diagnosis, and management strategies are described.

    Gestational Diabetes Mellitus (GDM)

    • Risk factors, diagnostic criteria (OGTT), management strategies (diet control, medication, and monitoring), and potential complications for both mother and fetus are detailed.

    Hypertension in Pregnancy

    • Classification of hypertensive disorders (gestational, pre-eclampsia, eclampsia, chronic hypertension, superimposed pre-eclampsia).
    • Diagnosis parameters for hypertension during pregnancy.
    • Causes and risk factors for different types of hypertension in pregnancy.
    • Potential maternal and fetal complications and management strategies for each type of hypertension.

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    Description

    Test your knowledge on key concepts related to fetal positioning and presentation in obstetrics. This quiz covers fetal engagement, heart rate, and alignments in the pelvis, helping you understand the critical aspects of prenatal care.

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