Routine Prenatal Care

Chapter 84 Routine Prenatal Care




Clinical Case Problem 1 A 24-Year-Old Primigravida at 8 Weeks of Gestation


A 24-year-old primigravida comes to your office at 8   weeks of gestation for her first prenatal visit. She has asked you to be her family physician and to look after her during the entire pregnancy. You agree to provide her pregnancy care. During your first visit, you explain your general philosophy regarding prenatal care and perinatal care.



Select the best answer to the following questions




1. Which of the following statements is (are) true concerning prenatal care in the United States?


a. only 70% of women in the United States receive prenatal care

b. reducing the number of prenatal visits in low-risk women has been shown to increase pregnancy risk

c. black women, teenagers, women with drug addictions, and the poor have the lowest rates of prenatal care in the United States

d. only approximately 50% of women in the United States receive prenatal care in their first trimester

e. a and b

2. The Department of Health and Human Services Expert Panel on Prenatal Care (DHHSEPPC) has recommended which of the following regarding routine prenatal care?


a. that the number of routine office visits be significantly reduced for women at low risk

b. that focus should be on the total health and well-being of the family, including medical, psychological, social, and environmental barriers affecting health

c. that provision of systematic health care start long before pregnancy because it was proved to be beneficial to the physical and emotional well-being of the prospective mother and child

d. all of the above

e. a and c only

3. Your patient had the first day of her last menstrual period on September 9, 2006. According to Nägele rule, what is the patient’s estimated date of delivery (assuming a 28-day cycle)?


a. June 2, 2007

b. June 16, 2007

c. July 2, 2007

d. July 9, 2007

e. June 23, 2007

4. Which of the following tests is not recommended at her initial prenatal visit?


a. complete blood count (CBC)

b. rapid plasma reagin (screening for syphilis)

c. screening for gestational diabetes

d. hepatitis B virus screen

e. blood typing (Rh and ABO)

5. Which of the following tests is recommended at her 26- to 28-week prenatal visit?


a. screening for gestational diabetes

b. screening for rubella immunity

c. screening for neural tube defects

d. screening for group B streptococcal infection

e. screening for hepatitis C

After discussion of the visits and tests that will be done during the pregnancy, your patient indicates that she is concerned about “getting fat.” She has been a smoker since the age of 16   years in an attempt to remain thin, and she assumes that she will continue to smoke after she delivers. She is concerned about breast-feeding for the same reason because people have told her that she would “have to eat for the baby” if she breast-feeds.



6. She is 5 feet 5 inches tall and weighs 130 pounds. How much weight gain do you recommend?


a. 5 to 15 pounds

b. 10 to 20 pounds

c. 15 to 25 pounds

d. 25 to 35 pounds

e. 28 to 40 pounds

7. In counseling your patient on weight, which of the following is not a complication associated with excessive weight gain?


a. infant macrosomia

b. gestational diabetes

c. shoulder dystocia

d. intrauterine growth retardation

e. post-pregnancy obesity

8. Which of the following statements would not be regarded as reasonable nutritional advice for your patient?


a. supplementation with iron if anemia is detected

b. supplementation with folic acid 1   mg daily throughout pregnancy

c. supplementation with vitamin A

d. supplementation with calcium (Recommended Dietary Allowance, 1000 to 1300   mg/day)

e. supplementation with vitamin D if sunlight exposure is limited

9. Which of the following statements regarding smoking in pregnancy is (are) true?


a. the risk of spontaneous abortion is increased significantly

b. perinatal mortality rates are increased significantly

c. abruptio placentae rates are increased significantly

d. birth weights are decreased significantly

e. all of the above

10. Which of the following statements regarding alcohol consumption in pregnancy and fetal alcohol syndrome is


a. limit alcohol intake to one or two glasses of wine

b. abstain completely from alcohol during pregnancy

c. fetal alcohol syndrome is decreasing in the United States

d. a and c

e. b and c


Clinical Case Problem 2: A 35-Year-Old Primigravida


A 35-year-old woman and her husband have been attempting to get pregnant without success. They had considered pursuing a fertility workup but were concerned about the expense. They had begun the process for adoption, but she has had a positive home pregnancy test result, and based on her last menstrual period (LMP), she is 6   weeks pregnant. She is in good health and takes no medication except for a multivitamin.



11. Which of the following is (are) true concerning your advice for and care of this patient?


a. she has a higher risk of having a child with trisomy 21 than does a younger woman

b. she must have an amniocentesis because of her age and risks

c. she should have checkups more often than a younger woman

d. a triscreen (triple screen) is a serum screen for aneuploidy and neural tube defects that is generally performed

e. a and d

12. She and her husband are happy about the pregnancy. She tells you that she is not interested in any invasive tests, such as an amniocentesis or chorionic villus sampling (CVS), but she is not sure about the blood test. She asks you for more information concerning the triscreen or similar tests. All of the following are correct except


a. the triple screen or triscreen includes α-fetoprotein, human chorionic gonadotropin, and unconjugated estriol

b. some cases of neural tube defects, trisomy 18, and trisomy 21 can be detected by the triscreen

c. the most common cause of an elevated α-fetoprotein level is an inaccurate gestational age

d. the triscreen is extremely sensitive and specific; fetuses with abnormal results are almost always abnormal

e. unconjugated estriol levels are decreased in trisomy 18 and trisomy 21

13. Which of the following statements is (are) true concerning current recommendations on routine prenatal visits?


a. clinical components of routine prenatal visits are agreed on by everyone

b. most guidelines recommend routine assessment with fundal height, maternal weight, blood pressure measurements, fetal heart auscultation, urine testing for protein and glucose, and questions about fetal movement

c. some authors recommend screening for domestic violence with brief questions

d. a and b

e. b and c


Clinical Case Problem 3: Sexually Transmitted Diseases and Pregnancy


An 18-year-old primigravida who has seen you since 16 weeks of gestation comes for a visit at 32 weeks. She found out that her boyfriend (the father of the baby) has herpes. She has “broken up” with him but does not know when he contracted the herpes virus. She does not recall ever having herpes, but she is worried about the baby.



14. Which of the following statements is not true concerning herpes infection in pregnancy?


a. rates of vertical transmission at the time of delivery are highest for a primary herpes simplex virus (HSV) infection and lowest for a recurrent HSV infection

b. genital herpes acquired during pregnancy does not increase rates of neonatal illness if the HSV seroconversion has completed by the time labor begins

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Routine Prenatal Care

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