Which one of the following statements regarding nutrition during pregnancy is correct?
Correct Answer C:
The greatest demand for iron is during the latter half of pregnancy. Only vegetarians and those with actual serum vitamin B12 deficiency require vitamin B12 supplementation. Unless there are complications, e.g., hypertension or cardiovascular disease, there is no reason the pregnant patient cannot salt her food to taste.
Obstetric risk factors for teenagers include poor nutrition, smoking, alcohol and drug abuse, and genital infections. In women of average or low weight, lack of weight gain throughout pregnancy is often associated with fetal growth retardation.
A recently married 29-year-old nulliparous black female presents with uncomplicated cystitis. She is otherwise healthy. She reports that she is currently using barrier birth control methods but plans to discontinue this soon, as she would like to become pregnant.
Which one of the following supplemental vitamins or minerals would you advise this patient to begin taking?
Correct Answer D:
A significant number of neural tube defects can be prevented with a daily intake of supplementary folate through the preconceptional and prenatal period. The current health guidelines recommend a daily supplement of 0.4-0.8 mg of folic acid, beginning at least 1 month prior to conception and continuing through the first trimester in otherwise healthy women. Women with a prior history of a pregnancy affected by a neural tube defect should take 4 mg/day in the preconceptional period. The other options listed do not require supplementation in the preconceptional period.
Which one of the following is true regarding the fetal biophysical profile?
Correct Answer B:
The fetal biophysical profile is a means of assessing fetal well-being by combining information from dynamic ultrasonography with fetal heart rate response to fetal movements. The ultrasound components include fetal breathing movements, gross body movements, fetal tone, and a qualitative assessment of amniotic fluid volume. This test is commonly done after 28 weeks gestation (after which fetal viability is likely) and can be used to assess fetal well-being in patients with intrauterine growth retardation (IUGR) or other high-risk pregnancies.
→ Adequate amniotic fluid (choice A) is defined as one of more pockets of fluid > 2 cm in vertical diameter.
→ The test is performed at varying frequencies depending upon the obstetric or fetal risk level. A normal score (10/10) is reliable evidence of fetal well-being at the time of the test and that fetal demise is unlikely in the following 7 days (choice C). Lower scores have variable interpretations, depending on the clinical circumstances. For example, a score of 8/10 with low amniotic fluid volume may indicate a risk for acute decompensation.
→ It can be used to assess (not diagnose, as stated in choice D) fetal well-being in patients with intrauterine growth retardation (IUGR).
You see a 29-year-old white gravida 2 para 1 at 18 weeks gestation. She had routine prenatal laboratory tests 2 weeks ago, and her platelet count was 100 x 109/L. She is on no medications except prenatal vitamins, her past medical history is negative, and she denies drug use. On the review of systems, she denies easy bruising or bleeding. Her previous pregnancy was normal.
You order test for antinuclear antibody, antiphospholipid antibody, anticardiolipin antibody, lupus anticoagulant, and HIV. All results are normal. A peripheral smear is normal except for a low platelet count.
Appropriate management of this condition would include which one of the following?
Correct Answer A:
The most likely diagnosis is gestational thrombocytopenia, which accounts for 75% of all cases of thrombocytopenia in pregnancy. Characteristic findings include an asymptomatic patient with a platelet count less than 150 x 109/L but usually above 70 x 109/L, no prior history of bleeding, no preconception history of thrombocytopenia, normal first trimester or preconception platelet counts, and a platelet count that returns to normal 2-12 weeks post partum. no interventions such as cesarean section or fetal platelet count monitoring are necessary. Periodic monitoring of maternal platelet counts is recommended. These patients are not at risk for fetal thrombocytopenia or maternal bleeding complications.
An absolute contraindication to Hormone Replacement Therapy (HRT) is:
Correct Answer E:
Due to hepatic metabolism, the daily dose of the estrogens contained in HRT’s must be approximately 10 to 20 times higher than ovarian production of estrogens to render a comparable physiologic effect. Such concentrations increase the production of certain liver proteins (including coagulation factors) that are estrogen sensitive. This, in turn, may result in a slight and dose dependent increase in blood coagulability. Active/severe liver disease along with any hypercoagulable condition would serve to compound this effect. Concept: Hypercoagulable states are contraindications to HRT or OCPs.
Absolute contraindications to HRT include:
Relative contraindications include:
Key point:
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