Where should you expect to find the uterus at 12, 20 and 27 weeks?
12 weeks: Top of uterus (fundus) located at syphysis pubis
20 weeks: Fundus located at umbilicus
27 weeks: Fundus located at sternum
Note: Between 20 and 27 weeks, SFH should be within 1-2cm of GA
How many fetal movements is considered normal (and in what time duration)?
< 6 movements in 2 hours is concerning. If this is the case, mother should move to quiet room, change position, drink juice and concentrate on counting babie's movements. If still < 6, contact MD.
What is a NST? What are its indications?
NST stands for Non Stress Test. It consists of looking at the fetal heart rate (FHR) for at least 2 accelerations of > 15bpm lasting at least 15 seconds over a 20 minute period. If none observed in 20 minutes, change position / stimulate baby, retry. If non-reactive, move to BPP.
What is a BPP?
BPP stands for biophysical profile. It is performed when a non-reassuring NST is performed, or if there's any indication of fetal distress or utero-placental insufficiency. It consists of looking at 4 parameters:
1) AFV: Amniotic fluid volume (look for at least 1 fluid pocket of 2cm x 2cm)
2) Fetal tone: One occurence of limb extension followed by flexion
3) Fetal breathing movements: One episode of breathing lasting 30 seconds
4) Fetal limb movements: Three discrete movements
When is the dating U/S best done?
Between 8 - 12 weeks
When is the anatomical U/S best done?
Between 18-20 weeks GA
Which is more accurate for genetic testing - amniocentesis or chorionic villous sampling?
What advantages/disadvantages are there to doing CVS?
Can be done earlier - 10 to 12 weeks (thus enables pregnancy to be terminated earlier if desired)
Rapid karyotyping possible (48 hours)
High sensitivity and specificity
Disadv 1-2% risk of sponatenous abortion (vs 0.5% with amnio)
Does not screen for oNTD (whereas amnio can)
May see false -ves due to genetic mosaicism
Termination of pregnancy - What are the medical and surgical options?
Medical<9 weeks:Methotrexate + misoprostol
>12 weeks:Prostaglandins or misoprostol
>16 weeks:Dilatation and evacuation
What are the potential complications of termination of pregnancy?
True! Need to provide pregnant woman with Fe supplementation, especially during 2nd and 3rd trimester
T/F: Folate deficiency anemia is not associated with Fe deficiency anemia?
False! It is associated with Fe deficiency anemia. Folic acid is necessary for closure of the neural tube and all women should get at least 0.4mg pre (1-3 months) and during pregnancy (especially T1). Women with past history of oNTD or diabetes or on anti-epileptics should use 4mg per day.