CCFP Exam marathon > Pregnancy > Flashcards

Pregnancy Flashcards

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1
Q

A pregnant patient reports the first day of her last menstrual period (LMP) was June 12, 2025. Her cycles are regular.

👉 What is her estimated date of delivery (EDD) using Naegele’s rule?

A

March 19, 2026

LMP June 12, 2025 → +7 days = June 19, 2025 → −3 months = March 19, 2026 → +1 year

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2
Q

A pregnant patient has regular 28-day cycles. The first day of her last menstrual period was November 30, 2025.

👉 What is her estimated date of delivery (EDD) using Naegele’s rule?

A

LMP: Nov 30, 2025

+7 days → Dec 7, 2025 (month jump #1)

−3 months → Sept 7, 2025

+1 year → Sept 7, 2026

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3
Q

Name 5 medications that are teratogenic

A

Methotrexate
Isotretinoin
Warfarin
Valproate
Lithium
Thalidomide
Tetracycline
ACE inhibitors
ARBs
Androgens / anabolic steroids

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4
Q

Name 5 components of history taking that should be asked on the first prenatal visit?

A

Planned pregnancy?
GTPAL
Mode of delivery
Previous pregnancy complications
Cycle history
LMP
Last pap test
Previous methods of contraception

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4
Q

How much should a woman with HIGH risk for NTD receive of daily supplemented folic acid?

A

4 - 5 mg

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4
Q

How much should a woman with low risk for NTD receive of daily supplemented folic acid?

A

0.4 mg/d

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4
Q

Name the 10 tests ordered on the first prenatal visit

A

Blood group & Rh factor
CBC (Hb and platelet count)
Urine C&S

Serologies
Rubella IgG and IgM
HBSAg
HIV antigen
Urine C & G
VDRL
Varicella IgG

**Transvaginal dating U/S **< 13 weeks

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5
Q

What is the frequency of prenatal visits?

A

Q4w until 28w GA
Q2w until 36w GA
Weekly until delivery

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5
Q

Name four red flags that should be asked of every pregnant patient on routine visits?

A

Vaginal bleeding
Gush of fluid
Cramping
↓ FM
UTI symptoms (dysuria, unusual frequency, hematuria)

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5
Q

How much of daily supplemental iron should women be on through pregnancy

A

27 mg/d

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6
Q

Name 3 risk factors for NTD

A

Higher risk
Personal history or previous pregnancy with NTD
FHx of NTD

Moderate risk
Maternal DM
Teratogenic meds
Anticonvulsants
Metformin
Methrotrexate
Septra
Celiac disease
Gastric bypass
Liver or renal disease

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6
Q

List 3 diet counseling points for pregnant patients

A

Caffeine reduction: < 300 mg/d (1 - 2 cups)

<2 servings of fish everyday

Foods to avoid
Liver
Soft cheese
Unspasteurized milk
Raw sources of protein in general

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6
Q

Name one contraindication to exercise during pregnancy

A

PROM
Unexplained vaginal bleeding
Placenta previa > 28w
Pre-eclampsia
Incompetent cervix
IUGR

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7
Q

What are the 5 most important physical exam components of routine prenatal visits after the 1st trimester?

A

BP
Weight
Leopold’s maneuvers
SFH
FHR

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7
Q

When can you send a patient for the Enhanced First trimester Screening (eFTS)?

A

11 - 14 weeks

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7
Q

What are the 5 components of the Enhanced First trimester Screening (eFTS)?

A

Nuchal translucency + “No Pretty Hair Always”
N → Nuchal translucency
P → PAPP-A
H → free β-hCG
A → Alpha fetal protein

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7
Q

What are the components of the Integrated Prenatal Screening?

A

11 - 14 weeks
Nuchal translucency (NT) by ultrasound
Maternal serum: PAPP-A and free β-hCG

15 - 18 weeks
“A Happy Unique Infant”
A → AFP
H → hCG
U → unconjugated estriol
I → Inhibin-A

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8
Q

When is the eFTS abnormal?

A

“Big Neck, Little Protein, High Hormone, Alpha Up/Down”

Big Neck → NT ↑ (trisomy 21/18)
Little Protein → PAPP-A ↓ (trisomy 21)
High Hormone → free β-hCG ↑ (trisomy 21)
Alpha Up/Down → AFP ↑ (neural tube defects), ↓ (trisomy 21/18)

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9
Q

When should you start measuring the SFH?

A

After 12 w GA

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10
Q

When should you order the anatomy scan during pregnancy?

A

18 - 20w GA

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11
Q

When should you order the GDM screening test?

A

24 - 28w GA

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12
Q

What two actions should be done at 28 weeks?

A

Repeat CBC
If Rh neg women → RhoGAM

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13
Q

When should women have their final RH antibody screen during their pregnancy if they are Rh negative?

A

At 35 - 37w

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14
Q

Differentiate between the two phases of the first stage of delivery

A

Latent
< 4 cm in nulliparous or 4 - 5 cm in multiparous woman

Active
≥ 4 cm

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15
How do you define dystocia in the first stage?
Dystocia: > 4h of < 0.5 cm/h dilatation OR 0 cm in 2h
16
What is dystocia of the second stage?
**Nulliparous women**: no progress for >4 hours with epidural (or >3 hours without) **Multiparous women**: no progress for >3 hour with epidural (or >2 hours without)
17
What is the 3rd stage of delivery?
Time that starts Immediately after delivery of the baby to the delivery of the placenta
18
What is the fourth stage of delivery?
Period 1h after delivery of the placenta
19
T or F: low risk pregnant patients during the first stage of pregnancy should be on continuous EFM
False - do it only for HIGH risk patients For low risk: intermittent auscultation of FHR
20
Name two pharmacological pain med options during delivery?
Nitrous oxide PRN (with contractions) Opioids Epidural Pudendal nerve block (2nd stage) Perineal infiltration
21
What is the typical length of the second stage of pregnancy?
**Nuliparous** No epidural → 3h Epidural → 4h **Multiparous** No epidural → 2h Epidural → 3h
22
What would be the two indications for episiotomy?
Risk of anal sphincter injury or shoulder dystocia
23
What are the three active management actions to be done during the third stage of delivery?
**Prophylactic oxytocin (uterotonic)** after the delivery of anterior shoulder **Cord clamping** (within 60 seconds if baby does not require resuscitation) Controlled cord traction
24
How and when do you screen for GBS?
35 - 37w GA (Vaginal and rectal swab)
25
Name three indications for GBS prophylaxis during the intrapartum period
* GBS + (including previous routine urine C&S during pregnancy) * Previous infant w/ GBS ** Unknown GBS status + at least one of:** < 37 weeks ROM > 18h Intrapartum fever (T > 38.0 C)
26
A patient requires GBS prophylaxis but is allergic to penicillin. What would be an alternative?
Cefazolin
27
Name five indications for induction of labour
* Spontaneous ROM * IUGR * ↓ Fetal Movement * Relative: post date (>41w) * Pre-eclampsia * Maternal conditions: T2DM Renal disease Pulmonary disease PIH Chorioamnionitis Placental abruption
28
Risks of induction of labour (3)
↑ risk of surgical delivery (operative vaginal delivery and C/S) Uterine rupture Fetal compromise
29
2 contraindications for induction of labour
Previous uterine rupture Fetal transverse lie Placenta previa Vasa previa Active genital herpes
30
How do you evaluate if a pregnant patient is ready for induction of labour?
Bishop Score
31
Name the 5 components of the Bishop score?
**DO PiSS** D – Dilation O – cervical Opening (Effacement) P – Position S – Station S – cervical Softness (Consistency)
32
When is cervical ripening indicated before induction of labour?
Bishop <7
33
What are the three options for cervical ripening?
Cervical Foley catheter insertion Intracervical dinoprostone gel Vaginal or oral misoprostol
34
What are two options for induction of labour?
Oxytocin infusion Amniotomy
35
What are the three requirements for doing an amniotomy?
Bishop ≥ 7 Head is engaged Concomitant oxytocin infusion
36
What are the etiologies of 2nd-stage labour dystocia?
**Power** Hypotonic contractions Inadequate maternal effort **Passenger** Fetal position Attitude Size Anomalies **Passage** Pelvic structure Maternal soft tissue **Psyche** Pain Anxiety
37
What are the two options for labour dystocia?
Oxytocin augmentation (power) Operative delivery
38
What are the four components of a reactive NST?
**15–15–2–20 rule** All 4 must be present: 15 bpm ↑ above baseline Lasts 15 seconds At least 2 accelerations Within 20 minutes
39
If a patient has a non-reactive NST, what would be the next step in management?
Biophysical profile (BPP)
40
What are the causes of the three types of FHR decelerations?
**Early decelerations** → head compression (benign) Usually benign, mirror contractions **Late decelerations **→ uteroplacental insufficiency Due to fetal hypoxia or poor placental perfusion **Variable decelerations** → umbilical cord compression
41
What is the management for variable decelerations
Maternal position change or amnioinfusion if recurrent/severe
42
Name the five next steps if a patient has a non-reassuring FHR on NST
1. Ensure continuous EFM 2. Call for help 3. Left lateral decubitus 4. 100% supplemental O2 through non-rebreather mask 5 . Correct maternal hypotension (IV fluids) 6. Fetal scalp monitor
43
When can placental abruption be diagnosed in pregnancy?
After 20w
44
3 risk factors for placental abruption
Previous placental abruption Gestational HTN/Pre-eclampsia Smoking history Cocaine use PPROM Rapid decompression of distended uterus
45
What is the management for placental abruption
Stabilize (IVF, O2) Monitors Blood products RhoGAM (if Rh-)
46
What are the 3 investigations to confirm PROM?
Pooling in the posterior fornix Nitrazine blue test Ferning under microscopy
47
What are the three interventions to be done if a patient has confirmed PROM?
1. If GBS + → IV penicillin 2. Induction . Term → can await 24h before induction (if GBS negative) NO NEED FOR BISHOP SCORE!!! 3. If < 34 weeks → Celestone for fetal pulmonary
48
What is the definition of pre-term labour?
Cervical dilation ≥ 4 cm before 37w GA
49
Management of pre-term labour (3)
1. Celestone if < 34 wks GA 2 . Tocolytics Nifedipine Indomethacin 3. If imminent pre-term birth (dilated > 4 cm) AND < 34 wks GA → Magnesium sulfate (fetal neuroprotection)
50
3 risk factors for should dystocia
Macrossomia Multiparity Obesity DM Prolonged second stage
51
Management of Shoulder dystocia
**ALARMER** Apply suprapubic pressure Ask for help Legs in full flexion (McRobert’s Maneuver) Anterior shoulder disimpaction Release posterior shoulder Manual corkscrew Episiotomy Roll over on hands and knees
52
3 risk factors for uterine rupture
Previous uterine scar Oxytocin Grand multiparous Previous uterine manipulation
53
What is the initial management of suspected breech presentation?
U/S → confirm presentation and rule out cord prolapse
54
What is the definition of decreaed cervical length?
Cervical length < 25 mm at 16 - 24w GA
55
Pharmacological management of decreased cervical length?
Vaginal progesterone at 16 - 36w GA
56
How many fetal movements should be perceived by a pregnant women > 26w GA?
6 movements/2h
57
What is the first step if someone has low fetal movements?
NST
58
5 risk factors of GDM?
Previous GDM Fhx of DM Hx of macrosomia > 25 y/o Obesity PCOS Steroids Ethnicity (Asian, Hispanic, African, indigenous)
59
Name 4 complications of GDM for the newborn
Cephalo-pelvic disproportion LGA VSD NTD Neonatal hypoglycemia Erb palsy Pyloric stenosis Prematurity Still birth Shoulder dystocia
60
What is the two-step screening test for GDM? (name all the values)
**50g Oral Glucose Challenge Test** < 7.8 → no further testing 7.8 - 11.1 → 75g OGTT ≥ 11.1 → GDM **2h 75 OGTT (2nd step)** GDM if: Fasting ≥ 5.3 1h ≥ 10.6 2h ≥ 9.0
61
What is the one-step screening test for GDM? (name all the values)
2h 75 OGTT GDM if: Fasting ≥ 5.1 1h ≥ 10.0 2h ≥ 8.5
62
Name the targets in GDM (4)
A1C < 6.0% FBG: 3.8 - 5.3 1h post-prandial: < 7.8 2h post-prandial: < 6.7
63
When should you start insulin on GDM?
Not meeting glucose challenges after 1 - 2 weeks
64
When is induction recommended in GDM?
38 - 40w GA
65
When should you screen for persistent DM after delivery? And how?
Repeat 2h 75g OGTT between 6w - 6mo
66
Name 3 criteria of hyperemesis gravida?
Persistent vomiting 5% weight loss Abnormal lytes
67
Name 2 non-pharm options for Hyperemesis gravida
Dietary changes (smaller and more frequent meals) Consider stopping iron supplementation
68
Name one first line and one second line medication for hyperemesis gravida?
1st line: Pyridoxine Diclectin 2nd line: Gravol
69
What are the TSH targets for a woman w/o hypothyroidism in the first trimester?
TSH: 0.2 - 2.5
70
What are the TSH targets for a woman WITH hypothyroidism in the first trimester?
TSH < 2.5
71
Definition of IUGR
fetus weight < 10th percentile on U/S
72
Name three etiologies of IUGR
Cigarettes Drugs TORCH Genetic abnormalities '
73
What is the screening method of IUGR? And if positive, what would be the two next investigations?
If SHF <3 cm below GA → U/S for BPP + umbilical doppler
74
Name 2 contraindications of trial of labour after C-section
Hx of uterine rupture Uterine reconstruction Classic/inverted T uterine scar Placenta previa
75
Name two activities that those with placenta previa should avoid
Exercise Vaginal or anal sex
76
When should you screen for Rh alloantibodies:
First visit and at 28w GA
77
Name 3 reasons to give RhoGAM to a Rh neg pregnant woman
If undergoing amniocentesis Abortion/ectopic pregnancy/molar pregnancy 28w GA w/ fetal Rh unknown or positive 72h after delivery of Rh positive baby
78
Which ONE laboratory test must be reviewed before administering routine antenatal Rh(D) immune globulin?
Indirect Coombs test
79
When should you prophylactily administer RhoGAM during pregnancy and post-partum?
At 28w GA and 72h after delivery
80
What is the definition of chronic hypertension in pregnancy:
diagnosed < 20 wks GA
81
Definition of pre-eclampsia
**Hypertension after 20 weeks** ≥140/90 mmHg on two readings at least 4 hours apart AND One of the following: **Proteinuria** ≥300 mg/24 h or protein/creatinine ratio ≥0.3 **End-organ dysfunction, such as:** Thrombocytopenia (<100 ×10⁹/L) Elevated LFTs (AST/ALT ≥2× normal) or RUQ/epigastric pain Renal insufficiency (Cr >90 µmol/L or doubling of baseline) Pulmonary edema New-onset headache or visual symptoms
82
4 risk factors of pre-eclampsia
Prior pre-eclampsia BMI >30 Chronic HTN DM CKD SLE Nulliparity Multifetal pregnancy Age > 40
83
Name three complications of pre-eclampsia
HELLP syndrome Placental abruption IUGR Oligohydramnios Stroke TIA Thrombocytopenia
84
Name three preventions for pre-eclampsia in low-risk women
Calcium supplementation (>500 mg d) No EtOH Exercise
85
What are the two agents that are recommended for the prevention of eclampsia in pregnancy? When should they be started?
At 12 wk GA: ASA and Calcium 500 mg/d
86
Name 5 routine investigations that should be ordered for patients with pre-eclampsia
**U/S q2w** **Labs** CBC (platelet count) Fibrinogen INR PTT Lytes Extended lytes AST/ALT Hemolysis: LDH, bilirubin, reticulocytes Creatinine 24h urine or ACR
87
Name 5 symptoms or lab changes that would warrant a patient with pre-eclampsia to be seen in the E.D.
**Signs of organ-damage** H/A Blurry vision CP SOB Epigastric pain Oliguria ↓ FM Severe BP (> 160/110) **Labs** ↓ platelets ↑ Cr Elevated enzymes ** U/S** IUGR
88
What are the three pillars of the management of severe pre-eclampsia in the hospital?
1. BP control 2. Fetal steroids 3. Magnesium sulfate
89
Name two agents to be used for non-severe pre-eclampsia
Labetalol Methyldopa Long-acting nifedipine Other beta-blockers
90
What is the BP cut-off value for severe pre-eclampsia
BP > 160/110
91
Until how many GA can you administer steroid for fetal lung development?
< 35 wk GA
92
Name the **four Leopold maneuvers** and their purpose.
* Fundal grip (1st maneuver): Determines what is in the fundus (head vs breech) * Lateral grip (2nd maneuver): Identifies the fetal back vs limbs (helps locate fetal position) * Pawlik’s grip (3rd maneuver): Assesses the presenting part and if it is engaged * Pelvic grip (4th maneuver): Determines degree of flexion/attitude of the fetal head and confirms engagement ## Footnote These maneuvers are used to assess fetal position and engagement during pregnancy.
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