Prenatal Care
Roughly 25% of the NARM written examination — about 69–81 scored items of the ~300 on the exam.
This is the second-largest domain. Master both routine care and the recognition of complications.
Physiology and routine care. Understand the anatomy and physiology of pregnancy and the normal changes by trimester. At each visit, track blood pressure, weight, urine (dip for protein, glucose, ketones, leukocytes, nitrites, blood), fundal height, fetal heart tones (fetoscope/doppler), and fetal movement. Use Leopold's maneuvers to assess lie, presentation, position, and estimated fetal size, and estimate the due date with standard methods (Naegele's rule: LMP − 3 months + 7 days; confirm/adjust with early ultrasound). Correlate fundal height in cm ≈ weeks of gestation between roughly 20 and 36 weeks.
Counseling and common complaints. Counsel on nutrition, weight gain, exercise, and supplements, and manage the common discomforts of pregnancy — nausea/vomiting, heartburn, constipation, hemorrhoids, round-ligament pain, sciatica, leg cramps, backache, carpal tunnel, varicosities, and sleep and emotional changes — distinguishing normal discomforts from red flags.
Recognizing and responding to complications. Identify, assess, treat within scope, or refer:
- Hypertensive disorders — gestational hypertension and pre-eclampsia (elevated BP with proteinuria and/or signs such as headache, visual changes, RUQ pain, hyperreflexia/clonus, edema). Pre-eclampsia is a referral/transfer situation; know the warning signs cold.
- Gestational diabetes, UTI, anemia, thrombophlebitis, oligohydramnios/polyhydramnios, and IUGR / SGA / LGA.
- Bleeding — first-trimester (threatened/spontaneous abortion, ectopic — a surgical emergency), and second/third-trimester bleeding: placenta previa (painless bleeding — no vaginal exam; refer) vs. placental abruption (painful bleeding, rigid tender uterus — emergency transfer).
- Malpresentation — identify breech and occiput-posterior; know positioning, ECV referral, and non-allopathic options (e.g., moxibustion), plus management if an unexpected breech presents. Identify multiple gestation.
- VBAC — indications/contraindications for out-of-hospital birth and uterine-rupture risk factors (classical vs. low-transverse incision, scar thickness, short interdelivery interval, multiple prior cesareans). Recognize the signs of uterine rupture (severe pain, loss of fetal station, abnormal FHTs, bleeding, maternal instability) as an emergency.
- Preterm labor — risk assessment (infection, smoking, prior PTB, periodontal disease, stress), counseling against elective early induction, and prompt referral/consult. Post-date pregnancy — surveillance with fetal-movement counts, FHR, amniotic-fluid assessment, and referral for NST/BPP/ultrasound.
- PROM — distinguish full-term from preterm. At term: monitor FHTs and temperature, minimize vaginal exams, reinforce hygiene, review GBS status, and consult for prolonged rupture. Preterm PROM: consult/refer.
- Cholestasis of pregnancy, and identification of molar/ectopic pregnancy.
Emergency and transport planning. Establish contingency plans, educate on hospital transport (including augmentation and pharmacologic pain relief), and provide informed, supportive counseling around cesarean birth and recovery.
Sample questions from this domain
Three of the 112 questions in this domain, with the reasoning. The full set is in the question bank.
Screening for gestational diabetes is typically performed around which gestational window?
- A. 24–28 weeks ✓
- B. 6–10 weeks
- C. 36–40 weeks
- D. 14–16 weeks
Why: Routine gestational diabetes screening is usually done at 24–28 weeks, when placental hormones peak insulin resistance. Earlier screening is offered when risk factors are present.
Leopold's maneuvers are performed to determine all of the following EXCEPT:
- A. Cervical dilation ✓
- B. Fetal position
- C. Fetal lie
- D. Fetal presentation
Why: Leopold's maneuvers are abdominal palpation techniques used to assess fetal lie, presentation, position, and engagement/estimated size. Cervical dilation is determined by vaginal examination, not palpation of the abdomen.
Quickening — the first maternal perception of fetal movement — typically occurs around:
- A. 16–20 weeks ✓
- B. 34–36 weeks
- C. 8–10 weeks
- D. 28–30 weeks
Why: Quickening is usually felt around 16–20 weeks, often earlier in multiparous clients. It is one supportive data point for dating and fetal well-being.
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