Hp&p E2 Prevent Issues In Pregnancy

Front 1

Pregnant women cannot:

Back 1

- eat lunch meat that isn't heated
- eat sweet n' low because of saccharin
- drink energy drinks
- drink herbal teas

Front 2

Goals of preconception care:

Back 2

- Optimize maternal health status
- Genetic screening
- Reduce environmental threats
- Prevent maternal infection that can affect fetus

Front 3

Preconceptual counseling H&P:

Back 3

- FH and Genetic Hx
- Medical Hx
- Current medications
- Social Hx (alcohol, tobacco, drugs, education, SES, culture)
- Domestic abuse and violence
- Nutrition
- Environmental and occupational exposures
- Immunity and immunization status
- OB/GYN hx

Front 4

Preconceptual counseling PMH

Back 4

- Diabetes
- Asthma
- HTN
- Infections (Hep B and C, HIV, HPV, HSV)
- Seizure d/o
- Migraines
- CV disease
- Thyroid d/o
- Thromboembolic disease
- Thrombophilias
- Coagulation defects
- Medications

Front 5

What are you looking for in genetic history?

Back 5

- Fraternal twins?
- Birth defects (NTD, MR, CHD, Autism, Trisomies)

Front 6

Preconceptual counseling education:

Back 6

- exercise
- weight management
- folic acid
- maintaing good control of pre-existing conditions
- exposures

Front 7

Folic Acid Recommendation?

Back 7

- 0.4 mg (400mcg) for low risk
- 4.0 mg for high risk
(family hx, folic antagonist medications, people who've had pregnancies with NTDs already)

Front 8

When should you start taking folic acid?

Back 8

- any woman of reproductive age
- at LEAST one month before conceiving
- better if 3 months before

Front 9

Environmental Issues:

Back 9

- Toxoplasmosis (cats)
- Lead
- Mercury
- Anesthetic gases
- Petrochemicals, Formalin, Hydrocarbons
- Paints
- Radiation

Front 10

What vaccinations should you have?

Back 10

- Rubella
- Varicella (do titer to see if exposed to chicken pox)
- Hep B
Make sure to give immunizations that you can give during pregnancy, before

Front 11

What other tests need to be done preconception?

Back 11

- HIV
- RPR/VDRL (syphilis)
- PPD (tuberculosis skin test)
- STDs (some at the time of delivery, can't have lesions present because baby could get it (HPV))

Front 12

What optional tests can you do?

Back 12

- Sickle hemooglobinopathies
- Thalassemias
- Tay-Sachs
- Cystic fibrosis
- Hemophilias

Front 13

Who should you refer for genetic counseling?

Back 13

- AMA
- Current child with disorder
- Known family hx of disorders
- 3+ spontaneous abortions (miscarriages)
- Abnormal lab results

Front 14

What is the #1 cause of miscarriages?

Back 14

chromosomal abnormalities (if 3 or more, could be because of another d/o as well)

Front 15

What do you need to look for in OB history?

Back 15

- Miscarriages
- Incompetent cervix
- Macrosomia or GDM
- HTN d/o of pregnancy (PIH, pre-eclampsia)
- Type of delivery (c-section)

Front 16

What do you need to look for in GYN history?

Back 16

- Infertility
- Ectopic pregnancy
- Molar pregnancy
- Endometriosis
- Prior pelvic surgery
- Prior pelvic infections
- Cervical procedures

Front 17

What are the goals of prenatal care?

Back 17

- Provide easy access to care
- Promote patient involvement
- Provide a team approach to ongoing surveillance and education for the patient and about her fetus

Front 18

What's done at 1st prenatal visit?

Back 18

- Physical (general, pap smear, GC/C, TVUS, pelvimetry)
- History
- Labs (blood type, antibody, H/H, MCV, VDRL, Syphilis)
- HBsAg
- UA and C&S
- HIV
- Varicella and Rubella titers
- Any optional tests

Front 19

Early PG Prenatal Landmarks?

Back 19

- 3-4 weeks: gestational sac seen with TVUS
- 5-6 weeks: gestational sac seen with Abd US
- 6 weeks: Hegar's and Chadwick's

Front 20

Hegar's?

Back 20

softening of uterine isthmus

Front 21

Chadwick's?

Back 21

blue-purple hue of cervix

Front 22

Middle PG Prenatal Landmarks?

Back 22

- 10-12 weeks: FHT by Doppler
- 12 weeks: uterus palpable at symphysis
- 16-18 weeks: "quickening"
- 20 weeks: uterus at umbilicus

Front 23

At what point should you increase 1 sonometer (cm) for each week of pregnancy?

Back 23

After 20 weeks

Front 24

T1 Genetic Screening:

Back 24

- Purpose: enhanced detection for trisomy 13, 18, 21
- Time period: 10-13 weeks GA
- What it tests: PAPPA-A (plasma protein), hCG, and nuchal translucency

Front 25

T2 Genetic Screening:

Back 25

- Purpose: enhanced detection of trisomy and NTD
- Time period: 15-18 weeks
- What it tests: "Triple screen (TS)" (MSAFP, hCG, estriol) or "Quad screen" (TS + Inhibin A)

Front 26

2 most common NTDs?

Back 26

- spina bifida
- anencephaly

Front 27

When are antepartum visits?

Back 27

- Q4 weeks until 28 weeks
- Q2 weeks from 28-36 weeks
- Q week from 36 until delivery

Front 28

Every antepartum visit includes?

Back 28

BP, Weight and UA for protein and glucose

Front 29

At what point do you give the glucose challenge?

Back 29

24-28 weeks

Front 30

At what point do you test for Group B strep?

Back 30

36 weeks

Front 31

What are some general OB risks?

Back 31

- Age extremities (<18 and >35)
- Nulliparity
- Smoking/Drugs
- Weight extremes
- Low SES
- Race: AA and Hispanics
- Co-morbid conditions
- Infection

Front 32

What is the average weight gain between monthly visits?

Back 32

3-4 pound for a healthy person

Front 33

What is pica and what most likely causes it?

Back 33

Craving for substances not normally considered food, usually caused by a deficiency
- Clay, laundry starch, tar/charcoal, coffee grounds

Front 34

Classifications of Teratogens:

Back 34

A: no evidence of risk in any trimester
B: no evidence of harm, but no adequate studies
C: animal studies have shown adverse effects but no pregnant women studies
D: adequate studies in PG women have shown risk (weight benefits v. harm)
X: adequate studies have shown evidence of fetal abnormalities or risk

Front 35

What are some main teratogens?

Back 35

- ACE inhibirotrs
- Seizure drugs
- Isotretinoin
- Tetracyclines and Quinolones
- Warfarin
- Accutane
- SSRI (paxil)