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2.1) My Cards > 1.1 MTB Step 3 - The Uncomplicated Pregnancy (Diagnosing Pregnancy & 1st Trimester Prenatal Screening) > Flashcards

1.1 MTB Step 3 - The Uncomplicated Pregnancy (Diagnosing Pregnancy & 1st Trimester Prenatal Screening) Flashcards

Cards Complete:

1
Q

DIAGNOSING PREGNANCY

What are (3) Clinical Findings in Suspected Pregnancy?

A
  1. Amenorrhea
  2. Enlargement of Uterus
  3. + Urinary Beta-HCG (pregnancy) test
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2
Q

DIAGNOSING PREGNANCY

What are the (4) parts to Confirming Pregnancy?

A
  1. Presence of Gestational Sac with Yolk Sac: seen by transvaginal ultrasound at 4 to 5 weeks. This corresponds to a serum β-hCG level of about 1,500 mIU/mL.
  2. Fetal Heart Motion: seen by ultrasound at 5 to 6 weeks.
  3. Fetal Heart Sounds: heard with doppler ultrasound at 8 to 10 weeks.
  4. Fetal Movements: Felt by physician after 20 weeks gestation.
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3
Q

DIAGNOSING PREGNANCY

  1. When is an Intrauterine Pregnancy normally seen on Vaginal US?
  2. When is an Intrauterine Pregnancy normally seen on Abdominal US?
A
  1. Vaginal sonogram at 5 weeks gestation when serum β-hCG > 1,500 mIU
  2. Abdominal sonogram at 6 weeks gestation when β-hCG > 6,500 mIU
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4
Q

PRENATAL SCREENING

FIRST TRIMESTER

  1. What is the first-trimester screening test for Anemia or Blood Disorders?
  2. What is the Diagnostic Significance?
A
  1. CBC
  2. Anemia = Hb < 11 g/dL in the first and third trimesters and < 10.5 g/dL in the second trimester.
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5
Q

PRENATAL SCREENING

BASIC SCIENCE CORRELATE

What is Anemia in Pregnancy caused by specifically?

A
  • Anemia in pregnancy is caused by Increased levels of Hepcidin, which Inhibits Iron Transport.
  • Pregnancy Increases Iron Demand, but Hepcidin Prevents Absorption.
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6
Q

PRENATAL SCREENING

FIRST TRIMESTER

  1. What is the Most Common Cause of Anemia in the first trimester?
  2. Which lab value is considered the Most Reliable Indicator of Anemia?
  3. What WBC count is considered Abnormal?
A
  1. Iron Deficiency
  2. MCV
  3. WBC > 16,000/mm3
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7
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for each of the following situations?

  1. Decreased Hg and Decreased MCV
  2. Decreased Hg, Increased MCV, Increased RDW
  3. Thrombocytopenia (<150,000)
A
  1. Give IRON. Test for Thalassemia if anemia does not improve.
  2. Give FOLATE.
  3. Correlate clinically for ITP or HELLP Syndrome.
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8
Q

PRENATAL SCREENING

FIRST TRIMESTER

What are the (2) first-trimester screening tests for Blood Type, Rh, and Antibody and what is the Diagnostic Significance for each?

A
  1. Type & Screen: Rh-negative mothers may become sensitized (anti-D Ab) → risk of erythroblastosis fetalis in the next pregnancy.
  2. Coomb’s Test (Direct & Indirect): Indirect Coombs test (or atypical antibody test [AAT]) detects atypical RBC Ab’s.
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9
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for Rh-negative Mothers?

A

Give RhoGAM to Rh-negative mothers at 28 weeks after first rescreening for the absence of anti-D antibodies or after any procedure (CVS, amniocentesis) and after delivery.

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10
Q

PRENATAL SCREENING

FIRST TRIMESTER

What are the (2) first-trimester Genitourinary screening tests and what is the Diagnostic Significance for each?

A
  1. Cervical Pap Smear: Detects cervical dysplasia or malignancy.
  2. Urinalysis & Urine Culture:
    • UA - Screen for underlying renal disease and infection.
    • UCx - Screen for asymptomatic bacteriuria (ASB).
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11
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for Asymptomatic Bacteriuria (ASB) in the first trimester?

A

Cephalosporins, Amoxicillin

  • Always treat ASB in pregnancy to prevent pyelonephritis (30% risk when untreated).
  • Need test of cure in pregnant women.
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12
Q

PRENATAL SCREENING

BASIC SCIENCE CORRELATE

  1. What type of parasite is Chlamydia trachomatis?
  2. What type of parasite is Neisseria gonorrhea?
A
  • Chlamydia trachomatis is an Obligate Intracellular Parasite (It needs a host cell to survive).
  • Neisseria gonorrhea is a Gram-Negative Diplococcus that grows on Chocolate Agar.
    • Nuclear acid amplification test (NAAT) is the test of choice.
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13
Q

PRENATAL SCREENING

FIRST TRIMESTER

What are the (2) first-trimester screening tests for Immunization Status and what is the Diagnostic Significance for each?

A
  1. Rubella Antibody: (–) Rubella IgG Ab’s means ↑ risk of primary rubella infection.
  2. Hepatitis B Surface Antigen: (+) HBsAg indicates risk for vertical transmission of HBV.
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14
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for first trimester (-)Rubella IgG status?

A
  • Do not give Rubella immunization in pregnancy.
  • Immunize seronegative patients after delivery.
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15
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for first trimester (+)HBsAg status?

A

(+) HBsAg: Order HBeAg:

  • (+) HBeAg signifies a highly infective state.
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16
Q

PRENATAL SCREENING

FIRST TRIMESTER

What are the (2) first-trimester screening tests for Syphilis Infection and what is the Diagnostic Significance?

A

VDRL or RPR

  • Confirm (+) VDRL/RPR with Treponema-specific tests (MHATP or FTA).
  • Alternatively, may start with Treponemal-specific tests (EIA/CIA) followed by VDRL/RPR (“reverse algorithm screening”).
17
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for confirmed Syphilis infection in the first trimester?

A

(+) Confirmatory Test = Treat with IM Penicillin.

Penicillin Allergy: Desensitize and then treat with Penicillin.

18
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the first-trimester screening test for HIV Infection and what is the Diagnostic Significance?

A

ELISA

Confirm (+) ELISA screen with Western blot test (presence of HIV core and envelope antigens).

19
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for confirmed HIV+ infection in the first trimester?

A
  • All babies born to HIV (+) women will be HIV antibody (+) (passive transport of maternal Ab’s).
  • (+) Ab’s do not indicate an infection in an infant.
  • Antiretrovirals are recommended in pregnancy.
  • Give Zidovudine in labor
20
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the first-trimester screening test for Chlamydia/Gonorrhea Infection and what is the Diagnostic Significance?

A

Cervical Culture

  • Gram stain
  • Chlamydia and Gonorrhea culture

Also treat Trichomonas Vaginalis (can cause premature labor).

21
Q

PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for confirmed Chlamydia/Gonorrhea infection in the first trimester?

A

(+) Chlamydia/Gonorrhea

  • IM Ceftriaxone
  • PO Azithromycin

(+) Bacterial Vaginitis

  • PO or Vaginal Metronidazole or clindamycin

(+) Trichomonas Vaginalis

  • PO Metronidazole for mother and partner
22
Q

OPTIONAL PRENATAL SCREENING

FIRST TRIMESTER

What are the (2) optional first-trimester screening tests for Tuberculosis?

A

Quantiferon Gold (QFT) (preferred) or PPD

23
Q

OPTIONAL PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for confirmed Tuberculosis in the first trimester?

A
  1. If (–) QFT or (–) PPD: No further follow-up is needed.
  2. If (+) QFT or (+) PPD: Order chest x-ray to rule out active disease.

Treatment for a Positive screen:

  • (+) QFT or (+) PPD and (–) CXR: INH and B6 for 9 months.
  • (+) QFT or (+) PPD and (+) CXR and (+) Sputum: Begin triple therapy antituberculosis Rx if sputum stain positive.
  • Obtain sputum for culture.
  • Avoid streptomycin in pregnancy because of the risk of ototoxicity in the fetus.
24
Q

OPTIONAL PRENATAL SCREENING

FIRST TRIMESTER

What are the (3) optional first-trimester screening tests for Trisomy 21 (Down Syndrome)?

A
  1. β-hCG
  2. Pregnancy Associated Plasma Protein A (PAPP-A)
  3. Fetal Nuchal Translucency
25
Q

OPTIONAL PRENATAL SCREENING

FIRST TRIMESTER

What is the Next Step in Management for a (+) Trisomy 21 (Down Syndrome) screening test in the first trimester?

A

A (+) Screening test is confirmed with Chorionic Villus Sampling (CVS) or Amniocentesis in the first trimester.

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