4 Flashcards
Who should be screened for chlamydia?
All sexually active women age 24 and younger
Sexually active women age 25 and older who are at increased risk`
What is sensitivity?
is the proportion of patients with disease who test positive. False Negative rate among those with disease = (1-Sensitivity).
If a person is rubella non-immune and wants to conceive, how long should they wait after recieving immunization?
patient must wait three months before conceiving to provide adequate protection from embryonic and/or fetal complications.
When to immunizae against influenza?
flu season October through March
What are the general groups of birth control available?
oral contraceptives, medroxyprogesterone (Depo-Provera) injections, transdermal options, IUDs, and the vaginal ring (NuvaRing)
How much folic acid should a healthy mom take? What if she has diabetes or cerebral palsy? What if there’s a history of neural tube defects?
1) normal = 400-800 micrograms
2) 1 mg in patients with diabetes or epilepsy
3) 4 mg in patients who bore a child with a previous neural tube defect
What are 3 diseases you may want to do carrier screening based on family’s ancestry/background?
sickle cell anemia thalassemia Tay-Sachs disease cystic fibrosis nonsyndromic hearing loss (connexin-26)
What are the main medical diseases to manage pre-conception and in pregnancy?
Diabetes: optimize control, folic acid, 1 mg per day, off ACE-inhibitors
Hypertension: avoid ACE inhibitors, angiotensin II receptor antagonists, thiazide diuretics
Epilepsy: optimize control; folic acid, 1 mg per day
DVT: switch from warfarin (Coumadin) to heparin
Depression/anxiety: avoid benzodiazepines
When and why can bleeding occur early in pregnancy?
around the time of the missed menses as a result of an invasion of the trophoblast into the decidua (implantation bleed)
How do we test for chlamydia?
Urine PCR
A girl recieved the live varicella vaccine before knowing she was pregnant. Is it likely the baby will have defects?
NO, never been reported. However, infection with chicken pox during pregnancy has been associated with defects
Why order a CBC prenatally?
detect various nutritional and congenital anemias, and to detect platelet disorders.
What two routine immunizations are live and should not be used in pregnancy?
MMR/rubella and varicella
What do you need to do for a patient who is bleeding in pregnancy, regardless of how far along she is?
50mcg dose of Rho(D) Immune Globulin (e.g., RhoGAM) in first trimester, 300 mcg 28 and beyond
What is the first vital sign to reflect loss of blood?
heart rate… can take some time and blood loss for blood pressure changes
What is ectropion?
When the central part of the cervix appears red from the mucous-producing endocervical epithelium protruding through the cervical os, onto the face of the cervix. It has no clinical significance and is common in women who are taking oral contraceptive pills.
What labs are recommended to evaluate first trimester bleeding?
1) Complete blood count (CBC)
2) PCR for gonorrhea and chlamydia
3) Wet mount preparation
4) Progesterone
5) Quantitative beta-human chorionic gonadotropin (quant. beta-hCG)
What does wet mount evaluate?
Trichomonas, yeast, clue cells for bacterial vaginosis
What’s the role of progesterone in diagnosing miscarriage?
Laboratory testing for progesterone is most useful in extreme situations. If the result is >25, it is highly associated with a sustainable intrauterine pregnancy. If the result is <5, it is highly associated with an evolving miscarriage or ectopic pregnancy. Levels between 5 and 25 have minimal diagnostic value in distinguishing intrauterine from ectopic pregnancy.
How does bHCG increase in early pregnancy?
doubles every 48 hours for the first 6-7 weeks of gestation
What do you expect on US and with bHCG for 5 weeks gestation?
gestational sac is visible on vaginal sonography and the β-hCG should be about 1398 (+155) mIU/mL
What are three most ocmmon causes of early bleeding pregnancy?
spontaneous abortion, ectopic pregnancy, and idiopathic bleeding in a viable pregnancy.
Can transabdominal nor transvaginal ultrasound can reliably detect an intrauterine pregnancy at a beta-hCG level less than 1500 mIU/mL?
NO
What are different kinds of spontaneous abortions?
A. Threatened abortion B. Inevitable abortion C. Incomplete abortion D. Missed abortion E. Septic abortion F. Complete abortion
What is a threatened abortion?
bleeding before 20 weeks gestation.
What is an inevitable abortion?
dilated cervical os.
What is a missed abortion?
fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding).
What is a septic abortion?
with intrauterine infection (abdominal tenderness and fever usually present).
What is the common cause of miscarriage?
About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities
About how many pregnancies end in miscarriage?
1/3
What are the classic signs of pregnancy?
Classic signs of pregnancy include a delayed menstrual period, symptoms of nausea, breast tenderness, and malaise. Additional classic signs include a bluish discoloration of the cervix from venous congestion (Chadwick’s sign), usually visible by eight to 10 weeks gestation, and a palpably gravid uterus, usually easily discerned by 10 to 12 weeks gestation.
Describe the hcg progression
Levels of hCG double approximately every 2.2 days over the first few weeks and then double more slowly approximately every 3.5 days by 9 weeks. Levels of hCG peak at 10-12 weeks and then decline rapidly thereafter until 22 weeks, when levels gradually rise until delivery.
When do you see a gestational sac by US?
A gestational sac can often be visualized by 4-5 weeks’ gestation
When do you see a fetal pole by US?
A fetal pole is often seen by 5-6 weeks
How often are babies born on due date?
About 5% of babies are born on their due date, with most deliveries occurring within two weeks of the due date (either before or after).
Which fish are high in mercury and should be avoided during pregnancy?
Shark, swordfish, king mackerel, and tilefish
A lady with normal BMI should expect to gain how much weight?
Expect to gain 25-35 lbs
An overweight lady (BMI 25-30) should limit pregnancy weight to what?
Limit weight gain to 15-25 lbs
Is 11-20 lb weight gain recommended for the obese patient (BMI >30)?
YES
When can serum screening for fetal anomalies take place?
approximately 15-21 weeks’ gestation
When is serum antenatal screening performed?
15-21 weeks
What does triple and quad screen consist of?
alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol, and (only in the quad screen) dimeric inhibin A
What are the two available invasive antenatal genetic tests?
chorionic villus sampling in the first trimester and amniocentesis in the second trimester
When does N/V of pregnancy typically self-resolve?
20 weeks
List three dietary supplements that help with N/V of pregnancy
Ginger powder, 1 g per day, was more effective than placebo in one European study
Pyridoxine (vitamin B6) 25 mg every 8 hours
Doxylamine, 25 mg at bedtime
What are the three main prescribed anti-emetics in pregnancy?
Prochlorperazine, 25 mg per rectum every 12 hours
Promethazine, 25 mg orally or rectally every 4 hours
Ondansetron, 8 mg two or three times daily
What’s the sensitivity of Quad screen detecting Downs?
80%
Describe gestation HTN
The presence of persistent systolic blood pressure of ≥140 mmHg and/or a diastolic blood pressure of ≥90 mmHg, without proteinuria, in a previously normotensive pregnant woman at or after 20 weeks of gestation.
In addition to bp > 140/90, how much urine is diagnostic of pre-eclampsia?
proteinuria of 0.3 grams or greater
3 common rashes of pregnancy
pruritic folliculitis, prurigo of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP)
Which organ can cause pruritic rash that should be considered in the pregnant woman with itchy rash?
gallbladder
Whats on your differential for causes of 3rd trimester discharge/ possible bleeding
placenta previa, placental abruption, BV, vaginal candidiasis, UTI, cervical trauma
List common features of down syndrome
Flat facial profile Poor Moro reflex Excessive skin at nape of the neck Slanted palpebral fissures Hypotonia Hyperflexibility of joints Dysplasia of pelvis Anomalous ears Dysplasia of midphalanx of fifth finger Transverse palmar (Simian) crease
