Aquifer 1 Flashcards
1
Q
List the general topics that should be discussed during preconception counseling (5).
A
- Genetic
- Infectious diseases
- Environmental toxins
- Medical assessment
- Lifestyle
2
Q
What topics related to genetics should women be counseled on prior to conception?
A
- Folic acid supplementation
2. Carrier screening
3
Q
What are some genetic diseases that should be screened for based on ethnic background or family history?
A
Ethnic background - sickle cell anemia (African descent), thalassemia (Italian, Greek, Mediterranean, Asian descent), hemophilia, Tay-Sachs
Family history - CF, non-syndromic hearing loss (connexin-26)
Other - neural tub edefects, congenital heart defects, Down syndrome, mental retardation, metabolic disorders, etc.
4
Q
What topics related to infectious diseases should women be counseled on prior to conception?
A
- Screen for HIV and Syphilis
- Hepatitis B immunization, counsel on preconception immunizations (rubella, varicella)
- Toxoplasmosis - avoid cat litter, garden soil, raw meat
- CMV, parvovirus B19 - wash hands frequently, universal precautions for child care and healthcare
5
Q
What topics related to environmental toxins should women be counseled on prior to conception?
A
- Occupational exposure (request Material Safety Data Sheets from employer), prolonged standing
- Household chemicals (avoid paint thinners and strippers, other solvents, pesticides)
- Smoking cessation (bupropion, nicotine patches)
- Screen for alcohol and illegal drug use
6
Q
What topics related to medical assessment should women be counseled on prior to conception?
A
- Diabetes - optimize control, folic acid 1 mg/day, stop ACEIs
- HTN - avoid ACEIs, ARBs, thiazides
- Epilepsy - optimize control, folic acid 1 mg/day
- DVT - switch from warfarin to heparin
- Depression/anxiety - avoid benzos
- Other conditions that increase risk in pregnancy (heart, kidney, autoimmune, endocrine, or neurologic diseases)
- TB
7
Q
What topics related to lifestyle should women be counseled on prior to conception?
A
- Regular moderate exercise (30 minutes on most days); avoid activities that put them at risk for falls or abdominal injuries
- Avoid hyperthermia (hot tubs, overheating)
- Caution against obesity and being underweight
- Screen for domestic violence
- Assess risk of nutritional deficiencies (vegan, pica, milk intolerance, calcium or iron deficiency); eat a healthy diet; avoid certain foods
- Avoid overuse of Vitamin A and Vitamin D
- Limit caffeine intake to 2 cups of coffee or 6 glasses of soda
- Intercourse during pregnancy is not associated with adverse outcomes
- Few medications have been proven safe for use in pregnant women, particularly during the first trimester
- Hair treatments - not clearly associated with fetal malformation, but should avoid exposure
- Screen for intimate partner violence
8
Q
What are the classic symptoms of pregnancy?
A
Amenorrhea with fatigue, nausea/vomiting, and breast changes/tenderness
9
Q
Urinary frequency is a symptom of pregnancy; what should also be considered?
A
UTI in a pregnant woman
10
Q
What are some signs of pregnancy?
A
- Goodell’s sign (softening of the cervix)
- Hegar’s sign (softening of the uterus)
- Chadwick’s sign (blue-purple hue in the cervix and vaginal walls; visible by 8-10 weeks)
- Enlargement of the uterus on bimanual exam
- Fetal heart tones
- Fetal movement
11
Q
When is enlargement of the uterus palpable in pregnancy?
A
As early as 8 weeks (experienced examiner), fundus palpated around 12 weeks above symphysis pubis
12
Q
When does uterine enlargement in cm approximate gestational age?
A
20-36 weeks
13
Q
When are fetal heart tones first detected by hand-held Doppler?
A
Between 10-12 weeks
14
Q
When is fetal movement first detected by mom?
A
18-20 weeks
15
Q
Describe the levels of beta-hCG in the blood throughout pregnancy.
A
Secreted by trophoblasts at day 7 post-ovulation
First few weeks - levels double every 2.2 days
By 9 weeks - double every 3.5 days
10-12 weeks - peak, then decline rapidly until 22 weeks, then gradually rises until delivery
16
Q
True or false - transabdominal U/S is more sensitive than transvaginal U/S for detecting pregnancy.
A
False - transvaginal is more sensitive (can often visualize by 4-5 weeks)
17
Q
How is Estimated Gestational Age (EGA) calculated?
A
Time elapsed since the Last Normal Menstrual Period (LNMP)
18
Q
How does the EGA compare to the actual embryonic age (age of the fetus since the date of conception)?
A
The actual embryonic age will typically be ~2 weeks less than the clinically calculated EGA
19
Q
What measure is used to calculate EGA in the various trimesters of the U/S?
A
First - crown-rump length
Second - biparietal diameter, head circumference, abdominal circumference, femur length
Third - n/a
20
Q
How does U/S measurement affect EGA?
A
If EGA/EDD measurements are within 1 week of LNMP estimate, no change is indicated. If >7 days, update to what is indicated by the first and second trimesters.
21
Q
At 20 weeks, the top of the fundus is usually at the level of the umbilicus. After 20 weeks, it elevates ___cm above the umbilicus/week of pregnancy.
A
1
22
Q
Calculate the Estimated Due Date (EDD) using Naegele’s Rule.
A
First day of the LNMP + 1 year - 3 months + 1 week (aka 40 weeks after the beginning of the last menstrual period)
23
Q
5% of babies are born on their due date; most deliveries occur within +/- ___.
A
2 weeks
24
Q
Which foods should be avoided in pregnancy and why?
A
- Raw eggs - salmonella
- Unpasteurized milk/milk products and unwashed fruits/vegetables - toxoplasmosis and listeriosis
- Soft cheese - listeriosis
- Large ocean fish - mercury poisoning
- Raw fish, shellfish
- Aspartame - likely safe in moderate amounts; women with PKU should avoid
- Saccharin - known to cross the placenta; use caution
25
List the lab studies that should be ordered at initial prenatal visit.
1. CBC
2. Rubella IgG Ab
3. HB surface Ag
4. Blood type and Rh status
5. RPR or VDRL test for syphilis
6. HIV status
7. Chlamydia and gonorrhea screening (NAAT) - F 24 years and younger, older women at increased risk
8. Urinalysis (?)
9. Hepatitis C Ab screen - women with risk factors
10. Varicella - if no history of chicken pox, serologic testing; if non-immune, preconception or postpartum varicella vaccination
11. TB skin/blood test - women with HIV or who live in a household with someone with active TB)
12. Herpes I/II Ab - if no history of genital/orolabial HSV, counsel avoiding exposure during pregnancy; if recurrent, use antiviral medication to reduce risk of cesarean delivery due to active lesions
26
Why is a CBC ordered at an initial prenatal visit?
Nutritional and congenital anemia, platelet disorders
27
Why is a Rubella IgG Ab ordered at an initial prenatal visit?
If platelet isn't immune, they should receive a POSTPARTUM immunization.
28
When should pregnant women be screened for asymptomatic bacteriuria?
12-16 weeks
29
List risk factors for Hepatitis C.
Contact with prison inmates, IV drug use, HIV+ status, multiple sexual partners, tattoos, elevated liver enzymes
30
True or false - women should be screened for bacterial vaginosis
False - screening is not recommended
31
___% of patients experience vaginal bleeding during the first trimester; when significant, there is a ___% chance of miscarriage.
25; 25-50
32
What is ectropion?
When the central part of the cervix appears red from the mucus-producing endocervical epithelium protruding through the cervical os, onto the face of the cervix; no clinical significant; common in women taking OC's
33
DDx - first trimester vaginal bleeding
Most likely - spontaneous abortion, ectopic pregnancy, idiopathic bleeding in a viable pregnancy
Less likely - gestational trophoblastic disease, vaginal trauma, cervical pathology
34
What supports diagnosis of spontaneous abortion with first trimester vaginal bleeding?
Cervical os dilated with spontaneous bleeding
35
What supports diagnosis of ruptured ectopic pregnancy with first trimester vaginal bleeding?
Distended acute abdomen
36
Does an unremarkable pelvic exam rule out spontaneous abortion, ectopic pregnancy, or idiopathic bleeding in a viable pregnancy?
No
37
What supports a diagnosis of gestational trophoblastic disease (moral pregnancy)?
Characteristic U/S appearance, markedly increased hcG
38
What supports/rules out vaginal trauma and cervical pathology?
Unlikely if nothing abnormal on physical, only ruled out with negative gonorrhea/chlamydia results
39
What is normal regarding newborn weight loss?
Most babies lose up to 10% of birth weight. They may regain it as early as 1 week, but are expected to have regained their birth weight by 2 weeks.
40
Once maternal milk is in, how much should a newborn gain/day?
1 oz
41
What lab studies are recommended to investigate first trimester vaginal bleeding and why?
1. CBC - Hgb/Hct
2. Wet mount preparation for trichomonas, PCR testing for gonorrhea and chlamydia
3. Progesterone - >25 highly associated with sustainable intrauterine pregnancy, <5 highly associated with evolving miscarriage/ectopic pregnancy (5-25 has minimal diagnostic value)
4. Quantitative beta-hCG - higher than normal in molar pregnancy, lower than normal in ectopic/spontaneous abortion; intrauterine pregnancy may not be conclusively detected until 1500-1800
42
Why is a WBC count in pregnancy limited in usefulness?
Most pregnant patients have a mild leukocytosis
43
Define spontaneous abortion.
Loss of a pregnancy without outside intervention before 20 weeks
44
Define threatened abortion.
Bleeding before 20 weeks
45
Define inevitable abortion.
Dilated cervical os
46
Define incomplete abortion.
Some but not all of the intrauterine contents have been expelled
47
Define missed abortion.
Fetal demise without cervical dilation and/or uterine activity
48
Define septic abortion.
Abortion with intrauterine infection
49
Define complete abortion.
Products of conception completely expelled
50
What are the options for management of inevitable abortion?
1. Expectant management
2. Surgery (D&C +/- vacuum aspiration)
3. Medical management (off-label)
51
What are the advantages/disadvantages of expectant management of an inevitable abortion?
Watchful waiting with precautions regarding unusual amounts of bleeding or pain, or fever; effective in 75% of cases; may take up to 1 month and can delay emotional closure
52
What are the main indications/contraindications of surgical management of an inevitable abortion?
Indication - heavy bleeding and patient preference
| Contraindication - active pelvic infection and patient refusal
53
What are the advantages/disadvantages of medical management of an inevitable abortion?
Vaginal administration of misoprostol; 95% effective, usually takes 3-4 days, but can take up to 2 weeks
54
What else must be addressed in management of inevitable abortion?
Administration of Rhogam in Rh negative patients
55
___ of all pregnancies end in miscarriages. 50% of all first trimester miscarriages are due to ___.
1/3; chromosomal abnormalities
56
____% of women who have miscarriages have subsequent normal pregnancies and births.
87
57
Discuss fetal development in the first trimester (first 12 weeks).
Heart, spine, arms, legs, and other organs begin to develop. Neural tube closes by 4 weeks. Heart begins to beat and movement begins around 7-8 weeks.
58
Discuss fetal development in the second trimester.
At 18 weeks, the baby will be able to display facial expressions, have early skeletal development, and may display perceptible movements. Sex can be determined. Soon, the baby will have visible hair, fingerprints, and footprints. Over the next several weeks, the baby will continue to grow and its lungs, liver, and immune system will continue to mature.
59
Discuss fetal development in the third trimester.
By week 27, eyes will open and begin to detect light, the baby will practice breathing. By 36 weeks, weight gain will increase.
60
What measurements should be taken at 10 week prenatal follow-up?
1. Weight measurement
2. Blood pressure
3. Fetal heart tones
61
What is the expected/recommended weight gain for women of normal, overweight, and obese BMI during pregnancy?
Normal - 25-35
Overweight - 15-25
Obese - 11-20
62
Is the influenza vaccine recommended for pregnant women?
Yes, as they are at increased risk for complications from influenza; the IM preparation is inactivated and safe
63
When should Rhogam be administered?
At 28 weeks and within 72 hours after delivery + with any episodes of vaginal or intrauterine bleeding
64
What is tested in a triple and quad serum screening?
AFP, hCG, unconjugated estriol, inhibin A (quad)
65
Abnormal levels in a triple/quad screening indicate increased risk for what issues?
Neural tube defects and trisomy 18 and 21
66
When should a triple/quad serums screening be performed?
15-21 weeks
67
What type of invasive prenatal genetic testing done in the first and second semester?
First - chorionic villus sampling
| Second - amniocentesis (risk of spontaneous abortion)
68
What is the sensitivity of quad screening for Down Syndrome?
81%
69
What is the course of N/V in pregnancy?
Self-limited, begins between 4-7 weeks, resolves by 20 weeks in most women
70
Risk factors for placenta previa?
Prior pregnancy, 35+ y/o, twins or higher multiple pregnancy, previous uterine surgery (including C-section)
71
When is placenta previa more likely to resolve?
When detected earlier, when marginal or incomplete (vs. complete)
72
Complications of placenta previa?
Excessive bleeding at or prior to delivery when covering the os
73
Management of placenta previa?
U/S surveillance; C-section if it does not resolve
74
What anticipatory guidance should be addressed at 23 weeks?
Breastfeeding, car seats, contraception
75
Define chronic hypertension due to pregnancy.
BP elevation detected before the 20th week that persists beyond 12 weeks postpartum
76
Define gestational hypertension.
Persistent systolic BP of 140+ and/or diastolic BP of 90+ (at least 2 readings, ideally >6 hours apart) WITHOUT proteinuria in a previously normotensive pregnant woman at or after 20 weeks
77
Define preeclampsia.
Gestational HTN + proteinuria of 0.3g or greater in a 24-hour urine or at least 1+ or 30 mg/dL on dipstick; increased risk in women who develop gestational HTN earlier in pregnancy
78
Symptoms of severe preeclampsia?
Visual distrubances, severe headache, RUQ or epigastric pain, N/V, decreased urine output
79
How can HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome or severe pre-eclampsia be ruled out?
Evaluation of renal and liver function (spot urine/protein creatinine ratio, CBC for hemoconcentration or thrombocytopenia)
80
Define eclampsia.
Preeclampsia + 1+ convulsions without the presence of underlying neurologic disorder
81
What qualifies preeclampsia or eclampsia as "severe"?
160+ systolic and/or 110+ diastolic BP for at least 6 hours OR RUQ pain OR a doubling of serum transaminases OR platelet count <100 OR pulmonary edema (indication for giving an anti-hypertensive)
82
Risk factors for pre-eclampsia?
White, nulliparous women, lower SES, younger and older (>35) women
83
When should pregnant women be screened for gestational diabetes?
24-28 weeks
84
How should women be screened for gestational diabetes? What is considered abnormal?
One-hour glucose tolerance test; if elevated, do a three-hour glucose tolerance test
85
What are some risks associated with gestational diabetes?
Preeclampsia, fetal macrosomia, birth trauma, need for operative delivery, neonatal mortality, newborn complications
86
Describe a three-hour glucose tolerance test.
Measure patient's glucose after fasting, and then one, two, and three hours after a 100-g glucose load
```
Abnormal: 2+ of the following:
Fasting 95+
One-hour 180+
Two-hour 155+
Three-hour 140+
```
87
Most common cause of life-threatening infection in newborns (sepsis, meningitis, pneumonia)?
Group B Strep
88
Discuss screening and management of GBS disease in pregnancy.
Universal screening for vaginal and rectal GBS colonization of all pregnant women at 35-37 weeks; if positive, IV intrapartum prophylactic penicillin (ampicillin is an acceptable alternative); also indicated for women who previously gave birth to an infant with early-onset GBS disease or with GB bacteriuria during their current pregnancy
89
What are the TORCHZ infections?
```
Toxoplasmosis
Other - varicella, syphilis
Rubella
CMV
HSV
Zika
```
90
Clinical features of congenital toxoplasmosis?
Diffuse intracranial calcifications, hydrocephalus, chorioretinitis
91
Clinical features of congenital varicella?
Microcephaly, cicatricial or vesicular lesions
92
Clinical features of congenital syphilis?
Persistent rhinitis, maculopapular rash of palms, soles, and diaper areas, osteochondritis, periostitis
93
Clinical features of congenital rubella?
Microcephaly, cataracts, glaucoma, retinopathy, sensorineural hearing loss, blueberry muffin rash, hepatomegaly, radiolucent bone disease, patent ductus, peripheral pulmonary artery stenosis, thrombocytopenia
94
Clinical features of congenital CMV?
Periventricular calcifications, microcephaly, cataracts, petechiae/purpura, hepatosplenomegaly, thrombocytopenia
95
Clinical features of congenital HSV?
Conjunctivitis or keratoconjunctivitis, mucocutaneous vesicles, scarring, elevated transaminases, thrombocytopenia
96
Clinical features of congenital Zika?
Severe microcephaly, thin cerebral cortices, subcortical calcifications, macular scarring, pigmentary retinal scarring, sensorineural hearing loss, arthrogryposis, early hypertonia
97
Congenital infections presenting with calcifications?
Toxoplasmosis - diffuse intracranial
CMV - periventricular
Zika - subcortical
98
Congenital infections presenting with microcephaly?
Varicella, Rubella, CMV, Zika (severe)
99
Congenital infections presenting with cataracts?
Rubella, CMV
100
Congenital infections presenting with sensorineural hearing loss?
Rubella, Zika
101
Congenital infections presenting with thrombocytopenia?
Rubella, CMV, HSV
102
List the three common rashes of pregnancy.
1. PUPPP (pruritic urticarial papules and plaques of pregnancy) - trunk and extremities
2. Prurigo of pregnancy - excoriated areas on trunk or limbs
3. Pruritic folliculitis
103
What constitutes evidence of active labor? What does not?
Strong regular contractions every 3-5 minutes and a cervical dilation of >6cm in the setting of contractions
FHR tracing does not impact diagnosis of active labor
104
A pregnant, non-labored cervix is usually at least ___cm in thickness - define 50% effacement.
3; 50% effacement would be 1.5 cm, etc.
105
Absolute contraindications to a digital cervical exam in pregnancy?
Vaginal bleeding with an undocumented placental location or known previa, leaking vaginal fluid with prematurity
106
What steps can be taken to decrease maternal blood loss?
Give mom oxytocin after delivery to help the placenta detach more quickly, pull on the cord gently when the placenta appears to have detached, massage the uterus to help stop the bleeding + early clamping of the cord
107
Define the stages of labor.
First stage: latent phase to regular contractions, cervix <6cm dilated -> active phase from 6cm dilation to full dilation
Second stage: full dilation -> delivery of baby
Third stage: birth of baby -> delivery of placenta
108
What is the average speed of dilation for primiparous and multiparous women?
Primiparous - 1cm/hour (average length of active phase of first stage - 2.4 hours)
Multiparous - 2cm/hour
(average length of active phase of first stage - 4.6 hours)
109
What is define as failure to progress/active phase arrest?
No cervical change for 2 hours in the active phase of labor
110
Treatment of labor dystocia?
IV oxytocin and/or artificial rupture of membranes
111
List the cardinal movements of labor.
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
7. Expulsion
112
What is the different between left and direct occiput anterior regarding fetal head orientation?
Left - back of the fetal head is anterior to the mother's pelvis and to the mother's left
Direct - back of the fetal head is directly posterior to the pubic symphysis (baby's face toward the rectum)
113
List the 4 causes of postpartum hemorrhage.
1. Tone (uterine atony)
2. Trauma (perineal or cervical lacerations, uterine inversion)
3. Tissue (retained/invasive placental tissue in the uterus)
4. Thrombin (bleeding disorder)
114
Recommend breastfeeding for at least ___ (time).
6 months
115
Components of the APGAR score?
```
Appearance (skin color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
```
116
When is the APGAR score reported? What are the ranges?
1 minute and 5 minutes after birth
7-10 (generally normal)
4-6 (fairly low)
<4 (critically low)
117
What reflexes should be assessed in the newborn exam?
1. Rooting (turn head toward finger when you touch cheek)
2. Sucking (suck on finger when touching the roof of the mouth)
3. Moro (startle)
4. Grasp (palmar and plantar)
5. Asymmetrical tonic neck response (turn head to one side, causes gradual extension of arm toward direction of infant's gaze with contralateral arm flexion)
6. Stepping response
118
DDx - third trimester vaginal discharge/possible bleeding
Most likely - placenta previa (22%), placental abruption (31%), bacterial vaginosis, vaginal candidiasis, UTI, cervical trauma
Less likely - PROM, preterm labor, uterine rupture
119
Compare the presentation of placenta previa and placental abruption.
Previa - painless vaginal bleeding after 20 weeks; usually bright red; does NOT usually involve abdominal pain (contractions in 10-20% of cases)
Abruption - vaginal bleeding with abdominal pain, uterine contractions, and a non-assuring fetal heart tracing
120
Compare the presentation of bacterial vaginosis and vaginal candidiasis.
Bacterial vaginosis - thin, clear, or mildly colored discharged, foul odor; may cause itching or dysuria
Vaginal candidiasis - itching, thick, whitish vaginal discharge, often associated with dysuria
121
Treatment for symptomatic bacterial vaginosis?
Metronidazole
122
Define PROM and preterm labor.
PROM - rupture of the fetal membrane prior to the onset of labor
Preterm labor - PROM before 37 weeks
123
What contraception can be started postpartum?
Progetin-only pills, injectiable progestin (Depo-Provera), and progestin implants (Implanon); copper-containing IUD
Note - if exclusively breastfeeding, women should delay starting progetin-only contraception until 6 weeks
124
Why should levonorgestrel-releasing IUDs (Mirena) not be inserted until 6 weeks postpartum?
Higher risk of perforation and expulsion before 6 weeks
125
Up to ___% of women get postpartum blues.
85
126
What is the incidence of major postpartum depression?
5-8%
127
When should women follow-up postpartum (C-section vs. vaginal delivery)?
C-section - 2 weeks
| Vaginal - 6 weeks
128
Which substances are associated with facial abnormalities in babies?
Alcohol us
129
What are the associated adverse effects of prenatal tobacco use?
Increased risk for low birth weight
130
What are the associated adverse effects of prenatal heroin/opiate use?
Risk of fetal growth restriction, placental abruption, fetal death, preterm labor, and intrauterine passage of meconium; monitor for neonatal abstinence syndrome
131
What are the associated adverse effects of prenatal cocaine/stimulant use?
Placental insufficiency, low birth weight, cognitive deficits (vasoconstriction)
132
SGA (small for gestational age) vs. IUGR (intrauterine growth restriction)?
SGA - diagnosed at birth; varying definitions (<10% for weight, etc.)
IUGR - diagnosed during pregnancy; has not reached growth potential at a given gestational age due to 1+ causative factors
133
Symmetric vs. Asymmetric IGUR?
Symmetric - head, length, and weight decrease proportionately
Asymmetric - greater decrease in length and/or weight without affecting head circumference (head sparing phenomenon)
134
What often results in symmetric IGUR? Asymmetric?
Symmetric - congenital infections
Asymmetric - poor delivery of nutrition (ie smoking)
135
Define "term" birth.
Born at >37 weeks gestation
136
What are three major risks for SGA newborns?
Hypoglycemia, Hypothermia, Polycythemia
137
Compare the etiologies/symptoms of hypoglycemia, hypothermia, and polycythemia in SGA newborns.
Etiologies:
1. Hypoglycemia: decrease glycogen stores, heat loss, possible hypoxia, decreased gluconeogenesis
2. Hypothermia: cold stress, hypoxia, hypoglycemia, increased surface area, decreased subcutaneous insulation
3. Polycythemia: chronic hypoxia, maternal-fetal transfusion
Symptoms:
1. Hypoglycemia and hypothermia: commonly asymptomatic, may exhibit poor feeding and listlessness
2. Polycythemia: ruddy or red color to skin, respiratory distress, poor feeding, hypoglycemia
138
List the routine newborn medications.
1. Vitamin K (IM injection)
2. HB vaccine
3. Erythromycin (topical)
139
Compare the timing of the 3 types of VKDB.
1. Early - 0-24 hours after birth
2. Classical - 1-7 days after birth
3. Late - 2-12 weeks after birth (typical), but up to 6 months in previously healthy infants
140
Compare the characteristics of the 3 types of VKDB.
1. Early - severe; mainly occur in infants whose mothers used medications that interfere with the body's use of vitamin K.
2. Classical - bruising, bleeding from the umbilical cord
3. Late - 30-60% have bleeding in the brain; tends to occur in breastfed only babies who have not received vitamin K
141
Discuss treatment of neonates to prevent vertical transmission of hepatitis B.
1. Infants weighing >2000g + Mom HBsAg+ - vaccine + HB Ig within 12 hours of delivery; routine series at age 1; test for Ab/Ag at 9-18 months, reimmunize if inadequate
2. Infants born to mothers without HBsAg testing - vaccine within 12 hours; delay Ig until status known; effective if given within 7 days (must be greater than 2kg)
142
What are some reasons to seek immediate medical care for newborns?
Fever, signs of poor feeding, worsening jaundice
