Aquifer Case 14

Question 1

what are some good ways to diagnose pregnancy?

Answer 1

1. blood tests of human chorionic gonadotropin (hCG) can identify pregnancy as early as 8 days post-conception (about 1 week prior to a missed period)
2. the presence of a delayed menstrual period in a female with previously regular periods and symptoms of nausea, breast tenderness, and fatigue are classical indications of pregnancy
3. transvaginal ultrasound is a useful method for dating early pregnancy but is not typically used to diagnose pregnancy

Question 2

what are some signs of pregnancy?

Answer 2

1. delayed period
2. nause
3. breast tenderness
4. malaise
5. Chadwick’s sign = blue discoloration of the cervix from venous congestion (8-10 wk)
6. palpably gravid uterus (10-12 wk_

Question 3

how do you calculate a due date?

Answer 3

month that they missed the period - 3 then add 7 days –> subtract 3 months and add 7 days

or determine the day 40 weeks after the beginning of the last menstrual period

the gestational age is calculated since the day of the start of the last period while the embryonic age is from the date of fertilization which about 2 weeks after the date of the LMP

Question 4

which blood tests do you get done at the initial pregnancy visit?

Answer 4

1. blood type/Rh status
2. chlamydia screening
3. Hb/Hct
4. hepB surface antigen
5. HIV test

you don’t need a hepC antibody, Herpes antibody, bacterial vaginosis, or toxoplasmosis test done

Question 5

what are the chlamydia and gonorrhea screening guidelines?

Answer 5

screen in sexually active females 24 and younger and in older females at increased risk for infection

level B

Question 6

how often do you HIV test pregnancy females?

Answer 6

all pregnant females

Question 7

how often do you do a urinalysis for pregnancy women?

Answer 7

dipstick every visit for prenatal patients

checks for proteinuria and glycosuria

also screen for asymptomatic bacteriuria with a urine culture at 12-16 weeks

Question 8

what are the HepB screening guidelines for pregnant people?

Answer 8

HepB surface antigen screening in pregnant females at first prenatal visit

Question 9

which foods aren’t safe in pregnancy?

Answer 9

1. shark, swordfish, king mackerel, and tilefish –> mercury poisoning
2. unwashed fruits and vegetables –> toxo and listeria
3. unpasteurized milk –> toxo and listeria
4. raw eggs –> salmonella
5. soft cheese –> listeriosis
6. saccharin

Question 10

what do you test for at the 10 week prenatal visit?

Answer 10

1. weight
2. BP
3. fundal height
4. auscultation of fetal heart tones

give the influenza vaccine and counsel about screening and prenatal diagnosis of fetal anomalies

Question 11

when do you give the Tdap vaccine to pregnant women?

Answer 11

between 27-36 weeks

it’s recommended for all pregnant females, irrespective of when they last received this vaccine

Question 12

when do you give the rhogam immunization to pregnant women?

Answer 12

if indicated, give at 28 weeks and within 72 hours after delivery and with any episodes of vaginal/intrauterine bleeding

Question 13

when do you give the rubella vaccine to pregnant women?

Answer 13

after pregnancy; not safe to be given during since it’s a live vaccine

Question 14

what is the sensitivity of a quad screen in detecting Down syndrome?

Answer 14

80%

AFP, estriol, hCG and inhibin-A

Question 15

do placenta previa resolve on their own?

Answer 15

if they’re found at 21 weeks, they usually resolve on their own –> the later the placenta prevue is detected the lower the likelihood of it resolving

having previous pregnancies increases your risk

the most common time for bleeding from placenta prevue is during late pregnancy or delivery

Question 16

what is defined as gestational HTN?

Answer 16

140/90 without proteinuria in a previously normotensive femal at/after 20 weeks gestation

Question 17

what is preeclampsia?

Answer 17

140/90 with proteinuria

Question 18

when do you screen for gestational diabetes?

Answer 18

24-28 weeks

1 hr oral glucose tolerance test should be under 130-140

if they fail the one hour, do the 3 hour which includes a fasting glucose, 1 hr, 2 hr and 3 hr test –> if 2 or more of the 4 glucose measurements exceed the cutoff then they have GDM

Question 19

what are the cutoffs for a 3 hr OGTT?

Answer 19

fasting serum glucose concentration ≥ 95 mg/dL (5.3 mmol/L)

one-hour serum glucose concentration ≥ 180 mg/dL (10 mmol/L)

two-hour serum glucose concentration ≥ 155 mg/dL (8.6 mmol/L)

three-hour serum glucose concentration ≥140 mg/dL (7.8 mmol/L)

Question 20

when do you test for GBS in pregnancy?

Answer 20

36 weeks

Question 21

which interventions or tools have been shown to be likely beneficial during labor and delivery?

Answer 21

1. attend childbirth education classes
2. delivery in a home-like environment
3. having a doula, birth coach or support person present during labor and delivery
4. having a birth plan

Question 22

which birth control is safe during breast fooding?

Answer 22

1. copper-containing intrauterine device
2. injectable medroxyprogesterone acetate (Depo-Provera)
3. progestin-only oral contraceptive

combined OCPs are not safe for the first 21 days due to increased DVTs

Question 23

how long do post partum blues last?

Answer 23

2 weeks

post partum depression shows up within first 4 weeks

Question 24

which topics should be discussed post partum?

Answer 24

1. breast feeding
2. contraception
3. mood
4. sexual activity