CBL 2_ 2_Initial labwork and discomforts of pregnancy

Question 1

Risk factors for Thyroid Disease?(12)

Answer 1

Age > 30 yo
More than 2 pregnancies
History of pregnancy loss, preterm delivery, infertility
Type 1 diabetes or other auto-immune disorders
Morbid obesity
History of hypo/hyper thyroidism
Family history of thyroid disfunction
History of head, neck radiation; thyroid surgery
Goitre or known TPO antibody
Currently receiving levothyroxine replacement
Use of amiodarone or lithium
Recently resided in areas of moderate to severe iodine insufficiency

Question 2

What vaccines should you get/be up to date on in pregnancy?

Answer 2

Flu vaccine
Covid vaccine
Tdap (27-32 weeks)
Hep B (during pregnancy to certain high-risk groups)

Question 3

Why frequency of urination in pregnancy and advice?

Answer 3

Uterus puts pressure pressure on bladder.
Early resolves around 12 weeks.
Decrease fluid intake before bed.

Question 4

Why nausea and vomiting and advice?

Answer 4

Progesterone, hCG, and estrogen linked, but exact mechanism unknown.
Vit B6 or B6 with doxylamine is recommended as first line treatment.
Ginger, acupressure, and mindfulness might be helpful.

Question 5

Why breast sensitivity in pregnancy?

Answer 5

Hormones of pregnancy cause mammary glands, breast arteries/veins, and Montgomery tubercles to grow.

Question 6

Why edema in pregnancy and advice? (3)

Answer 6

Total body water increases 6-8 L. colloid osmotic pressure decreases, hydrostatic pressure increases all causing excess fluid to go to tissues.

Regular exercise and movement, elevate legs, wear comfy footwear, increase water intake.

Question 7

How much blood flows to the uterus in pregnancy?

Answer 7

500-800 mL/min

Question 8

How much does maternal blood volume increase in pregnancy?

Answer 8

45%

Question 9

What causes gum sensitivity?

Answer 9

Estrogen

Question 10

How much folic acid recommended for low risk people?

Answer 10

0.4 - 1 mg

Question 11

How much folic acid recommended for high risk people?

Answer 11

4-5 mg

Question 12

What would make someone high risk for NTD (and need more folic acid)? (8)

Answer 12

family history
multiples
obesity
diabetes
previous infant with neural tube defect
teratogenic medications,
malabsorption
if daily consumption is difficult.

Question 13

What does HPLC screen?

Answer 13

Tests for sickle cell disorders or thalasemia - blood test that looks for abnormal hemoglobin

Question 14

What are risk factors for sickle cell disorders or thalassemia(7)?

Answer 14

Africa
Mediterranean
Middle East
South East Asia (only parts of India for SCD)
Western Pacific region
Caribbean countries
South American countries

Question 15

What is HCV screening?

Answer 15

For Hepatitis C

Question 16

Who should be offered HCV test? (10)

Answer 16

Luba and Val think it should be universal
-injection, intranasal or inhalation drug use with shared equipment, even once
-exposure to non-sterile medical, dental or personal services equipment via:
hemodialysis
-occupational injuries (e.g., health care workers exposed to blood from needle stick injuries)
-unsafe tattooing or body piercing practices using non-sterile equipment
-shared personal care items
surgical procedures
-receipt of blood, blood products or organ transplant before 1992 in Canada
-receipt of invasive medical procedures in countries where infection prevention and control practices are not standardized
-engaging in sexual behaviour where blood may be present (such as condomless anal intercourse)
-being born in, travelled to, or lived in a region with high prevalence of hepatitis C, such as:
Central, East and South Asia
Eastern Europe
North Africa and the Middle East
Sub-Saharan Africa
Australia and Oceania
-being born to a pregnant person with hepatitis C
Some populations are disproportionately affected by hepatitis C:

-people who inject or use drugs
-people from countries where the prevalence of HCV is high
people currently or previously living in correctional facilities
Indigenous Peoples (First Nations, Inuit and Métis)
gay, bisexual and other men who have sex with men (gbMSM)

Question 17

What’s the prevalence of HCV in pregnancy?

Answer 17

1 %

Question 18

What causes shortness of breath?

Answer 18

Progesterone and then a baby pushing into your lungs

Question 19

What causes heartburn in pregnancy?

Answer 19

Progesterone causes lower esophageal sphincter to relax (combined with pressure from growing uterus)

Question 20

What causes constipation in pregnancy?

Answer 20

Progesterone and decreased gastric motility

Question 21

What causes hemorrhoids in pregnancy?

Answer 21

Progesterone relaxing blood vessels and impaired blood return due to growing uterus

Question 22

What causes varicose veins in pregnancy?

Answer 22

Relaxing effects of progesterone and pressure of the uterus on veins in the pelvis

Question 23

Contraindicated vaccines in pregnancy? (7)

Answer 23

HPV
MMR
Varicella
Live Tyhphoid vax
Live herpes zoster vax
Yellow fever vax
Bacille Calmette-Guerin vax

Question 24

Vaccines safe in pregnancy with specific risk factors?(6)

Answer 24

Hep A
Meningococcal
Pneumococcal
Polio
Rabies
Travel vaccines