Maternity Flashcards
Dating ultrasound when?
7-12 weeks
Dating ultrasound when?
7-12 weeks
When to order prenatal genetic testing ?
FTS
11-14 weeks
Anatomic US when ?
18-22 weeks
When is GDM screening ?
All women 24-28 weeks
When do you screen for GBS ?
35-37 weeks
How often should you feel fetal movement ?
At least 6 movements in 2 hours,
If you don’t should contact HCP
There isn’t any definition of normal fetal movement l, women need to be made aware of what is normal for their baby and what to do if fetal decreases or changes in their baby’s environment
Screening for GDM with what? How is diagnosis made?
50g OGTT at 24-28 weeks
If abnormal needs to follow with 75g OGTT
Diagnosis is made:
FBG >5.3mmol/L
1hr >10.6 mmol/L
2hr > 9.0 mmol/L
What’s the alternative approach to GDM rather than the 50g OGTT
75g OGTT
FBG >5.1
1hr >10
2hr > 8.5
If one value is met or exceeded then GDM
If you are diagnosed with GDM when should you screen for T2DM ??
Within 6 weeks - 6months of giving birth
Then Q3year depending on risk factors
Anti D vaccine should be given when and for who ?
28 weeks gestation for Rh negative non sensitized women when fetal blood type is unknown or to be Rh positive
What are the Rh vaccines ?
300 mcq dose x1 at 28 weeks to Rh negative mothers
Alternatively 2 doses 100-120 mcq at 28 weeks then one at 34 weeks
First line agent trichomoniasis in pregnant asymptomatic patients
Treatment is not recommended
Treat all cases and their sexual partners regardless of symptoms
First line agent trichomoniasis in pregnant symptomatic patients
Metronidazole 2g in a single dose (any stage of pregnancy)
Alternative is metro 500mg PO BID x 7 days
Treat all cases and their sexual partners regardless of symptoms
First line treatment for asymptomatic bacterial vaginosis in pregnancy
treatment is unnecessary unless high risk (prior preterm delivery), prior to IUD insertion, gynaecological surgery, induced abortion, or upper tract instrumentation
First line for symptomatic BV in pregnancy
Metronidazole 500mg BID orally for 7 days
Metronidazole 0.75% gel , one applicatorful vaginally once nightly for 5 days
- some people would avoid using oral metro in first trimester
- in first and second trimester of pregnancy, topical metronidazole can be used instead of oral. The applicator should not be used after 7th month of pregnancy
- oral is recommended in 3rd trimester
Test of cure 1 month after
topical clindamycin has been associated with adverse outcomes in newborn, if needed only use oral clindamycin
First line treatment for asymptomatic vulvovaginal candidiasis
Treatment is unnecessary
First line treatment for vulvovaginal candidiasis in symptomatic pregnant patients
Topical antifungals #1
Clotrimazole 1% one applicatorful intravaginally daily for 6 days
Miconazole 2% one applicatorful intravaginally daily for 7 days
Male partners do not need to be treated unless there is candida balanitis
First line for Cervicitis in pregnancy and non pregnant individuals
Does it need to be reported ?
Must be reported for medical officer of health
All sex partners should be evaluated if they had sexual contact with the patient during the 60 days preceding the onset of symptoms
S/S= inflammation of the cervix with mucopurulent or purulent cervical discharge
Usually co-exists with vaginitis (Trichomonias)
Probable organisms are chlamydia and gonorrhoea
Non pregnant:
Cefixime 400-800mg single dose
+
Azithro 1g single dose
Or
Doxy 100mg BID x 7 days
Pregnant:
Cefixime 400-800mg single dose
If allergic to penicillin then Azithromycin or erythromycin can be used instead
Herpes simplex virus (genital) in pregnancy first line treatment for first episode
Acyclovir 200mg 5 times daily
Or
400mg TID x 5-10 days
A first outbreak in the first trimester constitutes a higher risk for perinatal transmission than does recurrent infection and warrants treatment
If occurs later in trimester consider C-section
PID in pregnancy
Uncommon but suspected cases should be hospitalized
All cases should be reported to PHU if confirmed with gonococcal // all partners should be treated
S/s - lower abdominal pain of recent onset, heavy menstruation , vaginal bleeding, deep dyspareunia, vaginal discharge that is unexplained, lower abdominal tenderness, cervical motion tenderness, adnexal tenderness on bimanual exam, Cervicitis, fever
PID in pregnancy
Uncommon but suspected cases should be hospitalized
All cases should be reported to PHU if confirmed with gonococcal // all partners should be treated
S/s - lower abdominal pain of recent onset, heavy menstruation , vaginal bleeding, deep dyspareunia, vaginal discharge that is unexplained, lower abdominal tenderness, cervical motion tenderness, adnexal tenderness on bimanual exam, Cervicitis, fever
Syphillis infection in pregnancy
Penicillin regimen
Bacillin L-A 2.4 million units IM x single dose
Consider a second dose 1 wk later if pt is pregnant
HPV or anogenital warts
HPV infections may be refractory during pregnancy and many specialists recommend removing them in pregnant women
Goal of treatment is to relieve symptoms only
Cryotherapy could be done
All meds are cytotoxic
A G2P1 patient presents for an initial prenatal visit at 12 weeks’ gestation. The patient’s blood type is O negative. Which of the following is the best course of action for this patient?
A.Plan delivery via cesarean section
B.Check an antibody screen and, if positive, administer RhoGAM
C.Check an antibody screen and, if negative, recheck at 28 weeks
D.Plan on administering RhoGAM when the patient is 72 hours post partum
Answer: C. Check an antibody screen and, if negative, recheck at 28 weeks
If the patient is Rh negative, the most appropriate course of action is to check an antibody screen. If the screen is negative, it means there has been no alloimmunization, and RhoGAM can be given in the third trimester. If the antibody screen is positive, alloimmunization has occurred and the patient needs to be referred to maternal–fetal medicine. RhoGAM is given post partum if the neonate is found to be Rh positive.
A G2P1 patient presents for an initial prenatal visit at 12 weeks’ gestation. The patient’s blood type is O negative. Which of the following is the best course of action for this patient?
A.Plan delivery via cesarean section
B.Check an antibody screen and, if positive, administer RhoGAM
C.Check an antibody screen and, if negative, recheck at 28 weeks
D.Plan on administering RhoGAM when the patient is 72 hours post partum
Answer: C. Check an antibody screen and, if negative, recheck at 28 weeks
If the patient is Rh negative, the most appropriate course of action is to check an antibody screen. If the screen is negative, it means there has been no alloimmunization, and RhoGAM can be given in the third trimester. If the antibody screen is positive, alloimmunization has occurred and the patient needs to be referred to maternal–fetal medicine. RhoGAM is given post partum if the neonate is found to be Rh positive.
When do you do a test of cure for chlamydia and gonorrhea infections in pregnancy?
1-2 weeks after completion of therapy
If NAAT test is used , no earlier than 3-4 weeks post treatment
Which vaccines should be given for pregnant women
RH- =28 weeks gestation
Influenza - during influenza season
TDAP = 27-32 weeks (every pregnancy)
MMR = if not immune after pregnancy
TORCH infections
T-toxoplasmosis
O- other agents (treponema palladium, VZV, parvovirus? HIV)
R- rubella
C- cytomegalovirus
H-HSV
