Mehl first antenatal visit + vaccines 03-25 (3) Flashcards
when is done, weeks?
8-10 weeks gestation
Comprehensive medical history is taken.
.
blood investigation?
Complete blood count; blood type; Rh factor (+) or (-); check for anemia.
if Rh(-) negative, when give RhoGAM?
28 weeks and again at delivery.
what intervention, give RhoGAM?
Also give RhoGAM if any interventions (e.g., amniocentesis), or if there’s complications like spontaneous abortion or abruptio placentae.
if second pregnancy onward, what about RhoGAM?
If Rh (-) woman is found to have titers against Rh, do not give RhoGAM
during the pregnancy, since it’s too late.
Check for STDs. especially what 2?
(especially Chlamydia and Gonorrhea).
Check for STDs.
Pap smears are not routinely done at first-trimester antenatal visit, but STD checks are.
.
Rubella, syphilis, Hep B, and HIV.
Standard screening performed for these.
Urinalysis looking for?
WBCs/bacteria, proteinuria, and kidney function.
Urinalysis or dipstic for proteins - not same as 24h proteins, which is not routinely done, only inf high risk preeclampsia patients.
Urinalysis.
Always treat asymptomatic bacteriuria in pregnancy due to risk of pyelonephritis (progesterone slows ureteral peristalsis, and, in third trimester, uterine compression causes backup).
- Blood pressure. chronic HTN?
“Chronic hypertension” = HTN prior to the pregnancy or diagnosed before 20 weeks’ gestation;
usually persists postpartum since BP present in early pregnancy, or prior to it, often reflects
underlying issue unrelated to the pregnancy.
- Blood pressure.
“Gestational hypertension”?
“Gestational hypertension” = new-onset HTN that develops after 20 weeks’ gestation; typically resolves postpartum.
- Blood pressure.
- Chronic hypertension can pre-exist or persist beyond pregnancy, while gestational hypertension is
specific to the pregnancy period. Both conditions require close monitoring due to potential risks to
the mother and fetus.
.
Glucose only if high-risk. discussed in DM section
.
Ultrasound to …..?
Ultrasound to confirm pregnancy, establish gestational age, and detect multiple pregnancies.
Crown-rump length to measure gestational age.
Flu shot is safe in first trimester (if fall or winter). killed I/M?
Give killed intramuscular; safe for everyone annually age 6 months and older.
Safe in every trimester + breastfeeding
while live atten. intranasal - dont give during trimesters, but safe during breastfeeding
Flu shot is safe in first trimester (if fall or winter). intra-nasal live?
Intra-nasal live attenuated only for non-pregnant, immunocompetent persons age 2-45.
Dont give during trimesters (can cause congenital infection), but safe during breastfeeding
viral-infections related stuff that is recommended during pregnancy. 3?
Influenza (as discussed above).
Tdap (tetanus, diphtheria, pertussis: given in third trimester.
Eg in 20w - no, suboptimal; give in 27-36, so antibodies can transfer to neonate and provide immunity
Hepatitis B (only if maternal surface antibody negative, meaning she is not immune).
Contraindicated during pregnancy? 2
Live-attenuated vaccines, including MMR, varicella, intra-nasal influenza, and BCG (TB).
HPV (insufficient evidence on safety during pregnancy, so currently not given).
