Module 2 lecture Part 1 Flashcards
What are some of the specific clinical situations in which we might provide preconception care?
Gynecologic care visit
Contraception visits
Visits schedule for the specific purpose of preconception care
Primary care visits
Any patient who wants to get pregnant or might become pregnant in the next year or so.
Preconception History
Reproductive/Menstrual history
Infection History
Vaccination history
Social history
Family/genetic history
A helpful place to start with a preconception menstrual history is determining cycle regularity:
What is that piece of information so important?
Because regular cycles are often ovulatory cycles
We know that ovulatory cycles are often regular
What other history elements tend to be associated with regular cycles?
Premenstrual syndrome symptoms and uterine cramping
Patient was treated for chlamydia when she was 18. She has had no STIs diagnosed since that time.
what connection does this history have to preconception health?
Chlamydial infections can result in scarring of the uterine tubes and difficulty getting pregnant or ectopic pregnancy,.
Undiagnosed and untreated!!
Vaccination history
MMR
Varicella
COVid-19
Tetanus, diptheria, pertussis (TDAP)
Influenza
HPV
Hepatitis B
what is ideal for MMR vaccination
Get MMR then wait at least one month before getting pregnant
OR
Could draw rubella titre
What individual are considered to be in the HIGH Risk Category
People with a personal history of NTD or previous child with NTD
Folic recommendation for low risk category for NTD
0.4 mg/day or 400 mcg
Folate is naturally present in
Beel liver
Vegetables (especially)
asparagus
brussels sprouts
dark green leafy vegetables
spinach
mustard greens
Fruits and fruit juices (especially)
oranges
oranges juice
Nuts, beans, peas
peanuts
Blacke-eyed peas
kidney beans
Folic acid is added to:
Enriched bread, flour, cornmeal, pasta and rist
Fortified breakfast cereal
Fortified corn masa flour (used to make)
corn tortillas
tamales
One of the person to be concerned about for potentially risk of inadequate dietary folate equivalent (DFE)
A person who follow a keto diet
Folate is what is naturally present in foods:
Folic acid is what is used in fortification and supplements
dietary folate equivalent (DFE) is the bioavailable folate
Do you think that folate or folic acid is better absorbed
Folic acid is better absorbed than folate
Notes about folic acid vs folate vs DFE
We absorb more folic acid from fortified foods and supplements than folate found naturally in foods
Folic acid is more heat-stable than natural food folate
Natural food folate is broken down easily by heat and light
Compared to folate found naturally in foods, we need less folic acid to get recommended amounts
Do clinicians always recommend that patient take vitamins specifically labeled as prenatal vitamins
Som clinicians prefer to individually assess whether patient would be best served by regular multivitamins or prenatal vitamins
Patient tells us that her cycles are reliably every 29-30 days long. On which cycle day does she most likely ovulate?
Day 15 or 16
When does ovulation normally happen?
Occurs 14 days before the END of the cycle
so : cycle length -14 days = ovulation day
29 day cycle - 14 days = 15
30 day cycle - 14 day = 16 days
Patient question about intercourse timing as she tries to get pregnant. l
What is the most likely to be reliable estimate FERTILE window for patient with her cycle 29-30 days
Days 12-19
So we do about 3 days before first part of cycle and about 3 days after……which would be 15 - 16 days…..etc etc…..
Not an absolute scientific exam!!!
How often should a patient and her partner have intercourse during their fertile period to become pregnant
To maximize the chance of pregnancy, having intercourse every 1–2 days is ideal but you should base it on your comfort level.
