Pregnancy Flashcards
Screening to do pre conception (List three pieces of advise and five tests to do)
Folic acid 0.4 mg po daily
Healthy exercise
Target BMI 19-27
Domestic violence
Finances
Healthy sleep
Quit smoking
Varicella titers
Rubella titers
HIV
Hep B Ag
G+C
HGB electrophoresis in at risk ethnicities
Hematopoietic stem cell screen for ashkenazi jewish populations
CF and Tay Sachs if fmaily history
First trimester labs and screening
Hgb
Blood type
Rh status
Antibody screen
HIV
Syphilis
HBsAG
Rubella
Varicella
MCV
Hemoglobin
C+G
TSH
Urine culture
Hemoglobin electrophoresis
Ferritin
B12
Pap
Dating ultrasound at 11-14 weeks
Offer Early First trimester screening
2nd trimester tests
Anatomy ultrasound at 18-20 weeks
2 h glucose tolerace test at 24-26 weeks
3rd trimester tests
GBS at 35-37 weeks
Diagnose and treat gestational hypertension.
140/90 x2
Rue out pre eclampsia
Treat with Labetalol, nifedipine, or hydralazine
Consider delivery if severe
General advise for conception with a chronic disease
Review medications
Review control
Advise delay conception until good control is achieved
When does someone need more than 0.4 mg of folate per day
1 mg if mod risk: Family history of neural tube issues
Teratogenic medications like metformin, methotrexate, anticonvulsants
Liver disease
IBD.Celiac
On dialysis
ETOH use
5 mg if high risk
Person history of NTD
What to do at each routine visit
Ask about symptoms of cramping, bleeding, fluid and fetal movements
Take BP wt, SFH, FHR and Leopolds
Do not do routine urinalysis if normotensive
What genetic screening can we offer a patient
Enhanced first trimester screen which is blood work and nuchal translucency ultrasound to be done on the same day weeks 11-14
Checks for trisomy 18 and trisomy 21
NIPT if high risk or positive EFTS (can be done basically any time)
MSS (maternal serum screening) good if you miss the window for eFTS
Just a blood test
Definition of pre-eclamsia
Proteinuria, increased creat, symptoms
Ask questions about preeclapsia:
Vision changes
Nausea vomiting
Headaches
SOB
Urine output
Tests to get for hypertension
Lfts
Platelets
Albumin
LDH
Haptaglobin
Urine dip to check for protein
If you see Increased LFTS, decreased platlets, hemolysis=HELLP
What is HELLP
Hemolysis
Elevated
Liver enxymes
Low
Platlets
How to treat HELLP
Consider blood products
If:
Platlets <20
20-50 if going for c section or heavy bleeding
>50 if heavy bleeding
How to treat eclampsia
Give fetal corticosteroids if <37 weeks
Treat with MgSo4 4 g IV ober 20 minutes and then 1 g per hour
Give also in pre eclampsia if severe
Diagnose and manage PROM
Sterile spec exam
Do Nitrazine blue, look for ferning, look for pooling
Check GBS
Antibiotics
Consider Steroids if <32 weeks
