Pregnancy

Question 1

Initial pregnancy bloodwork.

Answer 1

CBC & Ferritin
Blood ABO group
Rh factor and antibody screen
beta-hCG
Hep B screen (HBc Ab, HBs Ab, HBs IgM, HB IgG)
Syphilis
Varicella antibody (if unsure of hx)
Rubella titre (if unsure of vaccination status)
(Urine pregnancy test + urinalysis + C&S + chamydia + gonorrhea)

Question 2

Vitamins in pregnancy.

Answer 2

Folic acid: 1 mg/d if low risk for NTD otherwise 5 mg
Vit D: 600 IU
Calcium: 1000 mg
Vit B12: 2.6 mcg

Question 3

Caffeine limitation in pregnancy

Answer 3

300 mg/d
1 cup of coffee = 100 mg
1 cup of tea = 50 mg

Question 4

Normal pregnancy lab changes

Answer 4

Dec Hgb & Hct - r/o IDA by checking MCV
Inc WBC (leukocytosis) as high as 16K
Inc ESR
Inc ALP d/t fetal bone growth
Inc D dimer

Question 5

Fundal height measurement

Answer 5

13 weeks: symphysis pubis
20 weeks: umbilicus
36 weeks: xiphoid process
37-40 weeks: regression of fundal height b/w 36-32 cm
* Size discrepancy of 2 cm or more in uterine size from number of weeks gestation = refer!!

Question 6

DVT

Answer 6

The Wells score is not validated for use in pregnant women. D-dimers are not helpful in pregnant patients, as pregnancy is a cause of a raised D-dimer.

Question 7

When do fetal movements begin?

Answer 7

28 weeks

Question 8

How is bleeding in pregnancy managed?

Answer 8

If U/S confirms intrauterine pregnancy, a repeat U/S in 7-10 days
If U/S shows no embryo, no gestational sac of at least 25 mm in diameter or anembryonic crown-rump length of at least 7 mm w/ no fetal cardiac activity -> early pregnancy loss
Misoprostol = PG analogue -> 800 mcg inserted vaginally; repeat in 48 hours