Pregnancy

Question 1

Drugs and Vaccines During Pregnancy: Category A Drugs

Answer 1

Animal and human data show no risk to pregnant women.

Prenatal vitamins (high-dose multivitamins are not used during pregnancy)
Insulin
Thyroid hormone (levothyroxine)
Folic acid (vitamin B9), pyridoxine (vitamin B6)

Question 2

Drugs and Vaccines During Pregnancy: Category B Drugs

Answer 2

Animal studies show no risk. No human data available.

Antacids (Tums, Maalox) are safe for pregnant women.
Docusate sodium (Colace) is a stool softener and is approved for pregnant women. It is not a laxative. Avoid laxatives (e.g., Ex-Lax, Bisacodyl), especially in the third trimester (may induce labor).

Analgesics (acetaminophen preferred to nonsteroidal anti-inflammatory drugs [NSAIDs] especially in the third trimester

Antibiotics

Question 3

Drugs and Vaccines During Pregnancy: Category C Drugs

Answer 3

Adverse effects seen in animal studies. No human data available.

Sulfa drugs
Considered Category C in third trimester because they can cause hemolytic anemia in the fetus/infant, which results in hyperbilirubinemia. Sulfa drugs displace bilirubin from albumin. High blood levels of unconjugated bilirubin can cross the blood–brain barrier and cause brain damage (kernicterus).

Trimethoprim–sulfamethoxazole (e.g., Bactrim DS, Septra)

Clarithromycin (Biaxin) is the only Category C macrolide antibiotic. Avoid use in pregnant women. Consult with physician before using Category C drugs during pregnancy.

Pseudoephedrine (Sudafed): Increases risk of gastroschisis (intestines protrude through abdominal wall defect). Ideally, it should not be used in pregnancy and breastfeeding (repeated doses may interfere with lactation, as it crosses breast milk).

Question 4

Drugs and Vaccines During Pregnancy: Category D Drugs

Answer 4

Evidence of fetal risk.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)

Fluoroquinolones

Tetracyclines

NSAIDs

Acetylsalicylic acid (ASA) may be used and is often indicated to prevent preeclampsia in high-risk patients

Sulfa drugs: Risk of hyperbilirubinemia (neonatal jaundice or kernicterus); )

Question 5

Drugs and Vaccines During Pregnancy: Category X Drugs

Answer 5

Proven fetal risks outweigh the benefits.

• isotrentinoin
• methotrexate
• Proscar
• Misoprostol
• Evista and tamoxifen
• all hormonal drugs

Question 6

Vaccines contraindicated in pregnancy

Answer 6

Mumps, measles, and rubella (MMR); oral polio; varicella; and FluMist are contraindicated in pregnancy.

Question 7

Goodell’s sign

Answer 7

Cervical softening (4 weeks)

Question 8

Chadwick’s sign

Answer 8

Bluish discoloration of cervix and vagina (6-8 weeks)

Question 9

Hegar’s sign

Answer 9

Softening of the uterine isthmus (6-8 weeks)

Question 10

Probable Signs of Pregnancy

Answer 10

• Goodell’s sign (4 weeks): Cervical softening
• Chadwick’s sign (6–8 weeks): Blue coloration of the cervix and vagina
• Hegar’s sign (6–8 weeks): Softening uterine isthmus
• Enlarged uterus
• Ballottement (seen in midpregnancy): When the fetus is pushed, it can be felt to bounce back by tapping the palpating fingers inside the vagina
• Urine or blood pregnancy tests (beta HCG)

Question 11

Positive Signs of Pregnancy

Answer 11

• Palpation of fetus by health provider
• Ultrasound and visualization of fetus or embryo
• Fetal heart tones (FHTs) auscultated by health provider: 10 to 12 weeks by Doppler/Doptone; 20 weeks by fetoscope/stethoscope

Question 12

Naegele’s Rule

Answer 12

Method 1: LMP + 9 months + 7 days

Question 13

Chloasma (Melasma)

Answer 13

Blotchy hyperpigmentation on forehead, cheeks, nose, and upper lip seen in pregnant women and some birth control pill users. Usually gets lighter and regresses within 1 year; however, in some women, hyperpigmentation may be permanent.
Condition is more common in darker skins (olive skins and darker).

Caused by increased estrogen

Question 14

Mastitis S/S

Answer 14

Red, firm, and tender area (induration) on one breast. May also have fever/chills and malaise (flu-like symptoms).

May have adenopathy on the axilla by the affected breast. Most common in the first 3 months of breastfeeding

Question 15

Treatment for mastitis

Answer 15

Dicloxacillin 500 mg PO QID or cephalexin (Keflex)

Question 16

Preeclampsia s/s

Answer 16

Hypertension, proteinuria, and edema

BP ≥140 mmHg or diastolic ≥90 mmHg

Proteinuria: >0.3 g protein in a 24-hour urine specimen. Proteinuria ranges from trace to 1+ to 4+ (severe cases).

Rapid weight gain of 2 to 5 lb per week: The edema is most obvious in the face, around the eyes, and on the hands.

Refer to OB for management. Only cure is fetal delivery.

Question 17

Placenta Abruptio (Placental Abruption)

Answer 17

Premature partial to complete separation of a normally implanted placenta from the uterine bed. Rupture of the maternal blood vessels from the decidua basalis. Bleeding ranges from mild to hemorrhage.

Sudden onset of vaginal bleeding (mild to hemorrhage) with abdominal and/or back pain. Painful uterine contractions. Uterus is rigid (hypertonic) and very tender.

Question 18

UTI in pregnant women

Answer 18

A count of 103 CFU/mL or higher in a symptomatic pregnant woman is considered a UTI.