Putting it all together...Module 3 Flashcards
When is Naegele’s rule appropriate
Has known LMP
Has regular cycles
Did not conceive on hormonal contraception or while breastfeeding
Has a clinical picture that fits
Food to avoid to prevent Listeriosis
Listeriosis
- avoid food that could contain listeriosis
* raw sprouts
* soft cheeses
* dell meats and hot dogs (cold, not heated)
* smoked seafood
* Raw milk (unpasteurized)
Food to avoid to prevent Toxoplasmosis
Toxoplasmosis:
- Avoid undercooked meat..
- avoid contact with cat feces
- avoid drinking water contaminated with toxoplasma gondii
Fish to avoid to prevent mercury in fish
Avoid:
Tuna, bigeye
King mackerel
Marlin
Shark
Swordfish
Orange roughy
Tilefish (Gulf of Mexico)
U/S vs menstrual cycle dating in first trimester
when to change from menstrual cycle date to u/s date
< 9 weeks = more than 5 days
9 0/7-13 6/7 weeks = more than 7 days
14 0/7 - 15 6/7 weeks = more than 7 days
16 0/7 - 21 6/7 weeks = more than 10 days
22 0/7 - 27 6/7 weeks = more than 14 days
28 0/7 weeks and beyond = more than 21 days
OB labs:
Anemia:
H/H or CBC
Blood type and antibiotics:
Blood type compromised of the blood group and the presence or absence of the RH factor
Antibody screen
Infections:
RPR or VDRL
Rubella immunity
Hepatitis B and C
HIV
Urine Culture..
For individual patients: Chlamydia, gonorrhea, PPD, HSV, varicella
Other conditions:
Hgb electrophoresis
diabetes screen
Pap
Thyroid
why is an antibody screen needed
it evaluates for antibodies in the mother’s blood that might cross the placenta and attack fetal red blood cells, causing hemolytic disease of the new born.
Pan-ethnic nondirective
Screens for 100+ conditions simultaneously, without regard to ethnic group or ancestry
Expanded
Screens all patiets for specific conditions, regardless of identified ethnic group or ancestry
Ethnic-specified; targeted
screens for conditions considered to be common in ethnic group with which the patient identifies and conditions identified through family history
Example of ethnic-specified, targeted
Tay-Sachs: individuals of Ashkenazi Jewish, Cajun, or French-Canadian descent
Canavan disease and familial dysautonomia: individuals of Ashkenazi Jewish descent
Fragile X syndrome: Individuals with a family history of intellectual disability suggestive of fragile X syndrome
Example of pan-ethnic nondirective
Cystic fibrosis
Spinal muscular atrophy
Hemoglobinopathies
What is the First trimester screen
Ultrasound to measure nuchal translucency (NT) + blood draw for maternal serum markers ….NT/serum screen
Is the first portion of sequential and integrated screens
Time fame First trimester screen
10 (or 11) - 14 weeks
What conditions is tested for First trimester screen
Aneuploidies (Trisomies 13, 18, 21)
Time frame for Chorionic villus sampling (CVS)
10-13 (or 14 ) weeks
What conditions are tested for Chorionic villus sampling
Aneuploidies and other chromosomal conditions
Time frame for cell-free DNA (cfDNA)
Noninvasive prenatal testing (NIPT)
Noninvasive prenatal screening (NIPS)
Anytime between 10 weeks and term
What conditions tested for cfDNA
Aneuploidies (Trisomies 13, 18, 21)
What tests test for only Aneuplooidy test
First trimester screen
Triple, quad and penta screens
Integrated and sequential screen
Noninvasive prenatal testing (cell-free DNA)
What tests test for structural anomaly (neural tube defect) tests
Alpha-fetoprotein (AFP) component of triple, quad, penta, integrated and sequential screens
What to tell patient about NT/Serum screen
Nuchal translucency u/s + markers
- Noninvasive; does not risk fetal harm
- Does not determine fetal sex
- Positive results (abnormally thick nuchal fold or abnormal serum markers) require confirmatory testing
- In some settings, after the NT/serum screen, patients can choose to proceed to diagnostic testing OR have additional serum markers drawn in the second trimester OR do no additional testing
What to tell patient about chorionic villus sampling
Results available in less then one week
Determines fetal sex
Invasive; risk of pregnancy loss, harm to fetus, infection and amniotic fluid leakage. Specific stats for these risks vary with the provider performing the procedure
As a diagnostic test, it can be tremendously reassuring when the results are negative/normal
What to tell patients about cfDNA
Noninvasive; does not risk fetal harm
Can determine fetal sex
Positive results require confirmatory testing
Very high negative predictive value (a negative test is quite reassuring that the fetus does NOT have an aneuploidy)
Higher positive predictive value (A positive test is likely to be a true positive) compared with traditional genetic screening tests
Flexible timeframe of test (anytime between 10 weeks and term) allows for information early in pregnancy (which can be beneficial for people who might not continue the pregnancy) AND allows for information later in pregnancy for those who are late to care.
What genetic tests can determine fetal sex
Chorionic villus sampling
cfDNA
Non serious cause for 1st trimester bleed
Implantation bleeding
Cervical irritation from infection or intercourse
Subchorionic hemorrhage
Fibroids or endometrial polyps
Most relevant history for implantation bleed
Timing usually limited to around 2 weeks after ovulation
Usually small amount of bleeding for short duration
Most relevant history for cervical irritation from infection or intercourse
Timing in relation to intercourse or exam
STI sx
Most relevant history for subchorionic hemorrhage
Timing in relation to gestational age
Usual to have subchorionic hemorrhage prior to 8-10 weeks
Usually painless bleeding
Identified by U/S
Most relevant history for Fibroids or endometrial polyps
Pt may report history of fibroids or endometrial polyps\
Uterus may be enlarged and irregular if fibroids
Identified by ultrasound
What is listeriosis
Bacteria
Food concerning for Listeriosis
Raw sprouts
soft cheeses
smoked seafood
raw milk (unpasteurized)
deli meats and hot dogs (cold, not heated)
What is Toxoplasmosis
Parasites
Food concerning for Toxoplasmosis
Undercook/contaminated meat
Pork/lamb/venison/
shell fish
oysters/clams/mussels
Drinking water contaminated with toxoplasma gondii
Cat feces….cats that eat infected small animals
Indoor cats who are fed commercial, cooked food virtually no risk of passing Toxoplasma gondii
