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Pregnancy: Pre-conception Counseling

Terms in this set (57)

How much folic acid should be given to prevent NTD?
400mcg give at least 3 months prior to conception through 12 weeks and give larger dose (4-5mg) if high risk
Being overweight pose what risks to mother for pregnancy?
DM, HTN, Pre-E, Eclampsia
What can macrosomnia lead to?
Shoulder dystocia (the baby is too big so it gets stuck, Bony Impaction on pelvic bone)
What birth complications result from elevated BMI?
Macrosmnia, shoulder dystocia, operative delivery, congenital anomalies, Intrauterine growth restriction (IUGR), spontaneous abortion, stillbirth, eclampsia, preeclampsia
What is considered low BMI? What does this pose risk for in pregnant women?
BMI <18.5 Increased risk of amenorrhea and infertility, nutritional deficiencies, osteoporosis, assess for eating disorders
What is considered low BMI for women? What risk does this pose for the baby?
<18.5, preterm birth, low birth weight, increased risk of gastroschisis
What should you be aware of in pregnancy and bariatric surgery?
1/2 women of reproductive age will have it, pregnancy should be prevented 12-18 months after surgery, focus on nutrition
Recommendation for Hep B vaccine (preconception care)
Vaccinate all high risk women
How long do you have to wait to get pregnant ideally after MMR vaccine?
3 months (screen for immunity first, give if needed)
When should a woman get vaccinated during pregnancy with TDAP?
27-36 weeks
How long should you wait to get pregnant if you were to give varicella vaccine?
1 month (vaccinate non-immune women)
Which guidelines do we use for STD/STI screening?
USPSTF
Guidance for STD/STI testing
Chlamydia
Gonorrhea
Herpes
Syphillis
TB
Screen all women <25 (Chlam),
screen high risk women (gonorrhea),
Counsel about vertical transmission (herpes)
Universal screening, vertical transmission (HIV),
Screen high risk women (spyphillis),
Screen in high risk, treat active/latent before pregnancy (TB)
What is the preconception goal for A1C in women with DM? What are some of the complications of gestational DM for fetus?
<7%, increased risk SAB, congenital anomalies, perinatal death
What are some of the risks associated with HTN in pregnancy?
Preterm birth, placental abruption, intrauterine growth restriction, 25% develop Pre-E, end organ damage, fetal death (Outcomes related to degree of elevation)
Epilepsy in pregnancy
1/3 have more frequent Szs during pregnancy
What are the risks in pregnancy?
Miscarriage, low birth weight, developmental disabilities, microcephaly, hemorrhagic disease of newborns, congenital anomalies
In pts with epilepsy there is an increased risk of ____? You should give high dose of folic acid at dose of what?
NTDs, 4-5mg
What are some risks of asthma in pregnancy?
Neonatal hypoxia, intrauterine growth restriction, preterm birth, low birth weight, fetal/neonatal death
What are some precautions to take preconception for pts with asthma?
Get asthma under control, ID and reduce allergen exposure, reduce trigger exposure, smoking cessation and avoidance of 2nd hand smoke
What are some risks in pregnant women with thyroid disorders?
Preterm birth, low birth weight, placental abruption, fetal death
What is important to do in thyroid pts during pregnancy?
Monitor b/c thyroid levels will fluctuate, and you usually will have to increase dose of thyroid supplementation (30% higher.. try to get them euthyroid prior to contraception)
Can we give Coumadin to pregnant women?
Um, no (teratogenic consider unfractionated hep or LMWH)
What should we also consider in preconception care that are environmental exposures?
Workplace toxins (dry cleaning, printing, agriculture, clinical lab/healthcare), Household exposures (heavy metals, solvents, pesticides), avoid dietary mercury
What are some examples that may warrant family genetic counseling?
Hemoglobinopathies, sickle cell, cystic fibrosis, Tay-sachs, Spinal muscular atrophy, Fragile X
Psychiatric Illness
Screen for ___ and __
Depression, anxiety
Psychosocial preconception care
Screen for ___ partner violence, evaluate for ____, and refer if indicated!
Intimate, safety
What should we do for the partners of a pregnant woman?
Ensure positive outcomes for reproductive and sexual behaviors: Contraception alternatives, effectiveness
Family and genetic history, Ensure positive outcomes for reproductive and sexual behaviors -Contraception
alternatives, effectiveness
-Family and genetic history -Physical / Sexual / emotional abuse -Reproductive health & planning sperm quality and production
-Social and behavioral history -STI
Can partner of pregnant woman directly impact pregnancy health? How?
yes, 2nd hand smoke can cause low birth weight, IUGR, preterm delivery, SIDs
How early can urine pregnancy test detect pregnancy?
By 23 menstrual days or 8 days after conception (very accurate, false negatives are rare)
What's the difference between serum qualitative and serum quanative B-hCG?
Qualitative tells you if you're pregnant or not where quant gives a baseline value. Should increase steadily during pregnancy. If you see a decrease in quant it's a bad sign! (Not progressing.. SAB)
What is a birth plan?
legal document, must abide by it. Allocating for baby
What are some symptoms of pregnancy?
Amenorrhea
• Reliable if regular cycles • Enlarging uterus • Nausea & vomiting
• 50% of pregnancies
• 2-12 weeks gestation • Breast tenderness (mastodynia) • Quickening (fetal movement)
• 18-20 weeks in primigravida
• 14-16 weeks in multigravida • Bladder irritability, urinary frequency
Increased basal body temperature
• Chloasma -"mask of pregnancy"
• Linea nigra
• Darkening of the linea nigra
• Darkening of nipple
• Stretch marks: breasts and abdomen
• Spider telangiectases
• Vascular lesions - blanch
• Palmar erythema • Leukorrhea
• Increased vaginal discharge
How prevalent is morning sickness?
Super prevalent
(75% pregnant women, 50% vomiting alone, 80% - all day!)
What are some correlation of n/v/morning sickness?
Levels of human chorionic gonadotropin, size of placental mass
What do pregnancies with higher hcG levels more at risk for?
Multiple gestations, molar pregnancies, fetuses with Down syndrome
When do most cases of morning sickness resolve?
In 1st trimester, 90% by 20 weeks
What are some DDx for morning sickness for atypical cases that don't resolve within fist trimester? What labs should you order to help with ddx?
Biliary dz, GI disorders, migraine,
CBC, CMP, U/A, TSH, lipase, quant hcG
What are some maternal fetal outcomes if uncomplicated morning sickness?
Decreased risk SAB, preterm delivery, growth restriction
What re some maternal and fetal outcomes if complicated (hyper emesis,weight loss) morning sickness?
Growth restriction, low birth weight, fetal death, pre-E, Mallory-Weiss tear, pneumothorax, retinal hemmorage
Nonpharm morning sickness tx
Light dry foods (low fat, low fiber, BLAND), small meals, avoid strong smells, acupressure, acupuncture, ginger extract
Morning sickness Vitamin B6 and doxylamine (Unisom)
70% reduction in morning sickness
Anti-emetics options for morning sickness
Chlorpromazine (buccal and less sedating), Promethazine (can be suppository or topical), Odanstron (not in 1st trimester)
Antihistamines for pregancy
Diphenhydramine, meclizine
Promotility agents in pregancy
Metochlorpramide (=/- B6) short term only
When can corticosteriods be given in pregancy?
After 12 weeks
Acid reducing meds okay in pregancy?
Yes
What is extreme nausea and vomiting >3 days which creates more than 5% weight loss and is associated with dehydration leading to electrolyte imbalances and ketonuria?
Hyper emesis gravidarum
What is tx for hyperemisis gravidarum?
IV fluids, nutrition and possible hospitalization
How to diagnose multiples :)
Ultrasound findings,
Fetal heartbeats on exam,
Disproportionately large uterus for dates,
Greater than expected weight gain,
Maternal hypochromic normocytic anemia
___% are Monozygotic or identical twins and are often mirror images of each other
___ fertilized ovum by SINGLE sperm
One is ___ handed and other is __ handed
Is this random?
30, single, right, left
yes (it's random, 3/1000 pregnancies)
___ % are dizygotic or fraternal twins and are ___ fertilized ova with __ ova and __ sperm.
___% are the same sex
Is there a hereditary component?
70, separately, 2, 2, 75
Yes (hereditary component is maternal, can be recurrent-10 fold chance and is more common in blacks and less common in Asians)
What percentage of ART pregnancies result in twins?
20-30%
What do multiple gestations increase?
Morbidity and mortality (preterm labor, hemorrhage, UTI, pregnancy induced HTN)
If you have twins what is the percent that one emryo is lost in first 10 weeks of pregnancy?
1/3
How much higher is perinatal mortality rate in twins?
3-4x higher
Rate the likely hood of presentations for twins at delivery
Vertex/vertex 40%,
Vertex/nonvertex 40% first can be born vaginally then 2nd C section considered,
Nonvertex/vertex 20% straight to C-section
What is Nagele's rule? How is it calculated?
Estimated date of confinement (Due date)
Date of last normal menstrual period (FIRST DAY) -3 months + 7 days

(Ex. Jan 14 DD=Oct 21)
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