boards- primary care in women during pregnancy
late term
41 weeks to 41 weeks and 6 days
what week of pregnancy will you be able to auscultate fetal heart sounds via u/s?
12 weeks
hale's lactation risk category L5
contraindicated significant and documented risk -radioactive isotopes -cocaine
why is pumping and dumping not helpful in reducing drug levels in mother's milk?
creates area of lower drug concentration in empty breast drug diffuses from area of high concentration (mat. serum) to area of low concentration (empty breast)
how does progesterone contribute to n/v?
delays gastric emptying
When is "pump and dump" helpful?
during the 3-5 drug free 1/2 lives period when mom ingested a truly contraindicated drug: cocaine (t1/2 = 0.8 hrs = 2.5 - 4 hrs) pcp (t1/2= 24-51 hours + stored in fat = 3-7 days)
nongravid size of a uterus
lemon
how much xtra Fe should a preggo have?
no research to support non anemic women should have extra Fe- beyond prenatal vitiman
what are 2 herbs that are helpful w n/v in preggo?
vit b6 ginger
pregnancy risk category c
(NO) controlled studies in humans available (2/3s of meds) animal studies reveal adverse effect or no adequate studies in pregnancy: clarithromycin, fluoroquinolones, bactrim, SSRI (paroxetine- D), steroids, antihypertensives
Hale's Lactation Risk Category • L1
- Safest Controlled study=Fail to demonstrate risk • Acetaminophen • The penicillins • Medroxyprogesterone acetate (Depo-Provera®) given at recommended time postpartum
how much xtra folic acid should a preggo have (no prior hx of NTD)
0.4-1 mg/ d (100 > than baseline)
sickle cell trait
1. Carry one of the autosomal recessive genes 2. No symptoms
BMI normal weight
18.5-24.9
how much Ca should a preggo have
19-50 y.o. 1-1.5 gm/d 14-18 y.o. 1.3 gm/d
what's the most accurate source of EDD (estimated delivery date)
1st trimester ultrasound
embryo
2-8 weeks the developing human organism from about 2 weeks after fertilization through the second month
how much xtra folic acid should a preggo have (w hx of NTD)
4 mg/ d x 1 mo before preggo and 1st 3 mo 0.4-1 mg/ d (100 > than baseline)
BMI overweight
25-29.9
if Fe <11 g/ dL in 2nd trimester or < 10.5 g/dL in 3rd trimester how much Fe does mom need?
30 mg/ d re-check in 1 mo- if still low check Ferritin
BMI obese
30-39.9
how many xtra cal / d during pregnancy?
300 kcal/ d over baseline **if w/in 1-2 yrs of menarche and or w multiple gestation this is >
early term
37-38 6/7 weeks
full term
39-40 6/7 weeks
how many xtra cal / d during bf?
500 kcal/ d over baseline
when should a woman w gestational diabetes be screened for dm?
6-12 weeks w/ test other than A1C
BMI for underweight
<18.5
post term
>42 weeks
cystic fibrosis
A genetic disorder that occurs in people with two copies of a certain recessive allele; characterized by an excessive secretion of mucus and consequent vulnerability to infection; fatal if untreated.
Tay-Sachs disease
A human genetic disease caused by a recessive allele that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth.
Thalidomide
A mild tranquilizer that, taken early in pregnancy, can produce a variety of malformations of the limbs, eyes, ears, and heart.
which group of people is at risk for sickle cell trait?
African Latino Arabic Greek Maltese Italian Sardinian Turkish Indian
Category X pregnancy
Animal or human studies have shown fetal abnormalities or toxicity, and the risk outweighs the benefits. isotretinoin (accutane) thalidomide the statins
Treatment options for uncomplicated Chlamydia trachomatis infection in pregnancy include: Clarithromycin. Doxycycline. Azithromycin. Ofloxacin.
Azithromycin.
A 21 year old woman with normal BMI prior to pregnancy is now 38-weeks pregnant. Her weight gain up to 28 weeks was 12 lbs (5.45 kg) and she has gained 2 lbs (0.9 kg) from 29 weeks to 38 weeks. Her weight gain pattern is most likely to affect her baby's: Birth weight. Head circumference. Birth length. Apgar scores.
Birth weight.
Which of the following antimicrobials is preferred for the treatment of a UTI during pregnancy? Doxycycline Levofloxacin Cephalexin TMP-SMX
Cephalexin
When a pregnant woman takes a teratogenic drug, the fetal effects are usually seen in: Certain target organs in a predictable manner. Random body systems without a predictable pattern. Select organ systems with random outcomes. A pattern of systemic injury.
Certain target organs in a predictable manner.
low molecular weight heparin
Enoxaparin (Lovenox)
Hale's Lactation Risk Category • L4 -
Hazardous Positive evidence of risk but may be used if maternal life-threatening situation • Lithium • Ergot preparations • Daily HD systemic corticosteroids - Equivalent prednisone ≥10 mg/d long term
Beta-lactam antibiotics
Penicillins Cephalosporins Carbapenems Monobactams
pregnancy risk category a
RCT shows no fetal risk or possiblity levothyroxine
Felicia is 18-weeks pregnant with her first child. Which of the following is most consistent with her gestational age? Uterine fundus palpable through the abdominal wall Nausea and breast tenderness Report of quickening Fetal heart tones detectable by abdominal Doppler
Report of quickening
salpingitis
an inflammation of a fallopian tube
pregnancy risk category b
animal studies reveal no harm, however there are no adequate studies in pregnant women or animal studies show adverse effect, but studies in pregnant women failed to demonstrate risk to fetus: Beta lactams: penicillins, cephalosporins (cephalexin- uti), macrolides: azithromycin, erythromycin (but not clarithromycin) Nitrofurantoin (macrobid/ macrodantin) inhaled corticosteroids (pulmicort but not flovent) acetaminophen, ibuprofen
which group of people is at risk for tay-sachs dx?
ashkenzi jews french canadian cajun ancestry
which group of people is at risk for cf?
ashkenzi jews n euro (< AA/ uncommon Asian)
10 week size of a uterus
baseball
when is the best time to test for tay-sach's
before pregnancy
what is the tx for a preggo w chlamydia?
ceftriaxome 250 mg IV + azithromycin 1 gm po If allergic to PCN: (+GC) azithromycin 2 gm (-GC) azithromycin 1 gm **retest in 3-4 wks screen in 3 months for new infection
16 weeks size of a uterus
fundal height between symphysis pubis and umbilicus
20 size of a uterus
fundus at umbilicus
Vertex cephalic presentation
head is completely flexed, normal, smallest diameter 95% percent of babies by 36 weeks
strongest risk of ectopic pregnancy
hx of salpingitis
how is levothyroxine managed in preggers?
increase dosing- by 30%
Hale's Rule
infant receives </= 1 % of maternal drug dose
when should a pregnant woman get the tdap vax?
last trimester
what is the preferred anticoagulant for pregnant women?
low molecular weight heparin
hale's lactation risk category L3
moderately safe no control study or controlled study shows minimal non life threatening risk bactium FQs 1st generation antihx doxycycline
is bactrim ok for a pregnant woman?
no- cat c
what are 3 rx antiemetics to help w n/v?
phenothiazines (promethaine/ phenergan) metocolopramide (reglan) ondansetron (zofran)
pregnancy risk category d
positive evidence of human risk **really only acceptable if the mothers life is in danger can cause fetal malformation, require weighing potential benefits against possible risks Tetracylines: doxycyline ACE I ARB Carbamazepine (tegretol) Valproic acid (depakote) lithium Paroxetine
how does hCG contribute to n/v?
possibly d/t effect on cns- worst when peaks - 10 wks
when is the best time to test for sickle cell trait?
prior to or early in pregnancy
when is the best time to test for cf?
prior to or in early pregnancy
freq. of prenatal visits 28- 36 weeks
q 2 wks
freq. of prenatal visits up to 28 weeks
q 4 wks
freq. of prenatal visits >/= 36 weeks
q week
hale's lactation risk category L2
safer limited amount of women studied w o risk macrolides nitrofurantoin cephalosporins 2nd gen. antihx prednisone ssris
12 weeks size of a uterus
softball or gratefruit
what is the tx for a preggo w HSV?
suppression Tx 36 wk to delivery
8 week size of a uterus
tennis or orange
how much weight should a preggo gain? BMI >30
total: 11-20 lbs .4-.6 lbs/ week for 2nd and 3rd trimesters
how much weight should a preggo gain? BMI 25-29.9
total: 15-25 lbs .5-.7 lbs/ week for 2nd and 3rd trimesters
how much weight should a preggo gain? BMI 18.5-24.9
total: 25-35 lbs 0.8-1 lbs/ week for 2nd and 3rd trimesters
how much weight should a preggo gain? BMI < 18.5
total: 28-40 lbs 1-1.3 lbs/ week for 2nd and 3rd trimesters
are HIV + preggos start anti-virals?
yes- the earlier the better
