OB- Preconceptual Counseling
Card Set Information
OB- Preconceptual Counseling
What are 6 complications ACOG hope to avoid with preconceptual counseling?
2. Operative delivery
3. Late fetal death
4. Neural tube defects
5. Gestational HTN
6. Gestational DM
List the 8 key counseling areas.
1. Undx/untreated/controlled diseases
2. immunization status
3. med/radiation exposure
4. nutrition counseling
5. family hx/ genetic risk
6. tobacco/substance use/high risk behaviors
7. occupational/environmental exposures
8. social & mental health
What are the 8 parts of ACOG's routine screening?
2. Rh and type
3. rubella titer
7. Hep B
8 Drug screen?
What are the recommendations for HIV screening?
-NOT in mutually monogomous relationship x 10years
-Hx of IV drug use
-born in country with high heterosexual transmission
-sex industry worker
-partner with risk factors
What are 4 additional screenings?
1. TB test
4. Dental exam
What are potential sources for toxoplasmosis that women should avoid?
-Handling raw meat
-gloves when gardening
Why is CMV screening no longer recommended?
-high false pos
-no immunity past exposure
-no effective therapy
-vaccine of limited value
**educate and refer for genetic counseling if infection develops during pregnancy
What are 3 area so paternal screening during preceception counseling?
1. Smoking--> alters spermatogenesis, mobility, morphology
2. Occupation (lead, heavy metal)
3. Vitamins for normal spermatogenesis (A, E, linoleic acid, zinc)
What are 6 maternal risks for DM1 pregnant women?
2. accelerated retinopathy
5. DM ketoacidosis
6. Want to limit glucose variability (stric control w/in 24-48hr of pos HCG)
What are risk to infants of DM1 moms?
1. Congential malformations (~7weeks)
2. Spontaneous abortion (uteroplacental insufficiency)
What is the folic acid recommendations for low risk women, prior infant w/ NTD, high 1st tri A1C, and epilepsy?
-Low risk--> 0.4mg
-Prior NTD--> 4.0mg
-High A1C--> 0.4- 5.0mg
-Epilepsy--> 1.0-4.0 b/c drugs interfere with folate metabolism
What is the recommended amount for Vit A? When does it become teratogenic?
Vit A--> 3000-5000 IU QD
What populations are at increased risk of B12 deficiency?
-vegan, low cholesterol diet, gastric bypass
Women with B12 deficiency are at increased risk for what? (5)
What 5 substances should be avoided during pregnancy?
3. environment (lead, pesticides)
4. recreational drugs
5. Caffeine (mod consumption ok)
Which analgesics are classified as either drug category D or X?
D- all NSAIDS
Which anti-anxiety meds are drug class D or X?
X- Flurazepam (dalmane), temazepam (restoril)
What anticoagulant is drug category X?
What anticonvulsants and antidepressants are category D?
Anticonvulsants--> carbamezepine, clonazapam, phenobartibtal, phenytoin, primidone, valproic acid
Antidepressants--> amitryptyline, imipramine, nortriptyline
Which anti-fungals are pregnancy category D?
-Fluconazole, itraconazole, ketoconazole (all only in 1st trimester)
Which anti-neoplastics are category X?
-thalidomide, MTX, aminopterin
Which GI drugs are Category D and X?
D--> bismuth subsalicylate
Which antihypertensives are category D?
-ACE-I, Angio II, labetolol
-Onl in 2nd/3rd tri--> beta blockers & thiazides
Which lipophilic statins are category X?
-Simvastatin, lovastatin, atorvastatin
T or F. Nicotine gum is a category D.
False, actually a category X