OB- Preconceptual Counseling
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What are 6 complications ACOG hope to avoid with preconceptual counseling?
- 1. Macrosomnia
- 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?
- 1. Hgb/Hct
- 2. Rh and type
- 3. rubella titer
- 4. Pap
- 5. GC
- 6. RPR/STS
- 7. Hep B
- 8 Drug screen?
What are the recommendations for HIV screening?
- Screen if:
- -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
- 2. Chlamydia
- 3. Toxoplasmosis
- 4. Dental exam
What are potential sources for toxoplasmosis that women should avoid?
- -Handling raw meat
- -Kitty litter
- -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?
- 1. hypoglycemia
- 2. accelerated retinopathy
- 3. PIH
- 4. Pre-eclampsia
- 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
- **teratogenic >10,000
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)
- 1. NTD
- 2. SAB
- 3. Abruption
- 4. PIH
- 5. LBW
What 5 substances should be avoided during pregnancy?
- 1. smoking
- 2. alcohol
- 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
- X- Ergotamines
Which anti-anxiety meds are drug class D or X?
- D- benzos
- 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
- X--> misoprostol
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
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