OB- Preconceptual Counseling

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Author:
choward04
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218933
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OB- Preconceptual Counseling
Updated:
2013-05-10 11:22:40
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OB
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OB
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  1. 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
  2. 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
  3. 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?
  4. 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
  5. What are 4 additional screenings?
    • 1. TB test
    • 2. Chlamydia
    • 3. Toxoplasmosis
    • 4. Dental exam
  6. What are potential sources for toxoplasmosis that women should avoid?
    • -Handling raw meat
    • -Kitty litter
    • -gloves when gardening
  7. 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
  8. 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)
  9. 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)
  10. What are risk to infants of DM1 moms?
    • 1. Congential malformations (~7weeks)
    • 2. Spontaneous abortion (uteroplacental insufficiency)
  11. 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
  12. What is the recommended amount for Vit A?  When does it become teratogenic?
    • Vit A--> 3000-5000 IU QD
    • **teratogenic >10,000
  13. What populations are at increased risk of B12 deficiency?
    -vegan, low cholesterol diet, gastric bypass
  14. Women with B12 deficiency are at increased risk for what? (5)
    • 1. NTD
    • 2. SAB
    • 3. Abruption
    • 4. PIH
    • 5. LBW
  15. What 5 substances should be avoided during pregnancy?
    • 1. smoking
    • 2. alcohol
    • 3. environment (lead, pesticides)
    • 4. recreational drugs
    • 5. Caffeine (mod consumption ok)
  16. Which analgesics are classified as either drug category D or X?
    • D- all NSAIDS
    • X- Ergotamines
  17. Which anti-anxiety meds are drug class D or X?
    • D- benzos
    • X- Flurazepam (dalmane), temazepam (restoril)
  18. What anticoagulant is drug category X?
    -warfarin
  19. What anticonvulsants and antidepressants are category D?
    Anticonvulsants--> carbamezepine, clonazapam, phenobartibtal, phenytoin, primidone, valproic acid

    Antidepressants--> amitryptyline, imipramine, nortriptyline
  20. Which anti-fungals are pregnancy category D?
    -Fluconazole, itraconazole, ketoconazole (all only in 1st trimester)
  21. Which anti-neoplastics are category X?
    -thalidomide, MTX, aminopterin
  22. Which GI drugs are Category D and X?
    • D--> bismuth subsalicylate
    • X--> misoprostol
  23. Which antihypertensives are category D?
    • -ACE-I, Angio II, labetolol
    • -Onl in 2nd/3rd tri--> beta blockers & thiazides
  24. Which lipophilic statins are category X?
    -Simvastatin, lovastatin, atorvastatin
  25. T or F.  Nicotine gum is a category D.
    False, actually a category X

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