Folic acid pre-pregnancy and at Pg
Pre-pg 0.4mg (400mcg); Pg 1mg (1000mcg)
Why folic acid?
Prevents neural tube defects (spina bifida,
... [Show More] anencephaly , encephalocele
Meds to avoid in pregnancy
Zofran; Tylenol (new association with ADD/ADHD); Diflucan (not sure if single dose is ok); Macrobid (avoid in 1st trimester); Prozac; Lamictal; Paxil; tetracycline/doxycycline; thalidomide; misoprostol; quinolones; triptans; pseudo fed; Allegra; phenytoin
Confirming pregnancy
urine and serum about same detection. Serum is most sensitive & specific. Always confirm in office
Naegele's Rule
LMP -3months +7days +1 year
RF for domestic violence
<35 y.o.; single/divorced/separated; risky substances in patient or partner; smoker; childhood physical or sex abuse
Domestic violence clues
missed prenatal visits, improbable injury, bruising, depression/anxiety, late prenatal care, cancel appointments, overprotective partner (consider human trafficking)
hCG
qualitative (yes/no); quantitative (amount of hCG) In normal Pg will double every 24-72 hours. If tubal Pg it will not double as expected...it will be slower.
Safe vaccines in pregnancy
Td; Influenza
Baby relies on mom's immunities for first 4 months
Depression in Pg
post partum blues resolve in 10 days
PP depressive episode within 4 weeks of delivery
Use Edinburgh scale to screen, if (+) refer to psych
Affects about 13% of Pg women
Zoloft is safest med
Safe meds in Pg
Amoxicillin; Keflex; folic acid; B6; levothyroxine
When to stop air travel if PG
35 weeks; earlier if pre-term labor.
Zika
If male exposed then condoms x 3 months
If female wait 8 week before conceiving
Microcephaly, cleft palate
Highest risk in 1st trimester
Vaccines to avoid in Pg
any live vaccines
No MMR
No Varicella
Pg office visits
every 4 weeks until 28 weeks gestation
every 2 weeks from 29-36
every 1 week after 36 weeks
Diabetes screening
24-28 weeks
Goal for blood sugars to be normal/stable during Pg
Overt DM is Dx at initial visit
Gestational is Dx during Pg [Show Less]