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Questions and Answers
What about OTC pregnancy tests?
What about OTC pregnancy tests?
- No specific detection time
- Serum: Sensitive 8-11 days after conception (most sensitive and specific measure of pregnancy) (correct)
- Urine: Sensitive 9-12 days after conception (correct)
- Only effective after 1 month of pregnancy
When am I due according to Naegel's Rule?
When am I due according to Naegel's Rule?
Subtract 3 months from last menstrual period then add 7 days and one year.
What must be done today when a patient is diagnosed with pregnancy at 8 weeks gestation? (Select all that apply)
What must be done today when a patient is diagnosed with pregnancy at 8 weeks gestation? (Select all that apply)
- Establish a due date (correct)
- Schedule a C-section
- Prescribe a daily prenatal vitamin (correct)
- Refer to a surgeon
When does ACOG recommend that prenatal care be initiated?
When does ACOG recommend that prenatal care be initiated?
What are some risk factors for domestic violence screening during pregnancy?
What are some risk factors for domestic violence screening during pregnancy?
What are key components of a physical exam for pregnant women? (Select all that apply)
What are key components of a physical exam for pregnant women? (Select all that apply)
What diagnostic studies should be conducted at the first prenatal visit? (Select all that apply)
What diagnostic studies should be conducted at the first prenatal visit? (Select all that apply)
A pregnant patient has a MCV < 80 fL with no iron deficiency anemia. What is a likely cause?
A pregnant patient has a MCV < 80 fL with no iron deficiency anemia. What is a likely cause?
How should asymptomatic bacteriuria in a pregnant patient be handled? (Select all that apply)
How should asymptomatic bacteriuria in a pregnant patient be handled? (Select all that apply)
What is the recommended approach for TSH in pregnant patients?
What is the recommended approach for TSH in pregnant patients?
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Study Notes
OTC Pregnancy Tests
- Urine tests can detect pregnancy sensitivity 9-12 days after conception.
- Serum tests are more sensitive, detecting pregnancy 8-11 days after conception.
Estimated Due Date
- Calculate the due date by subtracting 3 months from the last menstrual period, then adding 7 days and one year.
- Naegel's Rule states that pregnancy typically lasts 281-282 days.
Actions After Diagnosis
- Prescribe a daily prenatal vitamin to the patient.
- Establish the due date for tracking pregnancy progress.
Prenatal Care Timing
- ACOG recommends initiating prenatal care by 10 weeks of gestation.
Domestic Violence Screening Risk Factors
- Warning signs include bruising, improbable injuries, depression, and late or missed prenatal appointments.
Physical Examination for Pregnant Women
- Perform cervical screening per non-pregnant guidelines.
- Obtain baseline blood pressure, weight, and height to assess risk and counsel for appropriate weight gain.
Initial Diagnostic Studies in Pregnancy
- Confirm pregnancy with hCG tests, which double every 48-60 hours in the first trimester.
- Conduct CBC to screen for anemia, noting that MCV < 80 fL (without iron deficiency) suggests thalassemia.
- Perform urinalysis to check for bacteria, protein, and glucose. Protein may indicate pre-eclampsia in the third trimester.
- Routine urine culture is essential due to the high risk of pyelonephritis in asymptomatic bacteriuria.
- Blood type and Rh status must be obtained to screen for hemolytic disease of the newborn.
- Assess rubella immunity, with immunization recommended after delivery if not immune.
- STI testing includes chlamydia using NAAT, syphilis screening, universal HIV screening (opt-out), and Hep B testing.
- Monitor TSH levels in hypothyroid patients, as their requirements increase during pregnancy.
Thalassemia Diagnosis
- An MCV < 80 fL in a pregnant patient without iron deficiency anemia is indicative of thalassemia.
Management of Asymptomatic Bacteriuria
- Monthly urine screenings should be considered until delivery.
- Treat with appropriate antibiotics regardless of symptoms.
TSH Monitoring in Pregnancy
- TSH levels need to be monitored for pregnant patients with a history of hypothyroidism, as treatment is crucial for healthy fetal development.
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