Clinical Medicine - TW: intimate partner violence, sexual violence

Question 1

What is the differential if the fundal height is lower than expected?

Height (cm)

Answer 1

• Wrong dates
• Intrauterine growth restriction
• Oligohydraminos

Question 2

Which patients should be screened for intimate partner violence?

Answer 2

ALL patients

• Every new patient
• Any patient with signs of trauma
• Any patient with conditions associated with IPV
  
  • Extensive, can affect many organ systems: GI, Repro, Psych, behaviorla signs

Question 3

G_P_ _ _ _

What does each blank stand for?

Answer 3

G_aP_{b c d e}

• a = Number of pregnancies
• b = Number of term births
• c = Number of preterm births
• d = Number of abortions (spontaneous or otherwise)
• e = Number of living children

Question 4

When should intimate partner violence be documented in a patient’s chart?

Answer 4

ONLY if the patient says it’s okay

Question 5

What is the differential if the fundal height is higher than expected?

Height (cm) > (#weeks gestation = 3)

Answer 5

• Wrong dates
• Multiples (twins, triplets)
• Fibroids
• Macrosomia
• Hydraminos

Question 6

List and describe the 3 components of the cycle of abuse

Answer 6

• Intimidation
  
  • Threats, abuse (physical, emotional, sexual)
• Violence escalation
  
  • This is often when pts will present to the ER or engage with healthcare providers
• Honeymoon phase
  
  • Abuser shows remorse
  • Vicitm may blame themselves

Question 7

After 20 weeks gestation, blood pressures above ____ would raise concern for pre-eclampsia or gestational HTN?

Answer 7

140/90

Question 8

How do you calculate the estimated date of delivery (EDD) for a pregnant patient?

Answer 8

From the first day of the last menstrual period (LMP)

EDD = LMP + one year - 3 months + 7 days

Question 9

When is it mandatory to report intimate partner violence?

Answer 9

When a patient presents with injuries from a firearm

If children are involved

Otherwise, not necessary to document/report - ALWAYS ask pt before documenting in their chart

Question 10

When during gestation does fetal movement begin?

When should there be a expected pattern?

Answer 10

Begins at 20 weeks

At 26 weeks, there is an expected pattern; deviations need to be evaluated for fetal well-being

Question 11

What is considered normal for fundal height?

At 20 weeks:

Beyond:

Answer 11

• At 20 weeks:
  
  • At umbilicus
• > 20 weeks:
  
  • #cm above pubic symphysis should be equal to weeks of gestation +/-3
  • Ex: 26 weeks => fundal height should be 23-29 cm above the pubic symphysis

Question 12

What tissue does Non-invasive prenatal screening (NIPS) look at to analyze the fetal genome?

Answer 12

Cell free DNA

Based on the assumption that the total number of fragments of any one chromosome is proportional to the size of the chromosome

Question 13

List 4 factors that will affect the fetal fraction of cell free DNA in maternal blood

Answer 13

• Gestational age
  
  • Slightly increases 10-21 weeks
  • Significant increase >21 weeks
• Maternal BMI
  
  • Higher BMI = lower Fetal fraction
• Small placenta
• Aneuploidy
  
  • Increased in Trisomy 21, decreased in Trisomy 18 and 13
  • This is what we’re actually looking for

Normally, fetal cell-free DNA is 10% of the total circulating cell-free DNA

Question 14

What is the earliest gestational age at which NIPS can be performed?

Answer 14

Any time after 10 weeks

Question 15

List 4 limitations of NIPS

Answer 15

• False positives
• Failed results
• Re-draw also has potential to fail
  
  • Delayed results delay time-sensitive decision making
• Results take 1-2 weeks
  
  • Especially important if close to 24 weeks

Question 16

What is the appropriate next test if NIPS is positive for a fetal aneuploidy?

Answer 16

Diagnostic testing

(Invasive method, ex: amniocentesis)

Question 17

Who should be offered prenatal genetic screening?

Answer 17

All pregnant patients

Offer either standard screening of cell free DNA