Module 3 Unit B Flashcards
What are the elements of an initial obstetric history and physical exam that clinicians should assess?
Why is each of them important? (In other words, don’t just memorize the list; think about why they matter.)
demographic, social, occupational, obstetric, gynecologic, medical, surgical, infections, vaccinations, family, genetic, nutrition, substance use, physical activity, and teratogen exposure
What are the principles of prescribing for pregnant people?
- When possible, choose drugs with the most reassuring safety profile and those that have been used and studied for the longest period of time.
- Prescribe the lowest effective dose for the shortest effective period of time.
- When possible, use a single medication as opposed to combination products.
- Weigh the risks vs. benefits and include the patient in the decision-making process.
- If possible, do not prescribe drugs during the first trimester.
- When appropriate, prescribe topical instead of systemic drugs.
-If the pregnant person is already taking a medication, discontinue only if the medication is harmful to the pregnancy and only if safe to do so. Some maternal conditions can be more dangerous if they are untreated (e.g. asthma, depression), compared with the risks of medication exposure during pregnancy.
How will you determine if a medication is safe for a person to continue during pregnancy?
What labs do clinicians order as part of the initial obstetric panel?
Which values for each lab are normal and which would require follow-up or consultation?
Anemia: Hemoglobin/hematocrit or CBC
Blood type and antibodies:
Blood type (comprised of the blood group and the presence or absence of the Rh factor)
Antibody screen
Infections
For all individuals: RPR or VDRL, Rubella immunity, Hepatitis B, Hepatitis C, HIV, urine culture
For selected individuals: Chlamydia, gonorrhea, PPD, HSV, varicella
Other conditions for selected populations
Hgb electrophoresis, diabetes screen, Pap, thyroid
Drug screen (controversial)
How do clinicians record obstetric history using the GTPALM system?
How do clinicians assess maternal well-being at subsequent/routine interval prenatal visits during the first trimester?
How do clinicians manage common discomforts in the first trimester, including subjective and objective data collection, development of assessment/differential diagnoses, determination of normalcy, development of a plan
What does GTPALM System mean
Gravies
Term
Preterm
Abortion
Living
Multiples
What is Gravida
The number of times a person has been pregnant, regain outcome
Parity: 5 digits
TPALM
T: Term( 37 0/7 or more)
P: Preterm(20 0/7-36 6/7)
A: Abortion: number of abortions/miscarriages/ectopic pregnancies occurring prior to 20 weeks.
L: Living
M: Multiples
Common discomfort resulting from pressure on anatomic areas that aren’t usually compressed
Urinary frequency, incontinence and nocturia
Vena Cava compression»_space;supine hypotensive episodes
Varicosities
Shortness of breath in the third trimester
Edema in lower extremities
Common discomforts that can result in stretching of anatomic areas that aren’t stretched
Round ligament pain
Common discomforts that can result in Progesterone-related slowing of GI tract
Reflux/heartburn
Bloated feeling/delayed emptying
Nausea/vomiting
Constipation
Flatulence
Hemorrhoids
Common discomfort that can result in other progesterone effects
Fatigue, especially in early pregnancy
Physiologic hyperventilation»_space;> SOB in the first trimester
Common discomfort that can result in increased blood flow
Higher GFR»urinary frequency (and glycosuria)
Palpitations
Lower fasting glucose levels»_space;nausea
