OB-GYN Halo-halo

Question 1

Things to requets at initial visit and first trimester

Answer 1

Hct, Bld type
Urinalysis

RPR/VDRL
Gonorrhea culture
Chlamydia culture
Pap smear
HIV offered

HBsAg
PPD
Rubella ANTIBODY screen ⭐️
VZV ANTIBODY titer in patients with no history of exposure ⭐️

Early screening for aneuploidy (NT plus serum markers)

Question 2

what is added to NT for screening of trisomies

Answer 2

hCG and PAPP-A (blueprints)

Question 3

what to test for in 2nd trimester

Answer 3

MSAFP/triple or quad screen (15-21 weeks AOG)
Obstetric ultrasound (18-22 weeks AOG)
amniocentesis for women interested in prenatal diagnosis

Question 4

things to test for in the 3rd trimester

Answer 4

hematocrit
RPR/VDRL
GLT
GBS culture

“in high-risk populations, vaginal cultures for conorrhea and chlamydia are repeated late in the 3rd trimester” (Blueprints)

Question 5

Quad screen

Answer 5

2nd trimester
MSAFP
estriol
ß-hCG
inhibin A (makes the test a quad screen)

Question 6

what is present in both the first trimester screen and quad screen for Down syndrome?

Answer 6

ß-hCG

Question 7

Sensitivities of the screening tests for down syndrome

Answer 7

NT alone: Sn 64-70%
Free ß-hCG and PAPP-A: Sn 60%

first-tri secreen: Sn 82-87%
quad screen: Sn 80%

Both: Sn 95%, positivity rate of 5%
cell-free DNA
Sn 99.3%
Sp 99.8%

Question 8

the ff are assessed on each follow-up prenatal care visit

Answer 8

BP
weight
urine dipstick
uterine measurement
FH auscultation

Question 9

after ______ weeks, patietns are asked about cocntractions and fetal movement

Answer 9

20 weeks

Question 10

screening for MSAFP is usally performed when?

Answer 10

bet 15 and 18 weeks AOG

Increased in NTD
Decreased in Down syndrome

Question 11

screening ultrasound is offered when?

Answer 11

bet 18 and 20 weeks (Blue prints)

Question 12

quickening usually felt when?

Answer 12

bet 16 and 20 weeks GA (blueprints)

Question 13

prenatal visits

Answer 13

every 4 weeks until 28 weeks
every 2 weeks until 36 weeks
weekly thereafter

Question 14

when is RhoGAM given?

Answer 14

28 weeks

Question 15

women with latent HSV should receive antiviral prophylaxis intiated at

Answer 15

36 weeks

Question 16

when is steroids given?

Answer 16

bet 24 and 36 weeks Blueprints)

Question 17

when is Mg sulfate given?

Answer 17

bet 24 and 32 weeks if delivery is occurring within 24 hours

Question 18

when to deliver px with placenta previa

Answer 18

34 weeks AOG (Blueprints)

Question 19

delivery plans for preeclampsia with severe features

Answer 19

“Preeclampsia with severe features is NOT an indication for cesaarean delivery and if delivery is needed, induction of labor in appropriate patients is recommended [at 34 weeks]

Question 20

uti STATS

Answer 20

occur in up to 20% of pregnancies and account for as many as 10% of antepartu hospitalization

Question 21

anti-malarials used in pregnancy

Answer 21

CHLOROQUINE
QUININE
CLINDAMYCIN
ARTEMISININ (artesunate [water-soluble]), †arthemeter [lipid-soluble])

MEFLOQUINE

• the only chemoprophylactic other than CHLOROQUINE approved for children <5 kg and for PREGNANT women
• s/e: neuropsychiatric symptoms

PROGUANIL

†Artemether + lumefantrine = Coartem

Question 22

anti-malarials contra-indicated in pregnancy

Answer 22

†ATOVAQUONE
DOXYCYLINE
HALOFANTRINE
PRIMAQUINE

†Atovaquone + proguanil = Malarone

Question 23

Treatment of uncomplicated falciparum malaria in pregnancy

Answer 23

FIRST TRIMESTERQ
†Quinine + clindamycin

2ND-3RD TRIMESTER
Artemisinin-based combination

†Quinine s/e: QT prlongation
Blackwater fever is a rare severe illness that includes marked hemolysis and hemoglobinuria in the setting of quinine therapy for malaria. It appears to be due to a hypersensitivity reaction to the drug, although its pathogenesis is uncertain.

Question 24

QUAD SCREEN result for down syndrome

Answer 24

“A-B”
AEBI

msAfp: decreased
Estriol: decreased

β-hCG: increased
Inhibin A: increased