a new ob visit
PDF Show Notes
Today we cover some topics for a brand new OB visit, which often centers around pregnancy risk factors. We then asked you to choose your own adventure on other complicating conditions of pregnancy. Here are links to all of the podcast pages if you want to listen!
Genetics:
https://creogsovercoffee.com/notes/2018/11/2/prenatal-genetic-screening-and-testing
Key Takeaways:
- Cell free DNA should be offered as a non-invasive test to all patients, but particularly for those over age 35 (new ACOG recommendation!)
- Serum screening has good sensitivity/specificity, and can be offered at a variety of timepoints.
- Invasive testing (CVS or amniocentesis) should be offered to all patients, if they desire it.
Key Takeaways:
- There are both one- and two-step screening methods for GDM.
- Diabetes, preexisting or gestational, can increase risk for macrosomia, growth restriction/placental dysfunction, cesarean delivery, and stillbirth.
- Insulin can't cross the placenta!
Hypertension:
https://creogsovercoffee.com/notes/2019/3/3/hypertension-and-pregnancy-trio
Key Takeaways:
- It's good to know the risk factors for HDP, and if present, low-dose aspirin can be used to reduce risk -- best to start by 12-16 weeks.
- The diagnostic criteria for chronic vs new-onset HTN is set at 20 weeks.
- Women with preeclampsia have a 3-4x higher lifetime risk of HTN, and 2x lifetime risk of heart disease and stroke!
HIV in Pregnancy:
https://creogsovercoffee.com/notes/2019/5/19/hiv-in-the-pregnant-patient
Key Takeaways:
- HAART is essential in pregnancy to suppress viral load and reduce risk of vertical transmission.
- VL > 1,000 copies/mL should deliver by cesarean at 38 weeks, with pre-delivery AZT prophylaxis.
- VL < 1,000 can dleiver vaginally at 39 weeks or later. Early AROM and fetal scalp electrodes should ideally be avoided to reduce risk of transmission.
