2017 – PAGE 83 – OB/GYN & SOME STDs
- Absolute Contraindications to oral contraceptive pills (OCPS): Pregnancy, liver disease, hyperlipidemia, breast cancer, and breastfeeding at < 6 weeks.
- Relative Contraindications: Hypertension
- Anticonvulsants interfere with absorption, so instruct the patient to use a backup method of contraception. Consider using an OCP with more ESTROGEN.
Fifty percent of all first-time pregnancies occur within 6 months of a girl/woman losing her virginity. Twenty percent of all pregnancies occur within the first month!
Eight (8) prenatal care visits are considered adequate.
Any child born to a mother who is GBS+ should be watched in the hospital for at least 48 hours.
Unlike regular DM, gestational diabetes mellitus is NOT associated with congenital anomalies.
A serum alpha-fetoprotein (AFP) screening is offered at 16 weeks gestation. If the AFP is elevated (more than twice the normal limit), there is likely some type of defect in which the baby’s skin is broken. This is usually a neural tube defect.
- If the AFP is elevated, get a fetal ultrasound.
- If the ultrasound is negative, obtain an amniocentesisto get amniotic AFP levels.
- Elevated AFP is also seen in gastroschisis (broken skin!), other abdominal wall defects, fetal demise, renal anomalies, wrong dates, and wrong number of kids (twins).
- LOW SERUM AFP is associated with DOWN
- MNEMONIC: “LOW kind of means DOWN”
A chorionic villus sampling is a fetal karyotype obtained from a placental biopsy. This has to do with CHROMOSOMES. This is the test that is most helpful for early detection (usually around 12 weeks) of any genetic/cytogenetic abnormalities you’re concerned about. For very high-risk pregnancies, the test may even be considered in the first trimester.
MNEMONIC: “CHROMOSOMIC” Villus Sampling. Also, imagine standing outside of a CVS at 12 midnight and craving a bag of chips. They’re closed, so throw a DOZEN EGGS at the CVS in anger (midnight and eggs representing 12 weeks).
PEARL: “CHROMOSOMIC” Villus Sampling has to do with chromosomes, so it SHOULD NOT be performed for suspected neural tube defects. (Those are usually due to a folate deficiency.)