Term
| what does it mean to say "in obstetrics, many outcomes/determinants are present before meet patients"? |
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Definition
| prenatal care starts too late to prevent many negative pregnancy outcomes |
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Term
| what is preconception care based on? |
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Definition
| women who have higher levels of health and better health before pregnancy have better reproductive outcomes |
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Term
| how can 5-70% of neural tube defects be prevented? |
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Definition
| folic acid supplementation during critical time of organogenesis |
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Term
| what is the potential risk reduction for birth defects in babies born to mothers w/DM through tighter glycemic control before pregnancy? |
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Definition
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Term
| how soon does CNS development start in the developing fetus? what is the second important structure to form? |
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Definition
| CNS development starts before the mother may know she's pregnant (before her first missed period) and heart development starts soon after the CNS. by the time the mother starts prenatal care, organogenesis is nearly complete. |
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Term
| what is the CDC definition of preconception care? |
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Definition
| preconception care is a set of interventions that aim to identify and modify biomedical, behavioral and social risks to a woman’s health or pregnancy outcome through prevention and management - more than a single visit and less than a well-woman care visit |
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Term
| what is preconception care? |
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Definition
| giving protection, managing conditions, and avoiding exposures to known teratogens |
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Term
| what is an example of the "giving protection" portion of preconception care? |
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Definition
| folic acid supplementation (protects against neural tube defects/other congenital anomalies) and protection against infectious disease: rubella, varicella, hep B, and HIV/AIDS |
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Term
| what is an example of the "managing conditions" portion of preconception care? |
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Definition
| managing DM, maternal PKU, obesity, hypothyroidism, STIs - and any chronic condition like HTN, thyroid disease |
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Term
| what is an example of the "avoiding exposures" portion of preconception care? |
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Definition
| avoidance of: medications (antiseizure rx, oral anticoagulants (warfarin), accutane, etc), alcohol (FAS), tobacco (placental insufficiency), and occupational exposure. |
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Term
| who is most likely to be in need of preconceptional health care? |
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Definition
| women least likely to have intended conceptions (~ 50% of pregnancies are unintended) |
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Term
| what characterizes risks of fetal congenital abnormalities in women w/epilepsy? how is this addressed? |
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Definition
| women w/epilepsy have a higher baseline risk for fetal congenital abnormalities, but if they are on anticonvulsants, that risk goes up 2-3x (for both major/minor malformations). these rxs include: phenytoin, carbamazepine, and especially *valproate* (which carries the greatest risk). common abnormalities caused by these drugs include *midline defects such as: NTDs, cleft lip/palate, and cardiac abnormalities. the best regimen for women who can't go of these meds is *monotherapy which carries the lowest risk for pregnancy. |
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Term
| what does family planning consist of for pts w/epilepsy? |
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Definition
| a reproductive life plan should be encouraged in general, but specifically b/c anticonvulsant medication induces CYP - which decreases the efficacy of OCPs = 4x greater risk of OCP failure. |
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Term
| what is the implication of increasing obesity/DM in the population? |
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Definition
| for each 1 standard deviation unit increase in Hgb A1c above normal (5.5%), the odds ratio of congenital anomalies increases by 1.2%. need to tighten dietary control as a part of preventative medicine. |
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Term
| what congenital anomalies are associated with DM? when do these occur? |
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Definition
| caudal regression, situs inversus, spina bifida, anencephaly, cardiac anomalies, anal/rectal atresia, and renal anomalies. these all occur w/in 5-8 wks - before 1st prenatal visit. |
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Term
| what are the DM rx-related risks for congenital abnormalities? |
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Definition
| *statins interfere w/cholesterol metabolism and are therefore are contraindicated in pregnancy. *ACE inhibitors/ARBs are associated w/cardiovascular, CNS, and renal congenital anomalies. |
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Term
| what fetal malformations are associated with obese mothers? |
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Definition
| increased risk of spontaneous abortion (obesity associated w/menstrual irregularity), congenital malformation (*neural tube defects - standard folic acid dose might not be enough, cardiovascular anomalies), macrosomia, shoulder dystocia (erb's palsy - due to downward traction in delivery), perinatal mortality, and childhood obesity |
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Term
| what should every woman w/a chronic disease know? |
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Definition
| the potential effects of her disease and its treatments on herself, her pregnancy and her baby as well as the opportunity to maximize good outcome |
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Term
| what should all women of childbearing age be taking (particularly those w/chronic disease)? |
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Definition
| MVI+folic acid (remember standard dose may not be adequate for obese women) |
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Term
| what should all women/couples develop (particularly those w/chronic disease)? |
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Definition
| a reproductive life plan (talk about the future) |
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Term
| what should all women be routinely assessed for and counseled about (particularly those w/chronic disease0? |
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Definition
| BMI, exercise, tobacco, alcohol, immunization status and other exposures |
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Term
| what should preconception care advice consist of? |
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Definition
| encourage women and their partners to be able to actively choose when or when not to become pregnant. provide contraceptive method counseling for pts based on medical condition/reproductive life plans. encourage women w/medical conditions to *discuss their desire to become pregnant w/all providers before pregnancy* (preferably at least 3 mos before desired conception). |
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Term
| what conditions should trigger an OB/GYN or primary care doctor to refer their pregnant pt to a maternal fetal medicine specialist (MFM)? |
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Definition
| pregestational DM, renal insufficiency, lupus, hx of thromboembolism, antiphospholipid syndrome, significant cardiac disease, hx of malignancy, crohn's disease, severe pulmonary disease, and hx of organ transplantation. |
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Term
| what are the recommendations on clinical content of preconception care from the AJOC? what are 2 other important topics? |
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Definition
| family planning and reproductive life plan, nutritional status, immunizations, infectious disease, substance abuse, chronic disease profile, medication use, reproductive hx, and family/genetic hx. *occupational hx/recreational hx also needs to be considered (screen for reproductive hazards - impair either sex's ability to reproduce). |
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Term
| what is the appropriate interval between pregnancies? |
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Definition
| should be between 18 months and 59 months (~ 5 yrs) based on meta-analysis (short and long intervals are associated w/increased of adverse perinatal outcomes) |
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