• Diclegis (FDA indication): first-line option Doxylamine succinate 10 mg (antihistamine) Pyridoxine
10 mg (B6) Sig: 2 tabs HS If symptoms persist, add 1 tab in am - ✔✔Nausea in Pregnancy?
• Urine: sensitive 9-12 days after conception • Serum: sensitive 8-11 days after conception (best
test); most sensitive and specific test - ✔✔Pregnancy Testing: OTC vs Office Labs?
Subtract 3 months from LMP
Add 7 days, Add 1 year
Pregnancy = 281-282 days • Note:
Not used any more - ✔✔Establishing the Due Date • Naegele's Rule?
• ACOG, AMA guidelines recommend
• "Routine assessment of ALL pregnant women for domestic violence" • Often begins or worsens
during pregnancy and postpartum
• 7-20% of pregnant women are physically abused
• If pregnancy unintended, 3X higher rate
• More medical problems during pregnancy and delivery compared to women who are not abused -
✔✔Domestic Violence Screening?
• Age <35 years • Single, divorced, separated • Alcohol or drugs: patient and/or partners • Smoker •
Childhood: physical or sexual abuse
Domestic Violence Clues • Bruising • Improbable injury • Depression, anxiety • Late prenatal care
(after 1st trimester) • Missed prenatal visits • Cancellation of appt (short notice) • Overprotective
partner If female, might indicate human trafficking - ✔✔abuse Risk Factors?
, Pregnancy Testing First
• Urine hCG: usually sufficient
• Serology: if problems/suspect ectopic
• Normal Pregnancy hCG doubles every 24-72 hours in 1st trimester - ✔✔Initial Labs for
pregnanacy?
-CBC
-URINALYSIS
-URINE CULTURE
-Blood type and Rh: antibody screening
-RUBELLA IMMUNITY (If immune, not needed If not immune, immunize after delivery and avoid
infected people!!!)
-TSH - ✔✔Standard Diagnostic Studies at 1st prenatal visit?
• HIV: first, third trimester
• Chlamydia: ages <25 years
• GC: If high risk, especially if <25 years
• Syphilis
• Hepatitis A, B, C (per risk)
• BV, Trich: consider screening
• HSV Type 2: if at high risk or symptomatic - ✔✔Pregnancy: STI Screening per 2021 CDC Guidelines?
• First trimester:
• Second trimester:
• Third trimester: - ✔✔Ultrasound: Indications:
confirm due date, fetal development, identify abnormalities
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