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MFM Objectives HO1

Page history last edited by Patrick Newman 3 years, 9 months ago

Pharmacology

 

  • Describe the role for nutritional supplementation in pregnancy. (e.g. iron, folic acid) 

    • Williams Obstetrics, Recommended Dietary Allowances p.178

  • Describe the impact of pregnancy on serum and tissue drug concentrations and drug efficacy.

    • Williams Obstetrics, Hematologic changes; Blood volume p.55 
    • Williams Obstetrics, Renal formation tests p. 1292
  • Describe the factors that influence trans placental drug transfer, such as: molecular size, Lipid solubility, Degree of ionization at physiological pH, Protein Biding

    • Williams Obstetrics, Placental transfer p.132-135
  • Describe the possible teratogenic effects of prescription drugs in pregnancy, such as: Tetracycline, Angiotensin-converting enzyme inhibitors and angiotensin antagonists, Quinolone antibiotics, Lithium, Isotretinoin, Seizure medications, Depression and anxiolytic medications.

    • Williams Obstetrics, Chapter 12 Teratology, Teratogens and Fetotoxic Agents p.240
  • Describe the possible teratogenic effects of non-prescription drugs, such as: Alcohol, heroin, cocaine, tobacco.

    • Williams Obstetrics –Chapter 12, Teratology, Teratogens and Fetotoxic Agents p.240

 

Preconception Care

 

  • Perform a thorough history, assessing historical and ongoing risks that may affect future pregnancy.

  • Counsel a patient regarding appropriate lifestyle modifications conducive to favorable pregnancy outcome.

    • Williams Obstetrics, -Chapter 8, p.156 Preconceptual Counseling

 

Prenatal Care 

 

  • Perform a thorough history and physical examination.

  • Order and interpret routine laboratory tests and those required because of risk factors during pregnancy.

    • Williams Obstetrics Laboratory Tests p.174
  • Counsel patients about lifestyle modifications that improve pregnancy outcomes.

    • Williams Obstetrics, Smoking cessation, alcohol, and drug use in pregnancy p.174
  • Counsel patients about warning signs of adverse pregnancy events.

  • Schedule and perform appropriate antepartum follow-up visits for routine and high risk obstetric care.
  • Counsel patients about appropriate immunizations during pregnancy.

    • Williams Obstetrics, Chapter 9, Prenatal Care p.167
    • Williams Obstetrics, Recommendations for Immunizations During Pregnancy (Table 9-9) p.185-186
  • Counsel patients about benefits of breastfeeding.

    • Creasy and Resnik p.112 Benefits of Breastfeeding

 

Diabetes Mellitus 

 

  • Classify diabetes mellitus in pregnancy.

    • Williams Obstetrics, Chapter 57 Diabetes Mellitus, p.1125
    • Creasy and Resnik, Chapter 59 Diabetes in Pregnancy, p.998
  • Interpret screening tests for gestational diabetes.

    • Creasy and Resnik, Chapter 59 Diabetes in Pregnancy
    • Box 59-4 Early Screening strategy for Detecting Gestational Diabetes
    • Table 59-2 Three-Hour 100g Oral Glucose Tolerance Test for Gestational Diabetes

 

Diseases of the Urinary System 

 

  • Evaluate signs and symptoms of urinary tract pathology in pregnant patients.

    • Williams Obstetrics, Chapter 4, Maternal Physiology p.63-66
  • Describe the indications for common diagnostic tests for renal disease in pregnancy.

    • Williams Obstetrics, Chapter 53, Renal and Urinary Tract Disorder

 

Infectious Diseases  

 

  • Perform a focused history and physical examination in pregnant patients who have known or separated infectious diseases.

  • Choose and perform laboratory tests to confirm the diagnosis of infection.

    • Creasy and Resnik, Clinical Chorioamnionitis p.617
    • Williams Obstetrics, Incisional Infections p.686
    • Williams Obstetrics, Breast Infections p.691
    • Williams Obstetrics, Puerperal Fever p.682
    • Creasy and Resnik, How a Viral Infection Affects the Fetus and the Pregnancy Outcome p. 91
    • Williams Obstetrics, Chapter 37 , Puerperal Complications
    • Williams Obstetrics, Endometritis p.683

 

Cardiopulmonary Disease 

 

  • Describe symptoms and physical findings suggestive of cardiopulmonary disease in pregnancy.

    • Williams Obstetrics, Asthma Clinical Evaluation p.1012-1013
    • Williams Obstetrics, Classification of Functional Heart Disease p.976
    • Williams Obstetrics, Clinical Indications of Heart Disease in Pregnancy (Table 49-2), p.975
  • Describe the indications for and interpret the results of common diagnostic tests for cardiopulmonary disease in pregnancy.

    • Williams Obstetrics, Electrocardiography, Chest Radiography, Echocardiography p.976

 

Gastrointestinal Disease 

 

  • Perform a history and physical examination for the diagnosis of gastrointestinal disease in pregnancy.

  • Describe the indications for and interpret the results of common diagnostic tests for gastrointestinal disease in pregnancy.

    • Williams Obstetrics, Chapter 54 Gastrointestinal Disorders, Non-invasive Imaging p.1069
    • Creasy and Resnik, Chapter 62, Gastrointestinal Disease in Pregnancy
      • p.1073 (Box 62-2) Indications for Endoscopy in Pregnancy
      • p.1065 (Table 62-3) Differential Diagnosis of Acute Appendicitis
      • p. 1065 (Table 62-4) Imaging of Acute Appendicitis

 

Neurological Disease 

 

  • Perform a focused history and neurological examination in pregnant patients with a known or suspected neurological disorder.

  • Describe the indications for and interpret the results of common diagnostic tests for neurological disease in pregnancy.

    • Williams Obstetrics, Chapter 46, General Considerations and Maternal Evaluation, Diagnostic Radiation, Fluoroscopy Magnetic Resonance Imaging p.932-937
    • Williams Obstetrics, Guidelines for Diagnostic Imaging During Pregnancy p.937 (Table46-9)

 

Endocrine Disorders (excluding diabetes mellitus)

 

  • Perform a focused history and physical examination in pregnant patients with a known or suspected endocrine disease.

    • Williams Obstetrics, Chapter 58, Endocrine Disorders p.1147
      • Hypothyroidism and pregnancy p.1153
      • Hyperthyroidism p.1148
    • Creasy and Resnik, Chapter 60, Thyroid Disease and Pregnancy
      • Laboratory Evaluation of Thyroid Function During Pregnancy p.1025
      • Thionamide Therapy p.1029
      • Hypothyroidism and Treatment p.1032-1033
    • Williams Obstetrics, Parathyroid Disease p.1157
    • Williams Obstetrics, Pituitary Disorders p. 1162

 

Collagen Vascular Disorders 

 

  • Describe the indications and interpret the results of common diagnostic tests for collagen vascular disease in pregnancy, such as: Serologic tests for rheumatoid factor, Anti-DNA antibodies, Antinuclear antibodies, Lupus anticoagulant, Anticardiolipin (antiphospholipid) antibodies, Anti-To, Anti-La.

    • Creasy and Resnik, Chapter 64, Pregnancy and Rheumatic Diseases
      • p.1093, (Table64-1) Common Autoimmune Rheumatic Illnesses: Characteristics
      • p.1099, (Table 64-4) Recommended Evaluation of Pregnant patients with Autoimmune Rheumatic Disease
    • Williams Obstetrics, Chapter 59, Connective Tissue Disorders p.1168
    • Williams Obstetrics, p.1169
      • (Table 59-1) Some Auto Antibodies Produced in Patients with Systematic Lupus Erythematosus
      • (Table 59-2) Clinical Manifestations of Systematic Lupus Erythematosus
      • Antiphospholipid Antibody Syndrome Diagnosisp.1174
      • Treatment in Pregnancy p.1175
      • Pregnancy and Rheumatoid Arthritis p. 1178
      • Vasculitis Syndromes p.1179

 

Psychiatric Disorders 

 

  • Perform a mental status examination.

  • Describe symptoms in pregnancy

    • Williams Obstetrics, Chapter 61, Psychiatric Disorders
      • Table 61-2, Symptoms of Depressive Illness p.1206
    • Creasy and Resnik, Chapter 66, Management of Depression and Psychoses in Pregnancy and in the Puerperium
      • (Table 66-1) Symptoms of Depression, Mania, and Psychosis p.1124,
      • (Table 66-2) Depressive and Psychotic Disorders

 

Substance Abuse in Pregnancy 

 

  • Describe behavior patterns suggestive of substance abuse.

  • Perform a thorough history and physical examination in patients suspected of substance abuse in pregnancy.

  • Counsel patients about the impact of substance abuse on the fetus/neonate.

    • Creasy and Resnik, Chapter 67, Substance Abuse in Pregnancy
      • Screening for Substance Abuse, 4 P’s plus Screen
      • CAGE Questionnaire – for ETOH p.1136

 

Hypertension in Pregnancy 

 

  • Describe the possible causes of hypertension in pregnancy.

  • Describe the usual clinical manifestations of chronic hypertension, gestational hypertension, and pre-eclampsia.

  • Perform a physical exam pertinent to patients with hypertension

  • Perform tests to:

    1. Determine the etiology of chronic hypertension
    2. Differentiate chronic hypertension from pre-eclampsia and gestational hypertension
    3. Asses the severity of chronic hypertension, gestational hypertension, and pre-eclampsia
  • Asses fetal well-being in patients with hypertension in pregnancy

    • Williams Obstetrics, Chapter 40 Hypertensive Disorders

 

Multiple Gestation 

 

  • Describe the factors that pre-dispose to multiple gestation.

  • Describe the physical findings suggestive of multiple gestation.

  • Confirm the diagnosis of multiple gestation by performing an endo vaginal or abdominal ultrasound examination

    • Williams Obstetrics, Chapter 45, Multifetal Pregnancy
      • Figure 45-1 Mechanism of Monozygotic Twinning p.893
      • Factors that Influence Twinning p. 894
      • Diagnosis of Multiple Fetuses- Clinical Evaluation p. 896
      • Sonographic Determination of Chorionicity p. 896

 

Intrauterine Growth Restriction 

 

  • Describe the factors that predispose to fetal growth restriction.

  • Assess uterine size by physical examination and identifying size/date discrepancies.

  • Evaluate the patient for causes of intrauterine growth restriction.

    • Williams Obstetrics, Chapter 44, Fetal Growth Disorders p. 872

 

Isoimmunization and Alloimmune Thrombocytopenia  

 

  • Describe the major antigen-antibody reactions that result in red cell isoimmunization or thrombocytopenia.

  • Interpret serologic assays that quantify antibody titers.

    • Williams Obstetrics, Chapter 15, Fetal Disorders, p.306
      • Table 15-1, Minor Red Cell Antigen and their Relationship to Fetal Hemolytic Disorder. p.308
      • Table 15-3 Fetal-Neonatal Alloimmune Thrombocytopenia (FNA IT) Treatment Recommendations p.314
      • Table 15-4 Some Etiologies of Nonimmune Hydrops Fetalis p.317

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