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MFM Objectives HO3

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

Preconception Care 


  • Counsel a patient regarding the impact of pregnancy on maternal medical conditions.
  • Counsel a patient regarding the impact of maternal medical conditions on pregnancy.
  • Counsel a patient regarding pregnancy associated risks and conditions, such as: Advanced age, Hypertension, Diabetes, Genetic disorder, Prior aneuploidy or anomalous fetus/newborn.
    • Creasy and Resnik, Chapter 52 Cardiac Diseases
      • Preconceptual Counseling p.852
    • Williams Obstetrics, Chapter 53 Renal and Urinary Tract Disorders
      • Chronic Renal Disease p.1061
    • Williams Obstetrics, Chapter 49, Cardiovascular Disease
      • Congenital Heart Disease in Offspring p.976
      • Table 49-4 Risks for Fetal Heart Lesions Related to Affected Family Members
    • Williams Obstetrics, Chronic Hypertension Preconceptual Counseling p.1001
    • Williams Obstetrics, Pregnancy and Chronic Renal Disease p.1061
    • Creasy and Resnik, Chapter 30, p.417 Prenatal Diagnosis of Congenital Diseases
      • Table 30-3 Risk for Down Syndrome Bases on Maternal Ages p.419
      • Table 30-7 Likelihood Ratios for Isolated Markers in Three Studies p.425
      • Table 30-1 Second Trimester Ultrasound Markers Associated with Down Syndrome p.425
      • Table 30-9 Ultrasound Finding Associated with Trisomy 18
      • Table 30-15 Common Autosomal Recessive Disorders in Ethnic Groups: Carrier Screening Recommended p.436


Diabetes Mellitus  


  • Asses, recognize, and manage fetal and maternal complications, such as; fetal malformations. Disturbances in fetal growth, Diabetic ketoacidosis.
  • Counsel patients with Diabetes regarding future reproduction and the long term health implications of their medical condition.
    • Creasy and Resnik, Chapter 59 Diabetes in Pregnancy
      • Table 59-5 Treatment Protocol for Diabetic Ketoacidosis p.999
      • Table 59-6 Congenital Malformations in Infants of Insulin-Dependent Diabetic Mothers p.1000
      • Complications of Diabetes During Pregnancy: Retinopathy, Nephropathy, Cardiovascular Complications, Pre-eclampsia, Heart Disease p.995
      • IUGR and Macrosomia p.1001


Diseases of the Urinary System 


  • Counsel patients about the possible adverse effects of diseases of the urinary tract on fetal and maternal outcome, such as: Intrauterine growth restriction, Prematurity, Perinatal mortality, Hypertension.
    • Williams Obstetrics, Chapter 53, Renal and Urinary Tract Disorders p.1051
      • Polycystic Kidney Disease-Pregnancy Outcomes p.1058
      • Acute Nephritic Syndromes and Pregnancy p.1059
      • Chronic Renal Disease and Pregnancy p.1061
      • Chronic Renal Insufficiency p.1063


Hematologic Disorders 


  • Evaluate possible causes of anemia, thrombocytopenia, deep vein thrombosis, and coagulopathy in pregnancy.
  • Institute appropriate acute and chronic management plans for these conditions, including prophylaxis to minimize recurrent risk.
  • Counsel patients about the fetal and maternal impact of hematologic disorders in pregnancy.
    • Williams Obstetrics, Chapter 56 Hematological Disorders
      • Table 56-1 Causes of Anemia During Pregnancy p.1102
      • Iron Deficiency Anemia p.1102
      • Anemia from Acute Blood Loss p.1103
      • Anemia Associated with Chronic Disease p.1103
      • Megaloblastic Anemia p.1104
      • Hemolytic Anemia p.1104
      • Hereditary Spherocytosis p.1106
      • Polycythemias p.1107  
      • Hemoglobinopathies Sickle-cell Hemoglobinopathy p.1107
      • Thalassemia Syndromes p.1112
      • Platelet Disorders p.1114
      • Inherited Coagulation Defects p.1117


Cardiopulmonary Disease


  • Counsel patients about the impact of pregnancy on cardiopulmonary disease and the impact of these diseases on pregnancy.
    • Creasy and Resnik, Chapter 58, Repertory Diseases in Pregnancy
      • Patient Education p.978
      • Table 58-3 Typical Dosages of Asthma Medications p.979
      • Box 58-2 Emergency Department and Hospital-Based Management of Asthma Exacerbation p.982
      • Restrictive Lung Disease in Pregnancy (Sarcoidosis and Cystic Fibrosis) p.983
    • Creasy and Resnik, Chapter 52 Cardiac Disease p.852
      • Pre-Conception Counseling p.852
      • Table 52-1 High Risk Maternal Cardiovascular Disorders
    • Williams Obstetrics, Chapter 49 Cardiovascular Disorders p.972
      • Table 49-3 WHO Risk Classification of Cardiovascular Disease and Pregnancy
      • Valvular Heart Disease p.983
      • Congenital Heart Disease p.984
      • Cyanotic Heart Disease p.985
      • Infective Endocarditis p.990
      • Arrhythmias p.991


Gastrointestinal Disease


  • Counsel patients about the impact of gastrointestinal disease on pregnancy and the impact of pregnancy on gastrointestinal disease.
    • Williams Obstetrics, Chapter 54 Gastrointestinal Disorders
      • Non-invasive Imaging Techniques p.1069
      • Laparotomy and Laparoscopy  p.1070
      • Nutritional Support p.1070
      • GERD p.1072
      • Peptic Ulcer p.1073
      • Upper Gastrointestinal Bleeding p.1074
      • Inflammatory Bowel Disease p.1075
      • Table 54-4 Some Shared and Differential Characteristics of Inflammatory Bowel Disease p.1075
      • Intestinal Obstruction p.1078
      • Appendicitis p.1078


Neurologic Disease 


  • Counsel pregnant patients regarding the impact of pregnancy on neurological disease and the impact of neurologic disease on pregnancy.
    • Williams Obstetrics, Chapter 60, Neurological Disorders p.1187
      • Central Nervous System Imaging p.1187
      • Headache p.1188
      • Table 60-1 Classification of Headache p.1188
      • Seizure Disorders in Pregnancy Preconceptual Counseling p.1189
      • Table 60-2 Teratogenic Effects of Common Anticonvulsant Medications p.1190
      • Cerebrovascular Diseases p.1191
      • Multiple Sclerosis p.1194
      • Myasthenia Gravis p. 1196
      • Bell’s Palsy p.1197
      • Carpel Tunnel Syndrome p.1198


Endocrine Disorders (excluding Diabetes Mellitus) 


  • Counsel patients about the impact of an endocrine disease and its treatment in pregnancy and the impact of the pregnancy on the endocrine disorders.
    • Creasy and Resnik, Chapter 60 Thyroid Disease and Pregnancy
      • Laboratory Evaluation of Thyroid Function During Pregnancy p.1025
      • Thionamide Therapy p. 1029
      • Hyperthyroidism- Signs and Symptoms p.1028
      • Hypothyroidism p.1027
      • Postpartum Grave Disease p.1036
      • Thyrotropin Receptor Antibodies p.1026
      • Antithyroid Antibodies p.1026
    • Williams Obstetrics, Chapter 58 Endocrine Disorders p.1147
      • Hyperparathyroidism in Pregnancy p.1158
      • Pheochromocytoma Complicating Pregnancy p.1159
      • Cushing Syndrome and Pregnancy p. 1161
      • Prolactinomas  p. 1162
      • Diabetes Insipidus p. 1162
      • Sheehan’s Syndrome p.1163


Collagen Vascular Disorder


  • Counsel patients regarding the impact of collagen vascular disease and its treatment on pregnancy and the impact of pregnancy on collagen vascular disease.
    • Williams Obstetrics, Chapter 59 Connective Tissue Disorders p. 1168
      • Systemic Lupus Erythematosus p.1169
      • Table 59-1 Some Antibodies Produced in Patients with SLE p.1169
      • Table 59-2 Clinical Manifestations of Systemic Lupus Erythematosus p.1169
      • Table 59-4 Complications in 12,555 Pregnancies in Women with Systemic Lupus Erythematosus p.1171
      • Antiphospholipid Antibody Syndrome Diagnosis p.1174
      • Rheumatoid Arthritis p.1176
      • Table 59-6 Criteria for Classification of Rheumatoid Arthritis p.1177
      • Vasculitis Syndromes p.1179
      • Hereditary Connective Tissue Disorders p.1181


Psychiatric Disorders 


  • Asses the risk of the psychiatric disorders such as: bipolar disorder, schizophrenia, depression and safety of psychiatric medications in the patient and the fetus.
    • Williams Obstetrics, Chapter 61 Psychiatric Disorders p.1204
  • Identify patients who require referral for psychiatric consultation.
    • Williams Obstetrics, Table 61-2 Symptoms of Depressive Illness 1206
      • Table 61-3 Some Drugs Used for Treatment of Major Mental Disorder in Pregnancy 1208
    • Creasy and Resnik, Chapter 66 Management of Depression and Psychosis in Pregnancy and the Puerperium p.1122
      • Table 66-2 Depressive and Psychotic Disorders p. 1124
      • Risks of psychopharmacologic Treatment During Pregnancy p.1126


Substance Abuse in Pregnancy 


  • Assess the fetus for adverse effects of substance abuse, such as congenital anomalies or growth restrictions.
  • Refer patients with known or suspected substance abuse for counseling and follow up.
    • Creasy and Resnik, Chapter 67 Substance Abuse in Pregnancy p.1131
      • Tobacco-Fetal Effects p.1134
      • Alcohol-Fetal Effects p.1136
      • Marijuana-Fetal Effects p.1138
      • Opioids-Fetal Effects p.1139
      • Cocaine-Fetal Effects p.1141
      • Methamphetamine-Fetal Effects p.1143
      • Benzodiazepines-Fetal Effects p.1144
      • Clinical Practice p.1145


Intrauterine Growth Restriction 


  • Perform an accurate ultrasound examination to assess fetal growth.
  • Monitor a fetus with suspected growth restriction (e.g. with antepartum heart rate tests, ultrasonography, and Dopples Velocimetry) to determine the appropriate time and method of delivery.
  • Counsel patients about the recurrence risk for intrauterine growth restriction.
    • Williams Obstetrics, Chapter 44 Fetal Growth Disorders p.872
      • Figure 44-4 Risk Factors and Causes of Impaired Fetal Growth Centering on the Mother, Her Fetus, and the Placenta. P.877
      • Sonographic Measurements of Fetal Size p.880
      • Amniotic Fluid Volume Measurement p.881
      • Doppler Velocimetry p.881
    • Creasy and Resnik, Chapter 47 Intrauterine Growth Restriction p.743
      • Box 47-1 Disorders and Other Factors Associated with Intrauterine Growth Restriction p.750
      • Antenatal Fetal Testing p.752
      • Timing of Delivery p.753


Isoimmunization and Alloimmune Thrombocytopenia 


  • Describe the appropriate indications for determination of paternal antigen status.
  • Describe the major fetal complications of isoimmunization and alloimmune thrombocytopenia.
    • Williams Obstetrics, Chapter 15 Fetal Disorders p.306
      • Management of the Alloimmunized Pregnancy p.309
      • Fetal Thrombocytopenia/Alloimmune Thrombocytopenia p.313
      • Hydrops Fetalis/Immune Hydrops p. 315

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