MFM Objectives HO3

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