A patient presents for prenatal care in the second trimester. She was born outside the United States and has never had any routine vaccinations.
Which of the following vaccines is contraindicated in pregnancy?
There is a benefit for some women to be vaccinated against certain conditions during pregnancy. Live, attenuated virus vaccines, such as the MMR or the nasally delivered influenza vaccine, are not recommended during pregnancy. Vaccines that contain killed antigens, virus-like particles, or noninfectious components of bacteria, are considered safe in pregnancy. Examples include tetanus toxoid, Tdap, and the injectable influenza vaccine. Pregnancy is not a contraindication to the hepatitis B vaccine, and pregnant women identified as being at high risk for HBV infection should be vaccinated.
A patient presents to your office at term with no prenatal care. An ultrasound is performed and shows the fetus to be in the third trimester and to have multiple congenital anomalies, including microcephaly, cardiac anomalies, and growth retardation.
You should question the patient if she has abused which of the following substances during her pregnancy?
Chronic alcohol abuse, which can cause liver disease, folate deficiency, and many other disorders in a pregnant woman, also can lead to the development of congenital abnormalities in the child. Ethyl alcohol is one of the most potent teratogens known. The chief abnormalities associated with the fetal alcohol syndrome (FAS) are cardiac anomalies and joint defects FAS may also be associated with growth problems (either before or after pregnancy), mental or behavioral problems, and abnormal facial features. There is no known “safe” amount of alcohol that a woman may drink during pregnancy. Women who drink heavily both before and during pregnancy are at the highest risk of giving birth to a child with FAS. Heroin, benzodiazepines, marijuana, and methadone are not major teratogens.
Your 25-year-old patient is pregnant at 36 weeks’ gestation. She has an acute urinary tract infection (UTI).
Which of the following antibiotics is contraindicated in the treatment of this patient?
Tetracycline may cause fetal dental anomalies and inhibition of bone growth if administered during the second and third trimesters, and it is a potential teratogen to first-trimester fetuses. Administration of tetracyclines can also cause severe hepatic decompensation in the mother, especially during the third trimester. Chloramphenicol may cause the gray baby syndrome (symptoms of which include vomiting, impaired respiration, hypothermia, and, finally, cardiovascular collapse) in neonates who have received large doses of the drug. No notable adverse effects have been associated with the use of penicillins or cephalosporins. Trimethoprim-sulfamethoxazole (bactrim) should not be used in the third trimester because sulfa drugs can cause kernicterus.
You diagnose a 21-year-old woman at 12 weeks’ gestation with gonorrhea cervicitis.
Which of the following is the most appropriate treatment for her infection?
An obese, 25-year-old G1P0 comes to your office at 8 weeks’ gestational age for her first prenatal visit. She is currently 5 ft 2 in tall and weighs 300 lb.
Which of the following is the best advice to give this patient regarding obesity and pregnancy?
Women who are markedly obese are at increased risk of developing complications during pregnancy. Obese women are more likely to develop gestational diabetes and preeclampsia during pregnancy. In addition, these women are more likely to develop fetal macrosomia and require cesarean delivery, which is associated with an increased risk of infectious and operative morbidity. This may include problems establishing and recovering from anesthesia, prolonged operating times, increased blood loss, higher rates of wound infection, and thromboembolism. Obese patients are less likely to have a successful vaginal birth after a cesarean delivery. Maternal obesity also has implications for the fetus, including increased risk of congenital anomalies, growth abnormalities, miscarriage, and stillbirth. Morbidly obese women who do not gain weight during pregnancy are not at risk for having a fetus with growth abnormalities, and therefore they do not need to gain the 25 lb to 35 lb recommended for women of normal weight. Although it is not recommended that obese women gain weight during pregnancy, diet restriction and weight loss are to be avoided. In addition, as with all women, it is not recommended that obese women initiate a rigorous exercise program during pregnancy.
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