A 29-year-old woman, gravida 2 para 1, comes to the office at 10 weeks gestation for her first prenatal visit. The patient feels well and has had no vaginal bleeding or pelvic pain. Her first pregnancy ended in an uncomplicated vaginal delivery, but she required penicillin during labor for group B Streptococcus colonization. The patient has no chronic medical conditions and takes no daily medications. She does not use tobacco, alcohol, or illicit drugs. She has been in a monogamous relationship with her husband since they married 5 years ago. They live in a house built in 1983. Vital signs are normal. BMI is 24 kg/m². Uterine size is at 10 weeks gestation, and fetal heart tones are 162/min. The remainder of the physical examination is unremarkable. Which of the following screening tests is indicated at this visit?

Question

A 29-year-old woman, gravida 2 para 1, comes to the office at 10 weeks gestation for her first prenatal visit.  The patient feels well and has had no vaginal bleeding or pelvic pain.  Her first pregnancy ended in an uncomplicated vaginal delivery, but she required penicillin during labor for group B Streptococcus colonization.  The patient has no chronic medical conditions and takes no daily medications.  She does not use tobacco, alcohol, or illicit drugs.  She has been in a monogamous relationship with her husband since they married 5 years ago.  They live in a house built in 1983.  Vital signs are normal.  BMI is 24 kg/m².  Uterine size is at 10 weeks gestation, and fetal heart tones are 162/min.  The remainder of the physical examination is unremarkable.  Which of the following screening tests is indicated at this visit?

Quizplus · Accepted Answer

11ec25c8_da87_4e46_bc81_d7fa5e8138c7_MD0003_00 Assessing maternal health, infections, and exposures is an important part of the first prenatal visit. As part of this assessment, a standard set of routine screening tests is recommended for every pregnant patient. Identifying sexually transmitted infections (STIs) is particularly important because many maternal-fetal transmissions are serious yet preventable with proper intervention. Therefore, universal screening for HIV, hepatitis B virus, and syphilis is required at the initial prenatal visit. High-risk patients (eg, prior STI, age <25) are also screened for Chlamydia trachomatis. standard set Syphilis can result in transplacental transmission with devastating obstetric (eg, preterm labor) and fetal (eg, intrauterine fetal demise) complications. At-risk patients are identified by screening with nontreponemal (eg, rapid plasma reagin) or treponemal (eg, fluorescent treponemal antibody absorption) serology. Either type may be used, but positive results require confirmation with a test from the alternate category because false-positive results are common. Treatment for syphilis is with intramuscular benzathine penicillin G. Pregnant women with penicillin allergy are a unique population; they typically undergo penicillin desensitization for syphilis treatment (due to the superior efficacy of penicillin and severity of syphilis-related fetal complications). (Choice A) An early 1-hour glucose challenge test may be indicated in patients with diabetes risk factors (eg, obesity, prior gestational diabetes mellitus). This patient has no risk factors and can undergo routine screening for gestational diabetes mellitus at 24-28 weeks gestation. (Choice B) This patient received intrapartum penicillin prophylaxis during her last delivery to prevent vertical transmission of group B Streptococcus (GBS). Because GBS is a transient colonizer of the maternal genitourinary tract, screening by rectovaginal culture should occur close to the anticipated delivery date (ie, 36-38 weeks gestation), not at 10 weeks gestation. (Choice C) Routine testing for herpes simplex virus (HSV) antibodies is not recommended due to low specificity and high false-positive rates in asymptomatic patients. Symptomatic patients (eg, new, painful, vesicular genital ulcers) require HSV testing, typically with PCR. (Choice E) Folic acid deficiency in pregnancy is associated with fetal neural tube defects. Although supplementation is recommended, folate levels are not commonly tested. (Choice F) Patients at risk for significant lead exposure (eg, living in a home built before 1978) require measurement of serum lead levels. Educational objective: Universal screening for syphilis is required at the first prenatal visit to identify patients at risk for transplacental transmission and associated obstetric and fetal complications. Syphilis is treated with intramuscular benzathine penicillin G. References: Sexually transmitted infections: recommendations from the U.S. Preventive Services Task Force. (http://www.ncbi.nlm.nih.gov/pubmed/27929270) Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/23476094)

A 29-Year-Old Woman, Gravida 2 Para 1, Comes to the Office