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Zorluk: ZorNormal Pregnancy and Prenatal Care

Match each clinical presentation during a prenatal visit to the most appropriate next step in management or indicated evaluation.

  • A 2828-week gestation primigravida with an O-negative blood type and a negative indirect Coombs test at her initial prenatal visit.Administer prophylactic Rho(D) immune globulin and repeat complete blood count.
  • A 3636-week gestation patient whose routine urine culture at 1414 weeks grew 100,000100,000 CFU/mL of Group B Streptococcus.Omit 3636-week rectovaginal culture and plan for intrapartum antibiotic prophylaxis.
  • A 1616-week gestation patient with pregestational type 1 diabetes mellitus and a first-trimester hemoglobin A1c of 8.2%8.2\%.Schedule targeted detailed fetal anatomic survey and fetal echocardiography.
  • A 2424-week gestation patient with a prior 4,6004,600 g infant who had a normal 5050 g glucose challenge test at 1010 weeks.Repeat the 5050-gram, 11-hour oral glucose challenge test.

Cevap

The correct matches represent standard evidence-based guidelines for routine prenatal care and specific high-risk exceptions, emphasizing the 28-week Rh prophylaxis, the GBS bacteriuria exception to 36-week screening, the need for fetal echocardiography in pregestational diabetes, and the requirement for a repeat glucose screen at 24 weeks in high-risk patients.
The correct matches align with ACOG guidelines for prenatal screening and prophylaxis, properly incorporating exceptions such as early-onset screening requirements and prior positive markers.

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1
Evaluate the 28-week primigravida with O-negative blood.
Identify the need for routine 28-week alloimmunization prophylaxis and anemia screening.
ACOG recommends Rho(D) immune globulin at 28 weeks for all Rh-negative patients without antibodies, alongside a CBC.
2
Analyze the 36-week patient with prior GBS bacteriuria.
Determine that the 36-week rectovaginal swab is not indicated.
GBS bacteriuria indicates heavy maternal colonization, automatically qualifying the patient for intrapartum antibiotic prophylaxis without further screening.
3
Assess the 16-week patient with type 1 diabetes.
Identify the high risk for fetal structural anomalies.
Pregestational diabetes carries a high risk for congenital heart defects, necessitating a targeted anatomic survey and fetal echocardiogram.
4
Review the 24-week patient with a prior macrosomic infant and normal early screen.
Recognize the need for routine 24-28 week screening.
A normal early glucose screen does not preclude the development of gestational diabetes later; repeat screening is mandatory due to increasing placental somatomammotropin (hPL) levels.

Anahtar Kavram

Routine Prenatal Care Timelines and Exceptions
Tahmini Süre:1m 30s
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Konular

Normal Pregnancy and Prenatal Care

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