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Zorluk: ZorPreventive Care and Screening

A 31-year-old woman, gravida 2, para 1, presents for her initial prenatal visit at 10 weeks gestation. Her first pregnancy four years ago was uncomplicated, and her prenatal laboratory panel at that time was negative for human immunodeficiency virus (HIV), syphilis, hepatitis B, and hepatitis C. She has been in a monogamous relationship with her husband for six years. Neither has a history of injection drug use, sexually transmitted infections, or occupational blood exposures. Her body mass index is 22 kg/m222 \text{ kg/m}^2. She feels well and takes a daily prenatal vitamin. Vital signs are within normal limits. In addition to a complete blood count, blood typing with rhesus factor, and screening for HIV, syphilis, and hepatitis B, which of the following screening tests is most appropriate to order for this patient today?

  1. Hepatitis C virus antibody testingCevap
  2. B
    Chlamydia trachomatis nucleic acid amplification testing
  3. C
    Type 2 herpes simplex virus serology
  4. D
    Hemoglobin A1c measurement
  5. E
    Toxoplasma gondii immunoglobulin G and M testing

Cevap

Hepatitis C virus antibody testing
The correct answer is Hepatitis C virus antibody testing. According to updated guidelines from the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG), universal screening for hepatitis C virus (HCV) is recommended for all pregnant individuals during each pregnancy. This recommendation aims to identify chronic infections, facilitate postpartum treatment, and monitor infants for vertical transmission. It replaces previous guidelines that advised either risk-based screening or a single lifetime screening.

Adım Adım Çözüm

1
Analyze the patient's demographic and obstetric profile.
The patient is a 31-year-old female at 10 weeks gestation with no significant high-risk behaviors or comorbidities.
Establishing baseline risk factors is required to differentiate between universal and risk-based prenatal screening guidelines.
2
Evaluate the indication for Hepatitis C virus (HCV) screening.
HCV screening is indicated today despite her previous negative screen four years ago.
The CDC and ACOG updated guidelines to recommend universal HCV screening during every pregnancy, superseding the older once-in-a-lifetime recommendation.
3
Exclude other screening tests based on patient-specific data.
Tests for Chlamydia, early diabetes, HSV, and Toxoplasma are ruled out.
Her age (>25) and monogamy exclude routine Chlamydia screening; her normal BMI excludes early HbA1c testing; and HSV/Toxoplasma are not universally screened.

Anahtar Kavram

Universal hepatitis C screening is recommended during each pregnancy, regardless of prior negative test results or the absence of new risk factors.
Tahmini Süre:1m 15s
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Preventive Care and Screening

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