Table 4-3. Pregnancy Danger Signs
| Complaint | Possible Diagnosis |
| Vaginal bleeding | Early (spontaneous abortion) |
| Later (abruption, previa) | |
| Vaginal fluid leakage | Membrane rupture (ROM) |
| Urinary incontinence | |
| Epigastric pain | Severe preeclampsia |
| Uterine cramping | Preterm labor |
| Preterm contractions | |
| ↓ fetal movement | Fetal compromise |
| Persistent vomiting | Hyperemesis (early) |
| Hepatitis | |
| Pyelonephritis | |
| Headache, visual changes | Severe preeclampsia |
| Pain with urination | Cystitis |
| Pyelonephritis | |
| Chills and fever | Pyelonephritis |
| Chorioamnionitis | |
SAFE AND UNSAFE IMMUNIZATIONS
Safe
Safe immunizations include antigens from killed or inactivated organisms:
• Influenza (all pregnant women in flu season)
• Hepatitis B (pre- and postexposure)
• Hepatitis A (pre- and postexposure)
• Pneumococcus (only high-risk women)
• Meningococcus (in unusual outbreaks)
• Typhoid (not routinely recommended)
Unsafe
Unsafe immunizations include antigens from live attenuated organisms:
• Measles
• Mumps
• Polio
• Rubella
• Yellow fever
• Varicella
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Prenatal Laboratory Testing
FIRST TRIMESTER LABORATORY TESTS
A 21-year-old primigravida G1 PO presents for her first prenatal visit at 11 weeks’ gestation, which is confirmed by obstetric sonogram. She has no risk factors. What laboratory tests should be ordered on her?
Complete Blood Count
Hemoglobin and hematocrit
Normal pregnancy hemoglobin reference range is 10–12 g/dL. Although nonpregnant female hemoglobin reference range is 12–14 g/dL, normal values in pregnancy will reflect the dilu-tional effect of greater plasma volume increase than red blood cell (RBC) mass.
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Mean corpuscular volume (MCV)
Because hemoglobin and hematocrit reflect pregnancy dilution, MCV may be the most reliable predictor of true anemia. A low hemoglobin and low MCV (<80 mm3) most commonly sug-gests iron deficiency, but may also be caused by thalassemia. A low hemoglobin and high MCV (>100) suggests folate deficiency or, rarely, vitamin B12 deficiency.
Platelet count
A low platelet count (<150,000/mm3) is most likely indicative of idiopathic thrombocytopenic purpura or pregnancy-induced thrombocytopenia. Disseminated intravascular coagulation is rare.
Leukocyte count
White blood cell count in pregnancy is normally up to 16,000/mm3. Leukopenia suggests immune suppression or leukemia.
Rubella IgG Antibody
Immunity
The presence of rubella antibodies rules out a primary infection during the pregnancy. Antibodies derived from a natural, wild infection lead to lifelong immunity. Antibodies from a live-attenuated virus are not as durable.
GI
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GI
USMLE Step 2 l Obstetrics
Susceptibility
An absence of antibodies leaves the woman at risk for a primary rubella infection in pregnancy that can have devastating fetal effects, particularly in the first trimester. Rubella immunization is contraindicated in pregnancy because it is made from a live virus but is recommended after delivery.
Hepatitis B Virus (HBV)
Surface antibody
HBV surface antibodies are expected from a successful vaccination.
Surface antigen
The presence of HBV surface antigen represents either a previous or current infection. HBV surface antigen indicates high risk for vertical transmission of HBV from the mother to the fetus or neonate. This is the only specific hepatitis test obtained routinely on the prenatal labo-ratory panel.
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E antigen
The presence of HBV E antigen signifies a highly infectious state.
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