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Risk assessment in early pregnancy

Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
Description
A 38 year old NZ European woman presents to her GP as she has not had a period for 7 weeks. She has a positive pregnancy test at the clinic. When you examine her, you note a blood pressure of 135/85 mmHg and a body mass index (BMI) of 34.
Applied Science for Medicine 
   - Physiology of pregnancy, hormonal and other physiological changes during the different stages of normal pregnancy
   - Pathophysiology of obesity
   - Pathology of metabolic syndrome
   - Outline the normal embryonic and fetal development from implantation to birth and trophoblast
   - Pathogenesis of hypertension in pregnancy
   - Medication use in early pregnancy; reliable sources of drug information
Clinical and Communication Skills 
   - Elicit a history from a woman with a high risk pregnancy; complete a risk assessment for the pregnancy
   - Calculate the estimated delivery date
   - Examination of a patient who is pregnant including blood pressure measurement, weight and height
   - Identify risk factors present at the start of this pregnancy, and list complications that may arise as a result of these risk factors
   - Interpret routine and relevant additional antenatal investigations, such as ultrasound and early diabetes testing
   - Management of high risk pregnancy based on the risk assessment and knowledge of complications that may arise as a result of the risks identified, both maternal and fetal: pharmacological (e.g. low dose aspirin, calcium, methyldopa) and non-pharmacological (lifestyle, diet and exercise,optimal gestational weight gain)
   - Management of pre-existing and gestational hypertension in pregnancy
   - Prescribing for pregnant women and women of child-bearing potential
   - Optimising maternal health pre-pregnancy
   - Role of periconceptual folic acid in preventing neural tube defect
Personal and Professional Skills 
   - Lifestyle changes
   - Ascertaining patient's feelings towards pregnancy
   - Counselling on high risk factors in pregnancy, prenatal screening, appropriate lead maternity carer (LMC) according to pregnancy risk
   - Ethical aspects of prescribing; recognise limits of competence and ask for help when needed; responsibility to update knowledge
   - Understanding the role of the midwife and obstetrician in a high risk pregnancy
   - Supporting normality during pregnancy
Hauora Māori 
   - Health literacy needs of patient and whānau
Population Health 
   - Models of antenatal care in New Zealand
   - Epidemiology of hypertension and pre-eclampsia/eclampsia in pregnancy
   - The role of pre-conceptual counselling in all women of reproductive age; folic acid, weight loss, smoke-free counselling, avoiding alcohol and drugs, early booking with lead maternity carer (LMC)
   - The role of high risk pregnancy clinics
   - Epidemiology of obesity; how to modify the risk of adverse outcomes
Conditions to be considered relating to this scenario
Common
essential hypertension, pregnancy induced hypertension, gestational diabetes mellitus, diabetes mellitus, metabolic syndrome, preeclampsia, fetal growth restriction
Less common but 'important not to miss'
eclampsia, renal disease, HELLP (haemolysis, elevated liver enzymes, low platelets)
Uncommon
secondary causes of hypertension
Related Scenarios
[Pregnancy diagnosis], [Fetal health]