Women's Health and Maternity Care
Prenatal essentials
Folic acid 400 mcg daily (4 mg with prior neural tube defect). Early risk assessment, first-trimester labs, aneuploidy screening, and gestational diabetes screening at 24–28 weeks. Rh-negative patients receive anti-D immune globulin at 28 weeks and within 72 hours postpartum if the newborn is Rh-positive. Group B strep screening at 36 0/7–37 6/7 weeks, with intrapartum penicillin for carriers.
Hypertensive disorders
Preeclampsia is new hypertension after 20 weeks plus proteinuria OR end-organ dysfunction (thrombocytopenia, renal insufficiency, hepatic involvement, pulmonary edema, cerebral or visual symptoms). Severe features (≥160/110, symptoms, abnormal labs) mandate delivery. Postpartum preeclampsia can present up to 6 weeks after delivery - a severe headache at a 2-week visit is not simply sleep deprivation.
Traps
- Assuming a first-trimester patient with abdominal pain and a positive pregnancy test has gastroenteritis - exclude ectopic pregnancy.
- Leaving asymptomatic bacteriuria untreated; it causes pyelonephritis and preterm birth.
- Forgetting that postpartum hemorrhage is most often uterine atony, managed with massage and oxytocin first.
- Counseling that breastfeeding is contraindicated with most medications - usually it is not.
- Missing that a 35-year-old with a new breast mass needs diagnostic imaging, not screening mammography.
Rule of thumb
Any pregnant or postpartum patient with a new severe headache or elevated blood pressure gets a preeclampsia evaluation, including labs and urine protein.
Worked example: at 34 weeks, BP 162/108 with headache and platelets of 95,000 - preeclampsia with severe features. Give magnesium sulfate and antihypertensives and plan delivery; outpatient monitoring is wrong.