OBGYN Medications

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Oral Contraception Options

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Prophylaxis in Pregnancy

Aspirin for Preeclampsia

History of previous preeclampsia, chronic HTN, DM, renal disease, or systemic lupus erythematosus with antiphospholipid syndrome presents to establish OB care. No complications at present. Elevated BP on exam.

  • Start aspirin 81 mg daily during first trimester

  • Consider higher dose aspirin (162 mg daily) as per evidence

Makena for History of Preterm Delivery

History of previous spontaneous singleton preterm birth presents at <16 WGA.

  • Start Makena 250 mg weekly injections at 16 WGA; continue until 37 WGA

  • Cervix < 2.5cm on U/S exam

    • Perform serial cervical U/S measurements until 24 WGA

    • Administer vaginal progesterone suppository 200 mg daily

Rho D Immune Globulin

  • Reduces risk of alloimmunization in RhD negative women with an RhD positive fetus to 0.2%

  • Risk for alloimmunization is low in the 1st trimester, but Rho(D) immune globulin 50 mcg should be offered to women with a threatened early spontaneous abortion

  • Indications for administration of Rho(D) immune globulin 300 mcg include

    • At 28 WGA and again within 72 hours of delivery if the infant is Rh positive

    • After events that increase risk of fetal-to-maternal transfusion, e.g.

      • Procedures including amniocentesis, chorionic villus sampling, external cephalic version

      • Abdominal trauma or bleeding in the 2nd or 3rd trimesters

Obtain culture at 35 to 37 WGA.

Obtain culture at 35 to 37 WGA.

Intrapartum PPx and Tx

Group B Strep

Prophylaxis criteria: Expected vaginal delivery (not required for planned C-section) and at least one of the following

  • Positive GBS swab (NAAT) and/or culture confirmed UTI at any point during pregnancy

  • Preterm delivery with unknown GBS status; swab is obtained at presentation and therapy is continued pending results

  • Term delivery with ROM lasting ≥18 hours

  • Maternal fever (≥38.0ºC) at any point during labor

Prophylaxis options

  • No PCN allergy: PCN-G 5 million units at presentation and then 2.5 million units q4h until delivery

  • PCN allergy (not anaphylaxis): Cefazolin 2 g at presentation and then 1 g every 8 hours until delivery

  • PCN and cephalosporin allergies:

    • If susceptible to clindamycin, administer 900 mg every 8 hours until delivery

    • Clindamycin resistant: Vancomycin 2g at presentation and then 1 g q12h until delivery