A 25-year-old G1P0 woman at an estimated gestational age of 9 weeks presents for her first prenatal visit following a positive home pregnancy test. She says she missed 2 periods but assumed it was due to stress at work. She has decided to continue with the pregnancy. Her past medical history is significant for migraine headaches, seizures, and asthma. She takes multiple medications for her condition. Physical examination is unremarkable. An ultrasound confirms a 9-week-old intrauterine pregnancy. Which of the following medications poses the greatest risk to the fetus?
AValproic acid
BBudesonide
CAcetaminophen
DSumatriptan
EAlbuterol
A 30-year-old woman, gravida 2, para 1, comes to the physician because she had a positive pregnancy test at home. During the last two weeks, she has had nausea and two episodes of non-bloody vomiting. She also reports increased urinary frequency. Her pregnancy and delivery of her first child were uncomplicated. Last year, she had two episodes of grand-mal seizure. She is sexually active with her husband and they use condoms inconsistently. She does not smoke or drink alcohol. She does not use illicit drugs. Current medications include valproic acid and a multivitamin. Her vital signs are within normal limits. Physical examination shows no abnormalities. A urine pregnancy test is positive. The child is at increased risk for requiring which of the following interventions?
ALower spinal surgery
BCochlear implantation
CKidney transplantation
DDental treatment
ERespiratory support
A 33-year-old Hispanic woman who recently immigrated to the United States with her newborn daughter is presenting to a free clinic for a wellness checkup for her baby. As part of screening for those immigrating or seeking refuge in the United States, she and her child are both evaluated for tuberculosis. The child’s purified protein derivative (PPD) test and chest radiograph are negative, and although the mother’s chest radiograph is also negative, her PPD is positive. She states that she is currently asymptomatic and has no known history of tuberculosis (TB). The mother’s vital signs include: blood pressure 124/76 mm Hg, heart rate 74/min, and respiratory rate 14/min. She is advised to begin treatment with isoniazid, supplemented with pyridoxine for the next 9 months. She asks about the potential for harm to the child if she begins this course of treatment since she is breastfeeding. Which of the following is the most appropriate response to this patient’s concerns?
A“You should not breastfeed your baby for the next 9 months because isoniazid in breast milk can damage your child’s liver.”
B“You should not breastfeed your baby for the next 9 months because pyridoxine in breast milk can damage your child’s liver.”
C“You may breastfeed your baby because you are asymptomatic and because neither isoniazid nor pyridoxine will harm your child.”
D“You should not breastfeed your baby because she is at greater risk for infection with TB than for adverse side effects of your treatment regimen.”
E“You may breastfeed your baby because pyridoxine will prevent isoniazid from causing peripheral neuropathy.”
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