Pregnancy
HIV (1st visit + 3rd trimester) - In areas where universal screening is not performed due to low prevalence of HIV infection, pregnant women with the following individual risk factors should be screened: past or present injection drug use; women who exchange sex for money or drugs; injection drug-using, bisexual, or HIV-positive sex partner currently or in the past; blood transfusion between 1978 - 1985; persons seeking treatment for STDs. HIV screen should be repeated in 3rd trimester if at continued risk.HBsAg (3rd trimester) - Women who are initially HBsAg-negative who are at high risk due to injection drug use, suspected exposure to hepatitis B during pregnancy, or multiple sex partners.
RPR/VDRL (3rd trimester) - Women who exchange sex for money or drugs, women with other STDs (including HIV), and sexual contacts of persons with active syphilis. Consider local epidemiology.
Advice to reduce parenteral infection risk - Women who continue to inject drugs.
D(Rh) antibody testing (24-28 wk) - Unsensitized D-negative women.
CVS (<13 wk), amniocentesis (15-18 wk) - Prior pregnancy with Down syndrome, age > 35 yr, or known carrier of chromosomal abnormality.
Folic acid 4.0 mg qd - Prior pregnancy with neural tube defect.
Multiple marker testing (15-18 wk), a-feto-protein testing (16-18 wk) - Prior pregnancy with neural tube defect.Conditions for Which Clinicians Should Remain Alert
Adolescents, young adults, persons at increased risk for depression -
Depressive symptoms.
General population
- Various presentations of family violence.
- Obvious signs of tooth decay or mottling, inflamed or cyanotic gingiva, loose teeth, and severe halitosis.
- Skin lesions with malignant features.
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