138 Obstetrics and Gynecology Board Review •••
❍ What medications for Chron’s disease may be used in pregnancy?
Azathioprine, 6-mercaptopurine, and cyclosporine are safe in pregnancy. Methotrexate should not be used.
❍ What is the effect of pregnancy on inflammatory bowel disease?
Pregnancy has not been shown to have any effect on Chron’s disease or ulcerative colitis.
❍ What is the rate of appendicitis in pregnancy?
1 /1000 to 1500 pregnancies.
❍ Is the risk of appendiceal rupture affected by pregnancy?
There is a higher risk of appendiceal rupture in pregnancy, 8%, 12%, and 20% in the first, second, and third
trimesters, respectively.
❍ How is appendicitis diagnosed in pregnancy?
Clinically, persistent abdominal pain and tenderness are suggestive. Ultrasound should be undertaken, and if
nondiagnostic, CT or MRI imaging should be obtained. Surgical exploration is necessary if the diagnosis is likely.
❍ What is the risk of fetal loss after appendectomy?
Approximately 23%; however, surgical intervention should not be delayed because appendicitis can quickly
progress to peritonitis.
RENAL/UROLOGIC SYSTEMS
❍ What is the most common bacterial infection during pregnancy?
Urinary tract infection.
❍ What is the prevalence of asymptomatic bacteriuria in pregnancy?
5% to 8%.
❍ When does asymptomatic bacteriuria usually present?
At the first prenatal visit.
❍ What are the possible consequences of untreated asymptomatic bacteriuria?
Low birth weight, prematurity, and pyelonephritis.
❍ What antibiotic regimen is recommended for suppression in women with persistent or frequent urinary
tract infections?
Nitrofurantoin 100 mg at bedtime for the remainder of the pregnancy.
❍ What is the probable cause of an infection in a woman with frequency, urgency, dysuria, and pyuria, but
with a negative urine culture and mucopurulent cervicitis?
Chlamydia trachomatis.