4 - Antenatal Care - Pre-pregnancy Counselling Flashcards
name 4 general health measures for mothers?
improve diet
optimise BMI
decrease alcohol consumption
smoking cessation
ideal scenario for smears?
to have up to date cervical smear
how does age play a role in healthcare for mothers?
teenagers and older mothers are at risk -
teenagers - not as engaged etc.
older - prone to more complications e.g. gestational diabetes, hypertension
relationship between preeclampsia and parity?
preeclampsia will usually appear during 1st pregnancy
define grand multiparity?
4+ deliveries of labour
risks of grand multiparity
post-partum haemorrhage
describe a specific occupational hazard to be avoided by mothers as it can increase the risk of anomalies?
chemicals - e.g. lab based work etc.
2 types of medications to be avoided while pregnant?
ACE-Is
Sodium Valproate
what is sodium valproate usually used for?
to control epilepsy
what are the risks of taking sodium valproate while pregnant?
increased risk of spina bifida
in terms of diabetes, when is pregnancy not advised?
when HbA1c is increased
what is a common problem associated with hyperthyroidism during pregnancy?
Grave’s disease
what is the effect on hypothyroid mothers when pregnant?
they need to increase their dose of thyroxine
name 3 increased risks for diabetic mothers?
pre-eclampsia
still birth
macrosomic infant
name 2 things which increase the risk of pre-eclampsia?
proteinuria
hypertension
what does renal transplant restore? (2)
renal function
fertility
how are previous pregnancies useful?
they are a good indicator on how current pregnancy will progress
choosing a delivery - what does 1 previous C-section indicate?
it is possible to trial labour or get a C-section
choosing a delivery - what does 2 previous C-sections indicate?
elective C-section again
describe 2 maternal measures that are taken in case of pre-eclampsia?
150 mg aspirin during pregnancy
regular BP monitoring
describe 2 maternal measures that are taken in case of gestational diabetes?
take HbA1c @ booking
OGTT @ 28 weeks
describe maternal considerations in case of DVT/ PE?
antenatal thromboprophylaxis + 6 weeks postnatal treatment
describe 2 measures that are taken in case of foetal intrauterine growth?
aspirin 150mg during pregnancy
serial US scans
describe a consideration in case of preterm birth?
transvaginal cervical length scans/ cervical suture
6 things to check for in maternal antenatal examination?
pre-existing conditions
increased BP
anaemia
urinalysis
mental health
birth planning
6 things to check for in foetal antenatal examination?
screening
decreased foetal movements
malpresentation
size
abnormalities
HR
5 things which are measured during antenatal examination?
SFH
size of baby
liquor volume
HR
presentation and lie of the body
what is SFH?
symphyseal fundal height
what is liquor volume used for?
to gauge foetal weight
what is normal liquor volume @ 12 weeks?
60 mL
what is the best presentation and lie for the baby?
vertex longitudinal
define screening?
testing of symptomless population to detect cases of a disease @ early stage & variety of tests are offered
screening for infection - name 4 things which are screened for?
Hep B
Syphilis
HIV
UTI
how is syphilis treated?
penicillin
if Hep B is present, what is effect on baby?
provides baby with passive & active immunisation or can be present as chronic carrier state
name 5 side effects of syphilis on the foetus?
intrauterine growth restriction
hepatosplenomegaly
anaemia
thrombocytopenia
skin rashes
define thrombocytopenia?
condition characterized by abnormally low levels of platelets (thrombocytes) in the blood
how is UTI screened for in mother?
MSSU - Mid Stream Specimen Urine
what type of anaemia is commonly screened for?
Iron deficiency anaemia
in terms of isoimmunisation, what causes anaemia?
increased red cell antibodies
what is offered in the interest of preventing rhesus disease in baby?
All Rhesus D -ve women are offered anti-D @ 28 weeks
which Rhesus D -ve women are most at risk of passing on rhesus disease to their baby?
Rhesus D -ve women with rhesus +ve partner
describe 4 key things which occur @ 1st visit scan?
ensure pregnancy is viable
multiple pregnancy
offer of Down’s syndrome screening
trisomy 18 screening
when does 1st visit scan typically occur?
11-14 weeks
trisomy of which chromosome results in Down’s?
trisomy 21
what is considered high risk of down’s syndrome?
1/150
what is average risk of down’s syndrome?
1/700
what is the risk of down’s syndrome in mother of 45yrs?
1/30
what are 2 risk factors for chromosomal abnormalities?
FH of chromosomal abnormality
personal history of chromosomal abnormality
what is Nuchal translucency scan used for and how is it taken?
used to detect chromosomal abnormalities, cardiac defects and many genetic syndromes
sonographic appearance of a collection of fluid under the skin behind the fetal neck - taken between the Crown Rump Length’s of 45-84mm
Name 2 instances when Nuchal translucency scan cannot be taken?
Maternal BMI
Foetal position
describe 4 things which are biochemically screened for @ 2nd scan visit?
hCG
unconjugated oestrodiol
alpha-feto protein
inhibin-A
at which value is Alpha-fetoprotein considered a risk and why?
> 2.0 MoM - this is increased risk of foetal abnormality
give 2 examples of conditions which could be indicated by increased alpha-fetoprotein?
Spina Bifida
Exomphalos
describe 3 possible next steps if there is an increased risk from biochemical screening?
CVS
Amniocentesis
Non-invasive prenatal testing
when is CVS carried out?
10-14 weeks
what is the risk of CVS?
1-2% miscarriage
when is amniocentesis carried out?
15 weeks
what is the risk of amniocentesis?
~1% risk of miscarriage
what is US scan used for and what does it show?
to detect foetal abnormalities - POOR test for chromosomal abnormalities
