5. Antenatal care Flashcards
What is another name for antenatal care
Prenatal care
List three steps /procedures in antenatal care
Diagnosis of Pregnancy
Initial Evaluation
Investigations
In the Initial evaluation during antenatal care what are the important pt histories taken
Reproductive
Medical/surgical
Social/family
In antenatal care initial evaluation
Which three areas of the body are examined
General
Abdomen
Pelvic
What are the symptoms of pregnancy during the first trimester
Amenorrhea Nausea and Vomiting Fatigue Breast tingling and fullness Urine frequency/nocturia Constipation
What is Piskacek’s sign
It consists of asymmetric enlargement of the pregnant uterus due to enlargement of the cornual region over the implantation site
What is the term used to describe “It consists of asymmetric enlargement of the pregnant uterus due to enlargement of the cornual region over the implantation site”
Piskacek’s Sign
Describe Hegar’s sign
Consists of a generalized softening of the lower uterine segment
List three general sings and symptoms of patients in the 2nd and 3rd trimesters
“Quickening”( maternal perception of fetal movements)
Dermatologic changes
Backache
For a patient experiencing their first pregnancy, when does “quickening” usually occur?
18-20 week
For a patient experiencing their second pregnancy, when does “quickening” usually occur
16-18 weeks
What are some dermatologic changes seen in the second and third trimesters
Chloasma (dark patches of skin on forehead, nose, upper lip and cheeks)
Linea Nigra (vertical black line on abdomen)
Striae (stretch marks)
What are four signs observed in the last two trimesters
Enlargement of the abdomen
Uterine contractions
Palpation of fetal parts
Auscultation of fetal heart
List three instruments used to auscultate a fetus
Pinard
“Bell” of regular stethoscope
Doppler “pocket” size
What is the symphiso-fundal height
This is the vertical distance from the superior aspect of the symphysis pubis to the apex of the uterine fundus
List three ancillary aids used to diagnose pregnancy in the first trimester
Urine Pregnancy test (total HCG)
Blood pregnancy test (beta subunit HCG assay)
Trans-vaginal ultrasound
Which ancillary aid is used to diagnose pregnancy in the 2nd trimester
Trans-Abdominal ultrasound
List three measurements taken during an ultrasound study to determine fetal size/age in the 2nd trimester
Biparietal Diameter
Abdominal Circumference
Femoral length
What term is used to describe all previous and current pregnancies
Gravida
Define Gravida
All previous and current pregnancies
What is the term used to describe all pregnancies in the past beyond the period of fetal viability (>24weeks or >500g birth weight)
Parity
At which week or birth weight is a fetus considered viable
> 24 weeks
>500 g
What is the term used to describe a woman who has not given birth to viable child
Nullipara
What is the term used to describe a woman who has had a pregnancy resulting in a viable fetus
Primipara
What is the term used to describe a woman that had more than one pregnancy resulting in viable offspring
Multipara
What is the term used to describe a woman who has given birth to at least five viable babies
Grand Multipara
Describe the time span of the first trimester
LMP to 12 weeks
Describe the time span of the second trimester
13-27 weeks
Describe the time span of the third trimester
28- term (37-42) weeks
What is the time span used to classify a pre term baby
> 24 but <37 weeks
What is the time span used to classify a postterm baby
> 42 weeks
What information is collected during taking the menstrual history at the first visit
Last Menstrual Period
Cycle Regularity & Frequency
Contraception Use
Which rule is used to calculate Estimated Date of Delivery
Naegeles Rule
Define / State Naegeles rule for Estimating Date of Delivery
Add 7 days
Subtract 3 months
Add 1 year
Calculate the EDD for the patient whose LMP is 1/12/15
8/9/16
Add 7 days
Subtact 3 months
Add 1 yr
Calculate the EDD for a patient whose LMP is 1/01/16
8/10/16
Add 7 days
Subtact 3 months
Add 1 yr
What information should be collected from the past obstetric history
Gravidity Parity Miscarriage Previous Complications Gestational age at Delivery Type of delivery Birth weights, neonatal or maternal complications
Why would you do a blood test on a pregnant patient
To determine the blood group
Why would you do a haemoglobin test on a pregnant pt
To detect anemia
Why would you do a Rapid Plasma Reagin/VDRL test on a pregnant pt
To screen for syphillis
Why would you do an HIV test on a pregnant pt
To detect HIV infection and possible need for HAART (highly active antiretroviral therapy) to prevent MTCT (mother to child transmission)
List six lab tests done on a pregnant pt
Blood group Haemoglobin Rapid Plasma Reagin/ VDRL HIV Hepatitis B Surface antigen Sickle cell
What amount of folic acid is prescribed per day until 12 weeks gestation
400 microgram/day
Booking for the first antenatal visit is ideally at what time
Prior 12 weeks
Fill in the blanks
Antenatal visits should be
Every _______ until 28 weeks then every 2 weeks until 36 weeks. Then weekly until delivery
4 weeks
Fill in the blanks
Antenatal visits should be
Every 4 weeks until _______ then every 2 weeks until 36 weeks. Then weekly until delivery
28 weeks
Fill in the blanks
Antenatal visits should be
Every 4 weeks until 28 weeks then every ______ until 36 weeks. Then weekly until delivery
2 weeks
Fill in the blanks
Antenatal visits should be
Every 4 weeks until 28 weeks then every 2 weeks until ______. Then weekly until delivery
36 weeks
Fill in the blanks
Antenatal visits should be
Every 4 weeks until 28 weeks then every 2 weeks until 36 weeks. Then _____ until delivery
Weekly
Which scan is taken at 20 weeks
Fetal anomaly scan
Which test is taken at 24-28 weeks
Osullivan’s glucose test
To screen for GDM Gestational Diabetes
At which week do you begin preparation for labour and delivery
36 weeks
Which two tests are used to detect fetal abnormalities
Amniocentesis
Chorionic Villus Sampling
When is a pregnancy considered a term pregnancy
38-42 weeks
What does a low risk antenatal team consist of
Midwife (led)
General Practitioner
8-10 antenatal visits
Who does a highrisk antenatal team consist?
Obstetrician (led)
Midwife
other specialist
more frequent visits >10
The first trimester combined test detects which chromosomal abnormalities
Down Syndrome (Trisomy 21)
Edward Syndrome (Trisomy 18)
The first trimester combined tests takes place during which weeks
9-13
What is the roleof the biochemical quardruple test?
2nd Trimester test
It determines the chance of the baby having a defect by assessing hormones : hCG, unconjugated estriol, inhibin A, alpha fetoprotein
HIFU!!!!
At which weeks is the biochemical quadruple test done?
Between weeks 15-20
List 7 danger signs of pregnancy
- vaginal bleeding
- headaches
- flashing lights
- epigastric pain
- reduced fetal movement
- persistent abdominal pain
- fever
What maternal characteristics classify a pregnancy as high risk?
- BMI greater than 30
- BMI <18
- Smoking
- age >40
- teenage mothers
What past medical history tclassifies a pregnancy as high risk
Cardiac disease
renal disease
endocrine disorders
epilepsy
diabetes that requires insulin
haematological disorders
Autoimmune disorders
severe asthma
recreational drugs
HIV, EBV
What is pre-eclampsia
This is a sudden spike in BP sometimes with fluid retention and proteinuria
What is HELLP syndrome
Hemolysis, elevated liver enzymes, and low platelets
What is the role of antenatal fetal evaluation
Confirm fetal viability
Determine gestational age
Diagnose multiple gestation
Screen for structural and chromosomal anomalies
Screen for fetal growth and well being
WHich chromosomal abnormalities are screened for in fetal evaluation
- down syndrome trisomy 21
- pernaud’s syndrome T13
- Edward’s syndrome T18
When is the anomaly scan done
between 18 and 22 weeks
What three measurements are taken during the 2nd trimester to determine the fetal size ofr age
- biparietal
- abdominal circumference
- femoral length
