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Laura MRCOG Part 2 > 8B) Antenatal Care - Other > Flashcards

8B) Antenatal Care - Other Flashcards

1
Q

How many appointments should an uncomplicated primip receive?

A

10

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2
Q

How many appointments should an uncomplicated multiple receive?

A

7

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3
Q

When should dating scan be done?

A

10-13+6

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4
Q

How much vitamin A is toxic?

A

> 700 micrograms

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5
Q

Food with lots of vitamin A

A

Liver

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6
Q

How much vitamin D in standard pregnancy?

A

10 micrograms (equivalent to 400 units) (found in pregnacare/healthy start)

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7
Q

What foods should be avoided to avoid listeriosis?

A

Only drinking pasteurised/UHT milk.

NO: soft cheeses, pate (even veggie), undercooked ready meals.

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8
Q

What foods should be avoided to avoid salmonella?

A

Raw/partially cooked eggs/mayonnaise

Raw/partially cooked meat.

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9
Q

When to screen for haemoglobinopathies and how?

A

Ideally by 10 weeks.
If prevalence sickle cell disease is high (>1.5 cases/100,000) then do lab screening.
If prevalence of sickle cell disease is low then do Family Origin Questionnaire. If high risk on FOQ or if MCH <27 then do lab screening.

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10
Q

When to do anomaly scan?

A

18-20+6

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11
Q

What infection screening is done at booking?

A

Asymptomatic bacteriuria
Hepatitis B
HIV
Syphilis

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12
Q

When to assess presentation by palpation?

A

From 36 weeks

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13
Q

When to auscultate FH?

A

Only if requested by mother

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14
Q

What percentage of deliveries in the UK were induced?

A

20%

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15
Q

What proportion of induced labours deliver without further intervention?

A

<2/3

15% Instrumental
22% EMCS

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16
Q

Preferred method of IOL

A

Vaginal PGE2 (tablets/gel one dose followed by second after 6h. pessary one dose over 24h)

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17
Q

When should post-dates IOL be offered?

A

Between 41+0 and 42+0

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18
Q

What monitoring should be offered to women who decline post-dates IOL?

A

Twice weekly CTG an ultrasound examination of maximum amniotic pool depth

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19
Q

When should women be offered sweeps?

A

Prior to any formal IOL.

40+41 weeks nullip. 41 weeks parous.

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20
Q

What monitoring should be offered during IOL?

A

Before IOL - assess Bishop score and do CTG.

Once contractions begin - CTG and if normal can then do I/A.

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21
Q

When to reassess Bishop score?

A

6h after tablet/gel, 24h after pessary

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22
Q

When is IOL classed as failure?

A

After 1 cycle

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23
Q

Risks of vitamin D deficiency in pregnancy

A

Classical:

  • Low calcium and phosphate
  • Secondary hyperparathyroidism
  • Osteomalacia and Rickets
  • Neonatal hypocalcemic tetany

Non-classical:

  • Pre-eclampsia
  • SGA
  • GDM
  • Fetal lung development
  • Neonatal immune conditions e.g. asthma
  • Increased risk primary CS
  • Bacterial vaginosis
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24
Q

How much calcium does a developing fetes require?

A

30g

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25
Q

How much vitamin D is delivered after 30 mins in sunlight in white skin?

A

50,000 units

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26
Q

By how much does melanin diminish cholecalciferol production?

A

90%

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27
Q

Vitamin D supplementation in women at high risk of PET

A

800 units combined with calcium

28
Q

Vitamin D supplementation in women at high risk of vitamin D deficiency

A

1000 units daily

29
Q

Treatment of vitamin D deficiency

A

Cholecalcierol: 2800 units OD and 20,000 units OW for 4-6 weeks.

Ergocalciferol: 2800 units OD and 10,000 units BW for 4-6 weeks.

30
Q

What are the key physiological changes that occur during air travel?

A

Altitude –> Reduced barometric pressure –> Reduced partial pressure O2 –> Reduced blood O2 saturation 10%

Humidity low 15% –> Increased insensible fluid losses.

31
Q

Effect of air travel on pregnancy outcomes

A

No increase in adverse pregnancy outcomes

32
Q

Change in fetal O2 pressures during air travel

33
Q

Radiation risk from air travel/body scanners

A

Radiation not significant for passengers but can be for staff.
Total radiation from body scanners <2 min flying or 1h on ground.

34
Q

When to advise against flying?

A

37 weeks in uncomplicated singletons and 32 weeks multiples.

35
Q

Contraindications to air travel

A
  • Hb <75
  • Recent sickling crisis
  • Recent haemorrhage
  • Otitis media & sinusitis
  • Serious cardiac or respiratory disease
  • Recent GI surgery (where anastomoses could come under stress with gaseous expansion)
  • Fracture (significant leg swelling can occur in flight)
36
Q

What is the increased risk of VTE with prolonged air travel?

A

3 x increased

18% increase in risk for each 2 hour increase in travel time.

37
Q

What is the incidence of VTE after flight?

A

1 in 4600 flights >4 hours

38
Q

What percentage of non-pregnant people at high risk for VTE will develop DVT after prolonged air travel?

39
Q

What is the benefit of TEDs during air travel?

40
Q

How often to do in flight exercises?

A

Every 30 minutes

41
Q

What is the change in steroid hormone physiology in pregnancy?

A

3 x increased cortisol levels (due to oestrogen stimulation of CBG and placental stimulation CRH) which peak in third trimester.

Postpartum cortisol levels remain normal but CRH and ACTH fall.

42
Q

What is the placental enzyme which protects fetus from high doses of steroids?

A

11B-HSD2 (metabolises cortisol)

43
Q

Duration of action of betamethasone/dexamethasone/prednisolone.

A

Beta and dex are long acting - 36-54h.

Prednisolone medium acting - 12-36h.

44
Q

Which steroids are not inactivated by placental enzymes?

A

Betamethasone and dexamethasone.

45
Q

Adverse effects of exogenous steroids

A
  • May be increased risk orofacial clefts
  • May be association with PTB
  • May be association with reduced fetal weight, head and height
  • GDM
  • Trend towards poorer neurological outcomes.
46
Q

What is the increase in risk of GDM for someone on LT steroids?

A

5-10 x increased

47
Q

BF on steroids

A

Safe but avoid BF for 4h after dose of pred

48
Q

Which drug involved in early pregnancy care can’t be used in women on long term steroids?

A

Mifepristone

49
Q

What should happen if woman on LT steroids starts COCP?

A

Monitor for steroid toxicity

50
Q

How many days background radiation is CXR equivalent to?

51
Q

Background radiation dose to fetes during pregnancy

52
Q

What are stochastic effects of radiation?

A

Effects which can occur at any radiation level without known threshold e.g. increased risk of childhood malignancy.

53
Q

What are deterministic effects of radiation?

A

Effects which are dependent on gestational age and dose used for diagnostic test.

54
Q

Units of measurement for exposure

55
Q

Units of measurement for dose

56
Q

Units of measurement for relative effective dose

57
Q

Which types of imaging are very low dose (<0.1mGy)?

A 
CXR
Cervical XR
Extremities
Mammography
CT Head and Neck
58
Q

Which types of imaging are low to moderate dose (0.1-10mGy)?

A

Chest CT

Limited pelvimetry

59
Q

Which types of imaging are high dose (10-50mGy)?

A

Abdominal/Pelvic CT

PET/CT

60
Q

What can sonographers do to ensure safety of USS?

A

Keep mechanical index and thermal index as low as possible and limit exposure < 60 minutes.

61
Q

Risks of gad contrast with MRI?

A

Nephrogenic systemic fibrosis, rheumatological/skin/inflammatory conditions. Increased risk SB and NND.

62
Q

Which radioactive isotopes can be used?

A

Technetium-99m (for V/Q scans)

Don’t use radioactive iodine (don’t become pregnant in 6 months after)

63
Q

Deterministic effects of radiation at different gestations

A

0-2 weeks: No effect at any dose
3-4 weeks: Possible increased miscarriage if >100Gy
5-10 weeks: Possible congenital anomaly at >100Gy, Fetal growth restriction (200-250)
11-17 weeks: Diminished IQ and Microcephaly
Gestational age >18 weeks - Effects not noted.

64
Q

What is the reduction in mammography risk by lead shielding?

65
Q

What percentage of CTPA inconclusive v V/Q scan?

Laura MRCOG Part 2 (56 decks)

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