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Laura MRCOG Part 2 > 8B) Antenatal Care - Pregnancy & complex social factors > Flashcards

8B) Antenatal Care - Pregnancy & complex social factors Flashcards

1
Q

Definition of domestic abuse

A

Incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are intimate partners or family members.

Can include forced marriage, FGM and “honour violence”.

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2
Q

Who is classed as a recent migrant?

A

Women who moved to the UK within previous 12 month

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3
Q

What percentage of women experience DV each year?

A

7%

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4
Q

What percentage of women report experiencing DV in their lifetime?

A

30%

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5
Q

What proportion of cases of DV start or escalate in pregnancy?

A

30%

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6
Q

On average, how many episodes of DV and how many professionals does a woman see before seeking help?

A

35 episodes and 5 professionals

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7
Q

Fetal mortality associated with DV

A

16 per 1000

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8
Q

Complications of DV in pregnancy

A 
Depression
Preterm delivery
Miscarriage
Low birthweight
IUFD
Perinatal maternal and infant death
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9
Q

Incidence of teenage pregnancy in UK

A

40 per 1000

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10
Q

What percentage of teenage pregnancies end in termination?

A

40%

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11
Q

What percentage of teenagers who become pregnancy will become pregnant again during their teenage years?

A

25% (including 18% of those who terminate first pregnancy)

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12
Q

What percentage of girls who leave school at 16 without qualifications will have a teenage pregnancy?

A

30%

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13
Q

What percentage of girls who leave school at 16 with qualifications will have a teenage pregnancy?

A

15%

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14
Q

What percentage of girls who leave school after the age of 17 will have a teenage pregnancy?

A

1%

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15
Q

Adverse pregnancy outcomes associated with teenage pregnancy

A 
Prematurity
SGA
Neonatal mortality
Anaemia
Pregnancy induced hypertension
STIs
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16
Q

In what age group (amongst teenagers) is the rate of miscarriage and PTB highest?

A

13-15 years (likely due to gynaecological immaturity)

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17
Q

What percentage of adolescents continue to grow whilst pregnant?

A

50%

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18
Q

What are the implications of an adolescent continuing to grow whilst pregnant?

A

Larger weight gains, increased fat stores and postpartum weight retention.
Reduced fetal growth due to competition for nutrients.

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19
Q

What percentage of UK women have signs of alcohol dependence?

A

4%

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20
Q

What is a safe amount of alcohol in pregnancy?

A

We don’t know!

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21
Q

How many units of alcohol in 1/2 pint lager/beer?

A

1 unit

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22
Q

How many units of alcohol in small glass wine?

A

1.5 units

23
Q

How many units in pint of lager/beer?

A

2 units

24
Q

How many units in large glass of wine or pint strong lager/beer?

A

3 units

25
Q

How many units in bottle of spirits?

A

30 units

26
Q

What is fetal alcohol syndrome?

A
  • Intrauterine or postnatal growth problems
  • Facial anomalies (short palpebral fissures, epicanthal folds, flat mid face, short nose, indistinct philtrum, thin upper lip, micrognathia)
  • CNS anomalies
27
Q

What is partial fetal alcohol syndrome?

A

Some of the growth/facial anomalies in addition to CNS abnormalities

28
Q

What is alcohol related neurodevelopment disorder

A

Range of possible abnormalities e.g. cognitive, speech & language deficits, sensory impairments, behavioural challenges, social/relationship abnormalities

29
Q

What percentage of women are smokers at the time of delivery?

A

10%

30
Q

What does the carbon monoxide in cigarette smoke do?

A

Binds Hb and forms carboxyhaemoglobin.

Causes left shift of dissociation curve and impairs delivery of O2.

31
Q

What does the tar in cigarette smoke do?

A

Contains majority of carcinogenic compounds.

Cadmium accumulates in placenta –> FGR.

32
Q

What does the nicotine in cigarette smoke do?

A

Stimulator of parasympathetic nervous system.
Leads to cognitive emotional and behavioural problems and increased risk of smoking (and other addictive behaviours) in the child.

33
Q

Who should be screened with CO monitoring?

A

Everyone!

34
Q

Who should be referred to smoking cessation services?

A
  • All smokers
  • People who have quit in last 2 weeks
  • People with exhaled CO levels >4ppm
35
Q

What percentage of smokers quit within first trimester?

A

27-47%

36
Q

Which women are more likely to maintain smoking cessation?

A

Women who quit early in pregnancy

37
Q

What is the effect on smoking cessation as pregnancy progresses?

A

Little change from 2nd trimester onwards and intention to quit is reduced.

38
Q

What percentage of spontaneous quitters in pregnancy remain abstinent 1 year postpartum?

A

<1/3

39
Q

What is the recommended smoking cessation technique?

A

Psychosocial interventions

40
Q

What benefits have been shown of psychosocial interventions?

A

Reduced incidence of low birthweight and NICU admissions

41
Q

What is the effect of NRT on cessation rates?

A

Improves 50%

42
Q

Effect of NRT on pregnancy

A

Doesn’t improve pregnancy outcomes.

May improve developmental outcomes.

43
Q

Percentage harm reduction reported by use of e-cigs

A

95%

44
Q

What percentage of adults smoke e-cigs?

A

5%

45
Q

What is the most common smoking cessation aid used in the UK?

A

E-cigarettes

46
Q

E-Cigs in pregnancy

A

Lack of safety data and effectiveness data

47
Q

Percentage of pregnant women with a drug abuse problem?

A

1%

48
Q

Most common drug of abuse in UK

A

Cannabis (second is cocaine)

49
Q

Effect of heroin on congenital abnormalities

A

No effect

50
Q

What is neonatal abstinence syndrome?

A

Opiates cross placenta and therefore fetus becomes physically dependent. Signs include CNS features, autonomic features and GI features.

51
Q

What percentage of infants born to opiate users develop neonatal abstinence syndrome?

A

40-80%

52
Q

When does neonatal abstinence syndrome occur?

A

usually 24-72h after birth but can occur up to 2w

53
Q

Risk of cannabis in pregnancy

A

Harmful primarily because of associations with other substances.

54
Q

Risks with benzos in pregnancy

A

Increased risk facial cleft and skeletal abnormalities.

Neonatal withdrawal.

Laura MRCOG Part 2 (56 decks)

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