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4: Y4 - Obstetrics [13] > [9] Antenatal Care - Normal Pregnancy > Flashcards

[9] Antenatal Care - Normal Pregnancy Flashcards

1
Q

What is preconceptual care?

A

An opportunity for the mother to improve their health before they start trying for a baby

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2
Q

What should all women ideally do before conceiving?

A

Present to their GP for pre-pregnancy care and counselling

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3
Q

What can a GP do for a woman prior to conception?

A

Undertake screening tests and provide advice regarding conception and early pregnancy care

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4
Q

What should be assessed in a woman prior to conception in order to maximise preconceptual care?

A
  • Plans for timing of pregnancy
  • Previous obstetric history
  • Dietary habits and BMI
  • Use of folic acid
  • Cervical smear status
  • Smoking status
  • Amount of alcohol consumed
  • Use of illicit drugs and hep B risk
  • Vaccination status
  • Use of medications
  • Chronic health problems
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5
Q

Why is previous obstetric history important when counselling a woman looking to conceive?

A
  • Inter-pregnancy interval may affect perinatal outcomes
  • Previous complications may need to be considered
  • Timing of pregnancy attempt after previous miscarriage
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6
Q

What inter-pregnancy interval has been shown to be safer in terms of perinatal outcomes?

A

18-59 months

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7
Q

What will a decision to try again after miscarriage be influenced by?

A
  • When woman and partner feel ready
  • Speed of recovery
  • Pending test results or follow up of surgery, ectopic or molar pregnancy
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8
Q

What advice should be given to women prior to conception regarding diet and BMI?

A
  • Health, balanced diet

- Attain and maintain healthy weight

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9
Q

Why is attaining and maintaining a healthy weight prior to pregnancy important?

A

It reduces the risk of pregnancy complications

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10
Q

What are the risks of being obese during pregnancy and conception?

A
  • Reduced fertility
  • Increased risk of miscarriage
  • Gestational diabetes
  • Gestational hypertension/pre-eclampsia
  • Macrosomia and shoulder dystocia
  • Preterm delivery
  • Birth trauma
  • Caesarean delivery
  • Post-partum complications
  • Congenital anomalies
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11
Q

What post-partum complications are more likely in obese mothers?

A
  • Haemorrhage
  • Thrombosis
  • Infection
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12
Q

What congenital anomalies are more likely in babies of obese mothers?

A
  • Neural tube defects
  • CVS abnormalities
  • Cleft palate
  • Limb reduction
  • Anorectal atresia
  • Hydrocephaly
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13
Q

What are the risks of being underweight in conception and pregnancy?

A
  • Reduced fertility
  • First trimester miscarriage
  • Pre-term birth
  • Low birth weight
  • Gastroschisis
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14
Q

When assessing a hopeful mothers use of folic acid what should be considered?

A

The dose being taken in relation to her risk of neural tube defects

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15
Q

What is the recommended dose and regime of folic acid for all women?

A

400 μg daily for at least 1 month pre- and 3 months post-conception

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16
Q

What is folic acid used for?

A

Reducing the incidence of neural tube defects

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17
Q

If patients are considered a higher risk for neural tube defects what dose of folic acid is used?

A

5mg daily

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18
Q

What might make a woman high risk for neural tube defects?

A
  • Those on anti-epileptics
  • Obese women
  • Diabetic women
  • Women with history of neural tube defects
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19
Q

Why is checking cervical smear status important in the pre-conceptual history?

A

To undertake routine cervical cytology if due

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20
Q

What advice should women wanting to get pregnant be given regarding smoking?

A

Stop smoking and initially try to do so without nicotine replacement

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21
Q

Where can a patient who smokes before conception be referred if needed?

A

Smoking cessation services

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22
Q

What vaccinations may be needed in women looking to get pregnant (if not already)?

A
  • Rubella
  • Varicella
  • Pertussis
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23
Q

What might a patient need if history of vaccinations and associated infections is uncertain?

A

Serology

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24
Q

What are women who require vaccines prior to conceiving advised to do?

A

Defer conception for 28 days after

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25
Q

Why should women defer conception for 28 days after vaccination?

A

Live attenuated viral vaccines can be dangerous to foetus

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26
Q

Why are seasonal influenza vaccines recommended in pregnant women?

A

There is increased risk of serious morbidity in pregnancy in flu

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27
Q

Use of what types of medications should be considered when taking a pre-conceptual history?

A
  • Prescription medications
  • OTC medicines
  • Herbal medicines
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28
Q

What chronic health problems should be considered in a pre-conceptual history?

A
  • Mental health issues
  • Epilepsy
  • DM
  • Thyroid disease
  • Chronic hypertension
  • Chronic cardiac disease
  • Renal disease
  • Asthma
  • Previous thromboembolism
  • Rheumatological conditions
  • IBD
  • Haemoglobinopathies
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29
Q

What lifestyle factors should be considered when pregnant?

A
  • Alcohol cessation
  • Exercise
  • Foods
  • Medicines and complementary therapy use
  • Nutritional supplements
  • Work
  • Travel
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30
Q

What advise should pregnant women be given regarding exercise?

A
  • Moderate exercise is not associated with adverse outcomes
  • Some activities can be dangerous
  • Sexual intercourse is not associated with adverse outcomes
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31
Q

What physical activities can be dangerous during pregnancy?

A
  • Contact sports
  • High impact sports
  • Vigorous racquet sports
  • Scuba diving
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32
Q

What effect can scuba diving have on the fetus?

A

May cause fetal birth defects and fetal decompression disease

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33
Q

What conditions are important to avoid during pregnancy in terms of food consumption?

A
  • Listeriosis

- Salmonella

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34
Q

How can the risk of listeriosis be reduced in pregnancy?

A
  • Only drink pasteurised or UHT milk
  • Don’t eat ripened soft cheese
  • Don’t eat pâté
  • Don’t eat uncooked or under-cooked ready meals
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35
Q

How can the risk of salmonella be reduced?

A
  • Avoid raw or partially cooked eggs or food that contains them e.g. mayonnaise
  • Avoid raw or partially cooked meat especially poultry
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36
Q

What is true of medicines (including prescription, OTC and complimentary therapies) in pregnancy?

A

Few have been established to be safe and should be taken as little as possible

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37
Q

When are medicines generally considered ok to use in pregnancy despite risks?

A

When the benefit outweighs the risk

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38
Q

What nutritional supplements are routinely advised in pregnancy?

A
  • Folic acid

- Vitamin D

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39
Q

What is the dose of vitamin D supplement in pregnancy?

A

10mg/day

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40
Q

Why is vitamin D supplement important in pregnancy?

A

Improves maternal health and baby’s health in pregnancy and breastfeeding

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41
Q

Who is particularly helped by vitamin D supplement in pregnancy?

A

Women with darker skin

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42
Q

What supplement is not offered routinely in pregnancy?

A

Iron

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43
Q

What supplement can be teratogenic and should be avoided?

A

Vitamin A

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44
Q

What should women be informed of with regards to work in pregnancy?

A

Their maternity rights and benefits

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45
Q

Why is an occupation history important in pregnancy?

A

To identify women with high occupational risk

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46
Q

What is important to inform pregnant women with regards to travel?

A

Seatbelt should go above and below the bump

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47
Q

What are the important aspects of previous obstetric history in pregnancy?

A
  • Number of all previous pregnancies
  • Duration of previous gestations
  • Previous antenatal complications
  • Details of induction of labour
  • Duration of labour
  • Presentation and methods of delivery
  • Birth weight and gender of each infant
  • Mode of delivery
  • Conditions of each infant at birth and need for care in a special baby unit
  • Complications of puerperium
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48
Q

What should be included in number of pregnancies in an obstetric history?

A
  • Miscarriages

- Terminations

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49
Q

What are the types of modes of delivery?

A
  • Spontaneous
  • Assisted
  • Caesarean sections
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50
Q

What are some possible complications of puerperium?

A
  • Post-Partum haemorrhage
  • Extensive perineal trauma or wound breakdown
  • Infections of genital tract
  • DVT
  • Difficulties with breastfeeding
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51
Q

What types of medications should be listed and given to doctor/midwife?

A
  • Prescription medications
  • OTC
  • Nutritional supplements
  • Herbal remedies
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52
Q

What other forms of substance use should be reported by the patient in pregnancy?

A
  • Smoking
  • Drinking
  • Use of illegal drugs
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53
Q

In what ways can medications and other substances harm the foetus?

A
  • Interfere with normal development
  • Damage baby’s organs
  • Damage the placenta
  • Increase the risk of miscarriage
  • Bring on premature labour
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54
Q

What can affect the harm medications and other substances can have on a foetus?

A
  • Type taken
  • How taken
  • Size of dose
  • How often taken
  • Whether used alone or in combination
  • Individual response of the baby
  • Gestational age of baby
  • Maternal health and diet
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55
Q

Give some examples of medications that can cause birth defects in the developing foetus?

A
  • ACE inhibitors and angiotensin II antagonists
  • Isotretinoin
  • Lithium
  • Some antibiotics
  • Some anti-epileptics
  • Some chemotherapies
  • Some thyroid medications
  • Warfarin
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56
Q

What antibiotics are not safe in pregnancy?

A
  • Aminoglycosides
  • Chloramphenicol
  • Co-trimoxazole
  • Tetracyclines
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57
Q

What effect can aminoglycosides have in pregnancy?

A

Risk of fetal ototoxicity

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58
Q

What effect can co-trimoxazole have in pregnancy?

A

May displace bilirubin and cause kernicterus in the foetus

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59
Q

What effect can tetracyclines have on a developing foetus?

A

Dental discolouration

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60
Q

What antibiotics are thought to be safe in pregnancy?

A
  • Erythromycin
  • Penicillins
  • Metronidazole
  • Cephalosporins
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61
Q

What are the risks of warfarin in pregnancy?

A
  • Congenital malformations

- Placental, fetal or neonatal haemorrhage especially in last few weeks of pregnancy and delivery

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62
Q

What are the periods of pregnancy in which warfarin use should be particularly avoided?

A

1st and 3rd trimester

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63
Q

When is it difficult to stop warfarin in pregnancy?

A

In women with prosthetic heart valves, AF or recurrent VTE or PE

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64
Q

What analgesic is generally advised to be avoided in pregnancy?

A

Ibuprofen

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65
Q

When should ibuprofen be only taken in benefits outweigh the risks in pregnancy?

A

Before 30 weeks

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66
Q

When should ibuprofen be absolutely not used in pregnancy?

A

After 30 weeks

67
Q

What is the risk of ibuprofen use before 30 weeks?

A

Increased risk of complications including miscarriage

68
Q

What is the risk of ibuprofen in pregnancy after 30 weeks?

A

Increased risk of complications including heart problems and reduced amniotic fluid

69
Q

Why should women stop smoking in pregnancy?

A

Tobacco smoke contains chemicals that can pass into the blood stream and cross the placenta

70
Q

What does smoking in pregnancy increase the risk of?

A
  • Miscarriage
  • Ectopic pregnancy
  • Low birth weight
  • Premature labour
  • Placental abruption
  • Still birth
  • Fetal abnormalities e.g. cleft lip or palate
71
Q

What are children who’s parents smoke after pregnancy at increased risk of?

A
  • Glue ear
  • Chest infections and asthma
  • Cot death
  • Behavioural problems e.g. ADHD
72
Q

Is nicotine replacement used in pregnancy?

A

It can be, but may have some effects on the baby (safer than smoking)

73
Q

What medications can be used to help stop smoking BEFORE pregnancy?

A
  • Bupropion

- Varenicline

74
Q

Are e-cigs safe in pregnancy?

A

Advised not to use as not enough evidence

75
Q

What is the risk of drinking alcohol during pregnancy?

A

Development of fetal alcohol syndrome

76
Q

What is fetal alcohol syndrome?

A

A range of disabilities and abnormalities a child is born with as a result of drinking during pregnancy

77
Q

What is fetal alcohol syndrome a part of?

A

A group of fetal alcohol spectrum disorders

78
Q

What is included under fetal alcohol spectrum disorders?

A
  • Alcohol-related birth defects
  • Partial fetal alcohol syndrome
  • Alcohol related neurodevelopmental disorders
79
Q

What other factors influence the development of fetal alcohol syndrome (as well as drinking)?

A
  • Genetic factors
  • Health of mother
  • Mother’s diet
  • Maternal stress
  • Maternal age
  • Maternal smoking
80
Q

What are the groups of abnormalities in fetal alcohol syndrome?

A
  • Typical shape of face
  • Stunted growth
  • Mental and behavioural difficulties
81
Q

What are the typical facial features of fetal alcohol syndrome?

A
  • Small head
  • Flattened philtrum
  • Thin upper lip
  • Flat bridge of nose
  • Ptosis
  • Epicanthic folds
82
Q

What is meant by stunted growth in fetal alcohol syndrome?

A

Babies tend to be small and grow up to be shorter than average

83
Q

What mental and behavioural difficulties can be present in fetal alcohol syndrome?

A
  • Lower than average IQ
  • Hyperactivity
  • Attention deficit
  • Memory problems
  • Poor judgement
  • Poor impulse control
  • Speech and language delay
84
Q

What other problems can present as part of the fetal alcohol spectrum disorders?

A
  • Poor vision and hearing
  • Heart valve problems
  • Kidney problems or genital abnormalities
  • Bone and joint problems
85
Q

How can fetal alcohol syndrome be treated?

A

It can’t

86
Q

How can fetal alcohol syndrome be prevented?

A

Don’t drink alcohol in pregnancy

87
Q

What illegal substances have known effects on pregnancy?

A
  • Amphetamines
  • Cannabis
  • Cocaine
  • Heroin
  • Inhalants
88
Q

What are the known effects of amphetamines in pregnancy?

A
  • Low birth weight
  • Birth defects
  • Prematurity
89
Q

What are the known effects of cannabis in pregnancy?

A
  • Growth restriction
  • Sleep problems
  • Behavioural problems
90
Q

What are the known effects of cocaine in pregnancy?

A
  • Miscarriage
  • Pre-term birth
  • Growth restriction
  • Stillbirth
  • Birth defects
91
Q

What can be affected by birth defects caused by cocaine use in pregnancy?

A
  • Brain
  • Heart
  • Genitals
  • Urinary system
92
Q

What are the known effects of heroin in pregnancy?

A
  • Low birth weight
  • Prematurity
  • Fetal distress
  • Still birth
  • Blood-borne viral disease e.g. hepatitis
  • Infant withdrawal after birth
93
Q

What are the known effects of inhalants in pregnancy?

A
  • Miscarriage
  • Low birth weight
  • Birth defects
  • Sudden unexplained death in infancy
94
Q

How can mothers who take illegal drugs be helped?

A
  • Offer treatment plans
  • Provide counselling and information
  • Provide harm-reduction strategies e.g. needle exchange schemes
95
Q

What treatment can be provided to pregnant women who are heroin or opioid dependent?

A

Methadone and buprenorphine can help treat dependency and is safer than heroin

96
Q

Why is maternal age important in pregnancy?

A

It can be a determinant of outcomes with increased risk at both extremes of age

97
Q

What has happened to the median age of pregnancy in developing countries in recent years?

A

Rise to around 30 years

98
Q

What has happened to the rate of pregnancy over 35 and 40?

A

Risen

99
Q

What has happened to the rate of teenage pregnancy?

A

Decline

100
Q

What reasons are behind the rising median maternal age in developing countries?

A
  • Social, economic and educational factors

- Access to assisted reproductive technology

101
Q

What has happened to rates of multiple pregnancies?

A

Increasing

102
Q

Why is there an increase in the number of multiple pregnancies?

A
  • Increase in ART

- Increasing maternal age

103
Q

Is the absolute number of babies born to each woman generally high or low?

A

Low

104
Q

What percentage of expectant mothers are going to give birth to their first or second baby?

A

75%

105
Q

What is done at the booking visit?

A
  • Identify need for additional care
  • Measure woman’s height, weight and BMI
  • Measure BP and test urine for protein
  • Offer GDM and pre-eclampsia screening
  • Check ABO and rhesus D groups
  • Offer screening for maternal condition
  • Offer early USS for gestational age assessment
  • Offer USS screening for gestational abnormalities
  • Identify women with FGM
  • Ask about past or present mental illness and current mood to identify depression
  • Ask about occupation to identify risks
106
Q

When is the gestational age assessed in the early USS?

A

10 weeks - 13 weeks 6 days

107
Q

How is the gestational age assessed using the early USS?

A

Crown-rump length (if <84mm)

Head circumference (if CRL >84mm)

108
Q

What tests are performed in women who opt for screening?

A
  • Blood tests
  • Urine tests
  • Down’s screening
109
Q

What do blood tests look for in antenatal screening?

A
  • Blood group and Rh D
  • Haemoglobinopathies
  • Anaemia
  • Red cell alloantibodies
  • Hep B
  • HIV
  • Syphillis
110
Q

What do urine tests look for in antenatal screening?

A
  • Proteinuria

- Asymptomatic bacteruria

111
Q

Antenatal screening for what conditions is offered to all women in the UK?

A
  • Anencephaly
  • Open spins bifida
  • Cleft lip
  • Diaphragmatic hernia
  • Gastroschisis
  • Exomphalos
  • Serious cardiac abnormalities
  • Bilateral renal agenesis
  • Edward’s syndrome
  • Patau’s syndrome
  • Down’s syndrome
112
Q

When does the physical abnormality ultrasound scan take place?

A

18-20+6 weeks

113
Q

How many tests are performed initially to screen for Down’s, Edward’s and Patau’s syndromes?

A

One combined test

114
Q

What is the combined test to assess for Down’s and other syndromes?

A

Measure the fluid at the back of the fetus’ neck using nuchal translucency and taking a blood sample

115
Q

When is the combined test for Down’s, Edward’s and Patau’s performed?

A

10-14+1 weeks

116
Q

What test is available for Down’s syndrome if the mother presents late between 14+2 and 20+0 weeks?

A

The quadruple blood test

117
Q

What is the quadruple blood test for Down’s?

A

A blood sample from the mother is taken to determine the levels of 4 biochemical markers that are used alongside maternal age to determine risk

118
Q

Which test is more effective at screening for Down’s syndrome?

A

The combined test

119
Q

What is offered if a mother has high risk based on either syndrome screening tests?

A

Chorionic villus sampling or amniocentesis

120
Q

When is chorionic villus sampling performed?

A

11 - 14 weeks

121
Q

What is involved in chorionic villus sampling?

A

Fine needle put through mothers abdomen and taking sample of tissue from the placenta

122
Q

When is amniocentesis usually performed?

A

After 15 weeks

123
Q

What is involved in amniocentesis?

A

Fine needle passed through abdomen to collect amniotic fluid

124
Q

What are the important sates in the schedule of antenatal care?

A
  • Booking visit
  • 16 weeks
  • 18 - 20 weeks
  • 25 weeks (nulliparous women)
  • 28 weeks
  • 31 weeks
  • 34 weeks
  • 36 weeks
  • 40 weeks (nulliparous women)
  • 41 weeks (if not given birth)
125
Q

What takes place at around 16 weeks in antenatal care?

A
  • Review and discuss results of screening tests
  • Measure BP and test for proteinuria
  • Give information
  • Discuss issues
  • Answer questions
  • Discuss routine anomaly scan
126
Q

What takes place between 18 - 20 weeks in antenatal care?

A
  • USS for structural anomalies (if opted for)

- Offering of 32 week scan if placenta extends across os

127
Q

What do nulliparous women receive at 25 weeks in antenatal care?

A
  • Measure and plot symphysis-fundal height
  • Measure BP
  • Test for proteinuria
  • Discussion
128
Q

What happens at 28 weeks in antenatal care?

A
  • Offer second screening for anaemia and atypical red cell alloantibodies
  • Offer anti-D prophylaxis to Rh -ve
  • Measure BP
  • Test for proteinuria
  • Give information
129
Q

What happens at 31 weeks in nulliparous women in antenatal care?

A
  • Measure BP
  • Test for proteinuria
  • Measure and plot symphysis-fundal height
  • Give information
  • Discuss results of 28 weeks screening tests
130
Q

What happens at 34 weeks in antenatal care?

A
  • Offer second anti-D dose to Rh -ve women
  • Measure BP
  • Test for proteinuria
  • Plot symphysis-fundal height
  • Give information
  • Review and discuss results of screening tests from 28 weeks
131
Q

What happens at 36 weeks in antenatal care?

A
  • Measure BP
  • Test for proteinuria
  • Check position of baby
  • Offer ECV for babies in breech position
132
Q

What is ECV?

A

External cephalic version

133
Q

What happens at 38 weeks in antenatal care?

A
  • Measure BP
  • Test for proteinuria
  • Plot symphysis-fundal height
134
Q

What happens at 40 weeks for nulliparous women in antenatal care?

A
  • Measure BP
  • Test for proteinuria
  • Plot symphysis-fundal height
135
Q

What happen at 41 weeks in antenatal care if the women has not given birth yet?

A
  • Offer membrane sweep and induction of labour
  • Measure BP
  • Test for proteinuria
  • Plot symphysis-fundal height
136
Q

What percentage of Caucasian women are Rh -ve?

A

Around 15%

137
Q

What are Rh -ve women at risk of developing?

A

Anti-D antibodies during or immediately after pregnancy

138
Q

Where does a baby inherit it’s blood type from?

A

Both parents

139
Q

What is the result of a baby inheriting its blood group from either parent?

A

An Rh-ve mother can carry a baby who is Rh +ve

140
Q

How can fetal blood enter the mothers circulation?

A

During FMH (fetal-maternal haemorrhage)

141
Q

What happens if RhD +ve blood enters the circulation of an RhD -ve woman?

A

Mounting of an immune response via sensitisation

142
Q

When does sensitisation to RhD antigens occur?

A

Any time in pregnancy but most commonly in the 3rd trimester or during birth

143
Q

What medical interventions can lead to sensitisation to RhD antigens in the mother?

A
  • Chorionic villus sampling
  • Amniocentesis
  • External cephalic version
144
Q

What types of pregnancy termination can lead to sensitisation to RhD antigens in the mother?

A
  • Late miscarriages
  • Antepartum Haemorrhage
  • Abdominal trauma
145
Q

Is RhD sensitisation reversible?

A

No

146
Q

Why can RhD sensitisation in a RhD -ve mother pose a risk to the RhD +ve fetus?

A

Antibodies can cross the placenta and attack the blood cells of the fetus

147
Q

What can happen as a result of anti-RhD antibodies attacking blood cells fo the fetus?

A
  • Anaemia
  • Hydrops
  • Neonatal anaemia
  • Jaundice and kernicterus
  • Fetal death in utero
148
Q

What can reduce the risk of RhD sensitisation?

A

Administration of anti-D immunoglobulin Post-Partum or when sensitisation may occur

149
Q

When should anti-D immunoglobulin be administers routinely?

A

In the third trimester, at 28 and 34 weeks

150
Q

What legal rights do working pregnant women have?

A
  • Maternity leave
  • Time off for antenatal appointments
  • Sick pay
  • Health and safety
151
Q

When are working women entitled to maternity leave?

A

If they are an ‘employee’

152
Q

How long are women entitled to maternity leave for?

A

Up to 1 year

153
Q

When is a working woman not usually entitled to maternity leave?

A

If they are a ‘worker’ e.g:

  • Works for an agency
  • Is a casual worker
  • Is on 0 hour contract
154
Q

Are all women entitled to maternity pay if they are entitled to maternity leave?

A

No, and not necessarily for the entire period, so they should check with the employer

155
Q

Who else may be entitled to leave due to childbirth?

A

Partner of the pregnant woman

156
Q

What must a pregnant woman to in order to be entitled to maternity leave?

A

Inform the employer at least 15 weeks before due date that:

  • They are pregnant
  • When the baby is due
  • They want maternity leave
  • When they want to start and end (these dates are flexible)
157
Q

When can maternity leave be started?

A

Any day from 11 weeks before due date

158
Q

When can maternity leave start earlier than 11 weeks before due date?

A
  • If the baby comes earlier

- If the mother has a pregnancy related illness 4 weeks before due date

159
Q

When can a pregnant woman receive paid time off for antenatal appointments?

A
  • If the appointments are advised by doctor, midwife or nurse
  • If entitled to maternity leave
  • If employed by an agency and worked or at least 12 weeks in a row
160
Q

What antenatal appointments may a woman receive paid leave to attend?

A
  • Parenting classes
  • Relaxation classes
  • Medical appointments
161
Q

How might maternity pay be affected if the woman takes sick leave whilst pregnant?

A

Can decrease as maternity pay is 90% of average pay during 8 week qualifying period

162
Q

What must an employer do once they have been informed of pregnancy?

A

A risk assessment for mother and baby at the work place

163
Q

If the employer finds the work isn’t safe for the mother and baby what must be done?

A
  • Change if possible
  • Give different work
  • Let them stay at home and pay in full

4: Y4 - Obstetrics [13] (61 decks)

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