A & P Tutorial Scenarios

Question 1

Why lie on LHS

Answer 1

Risk or aortocaval compression due to main blood supply on RHS, increase in pressure with size of uterus over 30 weeks. Restriction of blood flow effect on both mother and baby.
Sudden decrease in BP /dizziness
Wedge pillow/slightly upright/ LHS

Question 2

Where epidural into

Answer 2

Epidural space. Ideally T8-10 (allows movement and no respiratory depression)

Question 3

Checks with epidural

Answer 3

Assess pain at 30 mins as should be full effective
Check not one-sided
Check motor sensory every hour (sensation and straight leg raise)
BP - every 5 min for 15 min then every 30 min

Question 4

Concerns with epidural

Answer 4

Hypotension
Respiratory depression if too high
Movement Lower body if too low
Headache if spinal fluid leak

Question 5

Why whooping cough vaccine again?

Answer 5

Each response becomes more effective, quicker production of IgG (the later response) and these smaller protein antibodies pass over the placenta to fetus, will protect for the first 3 months of life when newborns are particularly vulnerable.
Strengthens maternal response and her risk of contracting/passing on.
As already immune some immunity may have been passed on from as early as 14 weeks.

Question 6

After pains

Answer 6

Due to uterus returning to normal state post pregnancy - contracting pains
Oxytocin production aids this so heightened /intense when skin to skin/feeding
First few days postpartum
Often more intense with subsequent babies
Relieve with hot water bottle/paracetamol
If worsens seek advice - post partum endometriosis

Question 7

Baby brain

Answer 7

Neuroplasticity adaptation to mothering - threat detection/empathy/ read emotional cues
Brain’s ability to change due to life events
Can last up to 2 years
Positive

Question 8

3 ways protected from infection in uterus

Answer 8

Placenta barrier
Mucus plug
Amniotic fluid
IgG antibodies from mother
Develops own second line of defence - wbc

Question 9

Why and how anti d works

Answer 9

Antibodies from blood donors - find any RH+ cells and neutralise them so body doesn’t recognise cells and create antibodies
For protection of subsequent pregnancies, not current
Usually blood doesn’t mix but sensitising events such as trauma to abdomen/amnio/CVS/ birth

Concerns would be risk of haemolytic newborn disease

Question 10

Why car seats not recommended for prolonged periods

Answer 10

Airway compression
Newborn airway is soft and shorter and easily compressed - tongue fills mouth
Neutral position advised
Occiput on head also effects this

Question 11

Protein traces in urine

Answer 11

-Often vaginal discharge
- kidneys working harder to filter extra blood
However……. in preeclampsia an indicator as due to increased BP larger molecules (protein) excreted into urine

Or….
Infection

Question 12

Protection from infection in early days

Answer 12

Skin protection by vernix
IgA in breast milk
IgG from mother.
Biome
Babies own first/second line of defence
Exposure and they will create first IgM