AN Key info Flashcards
Chromosomal screening- timing
blood test (protein + HcG levels)- ideally 10 weeks (9-13+6)
NT scan - ideally 12 wks (11-13+6)
alternative-
NIPT blood test- 10 wks (+gender)
what are key principles of Food safety
hand + food hygiene (esp toxoplasmosis)
eat fresh, pasteurised food - heat deli food that has been refrigerated - (listeria can grow in refrigerater) - see list.
Folic acid- dose/ timing/ rationale
Folic acid (800mcg)- brain and spinal dev. prenatally + first trimester
treatment for nausea / vomiting
assess impact (ability to eat + drink, weight loss )
If normal- advise usually passes after T1
1) diet- small regular meals, avoid fat + rich food, eat something before getting up, ginger
2) pyridoxine (Vit B6)- nausea prophylactic/ 25mg tid
3) metaclopramide - nausea + vomiting (if severe). 1 tab (10mg) every 8hrs
NOT ondansetron (first trimester)
what are the tests for anaemia, and “normal” levels
booking
Hb >110 (1+3 trimester) >105 (2nd)
Ferritin > 30 (“iron stores” - indicate IDA/ risk of IDA)
CRP>5 (Influence ferrtin levels)
normal folate + B12 (confirm anaemia is not caused by folate / B12)
Recheck
24-26 wks (2nd trimester)
34-36 wks (3rd)
AN Education available
Free- Plunket. 6 wks. Rolleston/ addington
home birth- $180. 1 day.
Birth+More- $180. 6 sessions. LC
Authored + Beautiful beginnings - ~$350. 4 sessions.
Anti-D immunoglobulin protocol
**prophylaxisis Antepartum
**28 wks
34 wks
**Additional treatment for sensitising events
* events that could cause fetal + maternal blood to cross- e.g. amniocentesis, CVS, trauma, forceps APH
*from 20wks, do Kleihauer tests (maternal blood checked for fetal cells) \
—-> use Kleihauer to estimate volume of fetal cells and inform whether additional anti-D dose req.
* give prophylaxis within 72hrs, regardless of whether woman has already received prophylaxis at 28wks)
**
**Post natal assesment
**assess
- baby - blood type positive?
- Cord Blood (Direct Coombs- test maternal antibodies in cord blood)–> risk of Rh haemolytic disease
- Kleihauer- fetal cells in maternal blood)- risk of isoimmunisation
- –> another dose Anti-D immunoglobulin
-
iodine- dose, timing, rationale
150 mcg
“neuro- tabs”
preconception/pregnancy / breastfeeding. brain dev
What is tested in booking bloods
blood type (Group + Rh factor)
Rh + ABO antibodies
CBC (iron, ferritin, platelets)
HbA1c (“Glycated Hb- “average BGL’s in last few months)-
bacterial STDs (hep B, syphilis)
Rubella immunity
HIV
key message testing for Rubella immunity
Not common viral infection
if mum is NOT immunised-
- risk of fetal transmission ( can’t be prevented via treatment / vaccination)
- woman should get immunised AFTER pregnancy (whanau get immunised now)- can do this at hospital. avoid pregnancy 1mth after rubella.
- avoid contact with people with rubella symptoms (difficult)
HSV - key messages
Common STI (aka Herpes)
Risk of herpes transmission to baby via vaginal birth if lesions present during labour
biggest risk if herpes presents for first time in labour
advice to women:
* 1st presentation- refer to GP. no transmission risk in pregnancy.
* if ‘active lesions’ appear- MW required to offer obsetetric consult. can take aciclovir (antiviral). may need to consider C section.
* NO ARM, FSE, Forceps
What is risk of UTi’s and how we do manage risk?
increased risk of UTI’s in pregnancy
- more common due to physical / hormonal changes - Asymptomatic UTI can become infection, leading to preterm birth, IUGR, stillbirth, maternal sepsis
Recommendations
- discuss UTi’s with women, encourate to be more careful with hygiene, fluid intake, regular PU
- treat UTI aggressively (AB’s)
- CONSULT- if UTI is recurrent
Group B Strep (issue + risk factors)
common transient asymtomatic bacteria in vaginal /GI tract
small risk of baby transmission + infection via vaginal birth —> death (0.1%)- esp. preterm
can be treated temporarily with IV AB’s in labour
recommendation
narrow spectrum AB’s for women with GBS risk factors
* preterm (<37wks)
* PROM >24hrs [ IOL + AB’s)
* GBS bacteriuria / GBS vaginal swab (unless refuted >37wks)
* baby with GBS infection previously
broad spectrum AB’s + increased monitoring if:
* fever (>38degrees)
* signs of chorioamnionitis (fever AND 2 other signs- incl. offensive liquor/ discharge, uterine tender, tachycardia)
Flu vaccine
risk of maternal pneumonia/ intensive care/ fetal IUGR, Labour distress
get free flu vaccine asap anytime
Covid vaccine
Covid more dangerous in pregnancy
mum increased risk of respiratory issues / Intensive Care admission
fetus- preterm, NICU
recommend- (Free) covid vaccine. anytime in pregnancy.
Whooping cough - timeframes
bacterial respiratory infection- can kill newborn
get free vaccine in 2nd trimester (16-28 wks)
encourage whanau to get vaccine
discussing Anatomy Scan
-20wks. $$?
Pacific radiology- wigram/ rolleston.
scan baby, placenta + uterus- growth + dev
brain, face, abdomen, arms, legs, spine), uterus, placenta
USS- no known risks
USS doesn’t pick up everything
results are discussed with you- bring a partner
general Pre-eclampsia discussion
pregnancy condition - believed to be caused by issues with placenta dev.
very serious- can affect major organs
risk factors- family hx / auto immune conditions - low dose aspirin+ca from 16wks
important to monitor signs from 20 wks-
* BP
* baby’s growth
* recurrent / severe headache
* visual disturbances- spots / blurry/ flashing lights
* pain tummy / shoulder / upper belly
* Sudden swelling
Pre-eclampsia assessment
BP (140/90)- twice
PET Bloods- renal, liver, CBC + diff (Platelets) -
MSU- Protein creatinine ratio
USS- growth + dopplers?
Screen for symptoms
baby movements- timing
16-22 wks- fluttery feelings
28 wks- pattern of movements develops
term- movements may feel different (as baby running out of space), however pattern should still be normal.
monitor movements from 28 wks.
if notice reduction / change of pattern / concerned, call MW asap for CTG assessment.
SGA Monitoring- timing
**Low chance SGA:
fundal height measurement - 26-28 wks (fortnightly)
USS if <10th centile; decline in FH >30 centile
3+ Minor risk factors / unreliable measurement
fortnightly fundal height measurement
USS at 30-32 wks + 36-38wks
Major Risk factor
“early FGR”- monthly USS from 24-26wks + consider doppler 20-24wks
“FGR” - monthly USS from 28-30wks
what is HbA1c testing, what are ranges for referral?
average BGL in last 4-6wks
≥ 41-49 mmol/ mol “prediabetic”–> refer to clinic for health coaching. Recommend OGTT at 24wks.
≥ 50 –> likely pre-existing diabetes- Refer to clinic
When do we talk to women about GDM?
24-28 wks
half way through pregnancy placenta produces human placental lactogen -> increases insulin resistance
car seat- when / where from
start early- <30 wks
Hire / buy. Free installation
Baby on the move / baby factory / baby bunting
what are the Pregnancy entitlements
-“paid parental leave”- 6mths GOV funding (match your income- assuming you’ve been working for last 12mths )
- 12mths unpaid leave from employer
-“ Best start” payments ($70/wk- whanau apply when they register baby)
“Four”- pelvic girdle pain / prolapse / abdominal separation/ pelvic floor- strowan. $$
“Liberty”- Addington. $200 / consult.
Explain heartburn and management
when stomach acid enters lower oesophagus, causing ‘burning sensation’ in chest / back of throat
increased incidence in pregnancy (relaxing sphincter / uterine pressure / slower gastric motility)
1) diet
avoid triggers- spicy / fatty/ acidic/ chocolate/ caffeine/ carbonated
chew food / eat slowly /eat small meals / eat at least 2hrs before bed
chew gum
elevate- stay upright after eating / use pillows to wedge upright wehn sleeping
loose clothing
drink lots of fluid, but not with meals
dairy if symptoms arise
2) Calcium carbonate (quick eze)
3) Omeprazole (proton pump inhibitor)
AVOID
antacids with sodium- (e.g. gaviscon)- causes fluid retention / with alumninion (causes constipation) / with aspirin
List the wellchild providers
Options-
Plunket- Community wide
Te Puawaitanga Ki - Māori / Pasifika focused
Public health nursing service- selwyn
