ANC and Screening Flashcards
Why is physiological adaptation necessary during pregnancy?
To allow mother’s body to cope with added strain
Physiological changes are often responsible for minor ailments of pregnancy
How common is morning sickness?
80-85% of pregnant woman get it
When is morning sickness worse?
When hCG levels are higher, e.g. molar pregnancy/twins
What is hyperemesis gravidarum?
Severe, persistent N&V assoc. with >5% loss of pre-pregnancy weight & ketonuria w. no other identifiable cause
What are the clinical features of hyperemesis gravidarum?
NV, dehydration, hypersalivation, orthostatic hypotension, malnourishment
How do you Rx hyperemesis gravidarum?
Steroids & hospitalisation if really bad
When does morning sickness tend to get better by?
16 weeks
What cardiac changes occurring during pregnancy?
CO increases by 30-50% - HR increases from 70 to 90bpm & palpitations common
BP drops in second trimester & returns to normal in third trimester (complain of feeling faint)
Why does BP drop in the 2nd trimester?
Expansion of the utero-placental circulation
Fall in systemic vascular resistance
A reduction in blood viscosity
Reduction in sensitivity to angiotensin (which constricts BVs)
What urinary changes occur during pregnancy?
Increased urine output (GFR increases by 50%) due to increased CO
Serum urea and creatnine decrease (due to increased GFR & dilutional effect of increased plasma vol.)
Why are UTIs more common in pregnancy? What risks do they carry in pregnancy?
Increased urinary stasis
Bladder capacity reduced to a third in third trimester due to pressure from expanding uterus, therefore more likely to have incomplete emptying & UTIs
Assoc. w preterm labour due to uterine infections so important to Rx
How do you treat hydronephrosis in pregnancy?
It is physiological in third trimester!
But does make them more prone to get pyelonephritis
What haematological changes occur during pregnancy?
Plasma vol increases by 50% & RBC by 25% –> drop in Hb by dilution from 133 to 121g/L
WCC increase slightly
Platelets fall by dilution
When should you give iron tablets in pregnancy?
Only if Hb at booking <110 or less than 100 on routine testing at 28wks
As v. unpleasant to take
NB symptoms of pregnancy v. similar to those of anaemia (SoB, tiredness etc.)
What are the respiratory changes during pregnancy?
Progesterone acts centrally to reduce CO2 –> increased TV, RR & plasma pH
O2 consumption increases by 20% but plasma PO2 is unchanged
Hyperaemia of respiratory mucous membranes (inc. BF)
What are the GI changes during pregnancy?
Oesophageal peristalsis reduced (relaxed mooth muscle)
Gastric emptying slows
Cardiac sphincter relaxes
GI motility reduced due to increased progesterone & decreased motilin
What does motilin do?
Increases intestinal contractions
Who gets pre-pregnancy counselling & where is it done?
Ideally should be everyone but 1/3rd of pregnancies are unplanned
Done in primary care
What does pre-pregnancy counselling involve?
General health measures (optimise BMI, improve diet, reduce alcohol consumption)
Smoking cessation advice
Folic acid 400mg (if high risk of NDTs take 3m before conception)
Confirm immunity to rubella
Risk assessment
Change any unsuitable drugs
Advise re complications assoc. w maternal medical problems
What does obesity increase the risk of during pregnancy?
Miscarriage, still birth, defective uterus function, VTE
Also reduces ability to measure fundal height & body’s progress
What does alcohol consumption during pregnancy lead to?
Foetal alcohol syndrome (dysmorphic features & learning difficulties)
What is involved in risk assessment during pre-pregnancy counselling?
Age
Parity
Occupation
Substance misuse
What are the outcomes with old and young age of pregnancy?
Teenagers more likely to drink and smoke and not receive ANC
>40s more likely to have pre-existing illness & higher risk of chromosomal abnormalities
Nulliparity/multiparity is more likely to get preclampsia
Nulliparity
Nulliparity/multiparity (+4) more likely to get PPH
Multiparity 4+
Why should occupation be assessed in risk assessment in pre-pregnancy counselling?
Exposure to teratogens
Not enough rest
What substances can cause neonatal withdrawal syndromes when used in pregnancy?
Heroine, methadone, diazepines
What drugs increase likelihood of placental abruption in pregnancy?
Cocaine & crack
Would you ever advise against pregnancy?
V. occasionally, e.g. aortic stenosis
What is PKU?
Inborn error of protein metabolism (inability to metabolise phenylalanine–> really high levels of phenylalanine) –> impaired mental development