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ANC and Screening Flashcards

1
Q

Why is physiological adaptation necessary during pregnancy?

A

To allow mother’s body to cope with added strain

Physiological changes are often responsible for minor ailments of pregnancy

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2
Q

How common is morning sickness?

A

80-85% of pregnant woman get it

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3
Q

When is morning sickness worse?

A

When hCG levels are higher, e.g. molar pregnancy/twins

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4
Q

What is hyperemesis gravidarum?

A

Severe, persistent N&V assoc. with >5% loss of pre-pregnancy weight & ketonuria w. no other identifiable cause

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5
Q

What are the clinical features of hyperemesis gravidarum?

A

NV, dehydration, hypersalivation, orthostatic hypotension, malnourishment

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6
Q

How do you Rx hyperemesis gravidarum?

A

Steroids & hospitalisation if really bad

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7
Q

When does morning sickness tend to get better by?

A

16 weeks

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8
Q

What cardiac changes occurring during pregnancy?

A

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)

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9
Q

Why does BP drop in the 2nd trimester?

A

Expansion of the utero-placental circulation
Fall in systemic vascular resistance
A reduction in blood viscosity
Reduction in sensitivity to angiotensin (which constricts BVs)

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10
Q

What urinary changes occur during pregnancy?

A

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.)

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11
Q

Why are UTIs more common in pregnancy? What risks do they carry in pregnancy?

A

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

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12
Q

How do you treat hydronephrosis in pregnancy?

A

It is physiological in third trimester!

But does make them more prone to get pyelonephritis

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13
Q

What haematological changes occur during pregnancy?

A

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

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14
Q

When should you give iron tablets in pregnancy?

A

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.)

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15
Q

What are the respiratory changes during pregnancy?

A

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)

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16
Q

What are the GI changes during pregnancy?

A

Oesophageal peristalsis reduced (relaxed mooth muscle)
Gastric emptying slows
Cardiac sphincter relaxes
GI motility reduced due to increased progesterone & decreased motilin

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17
Q

What does motilin do?

A

Increases intestinal contractions

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18
Q

Who gets pre-pregnancy counselling & where is it done?

A

Ideally should be everyone but 1/3rd of pregnancies are unplanned
Done in primary care

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19
Q

What does pre-pregnancy counselling involve?

A

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

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20
Q

What does obesity increase the risk of during pregnancy?

A

Miscarriage, still birth, defective uterus function, VTE

Also reduces ability to measure fundal height & body’s progress

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21
Q

What does alcohol consumption during pregnancy lead to?

A

Foetal alcohol syndrome (dysmorphic features & learning difficulties)

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22
Q

What is involved in risk assessment during pre-pregnancy counselling?

A

Age
Parity
Occupation
Substance misuse

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23
Q

What are the outcomes with old and young age of pregnancy?

A

Teenagers more likely to drink and smoke and not receive ANC

>40s more likely to have pre-existing illness & higher risk of chromosomal abnormalities

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24
Q

Nulliparity/multiparity is more likely to get preclampsia

A

Nulliparity

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25
Q

Nulliparity/multiparity (+4) more likely to get PPH

A

Multiparity 4+

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26
Q

Why should occupation be assessed in risk assessment in pre-pregnancy counselling?

A

Exposure to teratogens

Not enough rest

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27
Q

What substances can cause neonatal withdrawal syndromes when used in pregnancy?

A

Heroine, methadone, diazepines

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28
Q

What drugs increase likelihood of placental abruption in pregnancy?

A

Cocaine & crack

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29
Q

Would you ever advise against pregnancy?

A

V. occasionally, e.g. aortic stenosis

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30
Q

What is PKU?

A

Inborn error of protein metabolism (inability to metabolise phenylalanine–> really high levels of phenylalanine) –> impaired mental development

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31
Q

What advice should you give a mother with PKU?

A

Ensure strict low phenylalanine diet to ensure it high levels don’t get to the developing foetal brain

32
Q

What advise should you give to a pregnant lady with hypothyroidism?

A

Demand for thyroxine goes up during pregnancy so may req. increased dose

Normal thyroxine levels req. for foetal brain development

33
Q

What advise should you give to a pregnant lady with diabetes?

A

Ensure good diabetic control prior to conception High blood sugar assoc with congenital abnormalities, still birth, macrosomia, pre-eclampsia

34
Q

What advise should you give to a pregnant lady with epilepsy?

A

Major issue is anti-epileptics

Na valproate assoc. w. higher risk of spina bifida and should be avoided in pregnancy

35
Q

If a woman has had a C-section before is it customary to have a planned elective C-section?

A

No - only after 2 C-sections it is elective

36
Q

If a woman has had a DVT in her previous pregnancy what should you do?

A

Put her on LMWH as thromboprophylaxis

37
Q

If a woman has had pre-eclampsia in her previous pregnancy what should you do?

A

Start her on low dose aspirin

38
Q

Putting on high dose folic acid/low dose aspirin may be done if there was __________________ in the previous pregnancy.

A

Pre-term delivery, IUGR, foetal abnormalities

39
Q

If baby remains breech after ____weeks offer _____.

A

36wks offer ECV (turning of baby inside tummy)

If this fails - elective C-section

40
Q

Is antenatal screening compulsory?

A

No but it is offered

41
Q

What is the aim of antenatal screening?

A

Allows conditions to be detected early in symptomless population to be treated for mother/baby

42
Q

What are all pregnant woman screened for?

A

Rubella, Hep B, syphilis, HIV

Consent req. for all screening!

43
Q

How do we test for rubella?

A

Test for rubella antibodies

44
Q

What is congenital rubella syndrome?

A

Occurs if woman is infected with rubella up to 16 weeks of pregnancy
–> mental handicap, deafness, heart defects

45
Q

If a mother is infected with Hep B what can we do?

A

Provide passive & active immunisation for the baby

46
Q

If a mother is infected with syphilis what can be do?

A

Rx with penicllin

47
Q

Untreated syphilis can have what effects on the unborn child?

A

IUGR, hepato-splenomegaly, anaemia, thrombocytopenia, skin rashes

48
Q

If a mother has HIV how can we try to prevent the child from getting it?

A

ART to reduce viral load
C-section delivery
Avoid breast feeding

49
Q

Do we screen for anaemia?

A

Iron deficiency anaemia screened for with FBC at booking & 28 weeks

50
Q

How do we treat iron deficient anaemia?

A

Iron tablets

Additional Fe req. to make extra maternal RBCs as normal adaptation of pregnancy and needed b y foetus and placenta

51
Q

What is isoimmunisation?

A

Development of Ab against blood groups

52
Q

What is rhesus dx?

A

Rhesus -ve mother carrying rhesus +ve baby will develop anti-D if foetal RBCs enter maternal circulation
Occurs with miscarriage beyond 12 weeks, ectopic pregnancy, APH & at delivery)
Ab develop at first pregnancy
In subsequent pregnancies with rh +ve babies, anti-D crosses the placenta and leads to destruction of foetal RBCs –> foetal anaemia & death

53
Q

Why do we screen for rhesus factor?

A

To identify at risk woman and give them anti-D - which destroys foetal RBCs in maternal circulation before maternal immune system can make Ab against them

54
Q

What an we do if we identify a woman with existing anti-D Abs?

A

Monitor the pregnancy more closely to detect foetal anaemia & provide Rx

55
Q

When is anti-D given to Rh-ve woman?

A

Prophylactically & after sensitising events

56
Q

What USS scans do we do in ANS?

A

First visit scan

Detailed anomaly scan

57
Q

What is the first visit scan for?

A

Ensure viable pregnancy, rule out multiple pregnancy
Identify abnormalities incompatible with life
Offer & carry out Down’s screening

58
Q

What is the detailed anomaly scan for?

A

Systemic structural review of baby

Can identify problems that need intrauterine/post-natal Rx

59
Q

What is the overall risk of Down’s syndrome?

A

1 in 700

60
Q

What is the cut off for high risk of Down’s syndrome?

A

1 in 150

Offer definitive testing in this group

61
Q

How are maternal age and Down’s syndrome linked?

A

1 in 30 risk of Down syndrome at 45y

62
Q

Apart from increased age, what increases the risk of Down’s syndrome?

A

Personal/FH of chromosomal abnormalities

63
Q

What must you make the mother/partner aware of when screening for Down’s?

A

Will only provide risk of their baby being affected

May lead to difficult decisions regarding termination of pregnancy

64
Q

When is first trimester screening carried out?

A

10-14 weeks

65
Q

What does first trimester screening involve?

A

Maternal risk factors, serum b-hCG, pregnancy associated plasma protein A (PAPP-A) & foetal nuchal translucency measurement (bigger = higher risk of Down’s)

If high risk (>1 in 150) then offer further screening (CVS, amniocentesis, NIPT)

66
Q

What is CVS?

A

Chorionic villus sampling
Sample of chorionic tissue taken and tested

Done between 10-14 weeks
1-2% risk of miscarriage

67
Q

What is amniocentesis?

A

Sample of amniotic fluid taken and tested

15 weeks onward
1% risk of miscarriage

68
Q

What is NIPT?

A

Non-invasive prenatal testing
Maternal blood taken and can detect fetal cell free DNA & check for chromosomal trisomies

Not offered on NHS
If high risk still recommend to have invasive testing to confirm

69
Q

Who is offered NDT screening?

A

Not routinely offered anymore

70
Q

If personal/HF of NTD - what are you recommended to do during pregnancy?

A

5mg folic acid to reduce risk of NDT

71
Q

In relation to NDTs what will: the first trimester US detect?

A

Anencephaly & sometimes spina bifida

72
Q

When would you carry out second trimester biochemical screening?

A

If unable to get NT measurement

Maternal serum tested for alpha fetoprotein (>2MoM high risk & warrants Ix)

73
Q

Second trimester screening at ______ USS will detect _____ of neural tube defects

A

20 weeks

>90%

74
Q

What are the USS markers for NTD?

A

Cystic areas in base of spine
Lemon shaped skull that points down at the front
Banana shaped cerebellum

75
Q

What is involved in the second trimester USS?

A

Performed with purpose of detecting foetal abnormalities

Poor at picking up chromosomal abnormalities but good at picking up major structural abnormalities

76
Q

Cleft lip/cleft palate cannot be picked up on USS.

A

Cleft palate cannot

77
Q

What may lead to difficulties in seeing the foetus properly during the second trimester USS?

A

Foetal position & maternal BMI

Reproduction (28 decks)

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