Ante-natal care of normal pregnancy Flashcards
What is trisomy
Extra copy of a chromosome
What is antenatal care for
Used to detect early signs of complications
Educating pregnant women
What does adding folic acid supplementation do during pregnancy
Neural tube is the embryonic precursor to the CNS. Closes by day 28. Folic acid supplemnetation reduces the risk of neural tube defects
How much folic acid is given to pregnant women
400mcg daily
High risk groups are given 5mg daily
What are high risk groups in pregnant women
Diabetes
BMI>30
Sickle cell
History of child with NTD (neural tube defect) or family with NTD
Anti-epileptic medications
Methotrexate
What does a vitamin D deficiency result in
Rickets in children
Osteomalacia in adults
Neonatal tetany in babies
How much vitamin D should be given to pregnant women
10mcg daily high risk groups
What screening tests are done before 10 weeks pregnancy
Sickle cell
Thalassaemia (not enough haemoglobin production)
What screening tests are done weeks 8-10 in pregnancy
HIV
Hepatitis B
Syphilis
Blood group and rhesus status
What screening tests are done in weeks 11-14 in pregnancy
Down’s (trisomy 21)
Edward’s (trisomy 18). Most babies with this will not live
Patau’s (trisomy 13)
How are trisomies screened for and what are they
Combined test
- 10-14 weeks
- Blood test and ultrasound to measure nuchal translucency (size of the normal fluid filled space at back of fetal neck)
Diagnostic test
- Amniocentesis (from 15 weeks)
- CVS (from 11-14 weeks)
What is the downside of combined test used to screen for trisomies
Has a poor detection rate. Lots of false negatives, high false positive rates
What is non-invasive prenatal testing used for and how
When is it able to be done
screening for trisomies
Works by analysing the DNA fragments present in the maternal blood during pregnancy
Most comes from the mother, but around 10-20% of it comes from the placenta, which is representative of the unborn baby
Can be measured at 7 weeks gestation
How can you prevent rhesus disease
Give mother Anti Rh immunoglobulin
This mops up any fetal rhesus D antigens and prevents sensitisation
When is Anti D prophylaxis given
ONCE at 28 weeks
TWICE at 28 weeks and 34 weeks
PLUS
With any potentially sensitising event
After delivery
How is congenital syphiis preventable
Single dose of IM penicillin
When is risk of vertical transmission of Hep B high
If HBeAf positive
How to manage infants born to HepB infectious mothers
Vaccinated, often in combination with HBV specific immunoglobulin. This reduces vertical transmission
Consequences of smoking during pregnancy
Premature births Miscarriages 300 perinatal deaths Low birth weight Respiratory conditions Diabetes Obesity Problems of ear, nose and throat
How to manage smoking in pregnancy
Behavioural interventions; nicotine replacement therapy
Electronic cigarettes
What is pre-ecmalpsia
Condition arising only after 20 weeks
It is combination of hypertension and proteinuria
Complications of pre-eclampsia in mother and fetus
Maternal; fits; HEELP syndroms; stroke; liver failure; renal failure; pulmonary oedema
Fetal; growth restriction; stillbirth; prematurity
Prevention of pre-eclampsia
Low dose aspirin 75mg daily
High risk factors for pre-eclampsia
Hypertension in previous pregnancy CKD Autoimmune disease Type 1 or 2 diabetes Chronic hypertension
Moderate risk factors for pre-eclampsia
First pregnancy Age 40 or older Pregnancy interval> 10 years BMI> 35 Family history of pre-eclampsia Multiple pregnancy
How to screen for gestational diabetes
Treatment?
Screen high risk groups with oral glucose tolerance test
-Most women treated with dietary changes. Some require metformin and/or insulin
Complications of gestational diabetes in mother
Pre-ecmaplsia
Polyhydramnios (excess of amniotic fluid which can cause fetal malposition and maternal respiratory compromise)
Prolonged labour
Obstructed labour
Caesarean section
Uterine atony (uterus fails to contract after childbirth which can cause postpartum haemorrhage)
Postpartum haemorrhage
Complications of gestational diabetes in fetus
Congenital abnormalities
FETAL MACROSOMIA (a baby over 8lb)
Stillbirth
Birth injuries
Neonatal hypoglycaemia
What is fetal growth restriction majority due to
Placental dysfunction
How to surveil a pregnancy
Measure size of uterus with a tape measure
Measure BP and test urine for proteinuria and glycosuria
Listen to baby’s heartbeat if mum wants to
