Antenatal Flashcards
Define antepartum haemorrhage
Bleeding into the genital tract from 24weeks prior to birth of baby
What are the causes of antepartum haemorrhage?
Placenta Previa
Abruptio placenta
Vasa praevia
Local causes
Antepartum haemorrhage of unknown origin
What are risk factors for antepartum haemorrhage?
> Placental abruption = previous abruption, pre-eclampsia, fetal growth restriction, PROM, polyhydramnios, intrauterine infection, abdominal trauma, smoking, drug use
placental previa = previous previa, previous c/s, previous TOP, multiple pregnancy, smoking, assisted conception
How do you assess a patient with antepartum haemorrhage?
1) assess for urgent management (ie triage)
2) if unstable - resus (monitor Bp and pulse)
3) abdominal palpation - acute abdomen/tenderness. Uterus tense/woody = abruptio. Uterus soft/non-tender = lower tract bleed eg praevia
4) speculum = ID cervical dilation, ID lower tract bleed
5) digital exam = NB not in suspiected praevia
6) u/s = can diagnose placenta praevia, can’t exclude abruptio
7) bloods
>major bleeds = FBC, coag screen, U&E, LFT, cross match, 4units of blood
>minor bleed = FBC, type and screen
8) monitor fetal HR once mom is stable. CTG
When do you administer corticosteroids?
Between 26-34 weeks if risk of preterm birth
What are the aims of antenatal care?
> screen for problems and treat
medications to improve pregnancy outcome
pregnancy risk determination
optimise comorbidities
prepare physical and psychologically for birth
provide information
If a woman comes to you and says she wants to have a baby, what do you need to consider to prepare her?
> current comorbidites (get them controlled)
current medications (adapt for pregnancy)
immunity to rubella
family history and genetic risks
mental health issues
social and economic status
use of tobacco, alcohol and drugs
occupational exposures
nutritional issues
past obs history
What increases risk for genetic disease?
> family history of genetic disease
maternal age >35 years old
exposure of fetus to alcohol/drugs
incest
mom with poorly controlled medical conditions
teratogenic medications
low folic acid/B12 levels
How do you assess the risk of the mom/pregnancy and when do you do it?
Visit 1 (booking visit)
>BANC PLUS clinic checklist to classify the patient —> if yes to any of the questions, the patient doesn’t quality for BANC PLUS and must be referred for more specialist care
>BANC PLUS checklist for follow up visits for those who qualify for BANC PLUS
Which vaccinations are safe to give during pregnancy?
> Influenza
tetanus, diphtheria, pertussis (up to 20 weeks of pregnancy)
rabies
All others = before or after pregnancy
Define premature rupture of membranes
Chorio-amniotic membrane rupture before the onset of labour before 37 weeks gestation
What are signs of chorioamnionitis?
> /=2 of the following:
Maternal pyrexia
Maternal/fetal tachycardia
Purulent vaginal discharge
Tender uterus
What is the pH of amniotic fluid?
7-7.3
What are contraindications to steroid use?
> clinical/overt chorioamnionitis
active pulmonary TB
pulmonary oedema
CI for steroids in general (herpes keratitis, peptic ulcer disease)
When are steroids repeated?
They should NOT be repeated UNLESS
>it’s been >10weeks since initial dose and
>renewed risk of imminent delivery <34weeks gestation
When do extra-precautions need to be taken when administering corticosteroids for preterm labour?
> pre-eclampsia (may develop pulmonary oedema)
women with diabetes (receive in high care setting/labour ward)
do not admin if RR >24
increased risk of postpartum sepsis if receive steroids therefore careful follow up and education of early warning signs
What is the WHO criteria for corticosteroid treatment?
> GA must be accurately determined
adequate child care available and childbirth care
preterm birth is now imminent
no evidence of maternal infection
Define prolonged pregnancy
A singleton pregnancy that lasts >/=42 weeks or >/=294 days
What are the maternal complications of prolonged pregnancy?
> labour dystocia
perineal injury
Caesarian delivery
What are the neonatal complications of prolonged pregnancy?
> macrosomnia
meconium aspiration
intrauterine infection
oligohydramnios
non reassuring CTG
low umbilical artery pH
low 5 min APGAR score
perinatal mortality
Define induction of labour
The artificial initiation of labour before its spontaneous onset to deliver the feto-placental unit
What are the contraindications to the induction of labour?
> transverse/oblique/breech lie
umbilical cord prolapse
any CI to NVD
previous classical/fundal uterine incision, placenta/vasa preavia, active genital herpes infection
without indication
IUGR with abnormal umbilical artery Doppler flow
What scoring system is used to predict how successful induction of labour will be? What factors does it include?
Bishops Score
>9 = favourable for IOL
Dilation
Effacement
Station
Consistency
Cervical position
When should you plan for delivery of a patient with pre-eclampsia?
Mild = 37 weeks gestation
Severe = 34 weeks gestation
When do you plan for delivery of a patient with chronic hypertension?
38 weeks gestation
What kind of drug is misoprostol?
Prostaglandin agonists
What is effacement?
the thinning or obliteration of tissue or narrowing of an internal anatomical space (thinning of cervix)
Define recurrent early pregnancy loss
> /=3 consecutive losses of pregnancy before 14 weeks
Define reduced fetal movements
Less than 10 movements in 12 hours
When are fetal movements initiated usually?
From 20 weeks gestation
Multiparous = 16-20 weeks
Primiparous = 20-22 weeks
Define intrauterine fetal demise
Fetal death prior to delivery, after 20 weeks (or estimated fetal weight >500g)
Define hyperemesis gravidarum
Nausea and vomiting more than 3 times a day with ketones in urine or acetone in blood (dehydration, fluid and electrolyte changes)
AND weight loss >3kg or 5% of pre pregnancy weight
How do you determine if the hyperemesis gravidarum is mild, moderate or severe?
Using the PUQE score
Mild = </= 6
Moderate = 7-12
Severe = >/=13
Danger signs of a headache
Sudden onset of severe headache “worst of my life”
New onset migrainous headache
Headache in immunosuppressed women
Worsening headaches
Different from usual headaches
Associated with fever
Altered mental status
Related to exertion
Unrelieved by pain medication
What drug can be used to help treat opiate drug dependence in a pregnant woman?
How is it given
Methadone
Initial: 15-40mg daily PO
After 1-2 days: reduce by 20% daily
Detoxification usually achieved in 10 days
How do you treat cervix neoplasm during pregnancy?
LSIL = follow conservatively with another smear in pregnancy
HSIL = colposcopy to exclude invasive cancer
>absence of visible lesion = colposcopy directed biopsy = invasive = consider cone biopsy/progress with pregnancy
Cervical cancer suggested = urgent biopsy
>treatment determined by stage, GA, type, wish of mother to continue pregnancy
What are common teratogenic drugs?
NSAIDS
Warfarin
ACE-I
Tetracyclines
Quinolones
Diuretics
Beta blockers
Lithium
Radioactive iodine
Anticonvulsants (NTD)
Methotrexate
Misoprostol
Thyroid drugs
How would you test fetal lung maturity?
> lamellar body count
surfactant/albumin ratio
lectithin/sphingomyelin ratio = confirmatory test
What is a tap test used for and how does it work?
Used to determine fetal lung maturity
> 1ml amniotic fluid + 1 drop 6NaHCl + 1,5ml diethyl ether
briskly tap creating bubbles in ether layer
mature = bubbles rise to top and break down
immature = bubbles remain stable/breakdown slowly
