Antenatal Flashcards
What are the routine visits for low risk women?
Booking visit
Dating scan 12 weeks
Feral anomaly scan 20 weeks
36 weeks??
What time period can chorionic cilia sampling take place?
11-14 weeks
How much frolic acid should a woman take and how long for?
400 micrograms a day
For the first 12 weeks (and preconception)
What is the purpose of taking folic acid?
Prevent neural tube defects eg anencephaly and spinabifida
In a low risk pregnancy what dates are USS performed?
What is done in each scan?
12 week - early gestational age
20 week - structural fetal abrnomalities
What infections are screened for at booking?
TORCH
Bacteruria
What does TORCH stand for?
Why are they screened for?
Toxoplasmosis
Rubella
Cytomegalovirus
Herpes/HIV
Can cause congenital abnormalities
How many times should a woman’s height and weight be measured during preganancy?
Just once at booking unless there is concern about weight
What are the symptoms of preeclampsia?
Headaches (usually frontal) Visual disturbances RUQ pain Vomiting Breathless Sudden onset oedema
What is the purpose of a dating scan?
Determine gestational age
Diagnose multiple pregnancies
Confirm viability
Downs screening
The combined test for Down’s syndrome can be done in which dates?
11 weeks to 13 weeks 6 days
The combined test for Down’s syndrome involves which tests?
Nuchal translucency
bHCG
PAPPA - pregancy associated plasma protein a
What does the triple/ quadruple test measure?
bHCG
Unconjugated estriol
Alpha feroprotein
+inhibin A for quad
What age the triple or quadruple test offered?
15 weeks -20 weeks
What would make a woman high risk for neural tube defect?
How much folic acid should she take?
Previous neural tube defect Coeliac Diabetes Sickle cell Antiepileptics
How much vitamin D should women take and how long for?
10 micrograms OD
During pregnancy and breast feeding
What foods should be avoided in pregnancy?
Blue cheese/ Brie - listeria Pate -listeria Liver - too much vitamin a Raw shellfish - salmonella Caffeine - low birth weight
Where should you refer women to get more info on pregnancy?
NHS website
The pregancy book by DOH
What foods should be avoided in pregnancy?
Soft cheeses
Undercooked meat
Vitamin A
Lots of fish
Why is vitamins A supplementation not recommended in pregnancy?
It can impair folic acid absorption
What has too much vitamin A in?
Fish liver oil
Eating liver
In a woman with previous baby with neural tube defects or a woman who hasn’t taken foic acid 3 months prior to pregnancy
How much do they take?
5mg
How common is Down’s syndrome?
1:650-1000
What is the chance of miscarriage with
CVS
Amniocentesis?
2% cvs
1% amniocentesis
What is the difference between a threatened miscarriage and an antepartum haemorrhage?
Threatened is before 24 weeks and haemorrhage is after
Name some causes of antepartum haemorrhage? A
Placenta praevi Placental abruption Local bleeding from vagina/vulva Ectropion Cervical polyps
How common is placenta praevia?
1:200
If someone has a low lying placenta at 24 weeks, is this worrying?
Not really, the placenta may migrate up, only about 5% will end up with placenta praevia
What can cause placental abruption?
The cause is unknown but it is associated with
Trauma
SROM in polyhydramnios (sudden reduced pressure)
What are the risk factors for placental abruption?
Low socioeconomic class
Hypertension
Preeclampsia
Smoking
At what week gestation is the uterus normally palpable?
12-14 weeks
How many weeks is the uterus at the level of the umbilicus?
20 weeks
What signs of the abdomen do you look for in an obstetric examination?
Abdominal distension Scars Linea nigra Stiae Fetal movements
When palpating in an obstetrics examination what 3 things do you feel for?
Lie - ?longitudinal
Presentation -?cephalic/ breech
Engagement - 5ths palpable
What percentage of babies are breech at
28 weeks?
37 weeks?
30%
3%
How might antiphospholipid syndrome effect pregnanacy?
Recurrent miscarriage
IUGR
Preeclampsia
What can antiphospholipid syndrome be treated with?
Aspirin
And
Low molecular weight heparin
What antibodies are present in
Antiphospholipid syndrome?
Lupus anticoagulant
Anticardiolipin antibodies
How much is the risk of VTE in preganacy increased by?
x6
How common is a
PE
DVT
In preganacy?
0.3%
1%
What is used to treat VTE?
Low molecular weight heparin
What are the risk factors for VTE?
High parity Obesity Varicose veins Age over 35 Infection Preeclampsia Immobility (ie after c section)
Who are given anti D prophylaxis Rh -be or +be women?
Rh negative
What categories are there on the thesis system? Which predominates?
C D and E
D predominates
At what weeks gestation is anti D routinely given?
28 weeks
And
34 weeks
How quickly after a sensitising event should anti D be given?
Within 72 hours although could still have benefit 9 days later
What dose of anti d should be given after 20 weeks?
500 IU
What is the name of the test performed after birth to assess the levels of anti D antibodies in the mothers blood?
Kleihaur
What can transfer of the anti D antibodies do to the baby?
Neonatal jaundice
Neonatal anaemia - haemolytic disease of the newborn
Anaemia in utero if severe
What is the name of the test which looks for antibodies against red blood cells in the baby’s blood?
Coombs test (direct)
What does HELLP stand for?
Haemolysis
Elevated liver enzymes
Low platelet count
What may also occur in HELLP?
DIC
Liver failure
What are normal protein levels excreted in the urine did a pregnant lady?
0.3g in 24 hours
What is the triad of preeclampsia?
Hypertension
Proteinuria
Oedema
What trimester is blood pressure lowest?
Second trimester
How common is pre- eclampsia?
Severe preeclampsia?
6% of nulips
5:1000
What symptoms might be present in pre eclampsia?
Head ache
Drowsiness
Visual disturbances
Nausea / vomiting
How do you treat HELLP ?
Supportive treatment
Mg sulphate to prevent seizures
What is the main complication of pre eclampsia in relation to the fetus?
IUGR
Premature labour
Mortality
What is considered high blood pressure?
What blood pressure dictates immediate admission to hospital?
140/90
160/110
What is the first line anti hypertensive in pregnanacy?
Labetalol
What drug may also be prescribed in a wan with hypertension
Asprin if she has risk factors for pre eclampsia
What are the risks of mg sulphate?
Loss of patellar reflexes
Respiratory depression
Hypotension
Define ‘pre existing hypertension in preganancy’
BP above 140/90 before 20 weeks gestation
Where does fertilisation usually take place?
Ampulla of Fallopian tube as the egg normally waits there for up to 38 hours
Is the infundibulum lateral or medial to the ampulla of Fallopian tube?
Lateral
Is the isthmus lateral or medial to the ampulla?!
Medial
What feature on USS is used to estimate gestational age
At 10-14 weeks?
Over 14 weeks
Crown rump length
Bi parietal diameter
When is the estimated due date after LMP if regular 28 day cycle?
40 weeks after the first day of LMP
What is the risk of passing maternal rubella to the fetus in the first trimester?
In the second trimester?
80%
25%
What is the success rate of extra cephalic version?
50%
When should extra cephalic version be performed?
36 weeks for nullip
37 weeks for multip
What are the risks of extra cephalic version?
Placental abruption
Uterine rupture
Feto maternal haemorrhage
Increased risk of needing intervention when cephalic after ECV
Can extra cephalic version be performed at home?
No needs to be in hospital where there is monitoring and facilities available to deliver baby if any thing goes wrong
What are the absolute contra indications for extra cephalic version?
Antepartum haemorrhage in the last 7 days Abnormal CTG Major uterine abnormality Ruptured membranes Multiple preganacy
What are the relative contraindications for extra cephalic version?
SGA Preeclampsia Oligohydromnios Scarred uterus Unstable lie Major fetal abnormalities
Women who are at risk of pre eclampsia are advised to take aspirin, what are the tisk factors?
Previous pregnancy hypertension
Chronic kidney disease
Autoimmune disorders - SLE
Diabetes
In these women at risk of pre eclampsia when should they take aspirin?
OD
From 12 weeks till birth
