Antenatal Flashcards
When does antenatal care begin?
Preconception Folic acid 3 months prior Stabilise medical conditions Stop smoking, alcohol Weight in healthy range Avoid teratogenic drugs (AECi) Switch antihypertensives to labetolol and methydopa Pre-pregnancy counselling on antiepileptics, warfarin, lithium
In an uncomplicated pregnancy, how many contacts with the midwife/healthcare workers do you have?
Booking by 10 weeks gestation
10 appointments for nulliparous women
7 appointments for multiparous women
What is done in a booking appointment?
Vitamin D 10mcg Discussion: Food hygiene Lifestyle advice Screening tests The Pregnancy Book Antenatal classes and breastfeeding workshops
What is screened for in pregnancy?
HIV, HepB, syphilis, chlamydia for young women, NOT rubella
Group and save blood test (rhesus disease, in case of blood products later)
FBC (anaemia)
Haemoglobinopathy screen
MSU (asymptomatic infection)
20 weeks: placenta location scan, fetal anomaly scan
Glucose tolerance test if higher risk for gestational diabetes mellitus.
What is anti-D?
What else is done after trauma?
Anti-D immunoglobulin is given to women at risky events (eg road traffic accident, amniocentesis, any haemorrhage) and all women at 12 weeks.
Kleihauer test or Acid elution test, is a blood test used to measure the amount of fetal haemoglobin transferred from a fetus to a mother’s bloodstream. Used in women with Hx of trauma.
What increases maternal mortality significantly and women are asked to terminate their pregnancy?
Pulmonary hypertension
What intervention is offered to pregnant women with a high BMI?
Referred to slimming world
“pregnancy diet”
What needs to be considered in pregnant migrant women?
FGM?
Undiagnosed rheumatic fever?
What is cervical incompetence? Possible treatments?
- Screening for cervical opening/funnelling
- Cervical cerclage (stitch in cervix)
- Aram pessary
When is a C-section recommended?
Twins (depending on presentation and mother’s thoughts)
Breech presentation
Failure to progress in labour/complication
Mothers with epilepsy
Mothers with cardiovascular disease
If a mother has had a c-section in her last pregnancy, what is recommended?
Vaginal delivery
Unless due to a comorbidity
What is parvo virus?
Why is it different in pregnancy?
- Slapped cheek virus
- If primary infection during pregnancy, can cause fetal anaemia due to bone marrow suppression
- Anaemia tested for via MCA dopplers to assess relative brain arterial vasodilation
- Can be treated with blood transfer into umbilical artery or fetal peritoneum
What is antepartum haemorrhage?
Bleeding from genital tract or into genital tract after 24 weeks of pregnancy
3-5% of pregnancies
What is bleeding from/into genital tract called before 23 weeks gestation?
Threatened miscarriage
Name 7 causes of antepartum haemorrhage
- Placental abruption
- Placenta praevia
- Trauma (including sexual assault)
- Cervical ectropion/polyp/cervicitis
- Cancer
- Blood stained show (blood stained mucus from the cervical mucus plug)
- Membrane sweep from midwife at 40/41 weeks to release prostaglandins (finger inside cervix)
Define placental abruption
Premature separation of the placenta from the uterus
Blood dissects under the placenta
Types of placental abruption
Visible versus concealed
Visible: Bleeding
Symptoms: bleeding, uterine contractions and fetal distress
14 risk factors of placental abruption
- Previous abruption in previous pregnancy
- Pre-eclampsia
- Fetal growth restriction
- Malpresentation (and ECV)
- Polyhydramnos
- Advanced maternal age (over 40)
- Multiparity
- Low BMI
- IVF
- Chorioamonitis
- PROM
- Abdominal trauma
- Smoking
- Cocaine and amphetamines
Define placenta praevia
2 categories
- Placenta in lower segment of uterus (where peritoneum is not fused to uterine wall)
- Minor (does not cover internal os, more than 2cm away)
- Major (covers os, can’t delivery vaginally)
Define vasa praevia
Vessels of umbilical cord rupture near cervix
Small bleed of fetal blood
Rapid deterioration on CTG
Define placenta accreta
Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium. 3 grades according to the depth of invasion:
Accreta – chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis.
Increta – chorionic villi invade into the myometrium.
Percreta – chorionic villi invade through the perimetrium (uterine serosa).
Investigations if pt is not compromised with antepartum haemorrhage
• Pain, contractions • Quantity of bleeding • Post-coital bleeding • 20 week scan • Placental site assessment • Examine (hard wood like abdomen suggests abruption, ectropion? • CTG Blood tests: Hb, group&save, rhesus status, coagulation profile, Kleihauer test
When do you admit a pregnant lady with antepartum haemorrhage?
If more than 50ml blood
Treatment of antepartum haemorrhage
Don’t ignore someone with blood on her feet
If above 50ml, admit (? Deliver)
If above 500ml, admit, resuscitate, deliver
If above 1000ml, resuscitate, deliver C section under GA
Aim for vaginal delivery even if fetus has died
Maternal complications of antepartum haemorrhage
- Anaemia
- Shock
- Renal failure
- DIC
- Postpartum haemorrhage
- Hysterectomy (rare)
- Psychological effects
Fetal complications of antepartum haemorrhage?
- Acute fetal distress
- Anaemia
- Fetal death
- Fetal growth restriction
- Prematurity (iatrogenic/pathological)
Explain the need for anti-D
If mother does not have copy of Rh-D antigen gene they are Rh negative
if Rh negative pt has partner who is Rh positive, their offspring may be Rh positive.
if fetal blood enters maternal circulation, antibodies will develop to D-antigen
In subsequent pregnancies these Ab may cross placenta and attack fetal red cells and cause anaemia (+- stillbirth)
Anti-D immunoglobulin can prevent this and is given routinely at 28 weeks
If a patient has had 1 child born at 38 weeks, one miscarriage at 9 weeks and is pregnant, what is her GP?
G3 P1+1
When does nausea and vomiting during pregany usually resolve by?
16-20weeks
What foods should be avoided in pregnancy?
soft cheeses, unpasteurised milk, raw fish (listeria)
unwashed salad, fruit, veg, raw meat (toxoplasmosis)
shellfish, raw eggs (food poisoning)
Caffeine (limit to 300mg/day)
Dose of folic acid?
400ug OD in 1st 12 weeks
5mg if taking anti-epileptics or T1DM
Why is aspirin given to hypertensive/PET mothers in pregnancy?
To aid placental blood flow
What can be diagnosed with USS screening?
Anencephaly (cranium not formed) Congenital heart disease Ventirculomegaly Cleft lip Omphalocele/exomphalmos (midline abdominal wall defect with herniation of abdominal contents into base of umbilical cord, commonly contains liver and small bowel) Talipes
Define talipes
Talipes is a condition that can affect one or both of a baby’s feet from birth. In most cases, the front half of the foot turns inwards and downwards. This is called congenital talipes equinovarus (CTE). It is also known as club foot.
Define screening
Any testing procedure designed to separate people or objects according to a fixed characteristic or property, with the intention of detecting early evidence of disease.
