Antenatal Flashcards
Antenatal medicine
When is it recommended for a female to take folic acid tablets?
When they start trying to conceive and for the first 12 weeks of pregnancy
Why is folic acid intake important for expectant mother’s?
It decreases the risk of neural tube defects such as spina bifida and cleft palate as well as helping to produce RBC
What is the normal dose recommended for folic acid?
400 micrograms daily
Which group of women is it recommended take 5mg of folic acid daily?
Previous pregnancy with NTD, family history of NTD, anti-eplieptic medication, diabetes, bowel disease, obesity
How many appointments will a nulliparous woman have for an uncomplicated pregnancy?
10
How many appointments will a parous woman have for an uncomplicated pregnancy?
7
Why should pregnant women avoid liver?
it contains high levels of vitamin A which could be teratogenic if intake above 700 micrograms
How much is the recommended supplement of vitamin D?
10 micrograms daily
Which groups of women is it vital to recommend vitamin D supplement?
Those with dark skin or with limited exposure to sunlight (housebound, skin covered for cultural reasons)
Which foods should pregnant women avoid to reduce the risk of listeriosis?
unpasteurised milk
camembert, brie and blue-veined cheeses
any type of pate
uncooked or underprepared ready meals
Which foods should pregnant women avoid to reduce the risk of salmonella?
raw or partially cooked eggs or meat especially poultry and mayonnaise
What are the recommendations regarding alcohol consumption during pregnancy?
No safe limit
Increased risk of miscarriage in the first trimester
Binge drinking (>5 drinks on one occasion) maybe harmful to unborn baby
How should a pregnant woman wear a three point seatbelt?
Above and below the bump, not over it
Which interventions appear to be effective in reducing symptoms of morning sickness?
ginger
P6 (wrist) acupressure
antihistamines
What is the normal range of haemoglobin levels for pregnant women?
110g/L at first contact
105g/L at 28 weeks
If the woman is identified as a carrier of a clinically significant haemoglobinopathy what is the recommendation?
The father should be offered counselling and appropriate screening without delay
What are the four options to be discussed with the woman regarding the anomaly scan to enable an informed choice?
Reproductive choice
Parents to prepare
Managed birth at specialist centre
Intrauterine therapy
What is included in a ‘combined test’?
nuchal translucency
beta-human chorionic gonadotrophin
pregnancy-associated plasma protein-A
Which strain of hepatitis should be serologically screened for in pregnancy?
Hepatitis B
so that effective postnatal interventions can be offered to reduce the risk of mother to child transmission
What are the five primary prevention measures to avoid toxoplasmosis infection for pregnant women?
Washing hands before handling food
Thoroughly washing all fruit and veg, including pre-prepared salads
Thoroughly cooking raw meats and ready meals
Wearing gardening gloves and thoroughly washing hands after handling soli
Avioding cat faeces in cat litter and soil
Name 5 of the 9 risk factors for pre-eclampsia
Aged 40 or above Nulliparity Pregnancy interval greater than 10 years Family history Previous history BMI 30kg/m2 and above Pre-existing vascular disease Pre-existing renal disease Multiple pregnancy
What are the main 5 symptoms of pre-eclapsia?
Severe headache
Problems with vision (blurring or flashing lights)
Severe pain just below the ribs
Vomiting
Sudden swelling of the face, hands or feet
Which age groups are at higher risk of having problems with the grow of their baby?
less than 18
more than 40
What are the 3 main risks identified from the family origin questionnaire?
Diabetes
Haematological disorder such as Thalassaemia or Sickle Cell Disease
FGM
What events in a previous pregnancy can impact a current one?
Prematurity
Fetal growth restriction
Antepartum haemorrhage
Gestational hypertension, pre-eclampsia, diabetes, thrombocytopenia
Assisted delivery, c section, forceps, ventouse
PPH
Previous stillbirth, late miscarriage or neonatal death
3rd or 4th degree tear
Family history is associated with which risks in pregnancy?
First degree relative with diabetes increases risk of gestational diabetes
First degree relative with gestational hypertension or pre-eclampsia is at increased risk
Why is social history so important during antenatal booking?
Women are most vulnerable when pregnant
Women who do not usually engage with services are in contact with medical or midwifery services.
It is an important time to identify domestic abuse, homelessness, addiction, or financial problems
Which blood tests are taken at the booking appointment?
Haemoglobin level Platelets Infections - HIV, syphilis, Hepatitis B Blood group and antibody status Sickle cell & thalassaemia if indicated by FOQ
When is the dating ultrasound scan usually performed?
Between 8 to 14 weeks
Which factors are considered to give a predicted risk of the baby having down syndrome?
Size of nuchal fold combined with blood test, maternal age and some other factors
The quad test can be carried out between 14-20 weeks, what does it include?
Blood test for Alpha-fetoprotein, Inhibin A, Oestriol and Beta-HCG
What are the diagnostic tests for T21?
Chorionic villous sampling
Amniocentesis
When is the anomaly screening ultrasound scan usually performed?
Between 18-21 weeks
What are the 6 risk factors for gestational diabetes?
BMI>30 Ethnicity First degree relative with DM PCOS Previous baby >4.5kg (9lb 15) Previous gestational diabetes
Under which circumstances is a baby’s blood tested at birth and why?
If the mother is Rh-ve, she is at risk of Rhesus disease if her baby is Rh+ve
Rhesus disease will affect future pregnancies unless prophylactice Anti-D is injected
Which of the following is diagnostic for gestational diabetes? A - Fasting glucose >3.5 B - Fasting glucose >2.5 C - 2 hour glucose >6.0 D - 2 hour glucose >7.8
D
Which of the following is not a physiological change observed in early pregnancy? A - Increased cardiac output B - Reduction in blood pressure C - Reduction in clotting factors D - Increase in red cell volume
C
How and when would you screen for gestational diabetes?
GTT between 26-28 weeks
