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Year 4 Family and Children ANNA > Antenatal > Flashcards

Antenatal Flashcards

1
Q

What is the normal daily dose of folic acid required in pregnancy?

A

400 micrograms

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2
Q

What is the higher dose of folic acid required in some pregnancies?

A

5mg

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3
Q

When might you need a higher dose of folic acid?

A
  1. Previous pregnancy with NTD
  2. Mother/Father/family Hx of NTD
  3. Anti-epileptic medication
  4. Diabetes
  5. Obesity
  6. Bowel conditions
    1. Coeliac disease
    2. Crohn’s
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4
Q

When is folic acid supplementation most important?

A

Before conception and within the first 12 weeks

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5
Q

Intake of this vitamin above 700micrograms daily is teratogenic

A

Vitamin A

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6
Q

What are the advised daily supplement levels of vitamin D in pregnancy?

A

10 micrograms

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7
Q

What foods place a pregnant woman at risk of food-acquired infections and should be avoided?

A

Listerosis:

  • Un-pasturised milk
  • Pate of any kind
  • Ripened soft cheese such as Camembert, Brie and blue‑veined cheese (there is no risk with hard cheeses, such as Cheddar, or cottage cheese and processed cheese)
  • Undercooked / uncooked ready made meals

Salmonella:

  • avoiding raw or partially cooked eggs or food that may contain them (such as mayonnaise)
  • avoiding raw or partially cooked meat, especially poultry.
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8
Q

Is alcohol consumption safe in pregnancy?

A

No!

  • Risk of developing ‘fetal alcohol spectrum disorders’ (FASD)
  • FAS (fetal alchol syndrome) is a serious condition that can cause:
    • Growth restriction
    • Facial abnormalities
    • Learning / behavioural disorders
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9
Q

What is Naegele’s rule?

A

How to calculate due date from last mestrual period:

LMP + 1 year and 7 days - 3 months

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10
Q

What do the letters stand for in:

gravida x, para a + b

A

x = total number of pregnancies (incl. current)

a = births after 24 weeks

b = miscarriages or terminations before 24 weeks

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11
Q

What is the Family Origin Questionnaire (FOQ) used for?

A

To help interpret results for women at increased risk of carrying haemoglobin varient genes e.g. thalassaemia and sickle cell

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12
Q

What conditions is the fetus at increased risk of if the mother smokes? x 5

A
  1. premature birth
  2. low birth weight
  3. sudden infant death syndrome (SIDS), also known as cot death
  4. miscarriage
  5. breathing problems or wheezing in the first 6 months of life
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13
Q

What risks does being overwieght pose in pregnancy?

A
  • Gestational diabetes
  • HTN
  • Clots
  • Miscarriage
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14
Q

When should you do the OGTT for GDM?

When should you repeat?

A

26-28 weeks

Repeat if concerns around 24 Months

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15
Q

What fasting blood sugar is defined as definate GDM?

What 2 hour test is diagnostic of GDM?

A

Fasting = 5.5 +

2 hour = 7.8

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16
Q

what extremes of age are at increased risk in pregnancy?

A

Below 18

Above 40

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17
Q

What blood tests are included in the booking appointment with midwife?

A
  • FBC:
    • Hb
    • Platelets
  • Blood group and antibody status
  • Infections:
    • HIV
    • Hep B
    • Syphilis
  • If FOQ indicates then sickle cell and thalassaemia
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18
Q

What blood tests are combined with the nuchal translucency to give a Down’s Risk?

A

PAPP-A and HCG

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19
Q

If NT is unavailable, what 4 “quad” tests are used instead?

A
  1. AFP,
  2. Inhibin A,
  3. Oestriol
  4. Beta-HCG
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20
Q

Rh positive pregnancies in Rh negative mothers are at risk in this pregnancy. True or false?

A

False - they are at risk in the second pregnancy. Anit-Resus antibodies are given at 28 weeks

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21
Q

Which women are at high risk of pre-eclampsia?

A
  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome
  • type 1 or type 2 diabetes
  • chronic hypertension.
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22
Q

What preventative treatment is given for those at risk of pre-eclampsia?

A

75-150mg aspirin daily

week 12 → birth

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23
Q

What are the symptoms of pre-eclampsia?

A
  1. Headache
  2. Blurred / disturbed vision
  3. Vomiting
  4. Severe epigastric pain
  5. Sudden swelling of feet/hands/face
24
Q

What are the moderate risk factors for pre-eclampsia?

(woman will have to have more than one to be put on prophylactic aspirin)

A
  • first pregnancy
  • age 40 years or older
  • pregnancy interval of more than 10 years
  • body mass index (BMI) of 35 kg/m2 or more at first visit
  • family history of pre-eclampsia (1st degree relative)
  • multi-fetal pregnancy.
25
If urine dipstick is positive for protienuria, which test should you do next?
Albumin:creatinine ratio (\>30 is bad) Or protein:creatinine ratio (\>8 is bad)
26
What test is used to confirm pre-eclampsia? When is it used in genstation?
PlGF = placental growth factor Used between 20 - 35 weeks
27
What BP should be aimed for in HTN women?
\< 135 / 85 mmHg
28
What BP is concerning for pre-eclampsia?
\>160mmHg systolic
29
What does low PAPP-A indicate when found alone (not with NT)?
Possible small baby / poor growth
30
When should you test FBC for anaemia in pregnant women?
at booking and at 28wks
31
What is a low Hb in pregnancy: 1st trimester? 2nd trimester? 3rd trimester?
1st trimester: \<110g/L 2nd and 3rd: \<105 g/L
32
What is anaemia in Hb in non-pregnant women?
\<120g/L
33
If a pregnant woman is anaemic, what tests are used to confirm iron-deficiency anaemia?
1. Oral iron. If ↑ is seen in Hb after 2 weeks this is a positive result 2. Ferratin
34
What is given to the mother if she has **severe** **hypertension** or **severe pre**-**eclampsia** or previously had an **eclamptic fit?**
Magnesium sulphate, IV, to stabilise the brain
35
What 4 haematological changes are normal in pregnancy but might skew blood results?
1. **Physiological anaemia of pregnancy** 1. *Plasma volume increases by 50% above the non-pregnant value by the late second trimester. Red cell mass only increases by 25–30%, resulting in a fall in Hb concentration* 2. **Gestational thrombocytopenia** 1. *Up to 10% of healthy pregnant women have a count below the non-pregnant reference range of 150–400×109/L at term* 2. *The count rarely falls below 100×109/L and there is no increase in bleeding risk.* 3. **Hypercoagulability** 1. ***​** Many coagulation factors, including plasma fibrinogen and Factor VIIIc, are increased in normal pregnancy and the anticoagulant factor Protein S is reduced.* 4. **Raised WCC** 1. *​Raised from 6000 to 16000 in 2nd/3rd trimester*
36
How does pre-eclampsia occur?
37
What are the signs of magnesium toxicity?
- Loss of tendon reflexes (due to neuromuscular blockade) - Respiratory depression - Cardiac Arrest
38
What is a normal weight gain in pregnancy?
10-15kg
39
What are the common physiological changes in pregnancy? 1. Musculoskeletal 2. CV 3. Blood 4. Respiratory 5. Gynae 6. Renal 7. GI
1. Musculoskeletal * W/G 10-15 kg * Lordosis * Lower back pain * Sciatica * Carpal tunnel * Calf cramp 2. CV * ↑ CO, HR and SV * ↓ Peripheral resistance → ↓BP 3. Blood * 40% ↑ plasma volume but * only 20% ↑ in RBC * therefore anaemia * ↑ clotting factors (risk DVT) 4. Respiratory * ↑ Tidal vol, RR, Diaphragmatic breathing 5. Gynae * Uterine hypertrophy * Breast * enlargement * aereolar pigmentation * Mucus plug * Lactobacilli 6. Renal * ↑ blood flow → ↑ urine output 7. GI * constipation * reflux * haemorrhoids
40
What is placenta praevia?
Literally "placenta first". Placenta obstructs part or whole internal cervical os. Could block baby's exit, cause heavy bleeding or both. If found near term (36 weeks) requires C-Section.
41
What are the grades of placenta praevia?
1 (best) → 4 (worst)
42
What is the most accurate diagnostic tool for placenta praevia?
Transvaginal ultrasound
43
what is the average blood volume of a pregnant woman?
6-8L
44
how much blood does the uterus receive a minute?
700ml
45
In the third trimester, what are the 3 groups of causes of antepartum haemorrhage?
1. lower ano-genital tract (cervix - vaginal opening + anus) 2. Placenta / uterus 3. Unexplained (diagnosis of exclusion)
46
what are the 3 causes of placental bleeding in later pregnancy?
1. Placenta praevia 2. Placenta abruption 3. Vasa praevia
47
What is vasa praevia?
rare condition in which the umbilical cord inserts above the membranes of the placenta not into it
48
Name some lower anogenitary causes of bleeding in pregnancy
* Post-coital cervical trauma (ectropion) * Anal fissures * Cervical dilation * Cancer * Thrush
49
What does the Kleihauer test look for?
Fetal RBCs in maternal blood - to see if more anti-D is needed \> 5ml estimated fetal-maternal haemorrhage then more anti-D is required
50
What is a "wooden", rigid uterus a sign of ?
Placental abruption
51
Why is a bimanual exam sometimes risky in antenatal bleed?
Risk of damaging placenta if praevia
52
When should you give anti-D? how much?
When mother is resus negative, and when there is a sensitising event e.g. bleed \>20weeks then 500 units (+whatever kleihauer tells you to add)
53
What is defined as primary PPH? Secondary? How much blood loss is PPH?
Primary \<24hrs Secondary 24hrs - 12 weeks 500ml vaginal, 1000-1500ml CS
54
What are your treatment options for PPH?
1. A-E resuscitation 2. ID the cause 3. Treat the cause: 1. sutre tears 2. remove retained products 4. Use uterotonic drugs to promote contractions
55
When would you use hysterectomy as treatment for PPH?
If you can't stop the bleeding or if you have found placenta accreta
56
what are the 3 main causes of primary PPH?
1. Uterine atony (most) 2. Vaginal trauma 3. Placental 1. Retained products 2. Placenta accreta
57
what are the 3 types / severities of placenta accreta?
1. Accreta 2. Increta 3. Percreta

Year 4 Family and Children ANNA (23 decks)

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