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Year 4 Family and Children ANNA > Antenatal > Flashcards

Antenatal Flashcards

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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
Q

If urine dipstick is positive for protienuria, which test should you do next?

A

Albumin:creatinine ratio (>30 is bad)

Or

protein:creatinine ratio (>8 is bad)

26
Q

What test is used to confirm pre-eclampsia?

When is it used in genstation?

A

PlGF = placental growth factor

Used between 20 - 35 weeks

27
Q

What BP should be aimed for in HTN women?

A

< 135 / 85 mmHg

28
Q

What BP is concerning for pre-eclampsia?

A

>160mmHg systolic

29
Q

What does low PAPP-A indicate when found alone (not with NT)?

A

Possible small baby / poor growth

30
Q

When should you test FBC for anaemia in pregnant women?

A

at booking and at 28wks

31
Q

What is a low Hb in pregnancy:

1st trimester?

2nd trimester?

3rd trimester?

A

1st trimester: <110g/L

2nd and 3rd: <105 g/L

32
Q

What is anaemia in Hb in non-pregnant women?

A

<120g/L

33
Q

If a pregnant woman is anaemic, what tests are used to confirm iron-deficiency anaemia?

A
  1. Oral iron. If ↑ is seen in Hb after 2 weeks this is a positive result
  2. Ferratin
34
Q

What is given to the mother if she has severe hypertension or severe pre-eclampsia or previously had an eclamptic fit?

A

Magnesium sulphate, IV, to stabilise the brain

35
Q

What 4 haematological changes are normal in pregnancy but might skew blood results?

A
  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
Q

How does pre-eclampsia occur?

A
37
Q

What are the signs of magnesium toxicity?

A
  • Loss of tendon reflexes (due to neuromuscular blockade)
  • Respiratory depression
  • Cardiac Arrest
38
Q

What is a normal weight gain in pregnancy?

A

10-15kg

39
Q

What are the common physiological changes in pregnancy?

  1. Musculoskeletal
  2. CV
  3. Blood
  4. Respiratory
  5. Gynae
  6. Renal
  7. GI
A
  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
Q

What is placenta praevia?

A

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
Q

What are the grades of placenta praevia?

A

1 (best) → 4 (worst)

42
Q

What is the most accurate diagnostic tool for placenta praevia?

A

Transvaginal ultrasound

43
Q

what is the average blood volume of a pregnant woman?

A

6-8L

44
Q

how much blood does the uterus receive a minute?

A

700ml

45
Q

In the third trimester, what are the 3 groups of causes of antepartum haemorrhage?

A
  1. lower ano-genital tract (cervix - vaginal opening + anus)
  2. Placenta / uterus
  3. Unexplained (diagnosis of exclusion)
46
Q

what are the 3 causes of placental bleeding in later pregnancy?

A
  1. Placenta praevia
  2. Placenta abruption
  3. Vasa praevia
47
Q

What is vasa praevia?

A

rare condition in which the umbilical cord inserts above the membranes of the placenta not into it

48
Q

Name some lower anogenitary causes of bleeding in pregnancy

A
  • Post-coital cervical trauma (ectropion)
  • Anal fissures
  • Cervical dilation
  • Cancer
  • Thrush
49
Q

What does the Kleihauer test look for?

A

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
Q

What is a “wooden”, rigid uterus a sign of ?

A

Placental abruption

51
Q

Why is a bimanual exam sometimes risky in antenatal bleed?

A

Risk of damaging placenta if praevia

52
Q

When should you give anti-D?

how much?

A

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
Q

What is defined as primary PPH?

Secondary?

How much blood loss is PPH?

A

Primary <24hrs

Secondary 24hrs - 12 weeks

500ml vaginal, 1000-1500ml CS

54
Q

What are your treatment options for PPH?

A
  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
Q

When would you use hysterectomy as treatment for PPH?

A

If you can’t stop the bleeding or if you have found placenta accreta

56
Q

what are the 3 main causes of primary PPH?

A
  1. Uterine atony (most)
  2. Vaginal trauma
  3. Placental
    1. Retained products
    2. Placenta accreta
57
Q

what are the 3 types / severities of placenta accreta?

A
  1. Accreta
  2. Increta
  3. Percreta

Year 4 Family and Children ANNA (23 decks)

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