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Obs & Gynae > Antenatal > Flashcards

Antenatal Flashcards

1
Q

What is due date

A

Date of LMP + 9 months + 1 week

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2
Q

When is 1st scan

A

10-14 weeks

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3
Q

What does 1st scan look at

A

Dating scan
Identify multiple
Viability
Position of baby, placenta and growth

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4
Q

How is age worked out

A

Crown rump length

- Head to buttock

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5
Q

What do you look for in scan

A

Thickening of endometrium / yolk sac = 1st sign
Gestational sac
Foetal pole
Heart beat

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6
Q

What is included in 1st scan

A

Nuchal translucency

- Collection of fluid under skin fatal neck

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7
Q

When is NT increased

A

Down’s
Cardiac
Abdo defect

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8
Q

What causes a hyperchogenic bowel

A

CF
Down’s
CMV

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9
Q

When is the 2nd scan and what is it for

A

20 weeks

Detect anomalies

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10
Q

What are lethal anomoly

A

Anencephaly
Bilateral renal agenesis
Cardiac
Trisomy 13 + 18

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11
Q

When is 3rd trimester scan offered

A

Not routine

Only if problem

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12
Q

When would a fatal ECG be carried out

A

If high risk of fatal cardiac

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13
Q

What puts you at high risk of fatal cardiac

A 
FH
High NT
Drugs in pregnancy
DM 
Monochromic twins
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14
Q

When are booking bloods done

A

8-12 weeks

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15
Q

What does booking bloods include

A 
Blood group / Rhesus 
FBC - anaemia 
Haemoglobinopathy
Infection - Rubella / VSV / Hep B / Syphillis / HIV
MSSU
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16
Q

When do you do TORCH screen

A

IUGR

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17
Q

When does 1st trimester screen occur

A

10-14 weeks

Known as combined screen

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18
Q

What does 1st screen look at

A

Maternal RF - age
bHCG
PAPPA
USS to measure Fetal NT

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19
Q

What do you do if high risk (>1in150risk)

A

No further testing but inform at delivery
Chronic villous sampling (USS guided biopsy of placental tissue)
Amniocentesis if 15+ weeks (USS guided aspiration)
Tissue then undergo karyotype
Can now do non-invasive testing

If extremely high risk may get foetal ECHO due to risk of cardiac issues at delivery

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20
Q

What are risks

A

Miscarriage

Limb defects

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21
Q

When is 2nd trimester screen

A

15-20 week

If >14 weeks = unable to get accurate NT

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22
Q

What does 2nd look a

A 
Quadrouple test 
Inhibin A
B-HCG
Estridiol 
AFP
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23
Q

What is AFP

A

Glycoprotein - liver and GI

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24
Q

When is AFP increased

A 
Neural tube
Abdo wall defect 
Malformation 
GI 
Turner
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25
Q

When is AFP decreased

A

Down’s
Edward
DM
Obesity

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26
Q

What is PAPPA

A

Produced by placenta

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27
Q

What does low levels suggest

A 
18
21
PET
IUGR
Pre-term
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28
Q

What do high levels suggest

A

Neural tube

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29
Q

What are high risk pregnancy

A 
Uterine scar
Breech
IUGR
PIH
PET
APH
Pracenta praevia
Medical illness 
Anaesthesia issue
BMI >35
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30
Q

What are other issues that put pregnancy at higher risk

A 
Teen pregnancy
Older - chromosomal 
Parity 
Occupation 
Substance misuse
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31
Q

What does nulliparity increase risk of

A

PET

Small baby

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32
Q

What does multi parity increase risk of

A

PPH

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33
Q

What is an at risk baby

A

Mother smoker
Diazepam use
Poor DM control
Poor movement

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34
Q

What do at risk babies get

A

Frequency clinics and scans

CTG if worried

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35
Q

What is routine antenatal care

A 
Enquire health and movement
BP 
Urinanalysis - send if abnormla
Abdominal palpation 
Fundal height
Ausculate heart
RF for PET
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36
Q

What do you do if IUGR / previous poor growth

A 
Growth scans 
Doppler to measure flow through umbilical cord 
Amniotic fluid index (liquor volume) 
Placental position
TORCH screen
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37
Q

What can cause IUGR

A

Smoking
Hypertension / PET
GDM
Placental insufficiency

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38
Q

If placental issue what will be shown on growth scan

A

Baby should be small
Liquor volume reduced
Doppler

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39
Q

If doppler and liquor volume normal but small baby

A

Suggest not placental issue

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40
Q

What should be done pre-pregnancy counselling and what should be avoided

A 
General health
No alcohol
Control obesity 
Smoking cessation
Folic acid 400mg
Vit D if at risk 
Psychaitic issue
Sort out drugs - DM / AED / BP / anti-coagulant
Advise maternal medical issue 
LMWH if VTE risk
Oral iron if deficiency <110
Avoid soft cheese/ raw eggs (listeria) 
Avoid undercooked poultry (salmonella) 
Avoid cooked liver / pate as high vitamin A
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41
Q

When do you start folic acid and why

A

5 mg 3 months before if high risk -
400micrograms if not
Prevent NTD - closes day 30
Take to 12 weeks

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42
Q

Who at risk of vitamin D deficiency

A

Obese
Poor diet
Asian

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43
Q

Do you screen for group B strep

A

NO

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44
Q

What puts you at higher risk of NTD (anencephaly / spieabifida)

A 
FH
Coeliac
AED
DM
Thalassaemia
Obesity
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45
Q

What is isoimmunisation

A

Development of Ab to blood group
ABO
Rhesus

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46
Q

What is Rhesus disease

A

Incompatibility to Rh +ve blood

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47
Q

How does Rhesus develop

A

Baby Rh +Ve
Mother Rh -ve
Mother develops IgG Anti-D if fetes blood enters
Known as sensitisation
In next pregnancy Ab cross placenta and destroy fatal RBC if they are +Ve leading to haemolytic disease of the newborn

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48
Q

What allows fetal blood to enter mother

A 
Micarriage
PPH 
Procedures
Childbirth 
Same can happen with blood transfusion
49
Q

What Ig crosses placenta

A

IgG

IgM stays with mother

50
Q

How will an affected fetus present

A 
Haemorrhage disease of newborn
Hydrops fetalis 
Oedema
Jaundice
Aanemia
HSM
HF
Kernicterus due to jaundice
51
Q

What causes oedema

A

Albumin falls as liver focussed on producing RBC due to hydrous fetalis

52
Q

How do you treat

A

Transfusion

Phototherapy

53
Q

When do you give Anti-D to mother ASAP but within 72 hours

A 
If mother = Rh +Ve = doesn't matter 
Rh +ve infant and -ve mother
Any termination
Miscarriage >12 weeks
Ectopic surgical Mx any age
ECV
APH
AMnocentesis
CVS
Fatal blood sampling 
Abdo trauma
54
Q

What does AntiD do

A

Prevent sensitisation by attaching to Rhesus antigen on fatal blood preventing mothers immune system recognising

55
Q

When do you screen for Anti-D Ab

A

Booking

28 weeks

56
Q

What should you do if event in 2nd / 3rd trimester >20 weeks

A

Keilhauer test

See how much fatal RBC present in circulation and to see if another dose is needed

57
Q

What should all babies born to -ve mother have

A

Cord sampling to see if Rhesus +Ve
Mother get another dose at birth if +Ve
FBC, blood group and DAT

58
Q

When is passive immunisation given

A

28 and 34 weeks

All -ve mother to destroy fatal RBC before Ab develop

59
Q

When do you give larger dose Anti-D

A

2nd / 3rd trimester event

60
Q

What is hyperemesis Gravidarum

A 
Severe vomitng in early pregnancy 
Ketosis
>5% weight loss
Dehydration
Electrolyte imbalance
61
Q

When is hyperemesis common

A

1st trimester - 6-8 weeks

May persist up to 20

62
Q

What is normal N+V in pregnancy

A

Starts 5-6 week

Resolve by 16

63
Q

What puts you at higher risk

A 
Previous HX
High bHCG
- Multiple pregnany
- Molar
Hyperthyroid
Obesity
Nulliparity
64
Q

What is Ddx of vomiting

A 
UTI
Drugs - Ax / iron
Reflux
Thyrotoxicosis
Addison's
Pancreatiits 
Small bowel obstruction
Infection 
Hypercalcaemia
Peptic ulcer
Hepatits
65
Q

What are main symptoms of hyperemeiss

A 
Severe N+V
Cannot keep food down
Ketotic 
Weight loss >5% pre-pregnancy 
Dehydration
Electrolyte imbalance
66
Q

What are other symptoms

A

Inability to swallow saliva
Reflux
Vitamin deficiency
Hyperthyroid on blood - not clinical

67
Q

What score for severity

A

PUQE

68
Q

How do you investigate

A 
Dipstick - ketones / nitrites
MSSU - underlying UTI 
Bloods - FBC, U+E, LFT 
Weight patient 
BP
USS - rule out multiple / molar
69
Q

When do you do TSH / T4

A

If no improvement in 48 hours

Raised T4 and suppressed TSH

70
Q

LFT

A

Abnormal 50%
Raised bilirubin / AAT
Low albumin

71
Q

What is increased in dehydration

A

Haematocrit

Specific gravity on dip

72
Q

How do you monitor

A

U+E alternate days if abnormal or weekly
Urinanlysis
Weight

73
Q

What do you do as VTE prophylaxis

A

TED
LMWH
If in hospital

74
Q

What is 1st line for N+V

A

Anti-histmaine anti-emetic

  • Prochlorperazine
  • Cyclizine = 2nd line
75
Q

What is 2nd line

A

Other anti-emetic

  • Ondanstron
  • Metoclopramide - short term use only as risk of extra-pyramidal
76
Q

When should you admit

A

Unable to tolerate oral anti-emetic / oral fluid
Dehydration / electrolyte imbalances due to persistent vomiting
Wernicke’s
Ketones present
Co-morbid e.g. DM which can be affected by N+V
Failed RX

77
Q

What do you do if admitted

A 
IV fluid (saline / Hartman) according to daily U+E
\+- Kcl if hypokalaemia 
IV anti-emetic 
IV vit B/C (Paprinex) if Weirnecke
VTE prophylaxis
78
Q

When do you refer to dietician

A

48 hours

79
Q

What do you do for reflux

A

Elevate head
Frequent small meal
Alginate
Antacid

80
Q

What are alternative therapies

A

Ginger
B6
Acupuncture

81
Q

If >3 days what should you consider

A 
Change anti-emetic
Ranitidine for reflux
Vitamin injections 
Steroids as last resort
NG / NJ / TPN if >10%
82
Q

What anti-emetic if others tried

A

Aldonzartone but effects fetes

83
Q

Complications

A 
LBW / pre-term due to weight loss 
Mallory Weiss 
Wernicke - due to B1
Central pontine myelysis 
Acute tubular necrosis
VTE due to dehydration
84
Q

What is CI

A

Dextrose

Precipitate Wernicke and worsen hyponatraemia

85
Q

How does hypokalamiea present

A

Muscle weakness

Tetany

86
Q

How does Wernicke present

A

Ataxia
Confusion
Opthalmophlegia
Fetal death

87
Q

How do you treat

A

Thiamine

88
Q

What can Wrnicke progress to

A

Korsakoff’s
Retrograde amnesia
Recovery less likely

89
Q

What causes still birth

A

Infection
Placental / cord issue
APH

90
Q

What main cause of death <5

A 
Pre-term
Malformation
Pneumonia
Birth asphyxia
Infection
Malaria
Malnutrition
91
Q

What main case of maternal mortality

A 
Sepsis
Pulmonary odema 
Thrombosis
Unsafe abortion
Obstruction in labour
Maternal disorder
92
Q

Direct cause

A

Obstetric up to 6 weeks post partum

93
Q

Indrirect

A

Due to disorder worsened by pregnancy

94
Q

Down syndrome Antenatal Testing

A 
Low PAPPA
Low AFP 
Low oestrodiol
High bHCG
High inhibin A 
Thick NT
95
Q

What cause oligohydramnios

A 
PPROM
Renal agenesis - decreased urine
IUGR
PET - decreased perfusion
Post term 
NSAID
96
Q

What is oligohydramnios

A

<500ml at 32-36 weeks

AFI <5th percentile

97
Q

What is associated with oligohydramios

A

Pulmonary hypoplasia

98
Q

What causes polyhydramnios

A

Twins due to TTTS
DM
Anencephaly
Oesophageal atresia - unable to swallow

99
Q

If women found to be iron deficient in pregnancy

A

Start oral iron

100
Q

What if normal Hb but low ferritin

A

Start oral iron

101
Q

If B12 deficient

A

Test for pernicious anaemia
If Ab present = B12 injections
If no Ab present but mild anaemia suggesting diet = oral B12

102
Q

If found to be folate deficient

A

Take 5mg instead of 400mcg

103
Q

What can cause SGA

A

Constitutional - mother small
IUGR
Genetic / structural
Multiple pregnancy

104
Q

What does IUGR suggest

A

Reduced O2 / nutrients to baby due to pathology

105
Q

What will also be seen if IUGR

A

Reduced liquor volume
Abnormal doppler
Reduced fetal movement
Abnormal CTG

106
Q

What can lead to IUGR

A 
PET
Smoking
Alcohol
Anaemia 
Malnutrition
INfection
107
Q

What are RF for SGA

A 
Previous
Obesity
Smoking
DM
Hypertension
PET
Anti-phospholipid
Older mother
Low PAPPA
APH
Multiple pregnancy
108
Q

How do you manage

A

Investigate for cause
Careful monitoring - USS for growth and liquor, doppler
Paeds at birth of baby

109
Q

What causes LGA

A 
Constitutional 
DM 
Previous macrosomia
Maternal obesity
Overdue
Male
110
Q

What are risks to mother

A 
Shoulder dystocia
Failure to progress
Tears 
C-section
PPH
Uterine rupture
111
Q

What are risks to baby

A

Birth injury from shoulder dystocia
Neonatal hypoglycaemia
Obesity

112
Q

What do SGA have risk of in later life

A

Hypertension

DM

113
Q

What can twins be

A 
Monozygotic - 1 zygote / ovum
Dizygotic - 2 zygotes / ovum 
Monoamniotic - 1 amniotic sac 
Diamniotic - two amniotic sacs 
Monochorionic - 1 placenta 
Dichorionic - two placenta
114
Q

If twins what antenatal care

A 
Folic 5mg
Iron supplement 
Vit D
Regular scans for growth / TTS
Induction at 37-38 for diamniotic 
Steroids prior to delivery
115
Q

What are delivery options

A 
Monoamnitoic = C-section at 32-34 weeks
Diamniotic = aim 37-38, C-section if not cephalic
116
Q

What are complications of twins

A 
Anaemia
Polyhydramnios
Hypertension
IUGR
Pre-mature
Malpresentation
Congenital malformation 
TTTS

Mother
PPH
PET
HYyperemsis

117
Q

What is TTTS

A

Connection between blood supply of twins
One gets most of blood and become overloaded / plethoric = more dangerous
Other gets anaemia
May need laser to destroy

118
Q

What vaccines in pregnancy

A

Influenza

Pertussis

Obs & Gynae (23 decks)

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