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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
When is AFP decreased
Down's Edward DM Obesity
26
What is PAPPA
Produced by placenta
27
What does low levels suggest
``` 18 21 PET IUGR Pre-term ```
28
What do high levels suggest
Neural tube
29
What are high risk pregnancy
``` Uterine scar Breech IUGR PIH PET APH Pracenta praevia Medical illness Anaesthesia issue BMI >35 ```
30
What are other issues that put pregnancy at higher risk
``` Teen pregnancy Older - chromosomal Parity Occupation Substance misuse ```
31
What does nulliparity increase risk of
PET | Small baby
32
What does multi parity increase risk of
PPH
33
What is an at risk baby
Mother smoker Diazepam use Poor DM control Poor movement
34
What do at risk babies get
Frequency clinics and scans | CTG if worried
35
What is routine antenatal care
``` Enquire health and movement BP Urinanalysis - send if abnormla Abdominal palpation Fundal height Ausculate heart RF for PET ```
36
What do you do if IUGR / previous poor growth
``` Growth scans Doppler to measure flow through umbilical cord Amniotic fluid index (liquor volume) Placental position TORCH screen ```
37
What can cause IUGR
Smoking Hypertension / PET GDM Placental insufficiency
38
If placental issue what will be shown on growth scan
Baby should be small Liquor volume reduced Doppler
39
If doppler and liquor volume normal but small baby
Suggest not placental issue
40
What should be done pre-pregnancy counselling and what should be avoided
``` 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 ```
41
When do you start folic acid and why
5 mg 3 months before if high risk - 400micrograms if not Prevent NTD - closes day 30 Take to 12 weeks
42
Who at risk of vitamin D deficiency
Obese Poor diet Asian
43
Do you screen for group B strep
NO
44
What puts you at higher risk of NTD (anencephaly / spieabifida)
``` FH Coeliac AED DM Thalassaemia Obesity ```
45
What is isoimmunisation
Development of Ab to blood group ABO Rhesus
46
What is Rhesus disease
Incompatibility to Rh +ve blood
47
How does Rhesus develop
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
48
What allows fetal blood to enter mother
``` Micarriage PPH Procedures Childbirth Same can happen with blood transfusion ```
49
What Ig crosses placenta
IgG | IgM stays with mother
50
How will an affected fetus present
``` Haemorrhage disease of newborn Hydrops fetalis Oedema Jaundice Aanemia HSM HF Kernicterus due to jaundice ```
51
What causes oedema
Albumin falls as liver focussed on producing RBC due to hydrous fetalis
52
How do you treat
Transfusion | Phototherapy
53
When do you give Anti-D to mother ASAP but within 72 hours
``` 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
What does AntiD do
Prevent sensitisation by attaching to Rhesus antigen on fatal blood preventing mothers immune system recognising
55
When do you screen for Anti-D Ab
Booking | 28 weeks
56
What should you do if event in 2nd / 3rd trimester >20 weeks
Keilhauer test | See how much fatal RBC present in circulation and to see if another dose is needed
57
What should all babies born to -ve mother have
Cord sampling to see if Rhesus +Ve Mother get another dose at birth if +Ve FBC, blood group and DAT
58
When is passive immunisation given
28 and 34 weeks | All -ve mother to destroy fatal RBC before Ab develop
59
When do you give larger dose Anti-D
2nd / 3rd trimester event
60
What is hyperemesis Gravidarum
``` Severe vomitng in early pregnancy Ketosis >5% weight loss Dehydration Electrolyte imbalance ```
61
When is hyperemesis common
1st trimester - 6-8 weeks | May persist up to 20
62
What is normal N+V in pregnancy
Starts 5-6 week | Resolve by 16
63
What puts you at higher risk
``` Previous HX High bHCG - Multiple pregnany - Molar Hyperthyroid Obesity Nulliparity ```
64
What is Ddx of vomiting
``` UTI Drugs - Ax / iron Reflux Thyrotoxicosis Addison's Pancreatiits Small bowel obstruction Infection Hypercalcaemia Peptic ulcer Hepatits ```
65
What are main symptoms of hyperemeiss
``` Severe N+V Cannot keep food down Ketotic Weight loss >5% pre-pregnancy Dehydration Electrolyte imbalance ```
66
What are other symptoms
Inability to swallow saliva Reflux Vitamin deficiency Hyperthyroid on blood - not clinical
67
What score for severity
PUQE
68
How do you investigate
``` Dipstick - ketones / nitrites MSSU - underlying UTI Bloods - FBC, U+E, LFT Weight patient BP USS - rule out multiple / molar ```
69
When do you do TSH / T4
If no improvement in 48 hours | Raised T4 and suppressed TSH
70
LFT
Abnormal 50% Raised bilirubin / AAT Low albumin
71
What is increased in dehydration
Haematocrit | Specific gravity on dip
72
How do you monitor
U+E alternate days if abnormal or weekly Urinanlysis Weight
73
What do you do as VTE prophylaxis
TED LMWH If in hospital
74
What is 1st line for N+V
Anti-histmaine anti-emetic - Prochlorperazine - Cyclizine = 2nd line
75
What is 2nd line
Other anti-emetic - Ondanstron - Metoclopramide - short term use only as risk of extra-pyramidal
76
When should you admit
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
What do you do if admitted
``` 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
When do you refer to dietician
48 hours
79
What do you do for reflux
Elevate head Frequent small meal Alginate Antacid
80
What are alternative therapies
Ginger B6 Acupuncture
81
If >3 days what should you consider
``` Change anti-emetic Ranitidine for reflux Vitamin injections Steroids as last resort NG / NJ / TPN if >10% ```
82
What anti-emetic if others tried
Aldonzartone but effects fetes
83
Complications
``` LBW / pre-term due to weight loss Mallory Weiss Wernicke - due to B1 Central pontine myelysis Acute tubular necrosis VTE due to dehydration ```
84
What is CI
Dextrose | Precipitate Wernicke and worsen hyponatraemia
85
How does hypokalamiea present
Muscle weakness | Tetany
86
How does Wernicke present
Ataxia Confusion Opthalmophlegia Fetal death
87
How do you treat
Thiamine
88
What can Wrnicke progress to
Korsakoff's Retrograde amnesia Recovery less likely
89
What causes still birth
Infection Placental / cord issue APH
90
What main cause of death <5
``` Pre-term Malformation Pneumonia Birth asphyxia Infection Malaria Malnutrition ```
91
What main case of maternal mortality
``` Sepsis Pulmonary odema Thrombosis Unsafe abortion Obstruction in labour Maternal disorder ```
92
Direct cause
Obstetric up to 6 weeks post partum
93
Indrirect
Due to disorder worsened by pregnancy
94
Down syndrome Antenatal Testing
``` Low PAPPA Low AFP Low oestrodiol High bHCG High inhibin A Thick NT ```
95
What cause oligohydramnios
``` PPROM Renal agenesis - decreased urine IUGR PET - decreased perfusion Post term NSAID ```
96
What is oligohydramnios
<500ml at 32-36 weeks | AFI <5th percentile
97
What is associated with oligohydramios
Pulmonary hypoplasia
98
What causes polyhydramnios
Twins due to TTTS DM Anencephaly Oesophageal atresia - unable to swallow
99
If women found to be iron deficient in pregnancy
Start oral iron
100
What if normal Hb but low ferritin
Start oral iron
101
If B12 deficient
Test for pernicious anaemia If Ab present = B12 injections If no Ab present but mild anaemia suggesting diet = oral B12
102
If found to be folate deficient
Take 5mg instead of 400mcg
103
What can cause SGA
Constitutional - mother small IUGR Genetic / structural Multiple pregnancy
104
What does IUGR suggest
Reduced O2 / nutrients to baby due to pathology
105
What will also be seen if IUGR
Reduced liquor volume Abnormal doppler Reduced fetal movement Abnormal CTG
106
What can lead to IUGR
``` PET Smoking Alcohol Anaemia Malnutrition INfection ```
107
What are RF for SGA
``` Previous Obesity Smoking DM Hypertension PET Anti-phospholipid Older mother Low PAPPA APH Multiple pregnancy ```
108
How do you manage
Investigate for cause Careful monitoring - USS for growth and liquor, doppler Paeds at birth of baby
109
What causes LGA
``` Constitutional DM Previous macrosomia Maternal obesity Overdue Male ```
110
What are risks to mother
``` Shoulder dystocia Failure to progress Tears C-section PPH Uterine rupture ```
111
What are risks to baby
Birth injury from shoulder dystocia Neonatal hypoglycaemia Obesity
112
What do SGA have risk of in later life
Hypertension | DM
113
What can twins be
``` Monozygotic - 1 zygote / ovum Dizygotic - 2 zygotes / ovum Monoamniotic - 1 amniotic sac Diamniotic - two amniotic sacs Monochorionic - 1 placenta Dichorionic - two placenta ```
114
If twins what antenatal care
``` Folic 5mg Iron supplement Vit D Regular scans for growth / TTS Induction at 37-38 for diamniotic Steroids prior to delivery ```
115
What are delivery options
``` Monoamnitoic = C-section at 32-34 weeks Diamniotic = aim 37-38, C-section if not cephalic ```
116
What are complications of twins
``` Anaemia Polyhydramnios Hypertension IUGR Pre-mature Malpresentation Congenital malformation TTTS ``` Mother PPH PET HYyperemsis
117
What is TTTS
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
What vaccines in pregnancy
Influenza | Pertussis

Obs & Gynae (23 decks)

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