antenatal care Flashcards
How many appointments in total should a primigravida and a multigravida patient be taking ?
primi - 11
multigravida - 8
when should the booking appointment be for all pregnant women ?
ideally 10 weeks
what is the purpose of the booking appointment ?
for identification of risk factors and refer onwards
after the booking appointment hwne should the other scans be performed ?
first trimester ( 11-13 weeks ) second trimesteric ( 18-22 weeks) third trimesteric ( 34-36 weeks)
what is the purpose of the first trimesteric scan ?
dating
viability
identify if the pregnancy is single/multiple
offer DS screening
what is the purpose of the second trimester scan ?
anomaly scan that is multi dimensional to check for growth anomalies placental site liquor uterine doppler artery
what is the purpose of third trimester scans ?
multiple pregnancies growth presentation placental site anomalies
other than scans when should fetal and maternal assessments be made ?
16 22 25 28 31 34 36 38 39 40 41 weeks
what is important to discuss and manage inn week 28 ?
blood works for HB, antibodies and glucose levels
give Anti-D injection of Rh-ve
when should Hb be repeated ?
week 34
what are the limitations that may be present in the anomaly scan ?
maternal obesity
fetal positioning
what are the limitations for screening ?
false positive results
false negative results
definitive diagnosis is not always possible to reach
what screening tests are offered ?
HIV syphillis Blood group Rhesus haemoglobinopathies Rubella Hep B diabetes Down syndrome
what risk does using antiepileptic drugs impose on the fetus ?
increases the risk of neural tube defects
which anti epileptic drug should be avoided in pregnancy ?
sodium valporate
which alternative safe anti-epileptics can be used in pregnancy ?
Carbamazepine and lamotrigine
what is the gold standard for the screening of Down Syndrome ?
first trimesteric combined screening at 11-13 weeks
including :
1.nuchal translucency
2.Serum markers - BhCG and PAPP-A
3.maternal age
additional markers: nasal bone hypoplasia, ductus venosus , tricuspid regurgitation
what other trisomies can be screened using double markers ?
trisomy 18
trisomy 13
what results in the double marker test would favor DS ?
high Hcg
low PAPP-A
if it is too late for combined testing for DS what is the best next step ?
offer triple marker test at 15-20 weeks but 20 week scan is not a good screen
what other screening can be done for DS ?
NIPT , using free fetal DNA in maternal blood and can detect specific genetic syndromes or mutations
what are the benign conditions that may affect the mother during pregnancy ?
muscoskeletal pain acid reflux physiological dyspnea carpal tunnel syndrome pelvic girdle dysfunction urinary incontinence
what is the triad for hyperemesis gravidarum ?
defined as nausea and vomiting before 20 weeks of pregnancy along with :
dehydration
electrolyte imbalance
ketones in urine
if a pregnant woman complains of piles what is the best management ?
lidocaine
what is the most common cause of leg cramps in pregnant women ?
decreased levels of magnesium and calcium or elevated serum phosphorus
what is acroparesthesia and what are the causes ?
tingling or numb sensation on the fingertips that is usually caused due to oedema around the carpal tunnel or brachial plexus traction syndrome due to shoulder drooping
what is the management for acroparesthesia ?
vitamin b12
what is the recommended dose of folic acid for a low risk pregnant patient ?
400 ug/day
what instructions should be given on sexual intercourse during pregnancy ?
should be avoided in the first trimester then gradually allowed, it is only completely restricted if there is recurrent bleeding, risk of pre-term labour or antepartum hge
what risk does smoking during pregnancy impose ?
placental insufficiency
what advice should be given regarding vaccinations during pregnancy ?
flu vaccine should be given
tetanus vaccine
generally all vaccines are safe except live attenuated vaccines
what are examples of live attenuated vaccines ?
BCG MMR Varicella Yellow fever HPV
what are the causes of hyperventilation in pregnant women ?
may be physiological due to increased levels of progesterone
could be due to anemia so check HB
for leg cramps caused by elevated serum phosphorus what is the best medical management ?
aluminium hydroxide to decrease phosphorus absorption
what is the caloric intake of a pregnant lady ?
2300 kcl a day
