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Yr3 Reproductive > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

How many women get morning sickness?

A

80-85%

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2
Q

When is morning sickness worse and what do we call the extreme form?

A

Worse when Human Chorionic Gonadotrophin is high e.g. in twins or molar pregnancies

Can progress to Hyperemesis Gravidarum

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3
Q

Why does pregnancy increase Cardiac Output?

A

Normal pregnancy raises CO from 30-50% due to HR rising from 70-90BPM
This is to maintain a high blood flow to the foetus

This can present as palpitations

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4
Q

How does blood pressure change physiologically during pregnancy & why?

A

Drops during the 2nd trimester

A mixture of effects:
- Uteroplacental circulation expands
- SVR drops
- Blood viscosity drops
- Angiotensin sensitivity drops

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5
Q

When does BP return to normal during pregnancy?

A

Third trimester

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6
Q

Why does urine output increase in pregnancy?

A

Renal plasma flow and GFR increase
Serum Urea & Creatinine also decrease

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7
Q

Why are pregnant women more at risk of UTIs?

A

Urinary stasis increases, in fact, hydronephrosis is even physiological come the 3rd trimester.
Making UTIs and pyelonephritis very common

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8
Q

What is the major danger of a UTI to a pregnant woman?

A

Preterm labour.
So very important to treat them

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9
Q

Why are pregnant women at risk of anaemia?

A

Because plasma volume increases by 50% but RBC mass only goes up by 25%

So a lower Haemoglobin is normal in pregnancy but you still want to ensure it doesn’t drop too low.

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10
Q

How does pregnancy affect blood cell counts?

A

WBC count increases slightly
Platelet count falls (due to rise in blood volume not loss of platelets)

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11
Q

How does pregnancy affect the lungs?

A

Progesterone acts to reduce CO2 by:
- Increasing tidal volume
- Increased Resp rate
- Increases plasma pH

This increases O2 consumption by 20% but plasma PO2 is unchanged

You also get hyperaemia of the resp mucous membranes

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12
Q

How does pregnancy affect the GI system?

A

GI motility is reduced, specifically:

Oesophageal peristalsis reduced

Gastric emptyin slows

Cardiac sphincter relaxes

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13
Q

What hormones cause GI motility to be decreased in pregnancy?

A
  • Increased Progesterone
  • Decreased Motilin
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14
Q

What are some normal symptoms of physiological changes in pregnancy? (i.e. symptoms mothers get in normal pregnancies?)

A

Nose bleeds from resp mucous membrane hyperaemia

SOB from progesterone increases resp rate etc

Constipation & GORD from reduction in GI motility & pressure of foetus

Palpitations from increased HR

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15
Q

Whats included in pre-preganancy counselling?

A

Diet
Optimise BMI
Alcohol reduction
Smoking cessation

Folic Acid supplements
Rubella immunisation (if needed)

Optimise maternal health, mental health and medications
Advise on maternal complications

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16
Q

When would you advise against pregnancy in pre-pregnancy counselling?

A

In certain conditions like Diabetes or Epilepsy

17
Q

Many maternal issues may recur in the next pregnancy, give 3 examples of these that are important in pre-pregnancy counselling?

A

Caesarean section
DVT
Pre-eclampsia

Pre-term delivery
Intrauterine growth restriction
Fetal Abnormality

18
Q

Whan can we do at pre-regnancy counselling to reduce the risk of previous problems recurring?

A

Thromboprophylaxis if h/o DVT aka low dose aspirin

Treat any infections
High dose folic acid to reduce abnormalities

19
Q

Whats involved in a routine antenatal exam?

A

-Feeling well?
- Feeling fetal movements (>20wks)
- BP
- Urinalysis
- Abdominal palapation
- Listen to fetal heart

20
Q

Abdominal palpation is an important part of an antenatal exam, what can it tell us?

A
  • Fetal presentation
  • Sympheseal Fundal height (SFH)
  • Estimate baby size
  • Estimate Liqour volume
21
Q

How do we determine which mothers to do antenatal screening on?

A

We dont.
We offer it to everyone but its not compulsory

22
Q

What is looked for on an Antenatal screen?

A
  • Hepatitis B
  • Syphilis
  • HIV
  • MSSU for UTI
  • Rubella
  • Fe-deficient Anaemia
  • Isoimmunisation e.g. Rhesus disease

US scans for physical abnormalities
Down syndrome
Neural Tube defects

23
Q

How do we treat if a basic antenatal screen throws up an infection in the mother?

A

Hep B give passive & active immunisation to baby

Syphilis give penicillin

HIV give maternal treatment to prevent vertical transmission

24
Q

How many US scans are women offered?

A

One in their first and 1 in their second trimesters

25
Q

What is shown on a 1st visit US?

A

Is the pregnancy viable?
Single or multiple pregnancy?
Abnormalities incompatible with life

26
Q

When is down syndrome testing offered?

A

10-14 weeks gestation

27
Q

How do we initially test for Down’s Syndrome?

A
  • Serum B-human Chorionic Gonadotrophin (Beta-hCG)
  • Pregnancy associated plasma protein A (PAPP-A)
  • Fetal Nuchal Translucency (NT)
28
Q

How does fetal nuchal translucency help identify Down’s Syndrome?

A

Based on the size of the nuchal translucency, it increases with age so:
Risk of Down’s is related to size of NT relative to the maternal age.

29
Q

From initial tests how do we decide if a fetus requires further testing for Down’s?

A

Initial screening give a 1 in something risk of Down’s.

Further invasive tests are offered if risk is estimated at > 1in150

30
Q

What further tests are available for Down’s?

A

Chorionic Villus sampling (CVS) (10-14wks)
Amniocentesis (>15wks)
Non-invasive Prenatal Testing

These all have a small but significant risk of miscarriage (<1 -> 2%)

31
Q

How does Non-invasive prenatal testing for Down’s Work?

A

Its done after initial testing if high risk

Take maternal blood and detect fetal cell free DNA then look for Trisomies.

However its not on NHS (yet, it will be soon)

32
Q

How do we screen for neural tube defects?

A

Part of the first trimester US, should pick up anencephaly & sometimes Spina bifida

Possibly 2nd trimester biochemical screening

2nd trimester US

33
Q

Why & how would we do 2nd trimester biochemical screening?

A

If we couldn’t get a NT measurement from the US

Take maternal serum alpha fetoprotein. >2MoM is high risk

34
Q

What does and doesnt show on a 2nd trimester US?

A

Picks up >90% of major structural abnormalities e.g. exomphalos and cleft palate

But misses a number of chromosomal abnormalities such as Downs, T13 or T18

35
Q

In summary:

A

Pregnancy causes physiological changes that may present as “symptoms”

Pre-pregnancy counselling is essential for any woman with increased complication risk

Various investigations & examination are available to test for abnormalities

Initial screening includes a history, US & Maternal serum biochemistry

Yr3 Reproductive (40 decks)

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