antenatal care Flashcards
what supplement is advised for all women trying to get pregnant
folic acid 400mg from before conception to 12 weeks
which vitamin supplements may be advised and which should be avoided
10mg vit D is good // not Vit A
foods to avoid in pregnancy
listeria: unpasturised milk, ripened soft cheese, pate or undercooked meat // salmonella: avoid raw eggs, meat (esp chicken)
when should flying be avoided in pregnancy
single pregnancy >37 weeks // multiple pregnancies > 32 weeks
natural remedies for N+V in pregnancy
ginger or p6 acupuncture
medications for N+V in pregnancy
antihistamines (eg promethazine)
function folic acid
helps synthesise DNA
what can cause folic acid deficiency
phenytoin // methotrexate // pregnancy // alcohol
high risk neural tube defects
previous defect in parents or pregnancy // AED, coeliac, diabetes, thalassaemia // obese >30 BMI
risks with smoking and pregnancy + canabis
low birthweight // preterm // IUGR // stillbirth
risks of alcohol in pregnancy
fetal alcohol syndrome (smooth philtrum, thin lips, microcephaly) // IUGR
risks of cocaine in pregnancy
maternal HTN or placental abruption // foetal prematurity or abstinence
heroin risks pregnancy
abstinence syndrome
how many antenatal checks are recommended in first pregnancy (uncomplicated)
10
how many antenatal checks are recommended in subsequent pregnancy (uncomplicated)
7
which conditions are generally screened for in pregnancy (maternal)
anaemia // UTI // bloods group + rhesus // pre-eclampsia // hep B, HIV, syphilis
which conditions are generally screened for in pregnancy (foetal)
downs // abnormalities // neural tube
when is the booking visit in pregnancy
8-12 weeks (ideally <12)
invx booking visit
BP, urine, BMI // FBC, glucose, rhesus // Hep B, syphilis, HIV // urine culture
when are scans to confirm dates
10-13+6
what can increased nuchal translucency on USS indicate
downs // congenital heart defect // abdo wall defect
what can cause hyperechogenic bowel on USS indicate
CF // downs // CMV
when is the combined testing for downs syndrome offered
11-13.6
when is the quadruple testing for downs syndrome offered
those who missed combined testing - 14-20 weeks
when is the anomaly scan performed
18-20+6
when does second screen for anaemia and blood antibodies occur
28 weeks
when would first + second dose of anti-D be given to negative mothers
28 weeks // 34 weeks
when is cephalic version indicated
36 weeks
when is placental site identified
week 20
how is SFH measured
top of pubic bone to top of uterus (centimetres)
when should SFH be used
from 20 weeks // pregnancy should be within 2cm of gestation
what can increase FSH
fibroids, BMI, polyhydramnios
what tests are done in combined test for downs
nuchal transluceny + serum bHCG + pregnancy assoc plasma protein A (PAPPA)
what results from combined test indicate downs
thick nuchal translucency + raised hCG + low PAPPA
what results from combined test indicate edwards or patus
similar to downs but LOWER hCG
what is performed in quadruple test for downs + what indicates it
low AFP + low oestrogen + raised hCG + raised inhibin
how can trisomy results be interpreted
lower chance (less than 1 in 150) or high chance (more than 1 in 150)
what further screening is offered if high chance trisomy + what is involved
non-invasive prenatal test –> ccfDNA (detection 99%)
what diagnostic testing for downs is done in 1st trimester and what is the risk
chorionic villus sampling –> 2% risk miscarriage, adequate sample
what diagnostic testing for downs is done in 2nd trimester and what is the risk
amniocentesis –> 1% risk, sample may not be big enough
what does it mean to be rhesus negative
no D antigen on red blood cell
what type of pregnancy is at risk from rhesus incompatibility
rhesus -ive mum and rhesus +ive baby
what causes rhesus reaction in pregnancy
maternal blood forms antibody against rhesus antigen in baby –> IgG produced –> attacks baby and causes haemolysis
consequences of rhesus haemolysis on baby
hydrops fetalis // jaundice, anaemia, hepatosplenomegaly // heart failure
when should antiD be given
28 and 34 weeks (or after sensitising events + klehaur test))
sensitising events in pregnancy
delivery // TOP // miscarriage >12 weeks // ectopic // external cephalic version //APH // amniocentesis, CVS // trauma
what tests are done to babies with rhesus -ive mother
FBC, blood group, coombes test (for antiglobin)
