Antenatal Care Flashcards

1
Q

What is the purpose of antenatal care?

A

-Identify existing problems that may be worsened by pregnancy or may affect pregnancy development
-Optimise maternal health in pregnancy
-Assess risk of pregnancy complications and institute appropriate monitoring
-Build therapeutic relationship

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2
Q

Physiological changes of pregnancy

A

-Cardiac output increased by 40%
-Stroke volume increased
-Heart rate increased by 10-20 bpm
-Blood pressure reduced
-Systemic vascular resistance reduced by 25-30%
-Hypercoagulable state
-Oxygen consumption increased by 20%
-Glomerular filtration rate increases by 50%

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3
Q

Frequency of antenatal care

A

-Nulliparous, uncomplicated
-10 app
-Parous – uncomplicated 7 app
-Hand held record
-Appropriate environment

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4
Q

What is discussed in the booking visit?

A

-PMH
-FHx
-Screening
-Risk factors (diabetes, epilepsy, hypertension, medications, alcohol, drugs)
-Problems
-Contacts

-Advice about supplements – folic acid (400mcg for 12 weeks), vitamin D
-Foods to avoid
-Working advice
-Prescribed and OTC medication
-Exercise
-Sex
-Alcohol (CAGE questionnaire screens for dependence)
-Smoking (nicotine constricts blood vessels in placenta, miscarriage, delayed conception, club foot and cleft lip)
-Cannabis
-Air travel/ car/abroad (Zika?)
-Domestic violence and child protection issues

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5
Q

What investigations are done in routine antenatal care?

A

-Gestational age USS offered between 10 and 13+6weeks
-Calculate BMI

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6
Q

Common symptoms presenting to antenatal care

A

-Nausea and vomiting
-Fatigue, metallic tastes, dizziness, mood swings, swollen and tender breasts
-Heartburn (increasing fundus, more stomach acid)
-Constipation
-Haemorrhoid
-Varicose Veins
-Vaginal discharge (increased secretions)- may be implantation bleed
-Backache (loose joints due to progesterone)

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7
Q

What screening is done for the mother?

A

-Haematological conditions
1. Anaemia, 11g.ml booking, 10.5g.ml 28 weeks
=Iron studies
=Supplement/ transfusion
2. Blood grouping and red cell alloantibodies
=Rhesus status, anti-D prophylaxis
3. Haemoglobinopathies
=FOQ
=Ideally screening by 10 weeks

-High prevalence – lab screening of all women to identify carriers of sickle/thalassaemia
-Low prevalence
-FOQ questionnaire

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8
Q

Routine screening for infections

A

-Asymptomatic Bacteriuria
-Hep B
-Hep C
-HIV
-Rubella
-Syphilis

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9
Q

What infections are not screened for?

A

-Asymptomatic bacterial vaginosis
-Chlamydia
-CMV
-Hep C
-GBS
-Toxoplasmosis

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10
Q

Screening for clinical conditions

A

-Gestational diabetes
-Pre-eclampsia (criteria, low dose aspirin)
-Pre-term birth
-Placenta Praevia
-Foetal growth and well-being
-Foetal presentation

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11
Q

Screening for Down’s syndrome

A

-Pre-screening probability
=1 in 1500 aged 20
=1 in 270 aged 35
=1 in 100 aged 40

-Combined test ( NT, beta-HCG, PAPP-A) between 11+0 – 13+6
-Quadruple test between 15+0-20+0 weeks
-Screen positive/ Screen negative / implications
-CVS < 13 weeks 1-2%/ amnio 15 weeks 0.5%

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12
Q

What is the 12-14 week scan?

A

-Pregnancy dating and viability confirmation
-Counting the babies and determining chorionicity in multiples (T and lunar sign in 1st trimester)
-Anatomy assessment – head/brain, abdominal wall, bladder, limbs
-Combined screening for T13, T18 and T21

=Heart beat
=Twins?
=Abnormalities (anencephaly, Exomphalos, Gastroschisis)
=EDD
=Image
=Nuchal translucency
=Arrange fetal anomaly scan for 20 weeks

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13
Q

What is NT?

A

Nuchal translucency
=Hollow black space
=Altered by fetal position: Chin in relaxed position
=Down’s
=Normal= less than 3.5mm?

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14
Q

Screening for foetal abnormalities

A

-Structural
=18+0 – 20+6
=Reproductive choice
=Parents to prepare
=Managed birth in specialist centre
=Intrauterine therapy

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15
Q

What happens at the 18-22 week scan?

A

-Placental site
-Cervical length
-Anatomy screening- FASP conditions

-FA scan

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16
Q

Foetal conditions screened for as a minumum

A

-Anencephaly
-Open spina bifida
-Cleft lip
-Diaphragmatic hernia
-Gastroschisis
-Exomphalos
-Cardiac abnormalities
=Transposition of the Greta Arteries
=Atrioventricular Septal Defect
=Tetralogy of Fallot
=Hypoplastic Left Heart Syndrome
-Bilateral renal agenesis
-Lethal skeletal dysplasia
-Edward’s syndrome (Trisomy 18)
-Patau’s syndrome (Trisomy 13)

17
Q

New and emerging screening

A

-NIPT
-Pre-eclampsia screening

18
Q

What is NIPT?

A

?

19
Q

Limitations of NIPT

A

-Affected by mosaicism, multiple pregnancy
-Possibility of no result
-Screening NOT diagnosis
-Cannot detect single gene conditions, aneuploidies not affecting chromosomes 13, 18, 21, X or Y
-Can’t use with donor egg pregnancies

20
Q

Describe pre-eclampsia screening

A

-Use risk factors to identify women at risk and suitable for treatment with aspirin

21
Q

How to work out expected date of delivery

A

EDD= LMP + 9 months + 7 days (based on 280 day pregnancy, 28 day cycle)

22
Q

What neural tube defects does folic acid prevent

A

-Spina bifida (an incomplete closure of the spinal cord and spinal column)
-Anencephaly (severe underdevelopment of the brain)
-Encephalocele (when brain tissue protrudes out to the skin from an abnormal opening in the skull)

23
Q

Blood screening at booking

A

-FBC
-Glucose
-Trisomy 13.18.21 (PAPPA bHCG)
-Group and save
-Antibody screen
-Syphilis
-Hepatitis B/HIV

24
Q

What is measured in ultrasound?

A

“crown-rump-length” (CRL)
“bi-parietal diameter” (BPD)

=Check size of baby
=EDD