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Obstetrics And Gynaecology > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

When is the first trimester?

A

Start of pregnancy to 12 weeks

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2
Q

When is the second trimester?

A

13 to 26 weeks

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3
Q

When is the third trimester?

A

27 weeks til birth

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4
Q

When do we expect fetal movements to start?

A

Around 20 weeks

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5
Q

From when in the pregnancy would you measure symphysis-fundal height?

A

From 24 weeks

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6
Q

When in the pregnancy would you assess fetal presentation?

A

From 36 weeks onwards

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7
Q

What two vaccines are offered to all pregnancy women?

A

Whooping cough (pertussis) from 16 weeks
Influenza (flu)

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8
Q

What type of vaccines are avoided in pregnancy?

A

Live vaccines

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9
Q

how many apponitments will first time mums with mid wife led care have over thier pregnancy?

A

10

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10
Q

what is the general lifestyle advice around vitamins for pregnancy?

A

folic acid (400mcg) from before pregnancy to 12 weeks
vitamin D supplements
AVOID vitamin A supplements

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11
Q

what is the general lifestyle advice around wearing seatbelts in pregnancy?

A

put above and below bump not across

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12
Q

what can alcohol in early pregnancy lead to?

A

miscarriage, small for dates, preterm delivery, fetal alcohol syndrome

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13
Q

what are physical features of fetal alcohol syndrome?

A

microcephaly, thin upper lip, smooth flat philtrum, short palpebral fissure

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14
Q

what are non-physical features of fetal alcohol syndrome?

A

LD, behavioural difficulties, cerebral palsy, hearing/vision problems

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15
Q

what does smoking increase the risk of in pregnancy?

A

fetal growth restriction, miscarriage, stillbirth, preterm labour, pre-eclampsia, cleft lip/palate, SIDS (sudden infant death syndrome)

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16
Q

what is the advice around flying in pregnancy?

A

flying is generally okay in uncomplicated pregnancies up to 37 weeks (32 weeks with twins)
after 28 weeks most airlines need note from HCP pregnancy okay and no additional risks

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17
Q

when should the booking appointment ideally occur?

A

before 10 weeks

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18
Q

what bloods are taken during the booking appointment?

A

blood group, antibodies and rhesus D status. FBC, screening for thalassaemia and sickle cell (for those at higher risk)

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19
Q

what infectious diseases are women offered screening for at their booking appointment?

A

HIV, Syphilis, Hep B

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20
Q

what is the first line and most accurate screening test for downs syndrome?

A

the combined test

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21
Q

when is the combine test performed?

A

between11 and 14 weeks

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22
Q

what on maternal blood tests increases the risk of downs syndrome?

A

raised b-HCG, low PAPPA (pregnancy associated plasma protein A), lower AFP (alpha fetoprotein), lower serum oestriol

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23
Q

what is involved in the triple test looking at downs risk?

A

maternal blood levels of beta-HCG, AFP and serum oestriol

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24
Q

when is the quadruple test for down risk performed and what does it have in addition to the triple test?

A

performed between 14-20 weeks and includes maternal blood testing for inhibin-A (higher level= higher risk)

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25
Q

when would a woman be offered amniocentesis or chorionic villous sampling to determine the risk of downs syndrome?

A

when risk score from other screening predicts risk of greater than 1in 150 chance

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26
Q

what happens in chorionic villous sampling?

A

ultrasound guided biopsy of placenta (done before 15 weeks)

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27
Q

what happens in amniocentesis?

A

ultrasound guided aspiration of amniotic fluid

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28
Q

what does non invasive prenatal testing for downs involve?

A

a maternal blood test which is analysed for fragments of DNA from placental tissue

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29
Q

how does hypothyroidism medication need to be adjusted in pregnancy?

A

the dose will need to be increased usually 30-50%

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30
Q

for women with hypertension before becoming pregnant, which medications will need to be stopped because of risk of congenital abnormalities?

A

ACEi, angiotensin receptor blockers, thiazide and thiazide like diuretics

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31
Q

which antihypertensives are safe to continue into pregnancy?

A

labetalol, calcium channel blockers like nifedipine, and alpha blockers

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32
Q

what folic acid advice is given to women with epilepsy wanting to getpregnant?

A

5mg daily folic acid from before conception

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33
Q

how can being pregnant affect someones epilepsy?

A

can make seizure control worse because of lack of sleep, stress, hormonal changes and altered medication regimes

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34
Q

why are sodium valproate and phenytoin avoided in pregnancy?

A

sodium valproate=neural tube defects and developmental delay
phenytoin=cleft lip and palate

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35
Q

how can pregnancy typically affect rheumatoid arthritis?

A

often symptoms will improve during pregnancy but may flare up after delivery

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36
Q

what DMARDs used in rheumatoid arthritis are thought to be safe to continue in pregnancy?

A

hydroxychloroquine, sulfasalazine. corticosteroids can be used for flare-ups

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37
Q

can pregnant women have NSAIDs and why?

A

no
they can cause premature closure of the ductus arteriosus and delay labour

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38
Q

whatare side effects of ACEi and ARBs on a fetus during prgenancy?

A

oligohydramnios, hypocalvaria, renal failure, hypotension

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39
Q

why can ACEi and ARBs cause oligohydramnios?

A

they can corss the placenta and affect the baby’s kidneys and reduce urine production and therefore amniotic fluid

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40
Q

what is hypocalvaria?

A

incomplete formation of the skull bones

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41
Q

how does neonatal abstinence syndrome present?

A

between 3-72 hours after birth with irritability, tachypnoea, pyrexia and poor feeding

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42
Q

can warfarin be used in pregnancy?

A

no it is teratogenic causing fetal loss, conhenital malformations and bleeding

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43
Q

is lithium used in pregnancy?

A

usually avoided as linked with congenital abnormalities especially ebsteins anomaly

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44
Q

what are potential risks of SSRIs in pregnancy?

A

1st trimester use linked with congenital heart defects
3rd trimester use linked with persistent pulmonary hypertension

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45
Q

what can be a consequence of rubella virus infection during first 20 weeks of pregnancy?

A

congenital rubella syndrome

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46
Q

what are features of congenital rubella syndrome?

A

congenital deafness, cataracts, heart disease (PDA and pulmonary stenosis), learning disability

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47
Q

why id chickenpox dangerous in pregnancy?

A

it can lead to varicella pneumonitis, hepatitis or encephalitis in mother
fetal varicella syndrome and severe neonatal varicella infection if around delivery

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48
Q

what is the classic triad of features seen in congenital toxoplasmosis?

A

intracranial calcification, hydrocephalus, chorioretinitis

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49
Q

What is the main side effect of paroxetine in first trimester of pregnancy?

A

Congenital heart defects

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50
Q

What test can be done to check how much fetal blood has passed into the mothers blood during a sensitisation event?

A

Kleihauer test- involves adding acid to maternal blood sample which fetal Hb is more resistant to, then count number of cells still contains Hb

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51
Q

What two measurements of USS are used to measure fetal size?

A

EFW estimated fetal weight
AC fetal abdominal circumference

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52
Q

What is the definition of small for gestational age?

A

Less than 10th percentile for their gestational age

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53
Q

What is the definition of severe small for gestational age?

A

Less than the 3rd percentile for gestational age

54
Q

What is the definition of low birth weight?

A

Less than 2500g

55
Q

What are the two categories of causes for fetal growth restriction?

A

Placenta mediated - affecting nutrient transfer across placenta
Non-placenta mediated - pathology of the foetus

56
Q

Women at risk of SGA or with SGA, what will be monitored on their serial ultrasound scans?

A

EFW, AC, amniotic fluid volume, umbilical artery pulsatility index

57
Q

What are some risks of VBAC?

A

Risk of scar rupture 1 in 200
Risks to baby are comparable to first time labour but more than C section
1% Increased risk of blood transfusion
25% of needing emergency C section

58
Q

What are some advantages of VBAC?

A

75% chance of success after 1 previous C section
Avoids surgical risks
Faster recovery
Greater chance of uncomplicated vaginal delivery in future

59
Q

What induction methods are thought to be better in VBAC?

A

Non-hormonal e.g sweep and balloon catheter

60
Q

What are some risks to mother in an elective C-section?

A

Risk of haemorrhage, blood transfusion, infection, thrombosis, bowel/bladder injury, hysterectomy. Implications for future pregnancies with increased risk of placenta praevia or accreta

61
Q

What is symphysis dysfunction?

A

Ligaments in pelvis loosen and stretch which causes pain when when moving but this eases when mother lies down, typically starts around 20 weeks

62
Q

What are risks of macrosomia at delivery and how are these risks managed?

A

Shoulder dystocia which can cause brachial nerve palsies and HIE- this risk is reduced by using roberts manoeuvre, applying suprapubic pressure and other manoeuvres
Increased risk of postpartum haemorrhage as uterus been stretched by big baby so uterine atony more likely, managed by giving IM oxytocin at delivery

63
Q

When do women with previous gestational diabetes have their oral glucose tolerance tests?

A

As soon as possible after booking visit
Then again at 24-28 weeks

64
Q

What are risk factors for pre-eclampsia?

A

Nulliparity or pregancy interval of greater than 10 years, high BMI, over 40, FHx, prev history of pre-eclampsia, pre-existing vascular or renal disease, multiple pregnancy

65
Q

What screening is offered for Down syndrome after 14 weeks?

A

From 15-20 weeks screening is done by quadruple test

66
Q

When is the combined test for Down syndrome performed?

A

Weeks 11- 13+6

67
Q

From when is symphysis-fundal height measured and recorded?

A

24 weeks

68
Q

What are the detection rates of Down syndrome from screening and what are the rates of false positives?

A

Detection rate = 90%
False positives = 2%

69
Q

what is assessed on a 20 week scan?

A

Viability, growth measurements, fetal anatomy and any anomalies, liquor volume, placental location

70
Q

When is amniocentesis ideally performed?

A

After 15 weeks gestation

71
Q

What are some risks of amniocentesis procedure?

A

Risk of miscarriage (0.5-1%), preterm delivery and chronic liquor leak

72
Q

When is chorion Villous sampling ideally performed?

A

After 10 weeks gestation

73
Q

What can non invasive prenatal diagnosis investigation help us to identify?

A

Fetal rhesus phenotype, fetal sex and fetal aneuploidy

74
Q

What are there a greater risk of with multiple pregnancies compared to singleton?

A

Miscarriage, fetal growth restriction and preterm delivery

75
Q

What sign on USS can be seen with dichorionic twins?

A

Lambda sign

76
Q

How does obstetric cholestasis typically present?

A

In third trimester with itching mainly of soles of feet and hands, dark urine, pale stools, fatigue and jaundice

77
Q

What rash would we expect with obstetric cholestasis?

A

We would not expect a rash, a rash should make up think of other diagnoses

78
Q

What are some causes of deranged LFTs in pregnancy?

A

Gallstones, acute fatty liver, obstetric cholestasis, autoimmune hepatitis, viral hepatitis

79
Q

What changes can be seen on a woman’s LFTs with obstetric cholestasis?

A

Raised ALT, AST and GGT
Raised bile acids

80
Q

Why can ALP appear raised in pregnancy?

A

The placenta produces ALP

81
Q

How do we manage the pruritus in obstetric cholestasis?

A

Emollients (e.g calamine lotion) and antihistamine which helps with sleeping not the itch

82
Q

Why may clotting be deranged in obstetric cholestasis, how can we remedy this?

A

Reduced bile acids means reduced fat absorption and therefore fat soluble vitmains as well- vitamin K
We can give water soluble vitamin K

83
Q

What is acute fatty liver of pregnancy?

A

Occuring in third trimester there is rapid accumulation of fat within liver cells causing acute hepatitis

84
Q

What causes acute fatty liver of pregnancy?

A

Impaired processing of fatty acids in the placenta, usually from genetic condition in foetus which means it cant break down fatty acids so they end up in maternal circulation and then collect in liver

85
Q

How will acute fatty liver of pregnancy present?

A

Vague hepatitis symptoms: general malaise, N+V, jaundice, RUQ pain, anorexia, ascites

86
Q

What is the management of acute fatty liver of pregnancy?

A

As it is an obstetric emergency they will need admission and delivery of the baby
Treatment may be needed for liver failure if it occurs other wise most patients will recover after delivery

87
Q

What rash in pregancy typically starts in third trimester, is itchy with urticarial papules, wheals and plaques that start on the abdomen particularly around stretch marks?

A

Polymorphic eruption of pregnancy

88
Q

Does atopic eruption of pregnancy only affect those who had eczema before getting pregnant?

A

No it can also affect those who have never suffered from eczema

89
Q

What are the two types of atopic eruption of pregnancy?

A

E= eczema type: eczematous, red, itchy ski on flexor surfaces, face, neck and chest
P= prurigo type: intensely itchy papule affecting abdomen, back and limbs

90
Q

How is atopic eruption of pregnancy managed?

A

Topical emollients, topical steroids
Severe cases: phototherapy or oral steroids

91
Q

What would be the diagnosis if a pregnant woman presents with symmetrical, flat patches of increased pigmentation on sun-exposed areas?

A

Melasma

92
Q

How does a pyogenic granuloma appear?

A

like a discrete red/dark lump that develops over days to 1-2cm
Often over the fingers, upper chest, back, head or neck

93
Q

What would be the likely diagnosis for a pregnant woman presenting in second/third trimester with an initially itchy red popular rash around umbilicus which has spread to other parts of her body and now large fluid filled blisters have formed?

A

Pemphigoid gestationis

94
Q

How do we manage pempigoid gestationis?

A

Topical emollients and steroids
Severe: oral steroids or immunosuppressants

95
Q

What are the risks to baby with pemphigoid gestationis?

A

Fetal growth restriction, preterm delivery, blistering rash after delivery (as maternal antibodies pass to baby)

96
Q

What are three important causes of antepartum haemorrhage to consider?

A

Placenta praevia, placental abruption and vasa praevia

97
Q

What are common causes of spotting or minor PV bleeding in pregnancy?

A

Cervical ectropion, infection and vaginal abrasions from sex or procedures

98
Q

What is the distinguishing feature between a low lying placenta and placenta praevia?

A

Low lying means - within 20mm from internal os
Placenta praevia means over the os

99
Q

During which scan is position of placenta identified and diagnosis of placenta praevia can be made?

A

20 week anomaly scan

100
Q

What precautions are made to make delivery safer in placenta praevia?

A

Elective C sections offered between 36-37 weeks to reduce risk of spontaneous labour and bleeding. Vertical incisions in the uterus can be made and ultrasound used to avoid placenta

101
Q

What is the soft connective tissue layer that surrounds the umbilical vessels in the umbilical cord called?

A

Whartons jelly

102
Q

What are the two types of placenta praevia?

A

Type 1: fetal vessels are exposed as a velamentoud umbilical cord
Type 2: fetal vessels are exposed as the travel to an accessory placental lobe

103
Q

What is meant by concealed abruption?

A

Where placenta has come apart from uterus and there is bleeding but the cervical os is closed so bleeding is not visible from vagina

104
Q

What are the initial management steps with major or massive haemorrhage?

A

Escalate to senior midwife, obstetricians and anaesthetist.
2 grey cannula, bloods (FBC, U+Es, LFs, coag screen)
Crossmatch 4 units of blood
Fluid and blood resuscitation as required
CTG monitoring or fetus and close monitoring of mother

105
Q

What test is used to quantify how much fetal blood has mixed with the maternal to determine the dose of anti-D required?

A

Kleihauer test

106
Q

What is expectant management of placenta accreta and what are the risks of this?

A

Involves leaving the placenta in the place after delivery to absorbed over time
Risks of bleeding and infection

107
Q

What is the chance that when delivering a breech baby vaginally that emergency C section is required?

A

40%

108
Q

What medications can be used to supress lactation after still birth?

A

Dopamine agonists

109
Q

What are the three major causes of cardiac arrest in pregnancy?

A

Obstetric haemorrhage, pulmonary embolism, sepsis (leading to metabolic acidosis and shock)

110
Q

What are causes of massive obstetric haemorrhage?

A

Ectopic pregnancy, placental abruption, placenta praevia, placenta accreta, uterine rupture

111
Q

What is the definition of hypertension?

A

140/90

112
Q

What is difference between chronic hypertension and gestational hypertension?

A

Gestational starts >20 weeks into the pregnancy

113
Q

What i difference between pre-eclampsia and gestational hypertension?

A

No proteinuria with gestational hypertension

114
Q

How many women with gestational hypertension will go on to develop pre-eclampsia?

A

1 in 4

115
Q

What prophylaxis is given to those at risk of pre-eclampsia?

A

Aspirin 150mg daily from 12weeks

116
Q

What investigations (bloods and bedside) would you want to do for a woman with pre-eclampsia?

A

LFTs, FBC, U+Es/GFR, Coag screen
Proteinuria (dipstick or 24 hour collection)
CTG

117
Q

What investigations (bloods and bedside) would you want to do for a woman with pre-eclampsia?

A

LFTs, FBC, U+Es/GFR, Coag screen
Proteinuria (dipstick, protein: creatine or 24 hour collection)
CTG

118
Q

What imaging would be done for a woman with pre-eclampsia?

A

USS looking at fetal growth, amniotic fluid volume
Fetal doppler

119
Q

What blood pressure do we aim for when we give women antihypertensives in pregnancy?

A

135/85

120
Q

What is the definition of eclampsia?

A

Seizures occurring in pregancy or within 10 days of delivery with at least 2 of the following features within 24 hours of the seizure:
- hypertension
- proteinuria
- thrombocytopenia <100
- raised transaminases

121
Q

What postnatal follow-up is required for women with pre-eclampsia?

A

Continued antihypertensive meds for 6-12 weeks, follow up bloods if severe, VTE prophylaxis especially in severe proteinuria

122
Q

What is the risk of miscarriage with amniocentesis?

A

1 in 100

123
Q

What would be the next step in a labouring woman with late decelerations and reduced variability on CTG?

A

Fetal blood sampling to determine fetal compromise

124
Q

What are the risks associated with gestation diabetes mellitus?

A

4x higher rate of miscarriage, increase in congenital anomalies, macrosomia, pre-eclampsia, preterm birth, Caesarian section and perinatal mortality

125
Q

Why is macrosomia seen with GDM?

A

Hyperglycaemia of mother means baby has to produce more insulin which is related to growth factors, also it has more energy (glucose), so it grows more

126
Q

Can statins be taken during pregnancy?

A

No

127
Q

What are the blood glucose targets pre and 1 hour post meal?

A

Pre meal: less than 5.3
1 hour post meal: less than 7.8

128
Q

What investigations are done when a woman presents with suspected obstetric cholestasis?

A

LFTs and bile acids
Viral screen (Hep A/B/C, EBV cytomegalovirus)
Liver autoimmune screen
USS abdomen of liver and looking for gallstones

129
Q

What test can be done if you suspect a woman is smoking during pregnancy to support this?

A

Exhaled carbon monoxide levels
>4ppm in women who deny smoking are referred for advice on second hand smoke

130
Q

What is an amniotic fluid index?

A

Measures the liquor volume which is calculated by measuring the deepest pools of fluid in 4 quadrants of the abdomen on USS

131
Q

How much does pregnancy increase risk of VTE?

A

4-6 times

132
Q

How much more risk of VTE is there in puerperium compared to pregnancy?

A

5x risk in puerperium compared to risk in pregnancy

Obstetrics And Gynaecology (8 decks)

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