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Obs > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

PACES: Pre-pregnancy counselling for people with epilepsy

A

Aim for monotherapy where possible and emphasise the importance of maintaining good compliance
High dose folic acid (5 mg OD)
Provide advice about the risk of congenital malformations

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2
Q

What AED should be avoided in all girls and women of child bearing age?

A

Sodium valproate is highly teratogenic so should be avoided in all girls and women of child-bearing age

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3
Q

What are antiepileptic drugs associated with an increased risk of?

A

Neural tube defects
Cleft palate
Congenital heart defects

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4
Q

Safest AEDs in pregnancy

A

Lamotrigine
Levetiracetam
Carbamazepine

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5
Q

Can you breastfeed with AEDs in pregnancy?

A

Yes, all are safe

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6
Q

Differentials for seizures in pregnancy

A

Eclampsia
Intracranial infection (e.g. encephalitis)
Space-occupying lesion
Cerebrovascular accident
Thrombotic thrombocytopaenic purpura
Overdose
Metabolic abnormalities (e.g. hypoglycaemia)

NOTE: NOTE: it is important to be wary of other causes of seizures in pregnancy even if a patient has a background of epilepsy

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7
Q

What is sampled in chorionic villus sampling?

A

Foetal trophoblast cells

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8
Q

What route is chorionic villus sampling done via?

A

transabdominal or transvaginal route

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9
Q

What is chorionic villus sampling associated with?

A

small risk of miscarriage

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10
Q

When is chorionic villus sampling done in comparison to amniocentesis?

A

Can be performed earlier in the pregnancy than amniocentesis

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11
Q

What is amniocentesis?

A

Amniocentesis involves passing a needle into the amniotic sac and aspirating around 15-20 mL of fluid that contains these cells

NOTE: The amniotic fluid contains amniocytes and fibroblasts that have shed from the foetal membranes, skin and genitourinary tract

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12
Q

What is cordocentesis?

A

Involves passing a needle into the umbilical cord and sampling some foetal blood
Usually used in suspected severe foetal anaemia and thrombocytopaenia

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13
Q

Risk of amniocentesis

A

Associated with a small risk of miscarriage

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14
Q

Risk of cordocentesis

A

Associated with a risk of miscarriage

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15
Q

Prenatal genetic test with biggest risk of miscarriage

A

cordocentesis

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16
Q

Only prenatal genetic test with no risk of miscarriage

A

Cell-free foetal DNA (cffDNA)

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17
Q

When is cordocentesis typically used?

A

Usually used in suspected severe foetal anaemia and thrombocytopaenia

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18
Q

What is cell-free foetal DNA?

A

Foetal DNA is extracted from a maternal blood sample
It may be used to determine the foetal blood group and Rhesus status and to determine the sex of the foetus

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19
Q

What is cell-free foetal DNA typically used for?

A

used to determine the foetal blood group and Rhesus status and to determine the sex of the foetus

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20
Q

Safest prenatal genetic test

A

Cell free foetal DNA

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21
Q

Most dangerous prenatal genetic test

A

Cordocentesis - biggest risk of miscarriage

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22
Q

What is Haemolytic disease of the newborn?

A

Haemolytic disease of the newborn caused by the generation of maternal antibodies against RhD antigen on foetal red cells.

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23
Q

Pathophysiology of HDN

A

If the barrier between the circulations of a RhD-negative mother and a RhD-positive baby is breached, it can sensitise the maternal immune system against RhD.
The initial antibodies produced are IgM, which cannot cross the placenta and, so, do not cause any issues during the initial pregnancy.
IgG antibodies will be produced later as the immune response matures.
If the mother becomes pregnant with another RhD positive foetus, the IgG antibodies will then be able to cross the placenta, destroy foetal red cells and cause severe foetal anaemia (resulting in hydrops fetalis).

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24
Q

What are initial antibodies produced in HDN?

A

IgM

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25
Q

What are the mature antibodies produced in HDN that are able to cross the placenta?

A

IgG

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26
Q

What does HDN lead to?

A

Hydrops fetalis

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27
Q

Examples of sensitising events

A

Invasive prenatal diagnosis (e.g. amniocentesis)
Antepartum haemorrhage
External cephalic version
Ectopic pregnancy
Surgical evacuation of molar pregnancy
Intrauterine death or stillbirth
Miscarriage after 12 weeks’ gestation
Surgical termination of pregnancy

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28
Q

What is management of HDN?

A

Anti-D Immunoglobulin

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29
Q

How does Anti-D Immunoglobulin work?

A

Works by destroying foetal red cells within the maternal circulation before the maternal immune system has a chance to generate antibodies against the RhD antigen

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30
Q

Indications for anti-D immunoglobulin

A

Antepartum Haemorrhage
Abdominal Trauma in Pregnancy
Amniocentesis or Chorionic Villus Sampling
Surgical Management of Ectopic Pregnancy
Surgical Management of Miscarriage
Evacuation of Molar Pregnancy
All RhD-negative Women Undergoing Termination of Pregnancy
External Cephalic Version

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31
Q

What is Kleihauer test?

A

Used in some situations to measure the extent to which foetal blood mixed with the maternal circulation
This allows titration of the dose of anti-D immunoglobulin

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32
Q

Who is routine anti-D immunoglobulin given to?

A

Given to RhD-negative women at 28 weeks’ gestation (and may also be given at 34 weeks’ gestation

33
Q

How many antenatal appointments are there typically during pregnancy?

A

10 visits in all FIRST pregnancies if uncomplicated
7 visits in subsequent pregnancies if uncomplicated

34
Q

What tests are offered at antenatal booking?

A

Ultrasound Scans
Dating Scan: 10-14 Weeks
Measures crown-rump length to determine gestational age and to establish estimated delivery date
Measures nuchal translucency as part of antenatal screening
Anomaly Scan: 18-21 Weeks
Determine placental site

Blood Test Screen
Infections: HIV, Hepatitis B and Syphilis
Haemoglobinopathies: Sickle Cell Disease and Thalassemia
Establish RhD status

35
Q

When is the dating scan done? what is it for?

A

Dating Scan: 10-14 Weeks
Measures crown-rump length to determine gestational age and to establish estimated delivery date
Measures nuchal translucency as part of antenatal screening

36
Q

When is the anomaly scan done? What is it for?

A

Anomaly Scan: 18-21 Weeks
Determine placental site

37
Q

What is screened for in the blood test screen in antenatal booking?

A

Infections: HIV, Hepatitis B and Syphilis
Haemoglobinopathies: Sickle Cell Disease and Thalassemia
Establish RhD status

38
Q

What infections are screened for in antenatal booking?

A

Infections: HIV, Hepatitis B and Syphilis

39
Q

What haemoglobinopathies are screened for at antenatal booking?

A

Haemoglobinopathies: Sickle Cell Disease and Thalassemia

40
Q

What must be established at antenatal booking?

A

RhD status

41
Q

PACES: Key questions to ask at booking visit

A

Last Menstrual Period
Any previous pregnancies (incl. Miscarriages)
Past medical and surgical history
Ethnic origins of patient and partner (screen for inherited conditions and gain understanding of cultural factors affecting pregnancy)
Employment of patient and partner
Current living situation
How the patient is feeling about the pregnancy

42
Q

PACES: Common Sx in pregnancy

A

Nausea  
Heartburn  
Constipation  
SOB  
Dizziness  
Swelling  
Backache  
Abdominal discomfort  
Headache

43
Q

PACES: Risks of smoking in pregnancy

A

FGR
Preterm labour  
Placental abruption  
Intrauterine foetal death  
Provide support through smoking cessation programmes  

44
Q

PACES: Advice regarding diet in pregnancy

A

DO NOT eat for two - maintain normal portion side and try avoid snacking
Recommend high fibre foods (oats, beans, lentils, grains)
Base meals on starchy substances (potatoes, bread, pasta, rice)
Restrict intake of fried food and high sugars

45
Q

PACES: Advice regarding exercise in pregnacny

A

Aerobic and strength conditioning is safe to continue and may help recovery after delivery and improve overall wellbeing
Avoid contact sports
Pelvic floor exercises can reduce risk of incontinence

46
Q

PACES: Advice regarding breastfeeding

A

Recommend initiation of breastfeeding within an hour of birth 
Recommend exclusive breastfeeding for the first 6 months 
Can continue breastfeeding up to 2 years of age
Early education about breastfeeding is advocated to improve uptake and to engage women with breastfeeding services

47
Q

Options for delivery

A

Home birth
Midwifery units or birth centres
Hospital birth centres

48
Q

Advantages about home birth

A

ADVANTAGES: familiar surroundings, no interruption of labour to go to hospital, no separation from family members, continuity of care  

49
Q

Disadvantages of home birth

A

DISADVANTAGES: 45% of first-time mothers are transferred to hospital, poor perinatal outcome is twice as likely for home births, limited analgesic options  

50
Q

Advantages of midwifery units or birth centres

A

ADVANTAGES: continuity of care, fewer interventions, convenient location  

51
Q

Disadvantages of midwifery units or birth centres

A

DISADVANTAGES: 40% of nulliparous women require transfer to a hospital birth centre, limited access to analgesic options  

52
Q

Advantages of hospital birth centre

A

ADVANTAGES: trained personnel and facilities available to manage any potential complications

53
Q

Disadvantages of hospital birth centre

A

DISADVANTAGES: lack of continuity of care, greater likelihood of intervention 

54
Q

Summary of antenatal appointments

A
55
Q

How is trisomy 21 screened for in pregnancy?

A

First trimester - combined test
Second trimester - quadruple test

56
Q

What is the combined test for? when is it offered?

A

for trisomy 21 screeening,Offered from 11+3 to 13+6 weeks

57
Q

What is in the combined test?

A

Nuchal Translucency (NT)
Increased in trisomy 21

Maternal b-hCG and PAPP-A
Trisomy 21 is associated with high b-hCG and low PAPP-A

GET INCREASED B-HCG AND NUCHAL TRANSLUCENCY, LOW PAPP A

58
Q

What is the quadruple test for? When is it offered?

A

Screening for trisomy 21, Offered from 14-20 weeks

59
Q

What is in the quadruple test?

A

a-Fetoprotein - low
b-hCG - high
Unconjugated Oestriol - low
Inhibin A - high

60
Q

Mnemonic to remember trisomy’s screened for in prengnancy

A
61
Q

trisomy 13

A

patau

62
Q

trisomy 18

A

edward

63
Q

trisomy 21

A

down’s

64
Q

What further test may be offered if a pregnancy is deemed as being at high risk of trisomy 21 upon screening?

A

Chorionic Villous Sampling
Offered at 11-15 weeks
Associated with a small risk of miscarriage

Amniocentesis
Offered at over 15 weeks
Associated with small risk of miscarriage

Cell Free Foetal DNA
Not associated with any risk of foetal harm as it involves taking a peripheral blood sample from the mother

65
Q

When is chorionic villus sampling offered to test for down’s?

A

Offered at 11-15 weeks, If a pregnancy is deemed as being at high risk of trisomy 21 upon screening

NIOTE: Associated with a small risk of miscarriage

66
Q

When is amniocentesis offered to test for down’s?

A

Offered at over 15 weeks, If a pregnancy is deemed as being at high risk of trisomy 21 upon screening

NIOTE: Associated with a small risk of miscarriage

67
Q

What test can be done to test for down’s that offers no risk to foetus? Why?

A

Cell Free Foetal DNA
Not associated with any risk of foetal harm as it involves taking a peripheral blood sample from the mother

68
Q

When are those with SLE advised to get pregnant?

A

after their disease has been inactive and stable on treatment for over 6 months

69
Q

Effect of pregnancy on SLE

A

no increased risk of flares

70
Q

Effect of SLE on mother in pregnancy

A

Increased risk of miscarriage
Increased risk of pre-eclampsia

71
Q

Effect of SLE on foetus in pregnancy

A

Increased risk of stillbirth
Increased risk of IUGR
Increased risk of preterm delivery
Neonatal lupus syndrome
Congenital heart block

72
Q

SLE medications that are safe for conception in pregnancy

A

Safe: Hydroxychloroquine, Azathioprine

73
Q

SLE medications that are unsafe for conception i pregnancy

A

Ensure good disease control prior to conception (aiming for at least 6 months without flares before attempting to conceive)

74
Q

Baseline investigations for SLE in pregnancy

A

Renal Function (lupus nephritis is particularly strongly associated with poor pregnancy outcomes)
Anti-dsDNA
Blood Pressure
Quantification of Proteinuria
Anti-Ro and Anti-La antibodies (associated with congenital heart block)

75
Q

What medication is reccomended for SLE in pregnancy? Why

A

Recommend aspirin from 12 weeks’ onwards to reduce the risk of pre-eclampsia

76
Q

What are mothers with SLE in pregnancy at increased risk of? How do we treat this?

A

Pre-eclampsia, reccomend aspirin from 12 weeks onwards

77
Q

What additional scans to offer for SLE in pregnancy?

A

Offer growth scans at 28, 32 and 36 weeks’ gestation

78
Q
A

Obs (5 decks)

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