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Obstetrics > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Aims of Antenatal Care

A

to prevent and detect issues affecting mother and fetus
advice + education
general health

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2
Q

Fetal Heart appears using Doppler @

A

12 wks

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3
Q

Methods of Dating Pregnancy (figuring out gestation age)

A

Menstrual EDD: calculate from first day of last menstrual period.
Ultrasound via Crown-Rump Length (up to 13wks + 6days) or Head Circumference (14 -20 wks)

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4
Q

Why using ultrasound to determine gestational age is advised

A

more accurate
reduce induction of labor
maximise screening of abnormalities

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5
Q

Examinations done @ Booking Visit (for all women)

A

BP
Abdomen Exam
Height
weight
BMI
Urine Dip test

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6
Q

Investigations done @ Booking visit

A

CBC
Blood Group + RBC antibodies
Urine Analysis
Viral (Rubella,Hepatits B, HIV, Syphillis)

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7
Q

Screening for Fetal Abnormalities

A

11-22 wks

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8
Q

Screening for DOwn Syndrome

A

11-14 wks

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9
Q

Screen for neural tube defects (when and how)

A

@ 15-20 wks using maternal serum alfaprotein
@ 18- 20 wks using detailed structure scanning

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10
Q

Congenital anomalies scan @

A

18-20 wks

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11
Q

Risk Factors for Gestational Diabetes

A
  1. BMI +30kg/m2
  2. Prev baby + 4.5kg
  3. Prev history of Gestational Diabetes
  4. 1st degree relative w/DM
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12
Q

What to do if Risk factors of Gest. Diabetes present

A

Oral Glucose Tolerance Test @ 24-28 wks
if prev history of gest DM present, do test @ 16-18 wks.

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13
Q

How to assess Fetal Growth

A

Symphisus fundal height measured @ every visit after 25 wks
Concerns for Fetal growth: Do Ultrasound
Fetal Heart: via Doppler or Pinnard Stethoscope
@ 36 wks onwards: check fetal presentation and engagement

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14
Q

Benefits of Ultrasound

A

Safe
Cost effective
non-invasive

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15
Q

Use of Doppler U/S

A

assess velocity of blood in fetal and placental vessels
used to predict adverse pregnancy outcomes

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16
Q

Clinical Application of Ultrasound

A
  1. Diagnosis and confirmation of viability 2.Determination of gestational age
  2. Assessmnet of fetal size and growth
  3. Multiple Pregnancy
    5.Diagnosing Fetal Abnormalities
  4. Placental Localization
  5. Amniotic fluid Assessmnet
  6. Fetal well-being
  7. Measurement of Cervical Length
  8. Confirm IUFD/ fetal presentation
  9. Diagnose uterine or pelvic abnormalities
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17
Q

recommended Scheduled Scans for pregnant women

A

@ 10-14 wks
@18-21 wks
Any later scans if clinically indicated

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18
Q

Define Chorionicity, Differentiate between Monochorionic and Dichorionic

A

Number of Placenta in multiple pregnancies
Monochorionic: two layers of amnion separating babies + thin septum
Dichorionic: two layers of amnion + 2 layers of chorion + thick septum
Monochorionic have higher risk or perinatal mortality and pregnancy complications

19
Q

Amniotic Fluid is measured by

A

Maximum Vertical Pool
Amniotic Fluid Index

20
Q

Normal Amniotic Fluid measurements

A

Maximum Vertical Pool = 2-8cm
Amniotic Fluid Index= 5-25cm

21
Q

Amniotic Fluid Measurements in Oligohydraminos

A

Maximum Vertical Pool =Less than 2cm
AFI= less than 5cm

22
Q

Amniotic fluid measurements in Polyhydraminos

A

Maximum vertical pool= +8cm
AFI= +25cm

23
Q

Features of CTG

A

Baseline rate
Baseline Variability
Acceleration
Decleration

24
Q

Normal values of CTG

A

Baseline Rate @ term = 110-150 bpm
Baseline Variability= +10bpm
Acclerations; +2 acclerations on 20-30min CTG
Decelration none

25
Q

Increase in Baseline Rate in CTG (what is it called and what are the causes)

A

Fetal Tachycardia caused by:
maternal or fetal infection
fetal hypoxia
fetal anaemia
adrenoreceptor agonists (ritrodine)

26
Q

When is a baseline variability considered abnormal and its factors?

A

Less than 10bpm= abnormal baseline variability
factors: fetal sleep, fetal activity, hypoxia, infection, drugs

27
Q

Define Accleration and Deceleration in CTG

A

An increase or decrease in fetal heart rate by 15bpm for more than 15 seconds

28
Q

Deceleration in CTG indicates:

A

Hypoxia or Umblical cord compression

29
Q

What are the signs of hypoxia on a CTG

A

Increased Baseline Rate (Tachycardia)
Reduced Baseline Variability
Decelerations

30
Q

What to do if CTG is suspicious

A

If there are antenatal risk factors present and CTG is sus =Deliver Baby
No risk factors = repeat investigation after period of time

31
Q

Biophysical Profile checks

A

Fetal movement
Fetal tone
Fetal Breathing
CTG
Amniotic Fluid Volume
via a long Ultrasound scan (30min)

32
Q

Why Biophysical Profile is not used

A

Time consuming
Too late to solve problem by the time its discovered

33
Q

Use of Doppler U/S on Umbilical Artery

A

Gives info on placental resistance to blood flow.
Infarcted placenta= Increase in resistance

34
Q

Increase in Diastolic Flow in Mid Cerebral Artery indicates

A

Increasing hypoxia

35
Q

Fetal Hypoxia can be seen in a Doppler U/S through

A

an increase in diastolic flow in mid cerebral artery

36
Q

An increase in Mid cerebral artery velocity indicator of

A

Fetal Anaemia

37
Q

Use of Doppler in Preg Outcomes predictions

A

Uterine artery Doppler in 1st and 2nd Trimester to predict pre-eclampsia. Incomplete invasion of spiral arteries by trophopblast = increased resistance of utero-placental vessels = possibly pre-eclampsia

38
Q

Increase in Resistance in uteroplacental vessels on Doppler can be indictive of

A

Pre-eclampsia
FGR
Placenta Abruption

39
Q

U/S used in invasive procedures (which and why)

A

Amniocentesis
Chorion Villus Sampling
Cardocentesis
why: to decrease fetal trauma during procedure

40
Q

U/s in therapeutic procedures

A

Fetal Bladder Shunt
Chest Drain
to prevent fetal trauma

41
Q

Early U/S scan (11-14wks)

A
  1. confirm viability
    2.gestational age
    3.multiple pregnancy
    4.determine chorionicity in multiple pregnancies
    5.identify markers of chromosomal abnormality
    6.Gross structural abnormalities
42
Q

18-22 wk scan

A

1.Gestational age (if not prev done)
2.Detailed fetal anatomicall survey
3.locate placenta
4.estimate amniotic fluid volume
5.doppler (to predict adverse outcome)
6.Cervical length (might cause preterm delivery)

43
Q

3rd Trimester U/S scan

A

Fetal Growth and well-being

Obstetrics (15 decks)

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