antenatal care Flashcards by Evie Mander

when in pregnancy are abortions legal until (except from special circumstances)

23+6

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when is there no gestational limit for abortion

if there is a substantial risk the child would suffer physical or mental abnormalities if born, and would be seriously handicapped as a result

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medical termination of pregnancy

mifepristone orally
24-48hrs later misoprostol administered (may need more doses: max 5, 3-hourly)

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what is the role of mifepristone in a TOP

blocks progesterone required to continue the pregnancy

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what is the role of misoprostol in a TOP

prostaglandin analogue
causes smooth muscle contraction of the myometrium, leading to expulsion of uterine contents

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name some side effects of a medical TOP

severe nausea, cramps diarrhoea, vaginal bleeding

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what are the 2 main surgical options for a TOP

vacuum aspiration
dilatation and evacuation/curettage

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antibiotic prophylaxis for surgical TOP

doxycycline 7 days

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name 2 other prophylaxis that patients undergoing TOP will receive

anti-D Ig to rhesus negative women - to avoid sensitising event
VTE - LMWH

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what does it mean if a baby is small for gestational age

birth weight below the 10th centile for its gestational age

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what is classed as a low birth weight

any baby born with a weight less than 2.5kg at any gestation

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what is foetal growth restriction

pathological process has restricted genetic growth potential

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name some maternal causes for small for gestational age

smoking, alcohol and drugs
extremities of BMI
maternal disease e.g. hypertension, renal disease

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name some in-utero causes of small for gestational age

placental infarctions or abruption
infection, congenital or chromosomal abnormalities

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how are babies identified as SGA monitored during pregnancy

serial scans + doppler and liquour volume

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what can be given to preterm babies who are small for dates and why

steroids - enhance lung maturation
magnesium sulphate - neuroprotective against cerebral palsy etc.

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name some neonatal complications for SGA babies

birth asphyxia, meconium aspiration, polycythaemia, glycaemic issues, PPH, necrotising enterocolitis

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how is large for gestational age defined

birth weight > 4.5kg
estimated foetal weight above the 90th centile

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name some causes of large for gestational age

foetal macrosomia, polyhydramnios, maternal diabetes, maternal obesity

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what symptom might indicate a multiple pregnancy

exaggerated symptoms e.g. hyperemesis gravidarum
large for dates uterus

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what is gestational diabetes

state of insulin resistance induced by pregnancy

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name some risk factors for gestational diabetes

previous history, previous big baby, BMI >30, family history of diabetes

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how do we screen for gestational diabetes

oral glucose tolerance test

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what is the process of gestational diabetes screening

questionnaire at booking appointment, anyone with a risk factor offered OGTT (which is done between 24 and 28 weeks)

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screening for women with a previous history of gestational diabetes

offered an OGTT earlier in pregnancy, and then again at 24-28weeks if first one is negative

how is gestational diabetes defined on tests

fasting glucose > 5.6 or 2 hour plasma glucose > 7.8 on OGTT

what can be used to differentiate between gestational and pre-existing diabetes in early pregnancy

HbA1c

management of gestational diabetes with fasting glucose levels < 7

lifestyle modifications for 1-2 weeks, then offer metformin

management of gestational diabetes with fasting glucose >7

insulin +/- metformin

what supplement should be given to women with pre-existing diabetes who trying to conceive

folic acid

2 main complications of babies born from mums with gestational diabetes

macrosomia and neonatal hypoglycaemia

what is gestational hypertension

new onset HTN (systolic ≥140 mmHg and/or diastolic ≥90 mmHg) occurring after 20 weeks of gestation in the absence of proteinuria or other features of pre-eclampsia

when is gestational hypertension more common

in first pregnancy

name some risk factors for gestational hypertension

advanced maternal age, nulliparous, obesity, multiple gestation, pre-existing hypertension

what monitoring is needed for mothers with gestational hypertension

BP !!, urinalysis for protein, foetal growth

name 3 antihypertensives that are safe to use in pregnancy

methyldopa, labetalol, nifedipine

name a contraindication for methyldopa

depression

name a contraindication for labetalol

asthma

what should be given to all pregnant women with hypertension to prevent pre-eclampsia

aspirin 75mg daily

what does the presence of IgM and IgG suggest

IgM = new infection IgG = old infection

when is the highest risk of congenital rubella syndrome

first trimester

how is rubella trasmitted

viral infection - direct contact or respiratory droplet exposure

how can we prevent congenital rubella syndrome

MMR vaccine

can pregnant women get the MMR vaccine

no - its a live vaccine so should ideally be given before trying for a baby

name the 3 common features of congenital rubella syndrome

deafness, cataracts, congenital heart disease

skin reaction associated with chronic rubella syndrome

blueberry muffin rash

clinical presentation of a mother who has acquired rubella during pregnancy

fever, rash, lymphadenopathy, polyarthritis

test for congenital rubella syndrome

serology

how can we test to see if someone has immunity against rubella

IgG antibody - can be detected after natural infection or vaccination

what needs to be considered in congenital rubella syndrome

TOP if mother has no immunity

what causes measles

paramyxovirus called morbilivirus

what are koplik spots and what are they associated with

measles!! white spots inside the mouth

clinical presentation of measles

high fever, coryzal, conjunctivitis koplik spots and rash after prodromal symptoms

describe the usual pattern of rash associated with measles

appears behind ears, then spreads down the trunk to the limbs over 3-4 days

investigations for measles

ELISA for Ig or PCR for RNA detection

how can we prevent measles

MMR vaccine

what is recommended for patients with measles

vitamin A

what causes chicken pox and how is it usually transmitted

varicella zoster virus transmitted via droplets

name some clinical features of congenital varicella syndrome

foetal growth restriction, microcephaly, hydrocephalus, limb hypoplasia, eye defects

how to test for chicken pox immunity

VZV IgG levels

what can be given as prophylaxis against chickenpox

IV varicella immunoglobulins

management of chickenpox in pregnancy

acyclovir

what family of viruses does CMV come from

human herpes virus

how is CMV transmitted

close contact with a person excreting the virus in their saliva, urine, or other bodily fluid

how do pregnant women with CMV present

usually asymptomatic

presentation of a foetus with congenital CMV

intracranial calcifications, sensorineural deafness, visual impairment

management of congenital CMV

valacyclovir

names of infection caused by parvovirus B19

fifth disease, slapped cheek syndrome, erythema infectiosum

name some complications of parvovirus B19 infection during pregnancy

foetal anaemia, hydrops fetalis, maternal pre-eclampsia-like syndrome

investigation for a parvovirus B19 infection during pregnancy

IgM for acute infection IgG testing for long-term immunity to the virus after previous infection

how is zika virus spread

aedes mosquitos, or sex with someone infected

clinical presentation of congenital zika syndrome

microcephaly, foetal growth restriction

investigation for zika virus

PCR

what causes congenital toxoplasmosis and what is it associated with

toxoplasmosis gondii - protozoan parasite raw or uncooked meat and infected cat faeces

classic triad associated with congenital toxoplasmosis

intracranial calcification, hydrocephalus, chorioretinitis

what is chorioretinitis

inflammation of the choroid and retina in the eye

management of acute toxoplasmosis during pregnancy

spiramycin

microbiology of listeria

gram positive bacillus

what is listeria associated with

unpasteurised dairy products and soft cheeses

investigation for listeria infection in pregnancy

cultures: blood, CSF, amniotic fluid

management of listeria infection in pregnancy

ampicillin and gentamicin

management of listeria infection in pregnancy (penicillin allergic patient)

trimethoprim and sulfamethoxazole

name some risk factors for a neonatal GBS infection

previous birth with neonatal infection, pre-term labour, prolonged rupture of membranes, chorioamnionitis

prophylaxis for group B strep infection

IV benzylpenicillin clindamycin if penicillin allergic

what does nitrites on urinalysis indicate

presence of bacteria - nitrites are produced by gram-negative bacteria (break down nitrates into nitrites)

what is the most common cause of a UTI

e.coli

first line antibiotics for UTI during pregnancy

FOR 7 DAYS: - 1st or 2nd trimester nitrofurantoin - 3rd trimester trimethoprim

second line antibiotic for UTI during pregnancy

cefelaxin

what is RBC isoimmunisation

the production of antibodies in response to an isoantigen present on an erythrocyte

what does it mean if a person is rhesus negative / rhesus positive

whether or not they have the D antigen on the surface of red blood cells

who do we worry about with rhesus incompatibility

rhesus negative mothers

what is the consequence of rhesus incompatibility on following pregnancies

antibodies can cross the placenta and cause haemolytic disease of the newborn

what can be used to check the right dose of anti-D in rhesus incompatibility

kleihauer - quantifies foetal red blood cells in mothers circulation

when do we screen for rhesus incompatibility

booking appointment and 28 weeks

how does management of hypothyroidism change during pregnancy

levothyroxine needs to be increased

what drugs used to manage hypertension should be avoided during pregnancy

ACEi, ARBs, thiazide and thiazide-like diuretics

what supplement should all pregnant women with a history of epilepsy take

folic acid

why cant we use phenytoin to manage epilepsy during pregnancy

causes cleft lip and palate

first line management of rheumatoid arthritis in pregnancy

hydroxychloroquine

what is obstetric cholestasis

impaired bile flow leading to the accumulation of bile acids after 24 weeks gestation

who is obstetric cholestasis more common in

women of south asian ethnicity

classic symptom associated with obstetric cholestasis

itch !! more intense on hands and feet and worsens at night

clinical presentation of obstetric cholestasis

itch fatigue, malaise nausea + loss of appetite abdo pain - RUQ

bloods in obstetric cholestasis

raised bile acids LFT: raised bilirubin raised fasting serum cholesterol

symptom control in obstetric cholestasis

ursodeoxycholic acid emollients + antihistamines for itch