Antenatal Care 2.0 Flashcards
SGA is defined as
as an infant with birth-weight <10th customized centile
Risk Factors for SGA babies?
Demographic:
- >40 maternal age
- low parental birthweight
Current Pregnancy:
- Smoking
- Drugs + alcohol
- Low PAPPA
- Pre-eclampsia
- unexplained antepartum haemorrage
PMHx:
- previous SGA or stillborn
- HTN
- Diabetes
- Antiphospholipid Syndrome
High risk of SGA baby, what do you do for management?
- GROW scans every 4/52 until labour
- Low dose aspirin in the first trimester (reduce PET risk)
- Smoking cessation
- Healthy diet and lifestyle advice
- Specialist consult
Who should receive low dose aspirin for prevention of preeclampsia?
- Preeclampsia in previous pregnancy and birth <37/40 or HELLP syndrome
- Predisposing medical conditions:
- Autoimmune conditions (eg SLE, scleroderma, Anti-phospholipid syndrome)
- Chronic hypertension
- Diabetes (type 1 and type 2)
- Chronic kidney disease
Dose and timing of aspirin to reduce pre-eclampsia in pregnant women?
100mg at bedtime for maximum effectiveness
Apart from aspirin, what else can be administered to reduced PET risk?
Calcium 1000mg/day has been proven to be effective
**most notably in women with calcium deficient diets**
Modifiable risk factors for stillborn birth?
- Smoking
- Obesity
- Inter-pregnancy weight gain (excessive weight gain in pregnancy plus post-partum weight retention)
- Increased maternal age
- SGA
- Drug and alcohol abuse
What are some things we can modify to diminish the risk of spontaneous preterm labour
- Smoking
- Alcohol + drugs
- UTIs (treat)
- STI’s such as chlamydia and gonorrhea (treat)
- HPV vaccine + smears
- Influenza vaccine
- BP control
- Healthy diet
What can be given medically to women to reduce risk of preterm birth?
Progesterone
Recommended for asymptomatic women with a shortened cervix (<25mm) on transvaginal ultrasound in the second trimester
Pathophysiology underlying the development of pre-eclampsia?
abnormal placentation changes during the late first and second trimester
- The spiral arteries don’t become thin and dilate as they should
- Defective invasion into the placental space and abnormal remodelling of the spiral arteries means there is still high resistance and low flow of blood.
- placental ischaemia then results in endothelial cell dysfunction on the maternal side causing release of vasoactive substances, such as s-Flt, into the maternal circulation leading to vasoconstriction, hypertension, and capillary leakage
and/or an abnormal maternal immune response to the pregnancy.
Purpose of doppler studies and when do we do them?
Uterine doppler studies at 20-24 weeks are very helpful in determining if there is resistence in the uteroplacental circulation
What other factors allow you to test for PET
VEGF,
Whats the definition of gestational diabetes?
How many of these women develop preeclampsia?
New onset of HTN post 20 weeks gestation, BP >140/90 on two reading ~4hours apart.
25% go on to develop PET!!
Name at least 5 risks for developing PET.
- Previous PET
- Renal Disease
- Nulliparity
- inc Maternal age
- Antiphospholipid syndrome
- Chronic HTN
- Pre-exisitng diabetes
- Ehtnicity
- Previous SGA
- FHx of PET
When does PET and GEst HTN usually occur, can it occur any other time?
These usually occur at term, however patients that develop these earleir are usually more severe and likely to affect fetus + mother.
Preterm PET is associated with IUGR
