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Theo's Obs And Gynae > Antenatal Care > Flashcards

Antenatal Care Flashcards

0
Q

When is the 2nd trimester?

A

From 13-27 weeks

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1
Q

When is the first trimester?

A

From conception to 12 weeks

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2
Q

When is the 3rd trimester?

A

From 28-40 weeks

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3
Q

When does the booking visit take place?

A

Between eight and ten weeks

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4
Q

What investigations and examinations are involved in the booking visit?

A 
Risk assessment - history etc
Pulse
BP
Height, weight, BMI
Urinalysis
FBC - to detect anaemia
Blood group and antibody screen
Haemoglobin electrophoresis - sickle cell or thalassaemia
Rubella
Syphilis
Hepatitis B
HIV
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5
Q

When is the dating scan?

A

Between 10 and 14 weeks

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6
Q

What is the purpose of the dating scan?

A

Confirms viability

Estimates due date based in crown-rump length

Diagnoses multiple pregnancy and chorionicity

Identifies gross structural abnormalities

Can assess for Nuchal translucency - downs

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7
Q

When is triple assessment for downs carried out?

A

Between weeks 10 and 14

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8
Q

What is involved in triple assessment for downs?

A

B-HCG
PAPPA - pregnancy associated plasma protein A
Nuchal translucency

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9
Q

What does the screening test result tell you?

A

Calculates the probability of the foetus having Down syndrome, taking into account maternal factors such as age, weight, family origin, gestation of pregnancy

Cut off level for high risk is 1 in 150

Women are then offered diagnostic testing

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10
Q

Who is offered the quadruple test?

A

People who did not have the triple test in early pregnancy?

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11
Q

What does the quadruple test measure?

A

AFP
Beta HCG
Inhibin - A
Oestriol

Again combined with maternal factors such as age, weight and gestational age

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12
Q

When is the quadruple test offered?

A

15-20 weeks

This is less accurate than the triple (combined) test

Cannot give individual risks for multiple pregnancies, although the triple test can

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13
Q

When are women offered diagnostic tests for Downs syndrome?

A

If previous screening tests suggest they carry a foetus at higher risk (greater than 1 in 150) of having downs etc

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14
Q

How long does full karyotyping take?

A

7-10 days

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15
Q

How can commoner aneuploidies (trisomies 13,14 and 21) be tested for?

A

Fluorescent in situ hybridisation

Can be diagnosed within 48 hours

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16
Q

What is chorionic villus sampling?

A

Takes sample of cells from placenta

Cells are collected transabdominally under direct ultrasound guidance

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17
Q

When is CVS performed?

A

10-14 weeks

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18
Q

What is the risk of miscarriages in CVS?

A

1%

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19
Q

When is involved in amniocentesis?

A

Takes a sample of amniotic fluid which contains cells shed from the foetal skin and membranes

Amniotic fluid aspirated transabdominally under direct ultrasound guidance

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20
Q

When is amniocentesis performed?

A

After 15 weeks

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21
Q

What is the risk of miscarriage in amniocentesis?

A

0.5%

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22
Q

When is the foetal anomaly scan be performed?

A

Second trimester

Between 18 and 20+6 weeks

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23
Q

What does the foetal scan show?

A

Structural abnormalities - which may also indicate underlying chromosomal condition

Location of the placenta - eg placenta previa

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24
Q

What are maternal well being checks?

A

Routine checks carried out through the second and third trimesters

Involves - history, BP measurement, urinalysis

To assess each womans risk of pre-eclampsia or gestational diabetes

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25
Q

How is foetal well being checked in the second and third trimester?

A

Symphysis fundal height measurement

Asking mother about foetal movements

Option of using CTG and further scans for growth

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26
Q

How is foetal well being checked if growth excessive or restricted?

A

USS

To assess for growth - abdominal circumference and femur length, head circumference and biparietal diameter

Biophysical profile - foetal tone, movements, amniotic fluid vol

Umbilical dopplers - to check blood flow to foetus

27
Q

When is foetal presentation checked?

A

From 36 weeks onwards at maternal/foetal check up

28
Q

When is the final routine visit carried out, and what is discussed?

A

40-41 weeks

Discussion about induction of labour

29
Q

What intrinsic factors govern foetal growth?

A

Usually genetic factors:

Maternal height and weight
Parity
Ethnic group

Foetal sex
Foetal genes and inherited conditions

30
Q

What extrinsic factors govern foetal growth?

A 
Maternal:
Social class
Nutritional status
Environment: altitude
Pre-existing disease 
Pregnancy relates disease

Foetal:
Nutrition
Exposure to teratogens- tobacco, narcotics, alcohol, medication
Infective: viral, rubella, cmv, protozoan

31
Q

What is the definition of small for gestational age?

A

Foetus that has failed to achieve a specific biometric or estimated weight threshold by a specific gestational age

Either constitutionally small, or intrauterine growth restriction

32
Q

How is Doppler used to assess growth restriction?

A

Uterine artery doppler

  • assesses resistance within the placenta
  • indicates mother is at high risk of pre-eclampsia

Umbilical artery Doppler

  • assesses resistance within umbilical artery
  • indicates placental failure
33
Q

What is end diastolic flow on umbilical artery Doppler?

A

When the placenta is functioning normally, blood flows from mother to baby still in diastolic stage.

End diastolic flow may be absent or reverses in placental insufficiency

34
Q

How often does diabetes (established or gestational) occur in pregnancy?

A

2-5 % of cases

65% of these are gestational
35% of these are pre-existing

35
Q

How is glucose metabolism altered by pregnancy?

A

Insulin requirements increase throughout pregnancy to term

Normally women are able to increase insulin levels to counter diabetogenic hormones which increase in pregnancy - human placental lactogen, cortisol, glucagon, oestrogen and progesterone

36
Q

What are the effects of established diabetes on pregnancy?

A

Maternal hyperglycaemia leads to foetal hyperglycaemia

Foetal pancreatic cells produce insulin - this acts as growth factor

This causes macrosomia, organomegaly and increased erythropoeisis

37
Q

What are the effects of established diabetes on pregnancy?

A

Maternal hyperglycaemia leads to foetal hyperglycaemia

Foetal pancreatic cells produce insulin - this acts as growth factor

This causes macrosomia, organomegaly and increased erythropoeisis

Foetal polyuria causes polyhydramnios

Neonatal hypoglycaemia may occur

Surfactant production may be reduced, leading to respiratory distress syndrome at birth

38
Q

What are the effects of pregnancy on established diabetes?

A

Ketoacidosis - rare

Retinopathy - increased risk of development - all diabetic women require assessment in pregnancy

Nephropathy - renal function and proteinuria may worsen in pregnancy

Ischaemic heart disease - as pregnancy increases cardiac workload

Increased risk of caesarean or instrumental delivery

39
Q

What should be advised in pre-pregnancy counselling for diabetic women?

A

Optimal control of blood glucose - aim for normoglycaemia prior to pregnancy

Assess severity of diabetes - hypertension, retinopathy, nephropathy, neuropathy, cardiac disease

Education - establish need for control

General health - lose weight, stop smoking

Stop ACEis statins and oral hypoglycaemics (apart from metformin)

Folic acid - 5mg

Rubella vaccination

Contraception - until glycemic control achieved

Aspirin 75mg daily from 12 weeks onwards

Induce at 37 weeks

40
Q

How should women with established diabetes be monitored antenatally?

A 
Glucose control:
blood glucose 4x daily
Stop ACEis and oral hypoglycaemics, switch to insulin 
Hba1c every month
Educate about hypos

Dietitian review

Dating ultrasound

Down’s syndrome screening

Anomaly screening

Foetal echocardiography at 20-24 weeks

Serial USS every 2-4 weeks

41
Q

When is labour induced in pre-existing diabetics?

A

39 weeks

Earlier if glucose control is poor

Vaginally delivery is preferred

42
Q

In pre-existing diabetes, how is glucose control achieved during labour

A

Check blood glucose hourly - if glucose >6.0mmol, convert to sliding scale

If insulin dependent, use sliding scale when labour is established

43
Q

What are risk factors for gestational diabetes?

A

Previous history of gestational diabetes

Previous large baby >4kg

Previous unexplained still birth

First degree relative with diabetes

Polyhydramnios

Persistent glycosuria

Weight >100kg

Polycystic ovary syndrome

44
Q

How is an oral glucose tolerance test carried out?

A

Overnight fasting - eight hours minimum - only water

75g glucose in 250ml water

Plasma glucose measured whilst fasting and at two hours after consumption of the glucose

45
Q

What result on an OGTT indicates GDM?

A

Diabetes:
Fasting - > 7.0 mmol
2 hour - > 11.1 mmol

Only one value needs to be abnormal to make the diagnosis

46
Q

What are risk factors for gestational diabetes?

A

Previous history of gestational diabetes

Previous large baby >4kg

Previous unexplained still birth

First degree relative with diabetes

Polyhydramnios

Persistent glycosuria

Weight >100kg

Polycystic ovary syndrome

47
Q

How is an oral glucose tolerance test carried out?

A

Overnight fasting - eight hours minimum - only water

75g glucose in 250ml water

Plasma glucose measured whilst fasting and at two hours after consumption of the glucose

48
Q

What result on an OGTT indicates GDM?

A

Diabetes:
Fasting - > 7.0 mmol
2 hour - > 11.1 mmol

Only one value needs to be abnormal to make the diagnosis

49
Q

How many times can glycosuria be detected on routine urine dipstick before OGTT should be carried out?

A

2 occasions of glycosuria

50
Q

When should women with high risk of GDM undergo timed glucose levels?

A

At 28 and 34 weeks

Further testing if:
> 6 mmol - Preprandial glucose levels or greater than 2 hours after meal

Or

> 7 mmol - less than 2 hours after meal

51
Q

If investigations suggest GDM, how can need for insulin be assessed?

A

Glucose series - measure glucose levels at several points in the day

If consistently > 6 mmol, start insulin therapy

If not, diet may be adequate

52
Q

How is GDM managed antenatally?

A

Multidisciplinary team
Measure glucose 4x daily
Diet is first line
Insulin or oral hypoglycaemics if glucose consistently >6.0 mmol or evidence of complications eg macrosomia

Manage as per established diabetes

53
Q

How is GDM managed antenatally?

A

Multidisciplinary team
Measure glucose 4x daily
Diet is first line
Insulin if glucose consistently >6.0 mmol

Manage as per established diabetes

54
Q

What antenatal test screens for spina bifida?

A

Triple test for downs also screens for spina bifida

Spina bifida is suggested if there is an increase in AFP alone

55
Q

For which women is foetal echocardiography recommended?

A

Performed in second trimester

For women with congenital heart
Women with previous children with congenital heart disease
Women who have had a high risk nuchal translucency
Maternal diabetes
Maternal epilepsy

56
Q

What is the risk of major congenital malformation if the first hba1c is >10%?

A

25%

57
Q

When is the OGTT test undertaken?

A

24-28 weeks

58
Q

How many women with GDM have recurrence in future pregnancies?

A

60%

59
Q

What is the risk of developing type 2 diabetes after having GDM?

A

50% in the next ten years

60
Q

What happens to the respiratory rate during pregnancy

A

It stays the same

61
Q

What happens to haemoglobin concentration in pregnancy?

A

It decreases

62
Q

What happens to renal blood flow in pregnancy?

A

It increases

63
Q

What happens to albumin concentration during pregnancy?

A

It decreases

64
Q

What happens to maternal heart rate during pregnancy?

A

It increases

65
Q

What is the most reliable indicator of gestational age after 13 weeks?

A

Biparietal diameter

66
Q

What does the biophysical profile test?

A

Foetal wellbeing

Assess foetal breathing, foetal movement, amniotic fluid volume, and accelerations

This gives info about the central nervous system and tone

Theo's Obs And Gynae (22 decks)

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