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O&G > Antenatal Care 4 > Flashcards

Antenatal Care 4 Flashcards

1
Q

What is USS used for in the first trimester?

A
  • exclusion of ectopic
  • assess pregnancy viability
  • detect retained products of conception after miscarriage
  • estimate gestational age
  • detect multiple pregnancy and chorionicity
  • screen for chromosomal abnormalities
  • diagnose structural abnormalities
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2
Q

What is USS used for in the second trimester?

A
  • diagnose structural abnormalities
  • screen chromosomal abnormalities
  • aid amniocentesis or transfusion
  • Doppler for fetal assessment or of uterine arteries
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3
Q

What is USS used for in the third trimester?

A
  • assess fetal growth
  • diagnose placenta praevia
  • determine presentation in difficult cases
  • Doppler for fetal assessment
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4
Q

What is the definition of maternal death?

A

death of woman during pregnancy or within 42 days of its cessation, from
any cause related to or aggravated by pregnancy or its management, but nor from accidental or incidental causes

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5
Q

What are the causes of maternal morbidity?

A
  • Infection causing sepsis
  • Venous thromboembolic disease
  • Haemorrhage
  • Hypertensive disorders
  • Cardiac disease
  • Ectopic pregnancy + abortion
  • Neurological disease
  • Psychiatric disease + suicide
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6
Q

What is the definition of a stillbirth?

A

fetus delivered at 24 completed weeks gestation showing no signs of life

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7
Q

What are the causes of perinatal mortality?

A 
Unexplained antepartum stillbirth
IUGR
Prematurity
Congenital anomalies
Intrapartum stillbirth – mostly hypoxia, but also infection + inflammation, trauma +
fetal exsanguination
Antepartum haemorrhage
Pre-eclampsia – preterm delivery + IUGR, and term
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8
Q

What are the two types of pregnancy induced HTN?

A

pre-eclampsia

gestational HTN

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9
Q

What is pre-eclampsia?

A

hypertension and proteinuria appear in second half of pregnancy, often with oedema

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10
Q

What is gestational hypertension?

A

new hypertension presenting after 20 weeks without proteinuria

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11
Q

What is pre-existing or chronic hypertension?

A

Present when BP >140/90mmHg before pregnancy or before 20 weeks’ gestation, or
woman already on antihypertensive medication

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12
Q

How common is HTN in pregnancy?

A

commonest complication

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13
Q

What are the risk factors for developing pre eclampsia?

A 
Nulliparity 
Previous history 
FHx 
Older maternal age 
Chronic HTN 
Diabetes 
Twin preganancies 
Autoimmune disease 
Renal disease 
Obesity
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14
Q

What is the pathophysiology of pre-eclampsia?

A

Stage 1 – before 20 weeks, no symptoms, trophoblastic invasion of spiral arterioles
incomplete (poss caused by altered immune responses) resulting in decreased
uteroplacental blood flow

  1. Stage 2 – ischaemic placenta induces exaggerated maternal inflammatory response,
    induces widespread endothelial cell damage, causing vasoconstriction, increased
    vascular permeability + clotting dysfunction
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15
Q

How does pre-eclampsia present?

A 
HTN 
Proteinuria 
IUGR - reduced placental flow 
Eclampsia 
(occurrence of epileptiform seizures) - reduced cerebral perfusion
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16
Q

What investigations should be carried out if pre eclampsia is suspected?

A

urine dipstick - exclude infection and protein
24hr urine collection
monitor maternal complications - do bloods
monitor fetal complications - USS to monitor weight

17
Q

What are the maternal complications of pre-eclampsia?

A 
Eclampsia
Cerebrovascular accident (CVA)
Haemolysis, elevated liver enzymes + low platelet count (HELLP)
Disseminated intravascular coagulation
Liver failure
Renal failure
Pulmonary oedema
18
Q

What are the fetal complications of pre-eclampsia?

A

IUGR
Preterm birth
Placental abruption
Hypoxia

19
Q

How is pre-eclampsia managed?

A

investigate if BP >140/90
Admit if: confirmed pre-eclampsia (>0.3g/24hr) + BP 160/110mmHg
Antihypertensives if: BP >150/110mmHg
Steroids if: moderate/severe <34 weeks
Delivery: mild by 37 weeks, moderate-severe by 34-36 weeks (if maternal
complications then deliver regardless of gestation)
Magnesium sulphate if: eclampsia (consider prophylactic use in severe disease)
Postnatally watch BP, urine output, FBC UEs LFTs + follow up

20
Q

How is pre-existing hypertension managed in pregnancy?

A

medication changed pre-pregnancy (ACEI teratogenic, affecting urine production), labetalol normally used
may not be needed in second trimester due to physiological fall in BP
risk of pre-eclampsia - use uterine artery Doppler and have additional antenatal visits

21
Q

What is gestational diabetes?

A

glucose levels rise temporarily to diabetic level

3.5-16% prevalence

22
Q

What are the risk factors for gestational diabetes?

A 
Family or previous history 
Polycystic ovary syndrome (PCOS) 
Previous large baby/unexplained stillbirth 
BMI >30 
Persistent glycosuria 
Polyhydramnios
23
Q

What investigations should be carried out for gestational diabetes?

A

if high risk - screen at 28 weeks using GTT

if prev gestational diabetes - screen at 18 weeks

24
Q

What are the fetal complications of gestational diabetes?

A

congenital abnormalities, preterm labour, birthweight increased (increased urine
output + polyhydramnios), shoulder dystocia + birth trauma, fetal death

25
Q

What are the maternal complications of gestational diabetes?

A

increased insulin requirements, hypoglycaemia, worsening retinopathy, pre-
eclampsia, infections, operative delivery, ketoacidosis (rare)

26
Q

How is gestational diabetes managed?

A

Abnormal GTT – dietary + exercise advice, monitor glucose levels at home
If after 2 weeks, inadequate control, then oral hypoglycaemic drugs (e.g. metformin)
If after 2 weeks, inadequate control, then insulin + management as for pre-existing
diabetes
Discontinue insulin postnatally but glucose tolerance test at 3 months

27
Q

How is pre-existing diabetes managed in pregnancy?

A

Preconceptual glucose stabilization, patient education/involvement
Assessment of maternal diabetic complications
Low-dose aspirin from 12 weeks to prevent pre-eclampsia
Patient education + team involvement
Glucose monitoring + insulin adjustment
Anomaly + cardiac ultrasound + fetal surveillance
Induction/lower segment C-section by 39 weeks

O&G (25 decks)

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