Antenatal care Flashcards
When does the booking visit take place?
8 - 12 weeks
When does the dating USS take place?
11 - 12 weeks
When does the anomaly scan take place?
20 weeks
When do you get monthly visits in pregnancy?
Up to 28 weeks
When do you get fortnightly visits in antenatal care?
28 - 36 weels
When do you get weekly visits in antenatal care?
37 weeks until delivery
What needs to be done at every antenatal visit?
BP Urinalysis FSH Fetal heart/kicks Any problems refer to consultant
A women has hypertension present as 12 weeks gestation. What is the diagnosis?
Essential hypertension (not pregnancy related)
When does gestational hypertension occur?
After 20 weels
When does pre eclampsia occur?
After 20 weeks
What is HELLP syndrome?
Haemolysis
Elevated Liver Enzymes
Low platelets
What drug is given to women who are thought to be at risk of pre eclampsia?
Aspirin
What BP are you aiming for in pregnancy?
Less that 150/80
What BP are you aiming for in pregnancy if there is target organ damage?
Less than 140/90
If a women has pre eclampsia when should you aim to deliver the baby?
37 weeks
If the mother is diabetes is the baby more likely to be hypo or hyperglycaemia at birth?
Hypoglycaemia
How often should diabetic women have retinal screening in pregnancy?
Every trimester
What should the HBA1C be during pregnancy?
Less than 6%
Above what predicted weight of the fetus should a caesarean section be advised?
4000g
Why is there an increased risk of VTE in pregnancy?
Stasis secondary to venous compression by the pregnant uterus
Hypercoagulability due to oestrogen
Levels of which blood clotting factors increase in pregnancy?
VII, VIII, X and Fibrinogen
Levels of which blood clotting factors decrease in pregnancy?
XI and antithrombin 3
Which test for VTE should you not do in pregnancy?
D Dimer
How should you investigate VTE in pregnancy?
Duplex US
What is the treatment of VTE in pregnancy?
Heparin
Does heparin cross the placenta?
No
What investigations would you do if you suspected a PE?
ABG CXR ECG Duplex US of the lower limbs VQ scan CTPA
What is the treatment for PE?
Heparin
When should warfarin definately be avoided in pregnancy?
Week 6 - 12
Is warfarin safe during breastfeeding?
Yes
When does hyperthyroid get worse during pregnancy and why?
First trimester due to HCG
How often should you do thyroid function tests in pregnancy?
Every trimester
Describe the respiratory changes seen in pregnancy?
- Increase O2 demand
- Tidal volume INCREASE
- INCREASE respiratory rate
- INCREASED inspiratory capacity
- DECREASED residual volume
- DECREASED expiratory reserve
- DECREASE in functional residual capacity
- FEV1 and PEFR UNCHANGED
Why is there a decrease in functional residual capacity during pregnancy?
Diaphragmatic elevation
- Increase in tranvsverse thoracic diameter and subcostal angle
How is asthma treated in pregnancy?
Same as not in pregnancy!
How much folic acid should epileptic women take in pregnancy?
5mg
What vitamin should pregnancy women take from 36 weeks in they are taking liver enzyme inducing anticonvulsants?
Vitamin K
Why do epileptic women have an increased risk of seizure in the first trimester?
Hyperemesis and haemodiluation cause less available anti convulsant
What anomoly scans should pregnant epileptic women get?
Detailed fetal scan at 18 - 20 weeks
Fetal cardiac scan at 22 weeks
You suspect HELLP syndrome is a women who is 32 weeks pregnant. What tests would you perform?
FBC Coagulation screen LFTs U&E Lactate dehydrogenase
A women presents with abdominal pain and confusion is the 35th week of pregnancy. Her lactate dehydrogenase is elevated.
HELLP syndrome
What is the lactate dehydrogenase a marker of in HELLP syndrome?
Haemolysis
How do you treat HELLP syndrome?
Delivery of the baby
DIC is treated with fresh frozen plasma
IV fluids
(Magnesium sulphate may help stop seizures)
