Antenatal Care Flashcards
What occurs at the booking visit?
Risk assessment BMI Blood pressure USS between 11 and 13+6 Blood tests Vaginal infections Urine M+C Urinalysis - glucose, protein, nitrites
What is the combined test?
12 week USS
Blood beta hCG
Pregnancy associated plasma protein A (PAPPA)
What does the week 12 USS do?
- crown-rump length for dating
- multiple pregnancies
- nuchal translucency
What do the booking visit bloods test for?
FBC - anaemia Serum antibodies - syphilis GTT Rubella immunity HIV and hep B Hb electrophoresis Screening for chromosomal abnormalities
What lifestyle changes are advised in pregnancy?
2500 calories/day
Coitus fine unless placenta praevia
Avoid soft and blue cheese, pate, uncooked foods
Do exercise
Vit D for South Asian, Afro-Caribbean or BMI>30
What does the 20 week USS screen for?
Anomaly scan
What can be done at 23 weeks?
Doppler of uterine arteries
If OK then SGA
If reduced then IUGR or pre-eclampsia
How many appointments does a woman need?
10 for nulliparous
7 for multiparous
What investigations are done every appointment?
Ask about physical and mental state
Weighed
BP
Urine - protein, glucose, leucocyte, nitrites
What is done at 16 weeks?
Results of screening tests and booking bloods
Offer triple test
What is done at 18-21 weeks?
Anomaly scan
Repeat at 32 weeks if placenta is low
What is done at 25 weeks?
For PRIMIPS
Exclude early onset pre-eclampsia
What is done at 28 weeks?
fundal height measured
FBC and antibodies checked
GTT if indicated
Anti-D given to rhesus-negative women
What is done at 31 weeks?
For PRIMIPS
Fundal height measured
28 week blood tests are reviewed
What is done at 34 weeks?
Fundal height measured
FBC rechecked
What is done at 36, 38 and 40 weeks?
Fundal height, fetal lie and presentation is checked
Referred for ECV if breech
What is done at 41 weeks?
Membrane sweeping offered
Induction at 42 weeks
What minor conditions occur in pregnancy?
Itching- assess LFTs
Pelvic girdle pain - physiotherapy, corsets, analgesics, crutches
Abdo pain - rule out non-pregnant causes
Heartburn - antacids or ranitidine
Backache - sciatica
Constipation - exacerbated by iron
Ankle oedema - worsens at end, sudden increase is worrying
Leg cramps
Carpal tunnel syndrome - fluid retention compresses median nerve
Vaginitis - due to candidiasis, difficult to treat
What are physiological changes in pregnancy?
Weight gain 10-15 kg Uterus gets heavier 1kg Cervix softens Blood volume increases Haemoglobin decreases WBC increases CO increases Peripheral resistance decreases Blood pressure falls Thyroid enlarges
What causes congenital abnormalities?
Structural deformities Chromosomal abnormalities Inherited diseases Intrauterine infections Drug exposure
What is the difference between screening and diagnostic tests?
Screening - available for all women and gives a risk of being affected
Needs to be cheap, high sensitivity, specificity, safe
Diagnostic tests - performed on women with high risk to confirm
How are neural tube defects screened for?
AFP is produced in fetal liver and measured in maternal blood
- open neural tube defects
- gastrochisis
How is maternal blood tested for chromosomal abnormalities?
Blood markers are altered when fetus has chromosomal abnormality
- beta hCG
- PAPPA
- AFP
- Oestriol
- Inhibin A
How is USS used as a screening and diagnostic test?
Nuchal translucency measured between 11-14 weeks
Linked to cardiac abnormalities
20 week anomaly scan diagnoses most cardiac abnormalities
How else can fetal abnormalities be tested?
MRI scan in utero - better for intracranial lesions
3D USS
Chorionic villus sampling - biopsy of trophoblast after 11 weeks
Amniocentesis - removal of amniotic fluid from 15 weeks
What investigation results are seen in Down’s syndrome?
USS - thickened NT
- absent/shortened nasal bone
Blood - low PAPPA
- high beta hCG
- low AFP
- low oestriol
- high inhibin
What screening tests are done for Down’s?
Booking bloods + maternal age + NT = combined test
If screening is done after 14 weeks or baby was being awkward
Quadruple test = AFP, hCG, oestriol, inhibin
What are neural tube defects?
Result of failure of neural tube closure - neural tissue degenerates
Spina bifida, anecephaly
Give folic acid 3 months preconception
Increased AFP but anomaly scan has 95% sensitivity
What are cardiac defects?
More common in women with congenital heart disease and diabetes
Increased NT at 12 weeks and most picked up at 20 weeks
What abdominal wall defects exist?
Exomphalos - partial extrusion of abdo contents into peritoneal sac
50% have chromosomal problems
Gastroschisis - free loops of bowel in amniotic cavity
Common in young mothers
What chest defects exist?
Diaphragmatic hernia -> pulmonary hypoplasia
60% survive
What gastrointestinal defects exist?
Oesophageal atresia and TOF
Duodenal atresia
Lower gut atresia
What urogenital defects exist?
Hydronephrosis - prone to infection and renal damage
Posterior urethral valves - obstruct male urethra -> oligohydramnios, bladder, renal dilation
Ranges from lethal to renal failure in adulthood
What skeletal defects exist?
Skeletal dysplasia
Isolated limb abnormalities
What is fetal hydrops?
Extra fluid accumulates in 2+ areas of the fetus
Occurs in early pregnancy
Chromosomal abnormalities
Structural abnormalities - pleural effusion
Cardiac abnormalities
Anaemia -> cardiac failure
TTTS
What is polyhydramnios?
Increased liquor volume
Occurs in 1% of pregnancies
What causes polyhydramnios?
Idiopathic
Maternal disorders: diabetes, renal failure
TTTS
Fetal abnormalities (particularly upper GI obstructions or inability to swallow, chest abnormalities, myotonic dystrophy)
How does polyhydramnios present?
Maternal discomfort
Large for dates
Taut uterus
Difficult palpation
What are complications of polyhydramnios?
Preterm labour
Maternal discomfort
Abnormal lie
