antenatal care Flashcards
whah health checks should be made pre-conceptually?
- smoking
- drugs
- rubella vaccine (/ rubella immunoglobulin G)
- glucose control in diabetics
- prescribe 0.4mg of folic acid OD
- record date of menstruation
- smoking cessation advice
- reduce alcohol intake to one glass a day
when is the antenatal booking visit?
12 weeks
at what age groups are the maternal risks the biggest?
<17 yrs
>35 yrs
which familial diseases need to be asked about?
diabetes (esp if 1st degree relative) hypertension thromboembolic disease autoimmune disease pre-eclampsia
gestational diabetes is more common in women weighing ? >70kg >80kg >100kg >110kg
> 100kg
dystocia in labour is more common in women who are?
< 150 cm
as they may have narrow hips?
when can ultrasound be used to screen for chromosomal abnormalities? after 10 weeks\ after 11 after 12 after 14
after 11 weeks
the ultrasound is used in conjunction with pappa and bcg
true or false
true
which blood tests are done ?
fbc
serum antibodies (anti-D)- identify those at risk of intrauterine isoimmunization
blood glucose levels
blood tests for syphillis
rubella immunity
HIV and HEP B screening
haemoglobulin electrophoresis is offered in women at risk of sickle cell anaemias or thalassaemias.
other tests:
check for infections that can cause pre-term labour [chlamydia, bacterial vaginosis]
do urine microscopy and culture- as asymptomatic bacteria can lead to pyelonephritis
urinalysis- for glucose, protein, and nitrites screen. for underlying diabetes, renal disease and infection
health promotion and advice given to pregnant women:
balanced diet eat 0.4mg folic acid every day vitamin d if less exposure contra-indicate sex if placenta praevia dental check advised exercise is advised travel ( airlines mainly say if less than 34-36 weeks) risk of vte is reduced with adequate hydration, but if there is additional risk maybe give aspirin or lmwh.
alcohol in pregnancy?
max-one drink a day
more than 20 units can restrict the child’s intelligence and may cause foetal alcohol syndrome.
the rest of the booking visit talks about?
smoking, drugs (any ocp, or otc ?, drug abuse?) educating the woman about labour. intrapartum techniques about posture, breathing, and pushing are taught.
at the end the doctor/midwife can also advise the woman on the most appropriate type of antenatal care and a plan for visit frequency- do they want consultant led or community lead? ( oneis usually high risk one lower)
abnormality scan is done at which number of weeks?
20
what happens here?
it detects most structural fetal abnormalities.
what is used for iugr and pre-eclampsia risk assessment?
doppler of the uterine arteries.
when is the doppler performed?
23 weeks
how much vitamin D should women be advised to take?
10mcg of Vit D OD
what are the risk factors for gestational diabetes?
body mass index above 30 kg/m2
previous macrosomic baby weighing 4.5 kg or above
previous gestational diabetes
family history of diabetes (first‑degree relative with diabetes)
family origin with a high prevalence of diabetes:
South Asian,black Caribbean, Middle Eastern
what percentage of live births are affected by chromosomal abnormalities?
0.6% /
6/1000
what is the most affected trio of tests for screening for abnormalities?
-maternal age
-blood tests
-nuchal translucency scan (11-14 weeks)
these will detect 90% of the babies with down’s with 5 % false positive
structural abnormalities question:
what are the two main examples of failure of neural tube to join?
what is the screening for these defects?
spina bifida
anencephaly (not compatible with life)
alpha fetoprotein is elevated in pregnancies affected by NTD; has been used as a screening test, but now almost never done as 20 week abnormality scan has rendered the screening almost redundant.
what is fetal hydrops? signs? rf? ix? mx?
what is it?
when fluid accumulates in more than 2 places in the fetus.can be immune or non immune.
anaemia and haemolysis are the immune causes,
non-immune (secondary to another cause); structural, chromosomal, cardiac abnormalities, anaemia, twin-twin transfusion syndrome
ix:ultrasound, echo, assessment of the middle cerebral artery, maternal blood is taken for kleihauer, parvovirus, cmv and toxoplasmosis igm testing.
can do fetal blood sampling if suspect anaemia
can only cure if the hydrops is caused by anaemia ( or vessel compression.
polyhydramnios: what is it? causes: clin ft: complications: management:
liquid volume increased; deepest liquor volume is . >10m is generally abnormal
caused; idiopathic; maternal factors; fetal anomoly
mother will b - large for date, taut uterus and difficult to palpate
complications: abnormal lie, maternal discomfort, malpresentation
management:
can use amnio-reduction, NSAIDS to reduce fetal urine production. consider steroids, if < 34 weeks pregnant\
deliver vaginally unless persistently unstable lie or other obstetric indication.
