Antenatal Care Flashcards
What is the leading cause of direct maternal death? How long are women at risk of this?
thrombosis/thromboembolism
From start of pregnancy, up to 6 weeks after giving birth
What does ‘cause of direct maternal death’ refer to?
Cause of death that is a direct effect of pregnancy
Other than thrombosis, what is another leading cause of mortality during pregnancy?
Obstetric haemorrhage
What are the criteria to define major obstetric haemorrhage?
Blood loss >= 2500ml
OR blood transfusion >=5 units of RBC
Should the benefits of the flu vaccine be promoted to pregnancy women? Why/why not?
Yes - to women at any stage
What questions should you ask a pregnant woman about their mental health?
Past or present severe mental health illness incl: schizophrenia bipolar disorder Psychosis Depression
Whether they experienced these postnatally (if prior birth)
Previous treatment by psychiatrist/specialist mental health team (incl. inpatient)
FHx of perinatal mental illness
When does the booking appointment generally occur?
10 weeks
What things usually occur at booking?
MOST IMPORTANT APPOINTMENT
Obstetric history
Risk assessment and planning of care - incl. lifestyle (eg. high risk/low risk pregnancy), BMI, CO2 levels checked. Direct to appropriate care (midwife/GP-led or obstetrician-led)
Calculate EDD
Book dating scan
Ensure access to all maternity services - EPAU, MAC
Offer/gain informed consent for antenatal screening
First antenatal bloods
Complete medical, obstetric, social, mental health assessment
Help determine safe-place for birth
Health education advice - flu-vaccine, folic acid, vit D, smoking cessation, diet
What does EDD stand for?
Expected date of delivery
How can you work out the EDD using LMP?
If first day of last menstrual period is known and she has a normal menstrual cycle
LMP + 7/7 + 9/12
(eg. LMP 21/8/11 EDD 28/05/12)
How is EDD worked out accurately?
Dating scan
When is a dating scan done?
10-13 wks + 6days
How many antenatal appointments would a woman who has had children before have? Which weeks should they ideally be seen on? (EXCLUDING SCANS)
8
Booking (10), 16, 28, 34, 36, 38, 40 and 41 weeks
How many antenatal appointments would a woman who has had NO children before have? Which weeks should they ideally be seen on? (EXCLUDING SCANS)
10
Booking (10), 16, 25, 28, 31, 34, 36, 38, 40 and 41
What is the leading cause of INDIRECT maternal death?
Cardiac disease
What is the leading cause of late maternal deaths?
suicide
What is eclampsia?
Fit or convulsion (following pre-eclampsia)
Which things might be measured in the antenatal assessment?
General maternal well being
BP
Urinalysis
Foetal movements
FHR
Measure and plot symphysis-fundal height
Fundal heigh-symphysis pubis
Which blood tests are routinely done at booking?
FBC Haemopglobinopathies Blood group and antibody screen HIV Hepatitis B Syphilis
What different scans are/can be done?
Dating scan
Combined screening - nuchal translucency
Anomaly USS-20 weeks
Fetal assessment and growth scan
What is the combined test?
Nuchal translucency
Beta-human chorionic gonadotrophin
Pregnancy-Associated plasma protein-A
When should the combined test be offered?
11 weeks + 0 days - 13 weeks and 6 days
What does combined test screen for?
Down’s syndrome
What screening test for Down’s syndrome, would you offer to women who’ve booked later in pregnancy?
Quadruple test
15 weeks + 0 days - 20 weeks + 0 days
What is the definition of ‘primigravida’ or ‘primip’?
Women in first pregnancy
What is the definition of ‘multigravida’ or ‘multip’?
Women in second or subsequent pregnancy
What is the definition of ‘nulliparous’?
Woman who has never given birth over 24 weeks
What is the definition of ‘multiparous’?
Woman who has given birth one or more times over 24 weeks
What is the definition of ‘gravida’?
No. of times the mother has been pregnant (incl. miscarriages/terminations)
A current pregnancy is included in this count
What is the definition of ‘parity’?
No. of births after 24 weeks (live/stillborn)
Which maternal conditions increase the risk of placental insufficiency?
pre-eclampsia
obesity
diabetes
Which infections most commonly cause stillbirth?
Bacterial infections that travel from vagina into uterus - incl. group B strep, E.coli and chlamydia
What are the aims of antenatal care?
Provide advice, reassurance, health education and support
Offer antenatal screening
Plan labour and birth
Deal with mine ailments of pregnancy
Manage pre-existing maternal conditions
Identify and manage new medical or obstetric problems that may arise
Who runs antenatal care?
Midwife-led care if mother is healthy, uncomplicated, low risk
Maternity team care (obstetric specialist teams and midwifery care) if patient requires additional care. Midwife often central to this.
List some reasons that women might need additional (maternity team) care? (based on their current condition)
Hypertension Diabetes Psychiatric disorders Epilepsy Use of recreational drugs HIV/Hep B Obesity aged 40 & over Smoker Vulnerable women (i.e teenagers)
List some reasons that women might need additional (maternity team) care? (based on their obstetric history)
Recurrent miscarriage Preterm birth Pre-eclampsia Caesarean section Puerperal psychosis Grand multiparity (6+ pregnancies) Stillbirth/ neonatal death Baby with a congenital abnormality Baby below 2.5kg or above 4.5kg
What does EDD stand for?
Expected date of delivery
What is a customised growth chart? What info is needed for this?
Predicts/plots the growth of the baby based on: mother's age ethnicity parity BMI Symphysis fundal height
any previous children plotted
Allows you to arrange growth scans
What scans are needed in antenatal care?
Dating scan and nuchal translucency: 10-14 weeks
Anomaly scan: 18-22 weeks
NO GROWTH SCANS IF UNCOMPLICATED PREGNANCY
When are growth scans needed?
high risk women (eg. diabetes etc.)
What diet is recommended to woman who are pregnant/trying to get pregnant?
Balanced Plenty of fruit and vegetables Starchy carbs Dairy products (with some exceptions) Protein (fish, eggs etc.)
What food/drink should a woman NOT consume during pregnancy? Why?
Unpasteurised milk/cheese(with mould)/pate - listeria = flu Sx for mother, miscarriage and stillbirth
Undercooked meat - toxoplasmosis = neurological defects (salmonella effect unknown)
Vit A (eg. cod liver oil, liver) = birth defects
Tuna - <4 tins a week - mercury = teratogenic
TOO MUCH fish - 2 portions a week max - pollutants. Exception (safe) = shellfish, prawns
Alcohol - 2U a week 2x a week MAX. Can cross placenta = foetal alcohol syndrome = behaviour and intellectual problems
Caffeine (do not consume excessively - 200mg/day, about 2 cups tea/instant coffee) = LBW
What drinks should be avoided at meal times, because they impair the absorption of iron?
tea/coffee
Can pregnant women eat peanuts?
Yes (if there is no history of allergy)
No link to peanut allergy in child
What vitamins are given to women who are pregnant?
Folic acid
Vit D
How can smoking effect pregnancy?
Increases risk of: Placental abnormalities: abruption and praaevia Perinatal mortality Preterm delivery Premature rupture of membranes LBW Risk of miscarriage is doubled Reduction in the child’s reading age (under the age of 11)
Women unable to stop = advise cut back - decreases the amount of nicotine that crosses the placenta, and increases birthweight.
What is the ideal HbA1c for a pregnant woman?
<6.1
What should women be advised re. their weight during pregnancy?
(try to lose weight before)
Do not, if possible, lose weight during pregnancy = small baby = RF for obesity later in life
Why is it important to check that a pregnant woman is not suffering with hypothyroidism?
Baby does not produce own thyroxine until 12 weeks
hypothyroidism = neurological defects
What medications are considered teratogenic, therefore should be asked about?
Paroxetine
Lithium
Warfarin
Retinoids (similar structure to vit A)
What should pregnant women be advised about exercise and sex?
Not associated with a negative outcome.
Contact sports and scuba diving should be avoided.
How could a job which involves a lot of standing impact a pregnancy?
prematurity
hypertension
pre-eclampsia
How many spontaneous miscarriages need to occur before they cause concern? Why do they cause concern?
3 or more = concern
Risk of another is about 45% (nullips) or 35% (parous)
What BMI is considered obese at booking?
BMI >30
How can obesity impact pregnancy and labour?
Spontaneous first trimester and recurrent miscarriage
Still birth/neonatal death
Pre-eclampsia
Gestational Diabetes
Thromboembolism
Cardiac disease
Induced labour
Caesarian
Infection
PPH
Maternal mortality
Fetal risks
Prematurity
