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GOSH > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

What is the leading cause of direct maternal death? How long are women at risk of this?

A

thrombosis/thromboembolism

From start of pregnancy, up to 6 weeks after giving birth

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2
Q

What does ‘cause of direct maternal death’ refer to?

A

Cause of death that is a direct effect of pregnancy

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3
Q

Other than thrombosis, what is another leading cause of mortality during pregnancy?

A

Obstetric haemorrhage

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4
Q

What are the criteria to define major obstetric haemorrhage?

A

Blood loss >= 2500ml

OR blood transfusion >=5 units of RBC

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5
Q

Should the benefits of the flu vaccine be promoted to pregnancy women? Why/why not?

A

Yes - to women at any stage

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6
Q

What questions should you ask a pregnant woman about their mental health?

A 
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

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7
Q

When does the booking appointment generally occur?

A

10 weeks

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8
Q

What things usually occur at booking?

A

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

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9
Q

What does EDD stand for?

A

Expected date of delivery

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10
Q

How can you work out the EDD using LMP?

A

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)

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11
Q

How is EDD worked out accurately?

A

Dating scan

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12
Q

When is a dating scan done?

A

10-13 wks + 6days

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13
Q

How many antenatal appointments would a woman who has had children before have? Which weeks should they ideally be seen on? (EXCLUDING SCANS)

A

8

Booking (10), 16, 28, 34, 36, 38, 40 and 41 weeks

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14
Q

How many antenatal appointments would a woman who has had NO children before have? Which weeks should they ideally be seen on? (EXCLUDING SCANS)

A

10

Booking (10), 16, 25, 28, 31, 34, 36, 38, 40 and 41

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15
Q

What is the leading cause of INDIRECT maternal death?

A

Cardiac disease

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16
Q

What is the leading cause of late maternal deaths?

A

suicide

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17
Q

What is eclampsia?

A

Fit or convulsion (following pre-eclampsia)

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18
Q

Which things might be measured in the antenatal assessment?

A

General maternal well being

BP

Urinalysis

Foetal movements
FHR

Measure and plot symphysis-fundal height

Fundal heigh-symphysis pubis

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19
Q

Which blood tests are routinely done at booking?

A 
FBC
Haemopglobinopathies
Blood group and antibody screen
HIV
Hepatitis B
Syphilis
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20
Q

What different scans are/can be done?

A

Dating scan

Combined screening - nuchal translucency

Anomaly USS-20 weeks

Fetal assessment and growth scan

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21
Q

What is the combined test?

A

Nuchal translucency
Beta-human chorionic gonadotrophin
Pregnancy-Associated plasma protein-A

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22
Q

When should the combined test be offered?

A

11 weeks + 0 days - 13 weeks and 6 days

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23
Q

What does combined test screen for?

A

Down’s syndrome

24
Q

What screening test for Down’s syndrome, would you offer to women who’ve booked later in pregnancy?

A

Quadruple test

15 weeks + 0 days - 20 weeks + 0 days

25
Q

What is the definition of ‘primigravida’ or ‘primip’?

A

Women in first pregnancy

26
Q

What is the definition of ‘multigravida’ or ‘multip’?

A

Women in second or subsequent pregnancy

27
Q

What is the definition of ‘nulliparous’?

A

Woman who has never given birth over 24 weeks

28
Q

What is the definition of ‘multiparous’?

A

Woman who has given birth one or more times over 24 weeks

29
Q

What is the definition of ‘gravida’?

A

No. of times the mother has been pregnant (incl. miscarriages/terminations)

A current pregnancy is included in this count

30
Q

What is the definition of ‘parity’?

A

No. of births after 24 weeks (live/stillborn)

31
Q

Which maternal conditions increase the risk of placental insufficiency?

A

pre-eclampsia
obesity
diabetes

32
Q

Which infections most commonly cause stillbirth?

A

Bacterial infections that travel from vagina into uterus - incl. group B strep, E.coli and chlamydia

33
Q

What are the aims of antenatal care?

A

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

34
Q

Who runs antenatal care?

A

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.

35
Q

List some reasons that women might need additional (maternity team) care? (based on their current condition)

A 
Hypertension
Diabetes
Psychiatric disorders
Epilepsy
Use of recreational drugs
HIV/Hep B
Obesity
aged 40 & over
Smoker
Vulnerable women (i.e teenagers)
36
Q

List some reasons that women might need additional (maternity team) care? (based on their obstetric history)

A 
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
37
Q

What does EDD stand for?

A

Expected date of delivery

38
Q

What is a customised growth chart? What info is needed for this?

A 
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

39
Q

What scans are needed in antenatal care?

A

Dating scan and nuchal translucency: 10-14 weeks

Anomaly scan: 18-22 weeks

NO GROWTH SCANS IF UNCOMPLICATED PREGNANCY

40
Q

When are growth scans needed?

A

high risk women (eg. diabetes etc.)

41
Q

What diet is recommended to woman who are pregnant/trying to get pregnant?

A 
Balanced
Plenty of fruit and vegetables
Starchy carbs
Dairy products (with some exceptions)
Protein (fish, eggs etc.)
42
Q

What food/drink should a woman NOT consume during pregnancy? Why?

A

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

43
Q

What drinks should be avoided at meal times, because they impair the absorption of iron?

A

tea/coffee

44
Q

Can pregnant women eat peanuts?

A

Yes (if there is no history of allergy)

No link to peanut allergy in child

45
Q

What vitamins are given to women who are pregnant?

A

Folic acid

Vit D

46
Q

How can smoking effect pregnancy?

A 
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.

47
Q

What is the ideal HbA1c for a pregnant woman?

A

<6.1

48
Q

What should women be advised re. their weight during pregnancy?

A

(try to lose weight before)

Do not, if possible, lose weight during pregnancy = small baby = RF for obesity later in life

49
Q

Why is it important to check that a pregnant woman is not suffering with hypothyroidism?

A

Baby does not produce own thyroxine until 12 weeks

hypothyroidism = neurological defects

50
Q

What medications are considered teratogenic, therefore should be asked about?

A

Paroxetine
Lithium
Warfarin
Retinoids (similar structure to vit A)

51
Q

What should pregnant women be advised about exercise and sex?

A

Not associated with a negative outcome.

Contact sports and scuba diving should be avoided.

52
Q

How could a job which involves a lot of standing impact a pregnancy?

A

prematurity
hypertension
pre-eclampsia

53
Q

How many spontaneous miscarriages need to occur before they cause concern? Why do they cause concern?

A

3 or more = concern

Risk of another is about 45% (nullips) or 35% (parous)

54
Q

What BMI is considered obese at booking?

A

BMI >30

55
Q

How can obesity impact pregnancy and labour?

A

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

GOSH (33 decks)

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