Antenatal Care Flashcards
When is the dating scan?
Between 11 + 13+6 weeks
When is blood sugar tested and why?
Tested in at risk women at 26w
Which infectious diseases are tested for?
HIV, Hep B, syphillis
When is anti-D given if needed?
From 28w onwards
What does a Rh affected baby look like/what are the Sx?
Oedematous, jaundiced, anaemic, HF, kernicterus
What measurement is considered increased nuchal translucency?
> 3.5mm
When is the combined test performed? What does it test for?
Between 11-14w.
Down’s, Edward’s, Patau’s
What classifies high risk based upon combined test results? What can you offer to women with a high risk result?
1/150 or higher
From 11w - CVS
From 15w - amniocentesis
What is NIPT?
Non-invasive pre-natal testing
Available in private sector
placental DNA extracted from maternal blood –> screen for various conditions
How is a positive Hep B test managed in pregnancy?
Baby is given a hep B vaccine at birth and then 4 subsequent ones (5 in total).
Women with high viral load –> offered antiretrovirals in pregnancy and shortly after delivery to decrease risk further transmission
How many antenatal appointments are arranged?
10 if nulliparous, 7 if multiparous
How is syphilis in pregnancy Mx?
Abx in GUM clinic
How can you tell if twins are dichorionic or monochorionic?
Di = lambda sign Mono = T sign
What are some of the maternal risks of multiple pregnancy?
Higher risk pre-eclampsia, GDM, anaemia
APH, PPH, hyperemesis gravidum
How is multiple pregnancy managed? (not during labour)
- Folic acid 5mg, Fe supplements, aspirin
- DCDA 4 weekly scans from 24w
- MCDA 2 weekly scans from 16w
- regularly check BP & urine
When is labour suggested in twins?
DCDA –> 37-38w
MCDA –> 34-37w
MCMA –> 34w by C-sec
What are some foetal risks with multiples?
Miscarriage (vanishing twin) Congenital abnormalities Prematurity IUGR Monochorionic --> risk TTTS
When is HTN defined as pre-existing and when is it pre-eclampsia?
If onset <20w = pre-existing
BP >140/90
What can you give to women at increased risk of pre-eclampsia? Which women might you give this to?
Low dose aspirin from 12w gestation
Give in:
multiple preg, HTN in prev preg, CKD, SLE or antiphospholipid syndrome, DM, chronic HTN
What are the types of HTN in pregnancy?
Pre-existing/chronic: presenting <20w
Gestational HTN: >20w, resolves within 2w delivery
Pre-eclampsia: HTN >20w –> later develop proteinuria
How is eclampsia managed?
ABCDE
Mg sulphate & anti-HTN e.g. labetolol or nifedipine
DELIVER BABY!!
What are the red flag Sx & signs of pre-eclampsia?
Headache
Visual disturbance
Epigastric/RUQ pain - hepatic capsule distension
SOB - pul oedema due to ARDS
Signs: periorbital oedema, hyper-reflexia, clonus, fits
What are the Dx criteria for proteinuria in pre-eclampsia?
2+ on urine disptick
30mg/mmol PCR
300mg/24h urine collection
Mx of eclampsia?
ABC - recovery position, poss O2
IV MgSO4, IV labetolol
