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GOSH > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

In UK law when does pregnancy begin?

A

Implantation

6-12days post-fertilisation

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2
Q

How can pregnancy be diagnosed?

A
  • Amenorrhoea
  • Breast tenderness/swelling
  • Sickness
  • USS
  • Positive pregnancy test
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3
Q

What is a pregnancy test based upon?

A

hCG levels
Rise rapidly up to 10weeks
Urine positive at: 25IU/ml
Can be detected in serum & urine 4weeks after LMP

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4
Q

What are the main landmarks before & after 12weeks?

A

BEFORE: Organ development, placenta assumes major role
AFTER: Growth & maturation

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5
Q

When is the highest chance of miscarriage?

A

before 12weeks

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6
Q

What happens at the initial booking visit?

A
  • Calculate EDD
  • Book first scan
  • Obstetric Hx, risk assessment
  • Obs: BP, BMI, urine (culture for asymptomatic bacteriuria)
  • Dietary advice: Folic acid, iron, VitD, avoid certain diaries
  • Lifestyle advice: smoking, OH-
  • Bloods: FBC, Blood Group, Haemoglobinopathies (Rhesus -ve), resus status, red cell alloantibodies, Hep B, Syphilis, Rubella, HIV
  • Consent for antenatal screening & Genetic disorders tests
  • Flu vaccine
  • Antenatal classes
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7
Q

When is the booking visit?

A

Ideally before 10weeks

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8
Q

What disorders are tested for in the antenatal screening tests?

A
  • Combined test: Edward’s, Patau’s, Down’s syndrome

- Quadruple test for Down’s at 15-20weeks (women who present late)

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9
Q

How many antenatal appointments should be made for Multips & Primips?

A

P=10

M=7

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10
Q

What infections are screened for in antenatal clinic?

A
  • HIV
  • Syphilis
  • Hep B
  • Rubella
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11
Q

What are customised growth charts based on?

A

Age, ethnicity, parity, BMI, symphysis-fundal height (from 24weeks)

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12
Q 
What will be seen at each of the following stages on USS?
4-5weeks
5-6weeks
6weeks
6-7weeks
8weeks
A 
4-5: Gestational sac 6mm
5-6: Yolk sac
6: Fetal pole 5mm
6-7: Fetal heart activity
8: Limb buds, fetal movement
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13
Q

At what gestation will fetal movement occur?

A

Multips: 16weeks
Primips: 18weeks
Pattern to movement: 26weeks

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14
Q

What does a 1st &2nd trimester USS show?

A

1st: Optimal for dating (measure crown-rump length)
2nd: Placental location, relationship to internal cervical os

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15
Q

When is an anomaly scan done?

A

Screening test comes back with ‘high/increased probability’
18-22weeks
Checks for: Anencephaly, gastroschisis, heart defects, trisomy 13&18

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16
Q

How does the combined screening test work?

A 
Opt-in
11-14weeks
Measure crown-rump length
Nuchal translucency scan
Maternal blood test
Cut off 1 in 150
High probability= CVS or amnio
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17
Q

What chemicals are measured in the combined screening test?

A 
Nuchal translucency (measure size of nuchal pad at nape of the neck)
Beta-human chorionic gonadotrophin
Pregnancy associated plasma protein-A.
18
Q

What is amniocentesis?

A

Sample of amniotic fluid by passing a needle through the abdomen into the amniotic sac
15weeks+
Gives info about karyotype of fetus

19
Q

What are the risks of amniocentesis?

A

COMMON: Discomfort, failure to obtain sample, miscarriage (1%)
OCCASIONAL: fluid leakage
RARE: Fetal & bowel injury, failure of cell culture, chorioamnionitis

20
Q

What is chorionic villus sampling?

A

Sample of placental tissue obtained transabdominal/transcervial
11-14weeks
LA often used

21
Q

What are the risks of CVS?

A

COMMON: Discomfort, failure to obtain sample, miscarriage (2%)
OCCASIONAL: Same as amnio
RARE: Same as amnio

22
Q

What does increased nuchal translucency reflect?

A

Fetal heart failure

Strongly associated with chromosomal abnormality

23
Q

What happens if the mother is diagnosed with Hep B or Syphilis in pregnancy?

A

Hep B: Newborn on vaccination programme (5doses)

Syphilis: Receive full Tx 4weeks prior to delivery, newborn undergo IV therapy

24
Q

What is the management of a rhesus negative mother?

A

Anti-D immune globulin 500IU at 28weeks

25
Q

What is Rh incompatibility?

A

Destruction of fetal erythrocytes from transplacental passage of maternal IgG antibodies produced by the immune system.
Anti-D antibodies produced to a Rh+ve foetus and can freely cross the placenta binding to and destroying RBCs.
Rh-: RBC’s do not carry inherited RhD antigen

26
Q

What are the consequences of Rh incompatibility?

A

Sensitising event will cause maternal immune system to react to ‘foreign’ D antigens on RBCs & produce Abx
No problem in current pregnancy
Consequent pregnancies: Haemolytic disease of the newborn= Progressive fetal anaemia which may lead to hydrops fetalis and death

27
Q

Which pregnant women should be given Rho D immune globulin?

A

Ectopic pregnancy
Miscarriage/TOP
Any invasive procedure (amnio, CVS)
Possibility of fetal-maternal haemorrhage
If they deliver a neonate who is Rh-positive

28
Q

Which haemoglobinopathies should be tested for?

A

Thalassaemia (including carriers)

Sickle Cell

29
Q

How can Sickle Cell be identified?

A

Newborn Blood Spot

5days post-delivery

30
Q

What is IUGR an indicator of?

A

Placental insufficiency

31
Q

What does it mean if a baby is constitutionally small?

A

Small baby due to e.g small mother, placenta working sufficiently

32
Q

What fetal growth measurements should be taken?

A

BPD: Biparietal diameter
HC: Head circumference
AC: Abdominal circumference
FL: Femur length

33
Q

How is EDD calculated?

A

LMP +7days +9months

34
Q

Define gravidity & parity

A

G: Number of times a woman has been pregnant
P: Number of times that a woman has given birth with a gestational age of 24weeks

35
Q

How is parity calculated?

A

Parity = (A) + (B)
A)Deliveries after 24weeks (live/stillborn)
B)Losses before 24weeks (TOP/miscarriage)

36
Q

How do the following change in pregnancy:

  • RR
  • HR
  • Hb Conc
  • Albumin
  • Renal blood flow
A
  • RR: Stays the same
  • HR: Increases
  • Hb Conc: Decreases
  • Albumin: Decreases
  • Renal blood flow: Increases
37
Q

What are the changes to the CV, Resp, GI system in pregnancy?

A

CV:
Inc= Plasma vol, HR, SV, CO, Uterine & renal BF
Same= MAP, CVP
Dec= Systemic & pulm vasc resistance, mid-trimester BP
Resp:
Inc= Tidal vol, Insp capacity, O2 consumption
Same= RR, Peak flow
Dec= Total lung capacity, resid vol, exp & insp reserve, functional resid capacity
GI:
Inc= Weight, Gallstones, reflux, Nutritional requirements
Same= Amylase
Dec= GI motility, Stomach pH

38
Q

What are the changes to the liver, haematology, renal & immune system in pregnancy?

A

Liver:
Inc= Alkaline phosphatase
Same= Bilirubin
Dec= Albumin, Aspartate & Alanine transaminase
Haem:
Inc= MCV, RC mass, WCC, Total iron binding capacity
Same= MCHb, Ferritin
Dec= Hb Conc, Platelet count, haematocrit
Immune:
Inc= ESR
Same= CRP
Renal:
Inc= Blood flow, Creatinine clearance
Same= Daily voided vol, plasma Na+, K+, Cl-
Dec= Plasma urea, creatinine

39
Q

What test can be used to detect if a fetomaternal haemorrhage has occured?

A

Kleinbauer test at 20weeks
Detects & quantifies level of haemorrhage
Can alter amount of anti-D required

40
Q

What occurs at each antenatal appointment?

A

8-12: Booking
10-13+6: Dating scan
11-13+6: Triple test
16: Info on blood/rhesus results, routine BP & urine
18-20+6: Anomaly scan
25: PRIMIP ONLY- BP, urine, symphysis-fundal height
28: BP, urine, SFH, 2nd screen for anaemia & red cell alloantibodies. Hb < 10.5 g/dl consider iron, 1st dose anti-D to rhesus -ve women
31: PRIMIP ONLY- same as 25week
34: Routine monitoring as above, 2nd dose anti-D, info on labour & birth plan
36: Routine monitoring, check presentation (offer ECV), info on BF, Vit K, baby-blues
38: Routine monitoring
40: PRIMIP ONLY-Routine monitoring
41: Routine monitoring, discuss IOL

GOSH (17 decks)

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