Antenatal Care Flashcards
what is done at the booking visit
general pregnancy advice identify if low/high risk discuss screening check height, weight, BMI BP arrange dating USS at 12 weeks arrange booking bloods
what is checked at the booking bloods
FBC and blood group and antibodies
haemaglobinopathies
infection screen-Hep B, HIV, Rubella, VDRL
random blood glucose
how often is the patient seen by the midwife
Monthly visits until 28 weeks
fortnightly visits 28-36 weeks
weekly visits 37 week till delivery
(plus booking visit, dating USS, anomaly scan and any anti-D appointments
what is measured at each antenatal visit
accurately document gestation BP urinalysis SFH (FSH) fetal heart/kicks
gestational hypertension can only be diagnosed after how many weeks
20 weeks
what is the aim for BP control on medications
<150/80-100
if target organ damage, aim for BP <140/90
deliver at how many weeks if have pre-eclampsia
37 weeks
what are the physiological changes that make thrombus formtation for common in pregnancy
pro-coagulable state
increase in levels of factors 7,8,9,10,12 and fibrinogen and increase in the number of platelelts
decrease in the levels of factor 11 and antithrombin 3
what is the highest risk indicator for VTE in pregnancy
previous VTE not related to major surgery
if you have had a previous VTE not due to previous surgery when do you not prophylaxis from
1st trimester
what are intermediate risk factors for VTE
single VTE from surgery
high risk thrombophilia + no VTE
what are other risk factors for VTE
obesity-BMI >30 partity 3 or more than 3 age >35 smoker gross varicose veins current pre-eclampsia immobility eg paralplegia family history low risk thrombophilia
if you have 4 or more of these risk factors do what
propphylaxis from 1st trimester
3 of these risk factors do what
prophlyaxis from 28 weeks
is D dimer useful in pregnancy
no
can DVTs be asymptomatic
yes up to 50% of early DVTs can be asymptomatic
which side are DVTs more common on
the left side
what is a useful test for DVT
duplex ultrasound
is LMWH safe for the fetus
yes because it doesn’t cross the placenta
what does CTPA increase the risk of
breast cancer
do you stop heparin if you are in SVD
yes
do you stop heparin if having a C section
yes if therapeutic treatment for VTE stop 24 hours before
if prophylactic stop 12 hours before
how does treatment for hypothyroid change during pregnancy
increase levothyroxine by 25-50mcg in 1st trimester
repeat TFTs every trimester
why does hyperthyroid get worse in early pregnancy
due to HCG
