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OBGYN 4MB > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

What are the aims of antenatal care?

A
  1. Detect and manage pre-existing maternal disorders
  2. Prevent or detect and manage maternal complications of pregnancy
  3. Prevent or detect and manage fetal complications of pregnancy
  4. Plan pregnancy care to ensure maximum safety
  5. Provide education and advice regarding lifestyle and minor conditions of pregnancy
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2
Q

List the aspects of preconceptual care and counselling

A
  1. Previous pregnancies
    - Traumatic
    - Discuss implications of another pregnancy
  2. Health check - better if before conception
  3. Rubella status - checked so can be immunised before pregnancy if needed
  4. Optimise health in chronic disease (e.g. DM)
  5. Medication - optimised for pregnancy
  6. Folic acid - 0.4mg/day
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3
Q

What is the purpose of the booking visit?

A

To screen for possible complications that may arise in pregnancy, labour and the puerperium

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4
Q

What considerations are there in relation to age?

A
  • Increased risk of obstetric and medical complications if <17 or >35
  • Chromosomal trisomies increased with maternal age
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5
Q

How is the pregnancy dated?

A
  • US used to date all pregnancies except IVF

- Can use Nagles rule to get EDD

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6
Q

What considerations are there in relation to past obstetric history?

A
  • Obstetric disorders have a significant recurrence rate
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7
Q

What considerations are there in relation to past gynaecological history?

A
  • Previous gynae surgery may influence delivery recommendations are increase pre-term labour risk
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8
Q

What is important in the past medical history?

A
  1. HTN
  2. DM
  3. Autoimmune disease
  4. Haemoglobinopathy
  5. Thromboembolic disease
  6. Cardiac or renal disease
  7. Past mental illness (increased suicide risk)
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9
Q

What considerations are there in relation to medications?

A
  • Contraindicated drugs should be changed
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10
Q

What considerations are there in relation to family history?

A
  • GDM risk increased if first degree relative diabetic

- HTN, thromboembolic and autoimmune disease, pre-eclampsia = all familial

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11
Q

What considerations are there in relation to personal/social history?

A
  • Domestic violence
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12
Q

List the appropriate examination steps done on the booking visit

A
  1. General health and nutritional status
  2. BMI - >30 = increased complications
  3. Baseline BP - pre-existing HTN is a risk factor for pre-eclampsia
  4. Abdominal exam - this is limited before 3rd trimester
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13
Q

List the booking investigations

A
  1. Ultrasound scan
  2. Booking bloods
  3. Urine microscopy and culture
  4. Urinalysis
  5. Other tests depending on risk factors
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14
Q

List the routine booking bloods and explain why they are done

A
  1. FBC - pre-existing anaemia
  2. Blood group and antibody screen - to see if possibility of intrauterine isoimmunisation
  3. Syphilis - routine due to implications for the fetus
  4. Rubella immunity - if not immune vaccination offered postnatally
  5. HIV - counselling offered if positive
  6. Hep B - counselling offered if positive
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15
Q

List the other tests that can be done during antenatal care and give indications for them

A
  1. Oral glucose tolerance test - at risk women but done later in pregnancy
  2. Haemoglobinelectrophoresis - done in at risk women for sickle cell and thalassaemia
  3. Screening for infections implicated in preterm labour (not routine)
  4. Urine microscopy and culture - for asymptomatic bacteriuria
  5. Urinalysis - glucose, protein, nitrites
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16
Q

What advice should be given to pregnant women about medications?

A
  1. Avoid meds as far as possible in first trimester
  2. Regular meds ideally adjusted preconceptually
  3. Folic acid supplementation - continue until at least 12wks
  4. Vitamin D supplementation - 10mcg/day
  5. Aspirin - 75mg/day for increased risk of pre-eclampsia
  6. Immunisation - seasonal influenza and pertussis
17
Q

What advice should be given to pregnant women about lifestyle?

A
  1. Diet - balanced; 2500 calories
  2. Avoid alcohol completely
  3. Smoking - advise quitting and offer NRT
  4. Coitus - only CI in placenta praevia or ruptured membranes
  5. Drink only pasteurised milk, avoid soft and blue cheeses, paté or partially cooked ready meals - to prevent Listeriosis
  6. Exercise advised
  7. Wear seatbelt in car
  8. Sleep in left lateral position from 28wks
18
Q

What should pregnant women do to prepare for birth?

A

Antenatal classes

19
Q

List the conditions checked for in early pregnancy risk assessment and the interventions used if present

A
  1. VTE - give LMWH
  2. Pre-eclampsia - Aspirin 75mg
  3. HTN - monitoring
  4. Chromosomal abnormalities - non-invasive prenatal diagnosis or invasive testing (not in Ireland)
  5. Fetal growth restriction - serial US of fetal growth
  6. GDM - OGTT
20
Q

Describe the anomaly scan

A
  • Done at 20wks

- Detects structural fetal anomalies

21
Q

What other ultrasound screening tests can be done later in pregnancy?

A
  1. Cervical length measurement - risk assessment of pre-term delivery in low risk women
  2. Uterine artery resistance - screens for IUGR and pre-eclampsia
22
Q

Describe the conduct of an antenatal visit

A
  1. History briefly reviewed
  2. Ask about physical and mental state
  3. BP and urine dipstick
  4. Abdomen examined - presentation variable and unimportant to 36wks
  5. Listen to fetal heart
  6. Reassessment of pregnancy risk
23
Q

List the minor conditions of pregnancy

A
  1. Itching
  2. Pelvic girdle pain
  3. Abdominal pain
  4. Heartburn
  5. Backache
  6. Constipation
  7. Ankle oedema
  8. Leg cramps
  9. Carpal tunnel syndrome
  10. Vaginitis due to candidiasis
  11. Tiredness
24
Q

Discuss itching in pregnancy

A
  • Common

- Check for jaundice, LFTs and bile acids assessed

25
Q

Discuss pelvic girdle pain

A
  • pubic and sacroiliac joints
  • Varying degrees of discomfort
  • Physio, corsets, analgesics and crutches are management options
  • Care with leg abduction
26
Q

Discuss abdominal pain

A
  • Usually benign and unexplained
  • Can be medical or surgical problem
  • UTIs and fibroids
27
Q

Discuss heartburn

A
  • 70% of pregnant women
  • Extra pillows at night advised
  • Antacids
  • Pre-eclampsia can present as epigastric pain
28
Q

Discuss constipation

A
  • Exacerbated by oral iron
  • High fibre intake needed
  • Stool softeners
29
Q

Discuss ankle oedema

A
  • Common
  • Sudden increase = careful assessment
  • Benign oedema helped by raising foot at night
30
Q

Discuss leg cramps

A
  • 30% of pregnant women

- NaCl tablets, calcium salts or quinine all safe in pregnancy

31
Q

Discuss carpal tunnel syndrome

A
  • Due to fluid retention
  • Seldom severe, usually temporary
  • Splints may help
32
Q

Discuss candidiasis

A
  • Common
  • Difficult to treat
  • Imidazole vaginal pessaries for symptomatic infection
33
Q

List the physiological changes in pregnancy

A
  1. Weight gain - 10-15kg
  2. Genital tract:
    - Uterus weight increased to 1kg
    - Muscle hypertrophy, increased BF and contractility
    - Cervix softens
  3. Blood:
    - Increased BV by 50%
    - Increased red cell mass
    - Decreased Hb
    - Increased WBC
  4. CVS:
    - Increased CO by 40%
    - Decreased peripheral resistance by 50%
    - BP has small mid pregnancy fall
  5. Lungs:
    - Increased TV by 40%
  6. Others:
    - GFR increased by 40% so decreased creatinine and urea
    - Reduced gut motility
    - Thyroid enlargement

OBGYN 4MB (25 decks)

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