Antenatal Care Flashcards
Define antenatal care
Providing care and support to a pregnant woman, her partner and unborn baby, throughout pregnancy and managing any previous or intercurrent illness in a way as to facilitate safe delivery for both mum and baby
What is involved in antenatal care?
Providing support
Ensuring normalcy/detecting anomaly
Containing/managing ill health
Including mental and physical health
What are the possible signs of pregnancy
- Amenorrhea
- Nausea
- Vomiting
- Breast enlargement
- Nipple tingling
- Colostrum secretion (12weeks+)
- Urinary frequency (6weeks+)
- darkening areolae
- Montgomery tubercles
- Enlarged uterus on bimanual PV (6-8weeks)
Why do you get amenorrhea in pregnancy?
Persistence of corpus luteum maintains high progesterone - preventing uterine shedding
Uterine shedding is usually caused by decreasing progesterone levels.
What proportion of nulliparous and multiparous women respectively suffer N+V?
80% nulliparous
60% multiparous
What is often the first sign of pregnancy?
Nausea - often even before a missed period
When does nausea and vomiting usually stop by?
Usually by 16 weeks
Usually much better after 12
True/false - most women with nausea and vomiting don’t need hospital admission
True - only those with hyperemesis gravidarum or those who are severely dehydrated need admission
How does a pregnancy test work?
It detects levels of HCG, produced by trophoblastic cells, the beta-subunit of which is distinct.
Ultrasound may be useful to prove pregnancy - why is it important to see a yolk sac?
Early USS can show an intrauterine gestational sac. However this may not be a true intrauterine pregnancy and could be an ectopic with a pseudo sac. Must be able to see a yolk sac to prove intrauterine pregnancy.
abdominal USS - what is the earliest stage you can you see a gestational sac?
5 weeks of amenorrhea
Abdominal USS - At what stage can you see a foetal heart beat?
6weeks of amenorrhea
Abdominal USS - At what stage can you see a foetal pole?
7 weeks of amenorrhoea
True/false - transvaginal USS will not prove pregnancy any earlier than an abdominal USS?
False - it may do so a week or two earlier (5-6 weeks)
Explain the difference between the green and red pathways
Green pathway - midwife led, low risk pregnancy, no need for medical input and no access to pain relief except for gas+air
red pathway - consultant led, medium-high risk pregnancy, all appointments will be with a medic, full range of options for pain relief and will have to be delivered in labour suite.
At what stage is the first anomaly scan done?
11-13+6weeks.
when is the detailed anomaly scan done?
20weeks.
What other tests are done at booking?
FBC, BBV, blood group + rhesus status, HbA1c
Why don’t we screen for rubella in every patient now?
Vaccination rates are very high - makes it obsolete
What blood tests are done at 28 weeks?
FBC, blood group + rhesus, random glucose
When should a glucose tolerance be performed?
between 24 and 28 (usually at 26) weeks if indicated
What is the purpose of booking?
Identify suitability for green/red pathway
Identify personal/family risk of GDM or PET
What risk factors are looked at, at booking?
BMI
BP
Proteinuria
Family/personal history
First visit scan should be offered at booking - why?
Identify accurately the gestational age and EDD.
Women are also screened for other issues such as social and cultural issues - give examples
- Female genital mutilation
- Vulnerability
- Domestic violence
- Substance misuse
- other e.g. language barrier or religious/personal beliefs such as JWs and blood transfusions
Give some reasons (5-6 of the 16 overleaf) as to why a woman may need to move to red pathways +/or other specialist input
- renal disease
- endocrine disorder/IDDM
- Cardiovascular disease
- Psychiatric disorder needing psychotropics
- haematological disorder
- Autoimmune disorder
- epilepsy with anticonvulsants
- Severe asthma
- Recreational drugs
- HIV/HBV
- obesity (>/= 30)
- Underweight (=18)
- Higher risk of complication (e.g. >40year old)
- vulnerable/social support
- malignancy
- smoker
What factors from previous pregnancy need to be considered when planning pathway?
- recurrent miscarriage
- preterm births
- severe PET/HELLP/Eclampsia
- Rhesus isoimmunisation or other antibodies
- Uterine surgery or any kind including C/S
- APH or PPH on two occasions
- Para 4+
- puerperal psychosis
- Still birth/neonatal death
- SGA (<5th centile)
- LGA (>95th centile)
- low/high birth weight
- previous infant with congenital anomaly
What supplement(s) are important before/during pregnancy?
- folic acid: before and up to 12 weeks after becoming pregnant
- Vitamin D: during pregnancy and breastfeeding
True/false - women should have their urine and BP checked regularly during pregnancy - why?
True - to look for signs of pre-eclampsia
At what stage should the whooping cough vaccine be offered?
16 weeks
Why do we offer whooping cough vaccine?
To protect baby - its not for mum.
What is the indication for anti-D antibody>
When Mum is rhesus negative and dad is rhesus positive - i.e. if any chance baby could be rhesus positive.
At what gestational age is anti-D given (if indicated)?
28weeks
Why is anti-D given?
To prevent isoimmunisation to the baby’s D-antigens and prevent haemolytic disease of the newborn
at roughly what level should fundal height be at 12weeks?
Pubic symphysis
at roughly what level should fundal height be at 20weeks?
Umbilicus
at roughly what level should fundal height be at 36 weeks?
Xiphoid process
At what rate should the fundal height increase?
Approx 1cm/week
Should be +/- 2cm from the gestational age e.g. 32 weeks - fundal height should be 30-34cm
How do you measure fundal height?
Measure from the fundus to the pubis, blindly
Define foetal lie and presentation
Lie - how the baby is lying; transverse/oblique/longitudinal
Presentation - which part of the baby is the presenting part, engaged with the cervix; e.g. breech, cephalic, none etc.
Why should alcohol be avoided in pregnancy?
Can cross placenta and affect foetus same as any adult. May resulting foetal alcohol syndrome
Exercise should be avoided in pregnancy - true/false
False - exercise is recommended but excessive exercise should avoided
Travel advice should include…
Limiting travel to that which is comfortable for the pregnant lady. Planes>trains for long distance. May need fit to fly notes for some airlines at certain gestations.
Sex should be limited or avoided in all pregnancies and especially in late pregnancy - true/false
False - there is no restriction or contraindication on intercourse unless PV bleeding or placenta praevia.
Constipation in pregnancy is common - what causes this? What should you do about it?
Progesterone causing smooth muscle relaxation - eat more fresh fruits, drink plenty water, plenty of fibre and avoid laxatves unless symptomatic.
