Antenatal Care Flashcards
Listeria infection is a problem if contracted, with fetal
mortality being _______
30–50%.
Folic acid (0.5 mg tablets) is now generally recommended to commence about\_\_\_\_\_\_\_\_ preconception and \_\_\_\_\_\_\_post concepcion
3 months prior to conception, continuing to 12 weeks postconception
Rubella serology should be estimated and, if
required, immunisation_______ prior to conception
should be initiated
4 weeks
When to test for seroconversion for rubella
Test for seroconversion 6–8
weeks late
Rubella Vaccination should be avoided in early
pregnancy, and pregnancy avoided for ________after
rubella vaccination.
28 days
if vaginal bleeding: if Rh negative, send blood
sample for Rh antibodies—if absent, give one
ampoule ______ within
72 hours of first bleed
anti-D gammaglobulin
Perform the four classic techniques of palpation
(applies to later visits):
1 Fundal palpation
2 Lateral abdominal palpation
3 Pawlik palpation
4 Deep pelvic palpation
When to do Maternal serum screening (MSST)
(9–13 weeks, 11 is ideal):
MSST tests
— Free β -hCG
— PAPP-A
If MSST performed at 11 weeks and combined
with NT one week later, it enables the risk of
_____ and _________ to be defined and
compared with age-related risk
trisomy-21 and trisomy-18
Nuchal translucency (NT) ultrasound (usually \_\_\_\_\_\_\_\_
12–13 weeks)
Second trimester MSST
• performed at ________ (if desired)
15–16 weeks
Second trimester MSST
Genetic testing for recessive disorders
such as ________ and ________ can be
discussed at this time.
cystic fibrosis
thalassaemia
Recently, free fetal DNA testing has been available
in Australia and overseas. It is performed on a
maternal blood sample taken at about_______
10–12 weeks
If positive free fetal DNA testing, _______ or __________would usually be required for
confirmation
amniocentesis or
chorionic villus biopsy
A common routine schedule (if all appears normal)
- Initial in first trimester: _______
- Up to 28 weeks: every _______
- Up to 36 weeks: every _____
- 36 weeks–delivery:_____
8–10 weeks
4–6 weeks
2 weeks
weekly
Guidelines for OGTT
• First visit—if previous gestational diabetes or
strong family history
• About 20 weeks—as above + normal initial test
• About 26 weeks—for all other patients
The average number of visits is 12 but the need
for this number is being questioned, with some
authorities recommending as few as______
six visits
urinalysis (protein and sugar)—many clinics
repeat at each visit only if there is _______at
the first visit or if signs of hypertension, kidney
disease or pre-eclampsia develop.
proteinuria
Record day of first fetal movements (i.e.
‘quickening’) (ask patient to write down the dates):
• primigravida: ______
• multigravida:______
17–20 weeks
16–18 weeks
Causes of proteinuria in pregnancy
Urinary tract infection
Contamination from vaginal discharge
Pre-eclampsia toxaemia
Underlying chronic kidney disease
The uterus is a pelvic organ until the ______ of pregnancy
twelfth week
At about _______weeks it
has reached the level of the umbilicus and reaches
the xiphisternum between ________ weeks
20–22
36 and 40
If the symphysis fundal height is more than ____ different
from that expected for the gestation, the cause of
this should be evaluated by ultrasound examination
2 cm
______ and ________ helps prevent constipation of
pregnancy
Bran with cereal
It is usual to gain about ______ during pregnancy
12 kg
Smoking, alcohol and other drugs
1 standard drink of ______
• 1 cup of _____ or 2 cups of tea
alcohol
coffee
There is convincing evidence that promotion
of smoking cessation programs during pregnancy
is effective, with improved outcomes, including
reduction in_______ and _______
preterm birth rates and low birthweight rate
Mothers taking illicit drugs, especially opioids and
amphetamines, require identification, counselling,
treatment and surveillance for the __________
neonatal abstinence syndrome in the newborn child
Coitus should be encouraged during pregnancy but
with appropriate care, especially in the _______
4 weeks before
delivery
They should avoid international air travel after
______ weeks and travel after 34 weeks is usually not
permitted.
28
Normal weight gain is minimal in the first
20 weeks, resulting in a _____weight gain in the first
half of pregnancy
3 kg
From 20 weeks onwards there is
an average weight gain of _____ kg per week. From 36
weeks the weight gain usually levels off.
0.5
if the movements
drop to fewer than ______ per day, the patient should be
referred to hospital for fetal monitoring
10
Possible exposure to rubella
If her immune status is unknown, perform a _______ and repeat titres in 2–3 weeks
rubella IgG titre and IgM and repeat the IgG and IgM
Vaginal bleeding
<6 weeks: Do _________ (ultrasound
usually unhelpful).
serial quantitative HCG levels,
which should double every 2 days
Vaginal bleeding
6–8 weeks:________
Ultrasound will define an intrauterine
pregnancy and exclude an ectopic.
Vaginal bleeding
> 8 weeks: Normal ultrasound is reassuring since
miscarriage rate is only ________ unless the amount of
intrauterine blood is large
3%
T or F
Rest is not necessary for threatened
miscarriage
T
A small bleed between 18–24 weeks indicates
possible ________ and warrants a speculum
or vaginal examination plus fetal assessment
cervical ‘weakness’
Be aware that an incomplete abortion can cause
___________
cervical shock (pelvic pain and fainting).
If a threatened miscarriage occurs, check the blood
group and test for________
rhesus antibodies in maternal
serum.
If the mother is Rh-negative and no antibodies are detected, give one ampoule of \_\_\_\_\_\_\_\_\_\_ intramuscularly if the woman actually miscarries (not for threatened abortion).
anti-D
gammaglobulin
Medication for Nausea and vomiting during pregnancy
— pyridoxine 25–50 mg bd or tds
— if still ineffective add metoclopramide 10 mg tds
This is severe vomiting in pregnancy, which may
result in severe fluid and electrolyte depletion. It
occurs in about 1 in 100 pregnancies
Hyperemesis gravidarum
Hyperemesis gravidarum association
- Normal complication
- Hydatidiform mole
- Multiple pregnancy
- Urinary infection
________ is the basis of the cramps
Prolonged plantar
flexion
There is no evidence
that __________ help cramps during
pregnancy
calcium supplements
Painful haemorrhoids may be eased by the application of __________or perhaps haemorrhoidal ointments containing local anaesthetic
packs soaked in warm saline
Exercise guidelines during pregnancy
• avoid overheating and dehydration
• allow for a long warm-up before exercise and a
long cool-down
• choose low-impact or water exercise
If desperate for CTS, what to do?
an injection of corticosteroid into the carpal tunnel can be very effective (check drug category for risk relative to dates
Cause of hypotension during pregnancy
This is due to increased peripheral circulation and
venous pooling
Generalised itching (pruritus gravidarum) is usually
associated with ________ due to oestrogen
sensitivity in the third trimester
cholestasis
Obesity is associated with increased obstetric
morbidity, including_____ and ______
difficult labour and potential
anaesthetic risks
T or F
Iron is not routinely recommended for pregnant
women who are healthy, following an optimal diet and
have a normal blood test
T
_________ is essential for the developing fetus and
if deficiency is known or suspected (e.g. vegetarian/
vegan diet)
Vitamin B12
It is recommended, for pregnant and lactating
women and those planning a pregnancy, to take _______of supplementary iodine as soon as possible by
using iodised salt for cooking and a multivitamin that
includes iodine
150
mcg
