Antenatal Care Flashcards
IVF is associated with an increased risk of what negative outcomes?
Preterm labour and fetal growth problems
Women with PCOS have a higher risk of what negative outcomes?
Metabolic conditions during pregnancy such as gestational diabetes
Why are uterine fibroids important to know about in pregnant women?
Because the can cause abnormal fetal lie, postpartum haemorrhage and pain + pressure symptoms
What are important aspect of family history to know about?
Hypertensive disorders Women with a family history of preeclampsia in female relatives are at an increased risk of preeclampsia themselves
Venous thromboembolism (VTE) elicit as pregnancy is a pro-coagulable state, and all women have a higher risk of VTE in pregnancy
Diabetes more likely to develop gestational diabetes
Other inherited disorders
Stillbirths and neonatal deaths
Psychiatric history Women with a first-degree relative with bipolar affective disorder or schizophrenia have an increased risk of developing postpartum depression or psychosis
the fetal heart can be heard with a handheld doppler from about ______ weeks
14-16 weeks
Folic acid should be prescribed to all women up until ____ gestation to reduce the risk of________
Women at high risk of _______should take __ folic acid OD
Low risk women should take _____ folic acid OD
Folic acid should be prescribed to all women up until 14 week’s gestation to reduce the risk of neural tube defects (NTDs)
Women at high risk of neural tube defects (e.g. diabetes) should take 5mg folic acid OD until 14 weeks
Low risk women should take 800mcg folic acid OD until 14 weeks
What are the three screening tests available in NZ (2 funded and 1 non-funded)
- MSS1: first trimester screening is performed with a blood test (MSS1) and ultrasound for nuchal translucency at 11-13+6 weeks gestation.
- MSS2: Second trimester testing if the MSS1 is not achieved within the timeframe
- NIPT: non funded, from >10weeks of pregnancy, based on the detection of cell free fetal DNA (fragments of fetal DNA) present in maternal blood.
Hw does MSS1, MSS2 and NIPT work and what are they testing for?
What happens if its positive?
- MSS1 and MSS2 use ultrasound to assess nuchal translucency
- Downs Syndrome (Trisomy 21), Trisomy 18 and Trisomy 13 respectively, mayalso be increased in other conditions such as neural tube defects such as spina bifida
- If positive, these women are referred for amniocentesis for diagnostic testing
How accurate is MSS1/MSS2 for detection of Trisomy 21?
How does this to compare to NIPT (~$10,000)
Detection rate of 90% with a false positive rate of 5%
NIPT: 99% detection rate, false positive 1 %
Whats the differences between the two forms of diagnostic testing for women?
- Amniocentesis: from 14 weeks, the gold standard, small sample of amniotic fluid is taken with a risk of 0-0.4%
- Chorionic Villus Sampling: From 10 weeks, taking a sample of chorionic villus. More difficult, miscarriage rate <1%. Can have placental mosaicism.
What’s the purpose of the 18-20 week Morphology (Anatomy) Ultrasound
To ensure the fetal anatomy is normal.
Looks for anatomical defects of the fetus, the maternal ovaries and uterus, and the placenta. ~50% accuracy
Purpose of the 24-28 week blood tests
- Hb and ferritin: start on iron supplementation if needed
- Antibody status and Blood group
- Diabetic testing
What vaccinations are reccomended for pregnant women?
Influenza and Pertussis
Others may be reccommended in high risk women. (Hep B)
Signs and Symptoms of Pre Eclampsia
- (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg )
- proteinuria after 20 weeks of gestation
- New-onset cerebral or visual disturbance, such as:
- Photopsia (flashes of light) and/or scotomata (dark areas or gaps in the visual field).
- Severe headache (ie, incapacitating, “the worst headache I’ve ever had”) or headache that persists and progresses despite analgesic therapy.
- Altered mental status.
- Severe, persistent right upper quadrant or epigastric pain
- Pulmonary Edema
What does smoking increase the risk of ?
Infertility
Miscarriage
Ectopic
Cleft lip
Abruption / placenta praevia
Preterm labour
Small for gestational age(SGA)
Stillbirth
All of them.
Whats the safe level to drink during pregnancy?
There is no know safe level to drink during pregnancy.
Alcohol is a teratogen and the susceptibility of the fetus to the adverse effects of alcohol can vary between women and the gestation.
What are the clinical features of fetal alcohol spectrum disorder?
- Three characteristic facial features (short palpebral fissures, thin vermillion border, and smooth philtrum)
- Central nervous system (CNS) abnormalities
- Growth retardation
Specific Drugs that cause issues in pregnancy
- Amphetamines
- Benzodiazepines
- Cocaine
- Marjuana
- Opiates
What is the most common chronic condition in pregnancy and how does this change with pregnancy?
Asthma
It 50% of sufferers there is no change, 25% worsen and 25% improve
When are asthma exacerbations the most frequent during pregnancy?
In the third trimester which increase the risk of
- Hospital and ICU admission
- Preterm labour
- SGA
- Preeclampsia
- Perinatal mortality
What medical conditions are important to know about in pregnant woman?
- Asthma
- Heart Disease
- Hypertension
- Epilepsy
- VTE
- Thyroid Disease
- Diabetes
- Mental Health
How should hypertensive women who get pregnant be managed and what are they at risk for?
First Line: labetolol, nifedipine and methyldopa
Unsafe anti-hypertensives include ACEi, so pregnant women need other management to avoid risks such as
- Pre-eclampsia
- Placental Abruption
- SGA
- Preterm birth
Why are women with VTE at an increased risk during pregnancy?
Because pregnancy is a pro-coaguable state
if no prior risk, VTE occurs in <1% during pregnancy and 2% post natal
management of pregnant women with VTE is?
LMW and unfractionated heparin can be used safely.
Transition onto Warfarin post birth (can be used safely in breast feeding)
Does pregnancy lower your seizure threshold if epileptic?
NOT if epilepsy is well controlled, however in poorly controlled diabetic it worsens seizures
- Congenital abnormalities in the fetus (this risk is present even for women who are not taking medication)
- Epilepsy in the baby
- Sudden death in epilepsy in the mother
- Trauma to mother and baby with seizures
***labour and birth are the most high risk times
How should seizures be managed?
lower-risk anti-epileptic drugs for congenital malformations
eg; carbmazepine or lamotrigine
How do thyroid conditions change pregnancy management?
Hypothyroid: thyroxine will need to be increased as the pregnancy progresses
When thyrotoxicosis occurs for the first time in pregnancy, it is usually a first presentation of …….
Graves Disease
What shouldbe considered in management of women with preexisting type 1 or 2 diabetes
Glycaemic control around the time of conception and in the first trimester is vital in reducing congenital abnormalities
What are the risk factors for developing Gestational diabetes in pregnancy?
- Family history of type 2 diabetes, gestational diabetes or glucose intolerance
- Personal history of gestational diabetes or glucose intolerance
- Previous LGA baby
- Previous poor obstetric history (eg stillbirth)
- Belonging to a high risk ethnicity e.g. Polynesian, Indian, Middle Eastern, Asian, Mäori or Australian Aboriginal
- Obesity
- Maternal age > 30 years
- Previous abnormal glucose tolerance test
- Multiple pregnancy
- Glycosuria
- PCOS
What values currently diagnose Gestational diabetes in NZ?
NZ we currently use ≥5.5mmol/L fasting, ≥9.0 mmol/L at 2 hours (NSSD).
