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J Repro > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

what condition must you assess risk for at a booking appointment (2)

A

gestational diabetes

pre eclampsia

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2
Q

what are the risk factors for gestational diabetes

A

BMI >30
previous baby >4.5kg
PMH
Fx

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3
Q

gestational diabetes diagnosis

A

OGTT >5.1mmol fasting

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4
Q

why must you check haemoglobin at booking appointment

A

to see if anaemia

pregnancy = high risk of bleeding

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5
Q

as well as haemoglobin content, what other blood things do you want to check at booking screen

why

A

ABO - incase of blood transfusion

rhesus - if -ve give anti-D SC

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6
Q

why is a mother being rhesus -ve a potential problem

A

if baby is rhesus +ve and their blood comes into contact (eg trauma, abdo bleeding), the mum will undergo a sensitizing event and gain some -ve antibodies

if mum is to have another baby that is -ve

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7
Q

prevention of haemolytic disease of newborn

A

anti-D SC to any rhesus -ve mum at 12 weeks and 28 weeks

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8
Q

what sexual history do you want to know about in the booking appointment

A

STIs - syphilis, HIV, hep B/C

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9
Q

what 3 investigations do you want to do at booking appointment to screen for pre eclampsia

A

bp
urinalysis
maternal uterine artery doppler studies (MUAD)

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10
Q

top differential for positive hCG but empty uterus on US

A

ectopic pregnancy

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11
Q

when do people get a follow up antenatal appointment

A

20 weeks

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12
Q

things to do at follow up appointment

A 
screen for MENTAL HEALTH 
bp -pre eclampsia
urinalysis - pre eclampsia
symphysis fundal height 
fetal heart auscultation
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13
Q

where should the fundus be at 20w (rough guide)

A

umbilicus

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14
Q

where should the fundus be at 37w (rough guide) - full term

A

between costal margins of ribs

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15
Q

what rule is used to calculate due date

A

naegles rule

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16
Q

who delivers the baby if green pathway

A

midwives

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17
Q

who delivers the baby if red pathway

A

obstetricians

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18
Q

at how many weeks is US done

A

12 weeks

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19
Q

what do you measure nuchal thickness on US for

A

down syndrome

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20
Q

what is nuchal thickness on US

A

amount of skin/fat behind fetal neck

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21
Q

normal nuchal thickness

A

<3.5mm

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22
Q

if nuchal thickness >3.5mm, what are the potential causes

A 
chromosome abnormality (eg downs) 
cardiac abnormality

ie increased nuchal thickness doesn’t mean down syndrome - just a screening tool

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23
Q

screening test for downs syndrome

A

nuchal thickness

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24
Q

diagnostic test for downs syndrome

A

amniocentesis (14-16 weeks)

CVB (<14 weeks)

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25
Q

if nuchal thickness >3.5mm, what do you do next

A

amniocentesis (14-16 weeks)

CVB (<14 weeks)

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26
Q

what do you measure crown rump length (CRL) for on US

A

to date pregnancy, alongside date of last prior, up until 14 weeks

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27
Q

what 2 things do you look for on US at the 12 week scan

A

nuchal thickness

crown rump length (CRL)

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28
Q

what are you looking for on US at the 20 week scan (2)

A 
feotal abnormalities
placenta praevia (when placenta lies low in the womb)
29
Q

apart from US what other test can be done at 12 weeks

why would you do them

A

serum scanning - amniocentesis or CVB

done if NT>3.5mm or genetic testing required (eg family history)

30
Q

where is needle inserted in chorionic villous biopsy (CVB)

what are you sampling

A

needle inserted through vagina

sampling placenta

31
Q

why can CVB sometimes be inaccurate

A

confined placental mosaicism

32
Q

when do you use CVB over amniocentesis

A

<14 weeks

33
Q

where is the needle inserted in amniocentesis

what are you sampling

A

needle inserted through abdo wall

sampling amniotic fluid

34
Q

which test is superior to CVB and amniocentesis but not currently provided on the NHS

A

NIPT (non invasive prenatal testing) - just requires a maternal blood test

35
Q

which genetic test is used in amniocentesis/CVB to pick up downs syndrome

A

aCGH - picks up chromosome imbalances

36
Q

why might you use chromosome analysis over aCGH

A

chromosome analysis picks up balanced translocation

aCGH only picks up unbalanced translocations

37
Q

how many extra calories per day do you need when youre pregnant

A

250-300

not eating for 2!

38
Q

supplementation requirements for pregnancy

A

5mg folic acid + 10mcg vit D

39
Q

what does folic acid deficiency cause in babies

A

neural tube defects

40
Q

what other supplementation could you recommend for during pregnancy (on top of folic acid and vit D)

A

iron supplements

41
Q

which scheme provides those on benefits/<18yo with money for supplements during pregnancy

A

healthy start scheme

42
Q

generally, should people continue taking drugs during pregnancy

A

if benefits outweigh risks (eg seizure risk) yes

persons choice

43
Q

if on heparin and planning pregnancy, what should you do

A

switch to LMWH

44
Q

which drug for connective tissue diseases is teratogenic and hence should be stopped during pregnancy

A

methotrexate

45
Q

is there an increase in seizure frequently during pregnancy for epileptics if they take their medication

A

no - only increases if they stop medication!

46
Q

which antiepileptic MUST you avoid in pregnancy

A

sodium valproate

47
Q

what could happen if someone took sodium valproate during pregnancy

A

anencephaly

neural tube effects eg spina bifida

48
Q

which diabetic drug is teratogenic

A

sulphonylureas

49
Q

is insulin safe in pregnancy

A

yes

50
Q 
if obese what prophylaxis should you give 
for what (pregnancy specific condition)
A

75mg aspirin

for pre-eclampsia

51
Q

what does obesity increase your risk of during pregnancy

A

miscarriage

52
Q

what antihypertensives should you avoid in pregnancy

first line medication

A

ACEinhibitors and ARBs

labetalol

53
Q

how do you assess growth on US after 14w (before 14w = CRL)

A

had circumference

54
Q

what is the principle rule when prescribing something in pregnancy

A

weigh up pros and cons - ultimately patient decision

55
Q

teratogenic epileptic drug

A

sodium valproate

56
Q

teratogenic antidepressant

A

paroxetine - KNWO THIS!

57
Q

what can sodium valproate cause in babies

A

neural tube defects eg spina bifida, anencephaly

58
Q

teratogenic anticonvulsant

A

benzodiazepine

59
Q

teratogenic antipsychotic (2)

A

clozapine

olanzapine

60
Q

teratogenic rheumatology drug

A

methotrexate

61
Q

teratogenic anti coagulant

A

warfarin

62
Q

what can warfarin cause in babies

A

warfarin embryopathy - short limbs and phalanges, facial defects

also bleeding risk in mums (bad during pregnancy)

63
Q

which antibiotic stains childrens bone and teeth (hence should be avoided in pregnancy and childhood)

A

tetracycline

64
Q

what can benzodiazepine cause in babies if given in third trimester

A

‘floppy baby syndrome’

65
Q

which antidepressant should be avoided in breastfeeding

what should be used instead

A

citalopram

use sertraline

66
Q

what can alcohol during pregnancy cause

how does this present

A

fetal alcohol syndrome

thin upper lip, fat midface, smooth philtrum, microcephaly (small head)

67
Q

why should opiates be stopped during pregnancy

A

neonatal opiate withdrawal after birth if not

68
Q

at what stage (gestation) does the embryo gain rights

A

14 days - cant do embryo research after this

J Repro (28 decks)

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