Antenatal care Flashcards
Childbirth has become increasingly …
Medicalised
Birth rate is
Dropping
Average age of mother in 2017 =
30.5
Which group of women chose to give birth at home?
Older women
what study compared the safety of birth in 4 different settings?
Birthplace cohort study (2011)
Areas looked at in the birthplace cohort study:
- Home
- Freestanding midwifery units
- Alongside midwifery units
- Obstetric units
Main findings of birthplace cohort study:
- For low risk women the incidence of adverse perinatal outcomes was low
- No difference in outcomes for freestanding, alongside and obstetrics units
- For nulliparous, outcomes in obstetric units is associated with better outcomes
Aims of antenatal care:
- Continuity of care/personal relationship
- Monitor progress of pregnancy
- Monitor fetal and mother health
- Refer deviations from the norm
- Promote choice
- Public health promotion
- Prepare for birth and parenthood
What can be used to inform antenatal care?
MBRRACE-UK NICE Local policy Midwifery 2020 National maternity review
MBRRACE-UK
Mother and baby risk reduction using audits and confidential enquiries
Name of national maternity review report
‘Better births’
‘Better birth’ themes
Personalised care
Continuity of care
Safer care
Better postnatal and perinatal mental health
Booking appointments tends to last for:
1-1.5 hrs
NICE recommends booking appointment to be before when?
10 weeks
What happens in booking interview:
- Build relationship
- Identify concerns and discuss
- Baseline measurements
- Hx
- Public health promo
Information that should be gathered in the Hx at booking:
- Demographics
- Present pregnancy and menstrual Hx
- Previous pregnancies
- Medical Hx
- Surgical Hx
- Lifestyle and social Hx
- FHx (e.g. pre-eclampsia)
- baseline obs
How many antenatal visits would a parous women get?
7
How many antenatal visits would nulliparous women get?
10
Added visits to an NP women occur at:
25 weeks
31 weeks
40 weeks
Physical exam:
Weight BP Urinalysis Oedema Varicosities Nausea and vomiting Bladder and bowels Blood tests
What is checked for in blood tests?
ABO blood types Rhesus factor antibodies Full blood count Syphillis, HepB, HIV, Rubella immune status Haemoglobinopathies
What is the abdo exam used to assess?
Fetal growth and size Wellbeing Presentation Positioning Engagement
Abdominal palpation for presentation should be after when?
36 weeks
How to prep to assess fundal height:
Empty bladder
Fundal height is measured from
Fundus of uterus to top of symphisis pubis
Weeks gestation when fundus is at umbilicus:
24 weeks
Position of baby can be:
transverse
Logitudinal
Oblique
Ideal position:
Logitudinal
Ideal presentaiton:
Cephalic
Presentaiton can be:
Cephalic
Breach
Oblique
Engagement occur when
The widest diameter of detal head has entered into the pelvis
Engagement of head is measured in
fifths
Head is ‘engaged’ at what level
2-3/5
Engagement with 1st baby usually occurs around
36 weeks
Enagagement with parous women can occur
Just before labour
When does the combined screening test occur?
10-12 weeks
When does fetal abnormality scan occur?
18-20 weeks
Risk factors to look for that can effect pregnancy outcome:
- Chronic or acute disease
- Proteinuria
- Increase BP
- OEdema
- Uterus large/small for gestational age
- Mal presentation
- Bleeding
- Infection
Pre-eclampsia is due to problems with:
Spiral arteries
Signs of pre-eclampsia:
Proteinuria
Hypertension
HELLP syndrome:
Hemolysis
elevated liver enzymes
low platlets
Pre-eclampsia risk factors:
- FHx
- Hypertension
- Diabetes
- Obesity
- > 35 yrs
- 1st pregnancy
- multiple gestations
What causes seizures in ecclampsia?
Cerebral oedema
Miscarriage occurs before
24 weeks
Stillbirth =
Born after 24 weeks, no signs of life
