Antenatal care Flashcards

1
Q

What is the main purpose of antenatal care?

A

Identify mothers who need medical attention, to prevent maternal and fetal morbidity and mortality. Detect congenital fetal problems, plan the delivery, provide education and lifestyle advice

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2
Q

What are the most poorly appreciated risk factor for morbidity and mortality in pregnancy?

A

Language barriers, obesity and psychiatric disease

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3
Q

What does preconceptual care and counselling involve?

A

Health check (rubella and cervical smear abnormalities); chronic disease management (glucose control); medication can be optimised for pregnancies (some epilepsy medication); routine preconceptual administration of folic acid; advice regarding smoking, alcohol and drugs

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4
Q

When should the booking visit be ideally?

A

Before 10 weeks gestation

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5
Q

What is the purpose of a booking visit?

A

To screen for possible complications, assessing risk, decisions about type and frequency of antenatal care, check gestational age, appropriate prenatal screening.

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6
Q

What age of women have higher risk during pregnancy?

A

Under 17 and over 35

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7
Q

Which pregnancy complications have a small but significant recurrence rate?

A

Preterm labour, SGA, FGR, stillbirth, antepartum and postpartum haemorrhage, some congenital abnormalities, rhesus disease, pre-eclampsia and gestational diabetes.

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8
Q

Which gynaecology conditions increase risk during pregnancy

A

Subfertility, ART and previous uterine surgery (usually delivered by elective section)

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9
Q

Which medical conditions increase risk during pregnancy?

A

HTN, DM, autoimmune disease, haemoglobinopathy, thromboembolic disease, cardiac or renal problems, depression needs to be asked about

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10
Q

What would you ask about in the social history in a booking visit?

A

Smoking, drugs, alcohol. The possibility of domestic violence should always be considered

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11
Q

What is the 12 week US scan looking at?

A

Date of conception (using CRL), detects multiple pregnancy, nuchal translucency measurement, blood levels of beta-hCG and PAPPA

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12
Q

What blood tests are performed at the booking visit?

A

FBC (anaemia); serum antibodies (anti-D); glucose tolerance test; syphilis test; rubella immunity; HIV and hep B; haemoglobin electrophoresis;

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13
Q

What is the 18 week US scan looking for?

A

Looking for structured fetal abnormalities

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14
Q

What are some ‘minor’ conditions of pregnancy?

A

Itching, pelvic girdle pain, abdominal pain, heartburn, back ache, constipation, ankle oedema, leg cramps, carpal tunnel syndrome; vaginitis; tiredness

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15
Q

How does the genital tract change during pregnancy?

A

Uterus weight increases. There is muscle hypertrophy, increased blood flow and contractility. Cervix softens, may start to efface in late third trimester

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16
Q

How does blood change during pregnancy?

A

Blood volume - 50% increase
Red cell mass - increase
Haemoglobin - decrease
WBC count - increase

17
Q

How does the cardiovascular system change during pregnancy?

A

Cardiac output - 40% increase
Peripheral resistance - 50% reduction
Blood pressure - small mid-pregnancy fall

18
Q

How do the lungs change during pregnancy?

A

Tidal volume - 40% increase

Respiratory rate - no change