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Obstetrics & Gynaecology > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

What is involved in pre-pregnancy counselling?

A

Tailored to each patient, depending on their lifestyle habits and chronic conditions they may suffer from.

Topics discussed include:

  • Timing of pregnancy- >35 y/o have increased risk, pregnancy interval (optimal = 18-59 months)
  • Advice about conception - regular unprotected sex, family planning services
  • Advice on folic acid - risk of NT defect
  • Pregnancy testing - urinary B-hCG test
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2
Q

What are the risk factors for neural tube defects?

A
  • Either partner has NT defect
  • Family history of NT defect
  • Previous pregnancy with NT defect
  • Mother is taking AEDs
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3
Q

What dose of folic acid should women take when considering pregnancy?

A
  • Normal risk of NT defect = 400mcg OD from preconception to 12 weeks post-partum
  • High risk of NT defect = 5mg OD from preconception to 12 weeks post-partum
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4
Q

What lifestyle changes should be encouraged preconception?

A
  • Healthy diet - low fat and sugar, high in fruit, veg, fibre - 2,500 calories per day
  • Maintaining healthy BMI between 18-25 - women with BMI>30 should lose 5-10% of body weight before conception
  • Smoking cessation - referral to cessation services
  • Alcohol abstinence - referral to alcohol liaison service by midwife
  • Stop illicit drug use - use contraception until drug use has stopped, test for Hep B,C and HIV
  • Should not take OTC medications until doctor has been consulted first
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5
Q

Risks of obesity in pregnancy…

A
  • Pre-term labour
  • Pre-eclampsia
  • GDM
  • Miscarriage
  • Macrosomia
  • Shoulder dystocia
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6
Q

Risks of low BMI in pregnancy…

A
  • Pre-term labour
  • Low birth weight
  • Gastrochisis
  • First trimester miscarriage
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7
Q

Risks of smoking in pregnancy…

A
  • Pre-term labour
  • Low birth weight
  • Birth defects of the mouth
  • Sudden infant death syndrome
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8
Q

Risks of alcohol in pregnancy…

A
  • First trimester miscarriage
  • Structural abnormalities
  • Preterm labour
  • Low birth weight
    After 3 months: learning difficulties, foetal alcohol syndrome
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9
Q

Risks of illicit drug use in pregnancy…

A

Opioids: structural abnormalities, foetal growth restriction, foetal distress, sudden infant death syndrome

Stimulants: first trimester miscarriage, structural abnormalities, preterm labour, placental abruption, sudden infant death syndrome

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10
Q

When is the first antenatal appointment, and what is its purpose?

A

Takes place at 10 weeks:
Main purpose is to take a detailed history and examination to determine if antenatal care needs to be hospital or community led.

Investigations:

  • FBC (again at 28 weeks)
  • Blood group and rhesus status (again at 28 weeks)
  • Infection screen - syphillis, rubella, HIB, Hep B
  • Urine culture
  • Screening for GDM, sickle cell, thalassaemia
  • Consent for chromosomal anomaly scan
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11
Q

How can gestational age be estimated?

A

40 weeks from last menstrual period

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12
Q

When do the two routine antenatal scans take place?

A
  • Dating scan : 11-14 weeks - gestational age and EDD

- Anomaly scan: 18-20 weeks - most structural malformations can be assessed, amniotic fluid and foetal growth assessed

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13
Q

When are additional growth scans indicated?

A
  • Previous SGA
  • Pre-eclampsia
  • GDM
  • High BMI
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14
Q

How many antenatal visits are recommended during pregnancy?

A
  • 10 visits for nulliparous women

- 7 visits for multiparous women

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15
Q

What will most antenatal visits include?

A
  • BP and weight measurement
  • Urine dip - MSU, GTT
  • Foetal movements and maternal concerns
  • SFH, position and presentation
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16
Q

What ‘minor’ maternal complications should be looked out for in antenatal care?

A
  • Ankle oedema - raise legs when sat down
  • Candidiasis - give imadazole pessary for active infection
  • Pelvic girdle pain and backache - physiotherapy + analgesia
  • Constipation - high fibre intake + stool softeners
  • Abdominal pain - rule out pancreatitis/ appendicitis
  • Heartburn - use extra pillows
  • Carpal tunnel syndrome
  • Itchiness - check for scleral jaundice
17
Q

What happens in antenatal classes?

A

Education and training for both parents - intrapartum techniques for posture, breathing and pushing are taught.

18
Q

What are the two types of twins?

A

Dizygotic = fertilisation of different oocytes from different sperm therefore they are non-identical

Monozygotic = result from mitotic division of a single zygote leading to identical twins

19
Q

What does division at different stages mean?

A
  • Division before day 3 = dichorionic, diamniotic twins (separate amniotic sacs and separate placentas)
  • Division between day 4-7 = monochorionic, diamniotic (shared placenta and separate amniotic sacs)
  • Divison between day 8-12 = monochorionic, monoamniotic (shared placenta and amniotic sac)
  • Division after day 13 = conjoined twins
20
Q

How do women with twins usually present?

A
  • Significant vomiting occurs

- Uterus is much more palpable than the gestation

21
Q

Comlplications from multiple pregnancies…

A

Maternal:

  • GDM
  • Pre-eclampsia
  • Hyperemesis
  • PPH

Foetal:

  • Preterm delivery
  • IUGR
  • Miscarriage of one of the twins - twin-twin transfusion syndrome
  • Monoamniotic = risk of cord entanglement
22
Q

What is twin-twin transfusion syndrome?

A

Usually occurs in monochorionic twins where there is unequal blood distribution from the placenta leading to one donor twin (anaemic and depleted) and one recipient twin (polycyhthaemia and polyhydramnios)

23
Q

Antenatal management of multiple pregnancies…

A
  • More regular growth scans after 20 weeks: 28, 32 and 36 weeks - checking for IUGR
  • If twin-twin transfusion syndrome is identified, babies to be delivered at 26 weeks
  • Delivery = 37 weeks for dichorionic, and 36 weeks for monochorionic
24
Q

Intrapartum management of multiple pregnancies…

A
  • Mode of delivery = vaginal if first baby is cephalic presentation - otherwise C-section
  • CTG monitor - risk of intrapartum hypoxia
  • Foetal monitoring continuously
  • If second twin is not cephalic, external cephalic version (ECV -manually turning the foetus around) can be attempted before mother starts pushing again
25
Q

Different methods of antenatal screening…

A
  • Blood tests for potential neonatal infection e.g. hep B, HIV, syphillis, rubella
  • Foetal anomaly scan at 16-20 weeks gestation - looking for structural abnormalities e.g. spina bifida, cleft palate, anencephaly AND looking at placental localisation
  • Detailed cardiac scans offered at 20 weeks to at-risk groups
26
Q

Down’s syndrome screening tests…

A

Combined test - offered between 10-14 weeks:

  • Nuchal translucency test (from USS at booking scan) ->3.55mm
  • PAPP-A reduced
  • B-hCG raised

Quadruple test -offered between 14-20 weeks:

  • Oestriol, uE3 - reduced
  • B-hCG raised
  • Inhibin A raised
  • AFP reduced
27
Q

Diagnostic testing for down’s syndrome…

A
  • Chorionic villus sampling - between 11-14 weeks

- Amniocentesis - > 15 weeks

28
Q

Name some common structural abnormalities

A

CNS defects:
- Neural tube defects

Cardiac defects:

  • VSD, AVSD,
  • Cyanotic heart disease: 5 Ts

Abdominal wall defects:

  • Exomphalos - abdominal contents herniate through abdominal wall in a sac
  • Gastrochisis - abdominal contents exposed to air from herniating through abdominal wall

Chest defects:

  • Diaphragmatic hernias into chest cavity
  • Pleural effusions may be present

GI defects:

  • Oesophageal atresia
  • Trachea-oesophageal fistulae
  • Duodenal atresia
29
Q

What is foetal hydrops, and what causes it?

A

Large amounts of fluid build up in the foetal tissues, leading to extreme swelling - high risk of mortality in early pregnancy.

Immune causes: haemolysis from Rhesus D disease
Non-immune: any structural abnormality

30
Q

What is foetal alcohol syndrome?

A

Made up of three components:

  1. Facial abnormalities: microcephaly, thin upper lip, low-set ears
  2. IUGR - continues into short stature in adulthood
  3. Neurodevelopmental disorders - causing developmental delay and learning difficulties

Obstetrics & Gynaecology (10 decks)

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