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Obs & Gynae > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

What 5 things should be STOPPED before pregnancy? (part of the pre-pregnancy health promotion)

A

STOP:

1) SMOKING
2) DRINKING - causes FAS, miscarriage rates inc. as alc can cross placenta (binges esp harmful, 1-2units pwk not shown any adverse effects to foetus)
3) REC DRUG USE (assoc. w/miscarriage, preterm birth, poor foetal development, intrauterine death) & TERATROGENIC MEDS
4) RUBELLA - need vaccine before pregnant as the risk to foetus is in the first 8-10 weeks
5) WEIGHT - WL increases conception rates + encourage exercise (but avoid sports where abdo trauma possible)

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2
Q

What impact does smoking have on fertility and foetus/placenta?

A

Fertility: - reduces ovulation and tube function - causes abnormal sperk Harm to foetus: - 2x inc. of miscarriage - preterm labour & IUGR Harm to placenta: - placenta praevia & abruption

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3
Q

What 3 things should be STARTED before pregnancy (part of the pre-pregnancy health promotion)?

A

for 1m before preg = FOLIC ACID 0.4mg/day ==> 13wks after – avoids neural tube defects & cleft liP VITAMIN D SUPPLEMENTS - for @risk ethnic groups, obese, chronic disease and reduced motility “healthy start vitamins for women” - folic acid + vitamins C + D (10mcg/d) [these can be free to some during pregnancy and for 1 yr after birth)

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4
Q

Some at risk groups should be taking 5mg/day of folic acid. Who are these groups?

A

if past children with NTDs if they are taking anti-epileptics obese - BMI>30 HIV +ve - on co-trimoxazole prophylaxis (as blocks folic acid)

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5
Q

If a woman discovers she is pregnant what vaccines should she be offered (assume she has been protected against rubella already from pre-preg health)?

A

pertussis (whooping cough) flu vaccine

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6
Q

When should teratrogenic meds be changed?

A

pre-conception! these include anti epileptics, ACE-i and immune modulators

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7
Q

if a pregnant ladys family have or she/partner has genetic condition what should be offered?

A

offer genetic counselling (for relevant FHx or Personal history)

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8
Q

What is the rough miscarriage rate of all pregancies?

A

~15-20% all pregnancies (so ~1/5!) inc. risk at extremes of age

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9
Q

When is miscarriage considered recurrent?

A

>3!

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10
Q

A women presents to GP with N&V, increased frequency of micturition, excessive fatigue and breast tenderness/heavyness. her periods have also stopped. What could be the cause?

A

PREGNANCY! you will rule out UTI though from frequency of micturition – norm in pregn though is due to increased plasma volume / pressure effects

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11
Q

When does N&V occur during pregnancy?

A

normally happens within T1 - may sometimes persist throughout pregnancy can happen at any time of day (contrary to morning sickness)

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12
Q

When do people tend to feel excessive fatigue in pregnancy?

A

< 12 weeks

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13
Q

When are foetal movements normally felt?

A

> 20 wks gestation usually

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14
Q

What is the name given to the abnormal desire to eat something not normally regarded as nutritive e.g. dirt

A

Pica

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15
Q

When is the uterus palpable per abdomen?

A

> 12 wks – the foetal heart may be heard with doppler over this time too

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16
Q

how may the uterus be examined before 12 weeks?

A

size of uterus may be estimated by bimanual examination

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17
Q

Why may the vagina & cervix have a blue-ish tinge O/E in pregnancy?

A

blood congestion

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18
Q

What does a bhCG pregnancy test measure, what is the “positive” threshold and when can you no longer rmeasure bHCG?

A

hCG is secreted by trophoblastic tissue (>Day6) - from 8d after ovulation secretion increases exponentially (doubles every 2nd day in ongoing pregnancy) it peaks at 8-12 wks gestation - can be measured in blood or in urine positive - >50 IU/L

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19
Q

What are ways of calculating gestational age?

A
  • use LMP - USS - using crown-rump length on USS scan between 11-13 wks is most accurate - symphysis-fundus height is accurate from 28wks
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20
Q

How do you calculate pregnancy due date?

A

using Naegeles rule for 28 day cycle NB–> if longer than 28 day cycle add on the number of days in addition to the 7 already added LMP + 1 year - 3 months + 7 days

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21
Q

When should everyone have had a booking visit by?

A

in by 12 weeks

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22
Q

In an obstetric booking visit history what RF for GDM do you screen for and when are they next screened?

A

previous baby >4.5 or previous GDM screen at 16-28wks

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23
Q

apart from obstetric history what else needs to be elucidated in a booking visit?

A

menstrual, gynaecology & sexual history inc. cervical smears PMHx - FGM, VTE, mental health (schizo, bipolar, self harm, post natal depression) FHx - diabetes, HTN, foetal abnormality, inherited diseasae, twins Social hx - support, domestic violence, substance abuse

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24
Q

if a patient has a BMI over 30 at booking visit what should be done?

A

OGTT at 28 wks + 5mg folic acid until 13wks

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25
Q

What screening tests should be done at booking visit?

A
  1. FBC/electrophoresis 2. Blood grouping and Rh status 3. Infection screen of blood - serology: - a) HIV, - b) hepatitis B, - c) syphilis, - d) rubella - e) +/-chickenpox 4. Urine MSU, MC&S - even if dipstick is -ve as asymptomatic bacteriuria (protein, sugars, bacteria) 5. BP & BMI
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26
Q

Why do you do FBC/electrophoresis?

A

because pregnancy only makes you more anaemic as Hb is diluted physiologically TF fix pre-pregnancy anaemia The electrophoresis = sickle cell or thalassemia

27
Q

What is important about Rh status?

A

Rhesus D-ve women need to be informed of rhesus immunisation & sensitisation from a rhesus D+ve fetus Anti-D IgG crosses the placenta already from any PREVIOUS pregnancies giving risk of haemolytic disease

28
Q

What is a way of reducing hep B and HIV transmission to baby?

A

avoiding forceps / trauma to baby HIV: use ART <24wks and plan C-section if viral load is >400 give intrapartum ziovudine infusion give oral ziovudine for newborn until 6wks DO NOT BREASTFEED

29
Q

why is syphilis tested for in booking visit? how is it Rx?

A

risk of miscarriage, stillbirth & syphilis of newborn Rx: penicillin

30
Q

What problems does hepatitis B cause in newborns?

A

can infect newborns –> (fibrosis–>) cirrhosis, HCC & liver failure

31
Q

What problems does chickenpox cause?

A

pneumonitis in mum, foetal varicella syndrome varicella Ig should be considered if unsure history & no abs

32
Q

Which conditions is screening not effective for?

A

Hep C (check high risk women), chlamydia, GBS, CMV, Toxoplasmosis

33
Q

What happens at the “12 week scan” (technically can be between 11-13 wks)?

A

Confirms estimated due date - uses crown rump length AND “combined” test for down syndrome: pt. 1 of combined test = NT –> Downs, or any serious anomaly of heart & great vessels pt. 2 of combined test = combined risk score = NT + PAPP-A + bhCG + maternal age IF ABNORMAL–> ask if they want dx test cvs/amnio (1-2% procedure related miscarriage rate) NB: - (biggest RF = maternal age at conception) advise/information giving

34
Q

What advise and information should be given at the 12 wk scan?

A

smoking, alcohol, diet correct use of seat belts (above or below bump - not over it) offer antenatal classes information on maternity benefits - including free dental Travel: avoid malaria areas but usual exercise and travel are ok up to 36 weeks; but check with airline; many require a ‘fit to fly’ letter >32 weeks intercourse - is ok if no vaginal bleeding

35
Q

For a pregnant woman, what should be done at every visit and when are they?

A

at each visit = urine protein, BP, fundal height visits are at <12wks then 14, 25, 28, 31, 34, 40 & 41 (primip) e.g. from 25 weeks onwards it 3x weekly until 34 then its 4 weeks - 40wks and then +1 = 41

36
Q

At how many weeks should a patient with a PMHx of GDM have OGTT?

A

16 weeks

37
Q

At how many weeks should a patient with GDM RF’s: previous baby >4.5kg, BMI > 30, 1st degree relative diabetic have an OGTT?

A

28 weeks

38
Q

What happens at the 28 week visit?

A

OGTT if RF for GDM FBC/Hb & Rh antibodies –> give anti-D if needed weight only if clinically indicated NB: 28 weeks is the earliest time you can do a foetal MRI

39
Q

When do you discuss labour and birth including pain relief with the mother?

A

at 34 weeks

40
Q

You need to discuss and information give at 36 weeks as well as 34. What are the discussions at 36 weeks about?

A

breastfeeding neonatal vitamin K postnatal care postnatal depression baby blues [labour and birth are discussed at 34 weeks]

41
Q

when do you discuss post dates pregnancy & its Rx with a mother?

A

at 40 weeks

42
Q

When do you offer a membrane sweep and book induction of labour?

A

offer this at 41 weeks and have IOL booked by 42 weeks

43
Q

When is the next anomaly scan after 12 weeks? & what does it look at?

A

20-22 weeks anomaly scan (probably known to public as sexing scan) but is used for: - growth measurements - structural abnormalities - sexing is possible - poly/oligo hydramnios

44
Q

what parameters are used to look at growth measurement of a foetus @20-22wks?

A

1 important one = abdominal circumference @level of liver bi-parietal diameter head circumference femur length

45
Q

Structural abnormalities e.g. congenital heart disease, brain, bone, renal, abdo can be detected at the 20-22 week anomaly scan can be isolated or multiple. What is the difference?

A

isolated structural abnormalities can be noted e.g. ventriculomegaly and then prognosis and management decided if there are MULTIPLE structural abnormalities it is likely to be chromosomal, infectious or teratrogenic cause NB: between 3-8 weeks after fertilisation is the most vulnerable birth defect time (<20d = all or nothing effect; 2nd & 3rd tri. = organ development complete)

46
Q

Urinalysis is very useful in pregnancy. Why?

A

Nitrates show: asymptomatic bacteriuria which has an increased risk of preterm delivery and pyelonephritis during pregnancy –> do MC&S Protein shows: pre-eclampsia or renal disease Glycosuria shows: pre-existing or gestational diabetes

47
Q

Blood pressure typically falls in pregnancy then rises, when do you expect to see above pre-pregnancy levels?

A

expect above pre-pregnancy levels by the end of trimester 1 [>12wks] AKA in TRIMESTER 2 [13-28wks]. in trimester 1 if you diagnose previously unrecognised HT give antihypertensives and low-dose aspirin.

48
Q

What does this refer to: using snps to distinguish parts of free DNA from mum and foetus in blood plasma to find aneuploidy or foetal sexing in X-linked conditions e.g. Duchenne (from 9 weeks

A

Non invasive pre-natal testing - NIPT non-invasive as only requires a simple blood test on mum foetal sexing as indicated for x linked conditions can happen from 9 weeks

49
Q

the presence of “notching” on uterine arterial doppler USS late pregnancy refers to how many weeks? and also what does it represent?

A

> 22wks (e.g. nearly T3 onwards) - as early diastolic notch maybe normal up to 16wks –>represents increased UTERINE vascular resistance and impaired uterine circulation bilateral is more concerning unless the placenta is on only one lateral wall e.g. rhs or lhs then it is as concerning as bilateral

50
Q

What conditions may be related to notching on uterine arterial doppler USS assessment?

A

as well as adverse pregnancy outcomes, notching after 22w iss assoc. with:

  • Pregnancy induced hypertension (PIH)
  • pre-eclampsia
  • placental abruption
  • intra-uterine growth restriction (IUGR)
  • increased maternal serum alpha feto protein
51
Q

What are the invasive tests of antenatal care & when can they be done?

A
  1. chorionic villus sampling
    • 11w - 13+6wks (e.g. before 14)
  2. amniocentesis
    • > 15 wks
  3. cordocentesis
    • >20 wks
52
Q

What is the miscarriage risk associated with non-invasive prenatal testing (NIPT)?

A

there is none! - uses free foetal DNA from mothers blood, occasionally may need a repeat test

  • HOWEVER it remains a screening test whereas CVS, amniocent. and cordocentesis are diagnostic
  • it is also not on the NHS yet…
53
Q

What are the miscarriage risks associated with CVS, amniocentesis and cordocentesis and when can they be done?

A
  • CVS = 11 - <14 wks
    • 2% risk
  • Amniocentesis = >15 wks
    • 1% risk
  • Cordocentesis >20wks
    • 2-5%
54
Q

When can NIPT (non invasive prenatal testing) be done from?

A

10 weeks!

(earlier than even CVS)

55
Q

which is more accurate over CVS or amniocentesis and why?

A

Amniocentesis is more diagnostically accurate than CVS due to placental mosaicism

56
Q

What is the procedure of chorionic villus samplling?

A

foetal trophoblast cells taken from developing placenta through:

abdominal wall or alternatively though the cervix (if retroverted uterus or low lying placenta)

  • under USS guidance
  • w/local anaesthetic

the tissue collected –> chromosomal analysis

57
Q

What is the procedure of amniocentesis?

A

Extraction of amniotic fluid

containing: amniocytes & fibroblasts;

uses US guidance under LA

–> foetal cells taken for karyotyping and/or PCR

58
Q

What is cordocentesis used for?

(>20wks)

A
  1. When foetal blood is needed
      • taken from the point where the umbilical cord inserts into the placenta
    • e.g. foetal anaemia or thrombocytopenia w/availablity of immediate transfusion if confirmed
  2. when a rapid full culture for karyotyping is needed
59
Q

Do these complications come from CVS or amniocentesis?

  • Miscarriage risk (1-2%),
  • vaginal bleeding,
  • pain,
  • infection,
  • amniotic fluid leakage,
  • rhesus sensitisation
A

From CVS!

*bolded points are different from amniocentesis risk (e.g. they both have pain, infection, resus sensitisation risk- normally Rh abs @28wks and these are before)

  • CVS miscarriage risk is higher
  • vaginal bleeding as can go through cervix instead of abdo
  • Due to Rh sensitivity risk Rh-ve women will need anti-D ig after test! (for both CVs&amnio)
60
Q

Do these complications come from CVS or amniocentesis?

  • miscarriage risk (0.5-1%),
  • false reassurance,
  • risk infection,
  • pain,
  • rhesus sensitisation,
  • increased risk of club foot
A

Amniocentesis!

*bolded complications are different to CVS

Due to Rh sensitivity risk Rh-ve women will need anti-D ig after test! (both CVS&amnio)

61
Q

What are the indications for CVS?

A
  • ‘high risk’ on antenatal screening (risk >1:150),
  • (CVS better for fhx genetic problems etc because done earlier! 11-<14wks)
  • previous child with chromosomal or genetic abnormality,
  • known carrier status for genetic condition,
  • FHx genetic condition,
  • US showing foetal abnormalities associated with chromosomal/genetic condition (e.g. +multiple structural abnormalities)
62
Q

What are the indications for amniocentesis?

A
  • ‘high risk’ result from T1 screening
  • or previous pregnancy affected by a genetic condition
63
Q

Which test detects these:

aneuploidies,

placental mosaicism,

transverse limb defects

A

CVS

64
Q

Which test detects these?

foetal viral infections,

chromosomal conditions e.g. Down, Edwards, Patau

A

amniocentesis

Obs & Gynae (5 decks)

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