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Y4 cOGText > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

How much folic acid should be given before conception?

A

400mg folic acid

from before conception until 12 weeks gestation

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2
Q

What does folic acid reduce the risk of?

A

Neural tube defects

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3
Q

What pregnant women would have to continue taking 5mg folic acid after the 12 weeks?

A 
diabetes
on anti-epileptic medication
BMI>30
previous pregnancies with neural tube defects
FH
PMH
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4
Q

How much vitamin D should mothers be given?

A

10mg of Vitamin D supplements during pregnancy & breastfeeding

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5
Q

True or false: pregnant woman should eat for 2.

A

False.

Only an excess of 250-300 calories are needed (especially in last trimester)

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6
Q

List the side effects that alcohol in pregnancy can cause.

A 
Fetal alcohol syndrome 
IUGR & postnatal restricted growth
learning difficulties
risk of miscarriage
withdrawal
Wernicke's encephalopathy & Korsakoff's syndrome
microcephaly
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7
Q

Nicotine use in pregnancy increases the risks of…?

A

miscarriage

pre-term labour

IUGR

still-births

SIDS

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8
Q

when is the booking visit?

A

10-12 weeks (by a community midwife)

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9
Q

what is done in the booking visit?

A

history taken - medical, drug, social, FH, LMP, was pregnancy planned, ethnicity of parents,

obstetric history - previous pregnancy, mode of delivery, previous miscarriages/TOP

blood group & Hb checked - & screened for haemoglobinopathies

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10
Q

what haemoglobinopathies are screened for at the booking visit?

A

HIV/AIDS
Syphilis
Hep B & C

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11
Q

What conditions are screened for at 18-20 weeks?

A

Anencephaly

Spina Bifida

Cleft lip

diaphragmatic hernia

gastroschisis

exomphalos

bilateral renal agenesis

lethal skeletal dysplasia

cardiac anomalies (TGA, AVSD, TOF, HLHS)

Edward’s syndrome (Trisomy 18)

Patau’s syndrome (Trisomy 13)

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12
Q

What % of babies with downs syndrome will have a normal anomaly scan?

A

50%

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13
Q

what is the combined test?

A

screening test for down syndrome

blood test & USS at 11 & 13 weeks

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14
Q

what is nuchal translucency?

A

the amount of fluid collecting within the nape of the fetal neck

normal value is <3.5mm

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15
Q

what does the blood test for Down syndrome include?

A

Serum pregnancy-associated plasma protein A (PAPP-A)

alpha fetoprotein (aFP)

beta-HCG

aka the triple test

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16
Q

in a fetus with down syndrome what would the results of the combined test look like?

A

PAPP-A & aFP = LOW

beta-HCG & nuchal translucency = INCREASED

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17
Q

what is the second stage of testing for down syndrome?

A

done at 15-16 weeks

quadruple test

blood test - aFP, inhibin, oestriol & total hCG

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18
Q

when is anti-D given?

A

in mother’s who are rhesus negative

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19
Q

what are the two main fetal abnormality DIAGNOSTIC tests?

A

chorionic villus sampling (CVS)

Amniocentesis

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20
Q

when are each of the diagnostic tests carried out?

A

CVS between 11 & 13 weeks

amniocentesis from 15 weeks

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21
Q

what is Non-invasive prenatal test (NIPT)?

A

a new screening test

analyses the cell-free DNA in the mother’s blood from the fetus

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22
Q

define monozygotic & dizygotic…

A

monozygotic - splitting of a single fertilised egg

dizygotic - fertilisation of 2 ova by 2 sperm

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23
Q

what is chorionicity?

A

Number of placentas

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24
Q

What is dichorionic?

A

2 placentas

always dichorionic diamniotic (DCDA)

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25
Q

What is monochorionic?

A

1 shared placenta

monochorionic monoamniotic

monochorionic diamniotic

conjoined twins

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26
Q

when & how is chorionicity determined?

A

by USS using the shape & thickness of the membrane

more reliably done at the booking scan (11-13 weeks)

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27
Q

what are some signs/symptoms of multiple pregnancy?

A

exaggerated pregnancy symptoms e.g. excessive sickness / hyperemesis gravidarum

high AFP

large dates for uterus

multiple fetal poles

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28
Q

What is twin-twin transfusion syndrome (TTTS) ?

A

a condition where there is disproportionate blood supply to fetuses in monochorionic pregnancies

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29
Q

what is a breech presentation?

A

longitudinal lie but presenting part is fetal buttocks

(buttocks come out first)

complete, footling or frank

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30
Q

what is external cephalic version (ECV)?

A

Attempting to manually turn the fetus into a cephalic presentation

50% successful

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31
Q

what is a term pregnancy?

A

37 - 42 weeks

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32
Q

how many USS does an uncomplicated pregnancy get?

A

2

a booking scan & an anomaly scan

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33
Q

what is the leading cause of maternal death in the first year post-delivery?

A

suicide

34
Q

what are the hypertensive disorders of pregnancy?

A

pre-existing hypertension
gestational hypertension
pre-eclampsia

35
Q

what is hypertension in pregnancy defined as?

A

systolic > 140mmHg
or
diastolic >90mmHg

36
Q

describe gestational hypertension?

A

a.k.a idiopathic hypertension
develops after 20 weeks
no proteinuria or oedema

37
Q

what are the characteristics of PRE-ECLAMPSIA?

A 
pregnancy induced hypertension
with proteinuria (>0/3g/24hrs)
38
Q

what are features of SEVERE pre-eclampsia?

A 
>170/110mmHg &amp; proteinuria
headache
visual disturbances
papilloedema
right upper quadrant/epigastric pain
sudden onset oedema
hyperreflexia, clonus 
platelets/abnormal liver enzymes/HELLP syndrome
39
Q

what is eclampsia characterised by?

A

grand mal seizures

40
Q

how would pre-existing hypertension be managed in pregnancy?

A

switch from teratogenic ACEIs to either:
labetalol
nifedipine
methyldopa

41
Q

how would pregnancy induced hypertension be managed? (if below 20 weeks)

A 
antihypertensives:
labetalol
nifedipine
methyldopa
hydralazine
42
Q

how would pre-eclampsia be managed?

A 
antihypertensives:
labetalol
nifedipine
methyldopa
hydralazine

IV magnesium sulphate - if severe

43
Q

why are mothers with pre-eclampsia sometimes given IM steroids?

A

to encourage fetal lung maturation if gestation is <34 weeks

aim is to speed up the production of surfactant within the fetus’ lungs & avoid acute respiratory distress syndrome

44
Q

what IM steroids are given in pre-eclampsia?

A

betamethasone or dexamethasone

45
Q

what is the treatment of eclampsia?

A 
IV magnesium sulphate
urgent delivery (usually by caesarean section)
46
Q

what secondary prevention is there for women with a history of pre-eclampsia or have risk factors?

A

low dose aspirin started at 12 weeks

increased surveillance

47
Q

what is gestational diabetes mellitus (GDM)?

A

Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

48
Q

what are risk factors for GDM?

A 
Previous GDM
obesity (BMI>30)
FH
ethnicity
previous big baby
49
Q

what are signs of GDM?

A

Polyhydramnios

glycosuria

50
Q

at what HBA1C should pregnancy be avoided?

A

above 86mmol/mol

aim for 48mmol/mol

51
Q

discuss the screening & diagnosis of GDM?

A

assess RF at booking visit
previous GDM - recurrence risk >50%
blood glucose monitoring
oral glucose tolerance test at 24-28weeks

52
Q

what are the diagnostic values for GDM?

A

Fasting glucose >= 5.1mmol/l

2 hour >= 8.5mmol/l

53
Q

how are GDM mothers monitored postnatally?

A

fasting blood glucose monitored 6-8 weeks postnatally

annual screening

54
Q

what is PPROM?

A

Pre-term pre-labour rupture of membranes (PPROM)

= breakage of the amniotic sac before the onset of labour

55
Q

what are causes of PPROM?

A

Infection - may weaken tensile strength of the fetal membranes
cervical incompetence
over-distension of uterus
vascular causes - placental abruption

56
Q

what are the different stages of preterm birth?

A

extremely preterm - before 28 weeks
very preterm - 28 to 32 weeks
moderate/late preterm - 32 to 37 weeks

57
Q

What are the survival rates of preterm infants?

A 
less than 22 - close to 0
22 weeks - 10%
24 weeks - 60%
27 weeks - 89%
31 weeks - 95%
34 weeks - equivalent to baby born at full term
58
Q

how do you diagnose PPROM?

A

Speculum examination - pooling of blood in the posterior vaginal fornix
USS - may show oligohydramnios

59
Q

how do you manage PPROM?

A

Monitor for signs of clinical chorioamnionitis
antibiotics - to prevent ascending infections
tocolytics
maternal steroids
magnesium sulphate

60
Q

when does rhesus isoimmunisation occur?

A

occurs in rhesus D negative mothers who have a rhesus positive fetus

61
Q

what is antepartum haemorrhage?

A

bleeding from the genital tract after 24 weeks gestation & before the second stage of labour during birth

62
Q

what are causes of antepartum haemorrhage?

A 
placenta praevia
placenta abruption
local causes - cervical ectropion, polyps, infection, cervical cancer
vasa praevia
uterine rupture
indeterminate
can be a sign of preterm labour
63
Q

what is placenta praevia?

A

a placenta that is either covering the internal cervical os or one that is within 2cm of the cervical os

64
Q

how does placenta praevia typically present?

A

bright red painless vaginal bleeding

65
Q

what is placental abruption?

A

the separation of a normally implanted placenta either partially or totally before birth

66
Q

how does placental abruption present?

A

painful vaginal bleeding (can be painless or concealed)

results in a tender, tense uterus (woody hard uterus)

67
Q

what are some potential consequences of placental abruption?

A

intrauterine death & fetal hypoxia
PPH
DIC

68
Q

How do you manage placental abruption?

A

resuscitate mother
urgent C-section & replace blood products
fetal resus if needed

69
Q

what is vasa praevia?

A

occurs when there are fetal blood vessels in the membranes overlying close to the internal cervical os

70
Q

how does vasa praevia present?

A

membranes are ruptured followed by small amount of dark vaginal bleeding & is accompanied by an acute fetal bradycardia & decelerations becoming a significant fetal mortality risk

71
Q

how can uterine rupture present?

A

acute constant abdo pain
may refer to shoulder tip
sudden collapse
on abdo palpation, fetal parts will be easily felt as fetus may be in intra-abdominal cavity (out of womb)

acute fetal distress on CTG & sudden maternal collapse

72
Q

what is placenta accreta?

A

when the placenta grows too deeply into the uterine wall

73
Q

what is chicken pox?

A

a systemic disease characterised by a prodrome of fever and malaise, followed by the appearance of itchy vesicular skin rash which affects the whole body including palms, soles & mucous membranes

74
Q

what are the complications of chicken pox on mother & fetus?

A

mother - increased risk of pneumonia, encephalitis, hepatitis

fetus (before 28 weeks) - fetal varicella syndrome

neonatal - 30% will die

75
Q

what test can check if mother has immunity to virus?

A

blood test to check IgG antibodies to varicella zoster virus

76
Q

how is chicken pox in pregnancy treated?

A

varicella-zoster immunoglobulins (VZIG) - effective within 10days of exposure

aciclovir

symptomatic relief

77
Q

can a woman with HIV have a vaginal birth?

A

yes - if viral load is <50copies/ml

if not then Caesarean is protective for baby

78
Q

how are women with HIV treated during pregnancy?

A

combined antiretroviral therapy in 2nd trimester by the 24th week

79
Q

what is Virchow’s triad?

A

hypercoagulability
venous stasis
vascular damage

80
Q

why are babies born pre-term?

A

25% planned caesarean section - severe pre-eclampsia, kidney disease & poor fetal development

20% premature rupture of membranes

25% emergency - placental abruption, infection, eclampsia

30% unknown

Y4 cOGText (9 decks)

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