Antenatal Care Flashcards
How much folic acid should be given before conception?
400mg folic acid
from before conception until 12 weeks gestation
What does folic acid reduce the risk of?
Neural tube defects
What pregnant women would have to continue taking 5mg folic acid after the 12 weeks?
diabetes on anti-epileptic medication BMI>30 previous pregnancies with neural tube defects FH PMH
How much vitamin D should mothers be given?
10mg of Vitamin D supplements during pregnancy & breastfeeding
True or false: pregnant woman should eat for 2.
False.
Only an excess of 250-300 calories are needed (especially in last trimester)
List the side effects that alcohol in pregnancy can cause.
Fetal alcohol syndrome IUGR & postnatal restricted growth learning difficulties risk of miscarriage withdrawal Wernicke's encephalopathy & Korsakoff's syndrome microcephaly
Nicotine use in pregnancy increases the risks of…?
miscarriage
pre-term labour
IUGR
still-births
SIDS
when is the booking visit?
10-12 weeks (by a community midwife)
what is done in the booking visit?
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
what haemoglobinopathies are screened for at the booking visit?
HIV/AIDS
Syphilis
Hep B & C
What conditions are screened for at 18-20 weeks?
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)
What % of babies with downs syndrome will have a normal anomaly scan?
50%
what is the combined test?
screening test for down syndrome
blood test & USS at 11 & 13 weeks
what is nuchal translucency?
the amount of fluid collecting within the nape of the fetal neck
normal value is <3.5mm
what does the blood test for Down syndrome include?
Serum pregnancy-associated plasma protein A (PAPP-A)
alpha fetoprotein (aFP)
beta-HCG
aka the triple test
in a fetus with down syndrome what would the results of the combined test look like?
PAPP-A & aFP = LOW
beta-HCG & nuchal translucency = INCREASED
what is the second stage of testing for down syndrome?
done at 15-16 weeks
quadruple test
blood test - aFP, inhibin, oestriol & total hCG
when is anti-D given?
in mother’s who are rhesus negative
what are the two main fetal abnormality DIAGNOSTIC tests?
chorionic villus sampling (CVS)
Amniocentesis
when are each of the diagnostic tests carried out?
CVS between 11 & 13 weeks
amniocentesis from 15 weeks
what is Non-invasive prenatal test (NIPT)?
a new screening test
analyses the cell-free DNA in the mother’s blood from the fetus
define monozygotic & dizygotic…
monozygotic - splitting of a single fertilised egg
dizygotic - fertilisation of 2 ova by 2 sperm
what is chorionicity?
Number of placentas
What is dichorionic?
2 placentas
always dichorionic diamniotic (DCDA)
What is monochorionic?
1 shared placenta
monochorionic monoamniotic
monochorionic diamniotic
conjoined twins
when & how is chorionicity determined?
by USS using the shape & thickness of the membrane
more reliably done at the booking scan (11-13 weeks)
what are some signs/symptoms of multiple pregnancy?
exaggerated pregnancy symptoms e.g. excessive sickness / hyperemesis gravidarum
high AFP
large dates for uterus
multiple fetal poles
What is twin-twin transfusion syndrome (TTTS) ?
a condition where there is disproportionate blood supply to fetuses in monochorionic pregnancies
what is a breech presentation?
longitudinal lie but presenting part is fetal buttocks
(buttocks come out first)
complete, footling or frank
what is external cephalic version (ECV)?
Attempting to manually turn the fetus into a cephalic presentation
50% successful
what is a term pregnancy?
37 - 42 weeks
how many USS does an uncomplicated pregnancy get?
2
a booking scan & an anomaly scan
what is the leading cause of maternal death in the first year post-delivery?
suicide
what are the hypertensive disorders of pregnancy?
pre-existing hypertension
gestational hypertension
pre-eclampsia
what is hypertension in pregnancy defined as?
systolic > 140mmHg
or
diastolic >90mmHg
describe gestational hypertension?
a.k.a idiopathic hypertension
develops after 20 weeks
no proteinuria or oedema
what are the characteristics of PRE-ECLAMPSIA?
pregnancy induced hypertension with proteinuria (>0/3g/24hrs)
what are features of SEVERE pre-eclampsia?
>170/110mmHg & proteinuria headache visual disturbances papilloedema right upper quadrant/epigastric pain sudden onset oedema hyperreflexia, clonus platelets/abnormal liver enzymes/HELLP syndrome
what is eclampsia characterised by?
grand mal seizures
how would pre-existing hypertension be managed in pregnancy?
switch from teratogenic ACEIs to either:
labetalol
nifedipine
methyldopa
how would pregnancy induced hypertension be managed? (if below 20 weeks)
antihypertensives: labetalol nifedipine methyldopa hydralazine
how would pre-eclampsia be managed?
antihypertensives: labetalol nifedipine methyldopa hydralazine
IV magnesium sulphate - if severe
why are mothers with pre-eclampsia sometimes given IM steroids?
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
what IM steroids are given in pre-eclampsia?
betamethasone or dexamethasone
what is the treatment of eclampsia?
IV magnesium sulphate urgent delivery (usually by caesarean section)
what secondary prevention is there for women with a history of pre-eclampsia or have risk factors?
low dose aspirin started at 12 weeks
increased surveillance
what is gestational diabetes mellitus (GDM)?
Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
what are risk factors for GDM?
Previous GDM obesity (BMI>30) FH ethnicity previous big baby
what are signs of GDM?
Polyhydramnios
glycosuria
at what HBA1C should pregnancy be avoided?
above 86mmol/mol
aim for 48mmol/mol
discuss the screening & diagnosis of GDM?
assess RF at booking visit
previous GDM - recurrence risk >50%
blood glucose monitoring
oral glucose tolerance test at 24-28weeks
what are the diagnostic values for GDM?
Fasting glucose >= 5.1mmol/l
2 hour >= 8.5mmol/l
how are GDM mothers monitored postnatally?
fasting blood glucose monitored 6-8 weeks postnatally
annual screening
what is PPROM?
Pre-term pre-labour rupture of membranes (PPROM)
= breakage of the amniotic sac before the onset of labour
what are causes of PPROM?
Infection - may weaken tensile strength of the fetal membranes
cervical incompetence
over-distension of uterus
vascular causes - placental abruption
what are the different stages of preterm birth?
extremely preterm - before 28 weeks
very preterm - 28 to 32 weeks
moderate/late preterm - 32 to 37 weeks
What are the survival rates of preterm infants?
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
how do you diagnose PPROM?
Speculum examination - pooling of blood in the posterior vaginal fornix
USS - may show oligohydramnios
how do you manage PPROM?
Monitor for signs of clinical chorioamnionitis
antibiotics - to prevent ascending infections
tocolytics
maternal steroids
magnesium sulphate
when does rhesus isoimmunisation occur?
occurs in rhesus D negative mothers who have a rhesus positive fetus
what is antepartum haemorrhage?
bleeding from the genital tract after 24 weeks gestation & before the second stage of labour during birth
what are causes of antepartum haemorrhage?
placenta praevia placenta abruption local causes - cervical ectropion, polyps, infection, cervical cancer vasa praevia uterine rupture indeterminate can be a sign of preterm labour
what is placenta praevia?
a placenta that is either covering the internal cervical os or one that is within 2cm of the cervical os
how does placenta praevia typically present?
bright red painless vaginal bleeding
what is placental abruption?
the separation of a normally implanted placenta either partially or totally before birth
how does placental abruption present?
painful vaginal bleeding (can be painless or concealed)
results in a tender, tense uterus (woody hard uterus)
what are some potential consequences of placental abruption?
intrauterine death & fetal hypoxia
PPH
DIC
How do you manage placental abruption?
resuscitate mother
urgent C-section & replace blood products
fetal resus if needed
what is vasa praevia?
occurs when there are fetal blood vessels in the membranes overlying close to the internal cervical os
how does vasa praevia present?
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
how can uterine rupture present?
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
what is placenta accreta?
when the placenta grows too deeply into the uterine wall
what is chicken pox?
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
what are the complications of chicken pox on mother & fetus?
mother - increased risk of pneumonia, encephalitis, hepatitis
fetus (before 28 weeks) - fetal varicella syndrome
neonatal - 30% will die
what test can check if mother has immunity to virus?
blood test to check IgG antibodies to varicella zoster virus
how is chicken pox in pregnancy treated?
varicella-zoster immunoglobulins (VZIG) - effective within 10days of exposure
aciclovir
symptomatic relief
can a woman with HIV have a vaginal birth?
yes - if viral load is <50copies/ml
if not then Caesarean is protective for baby
how are women with HIV treated during pregnancy?
combined antiretroviral therapy in 2nd trimester by the 24th week
what is Virchow’s triad?
hypercoagulability
venous stasis
vascular damage
why are babies born pre-term?
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
