Antenatal Care Flashcards
1
Q
What is the booking clinic and when should it be?
A
It is the first appointment with the midwife it should be before 10 weeks gestation
2
Q
What educational topics are covered in the booking clinic?
A
What to expect at different stages of pregnancy
Lifestyle advice in pregnancy- not smoking, alcohol cessation, recreational drug use.
Supplements- folic acid and vit D
Birth plans
Antenatal Screening tests
Antenatal classes
Mental health
Breastfeeding classes
Exercises- pelvic floor exercises
RISK ASSESMENT
3
Q
What advice would you give to a patient who is pregnant to avoid listeria?
A
Drinking only pasteurised or UHT milk
Not eating ripened soft cheese like Camembert, Brie, and blue veined cheese
Not eating pate
Not eating uncooked or undercooked ready prepared meals
4
Q
What advice would you give to a pregnant woman to avoid getting salmonella?
A
Avoid raw or partially cooked eggs, or food that may contain them like mayonnaise
Avoid raw or partially cooked meat, especially poultry.
5
Q
What are the risks of drinking in pregnancy?
A
Long term haem, the more you drink the greater the risk
. Low birth weight
. Preterm birth
. Small for gestational age
. All increased in mothers drinking above 1-2 units/ day during pregnancy
6
Q
What does the examination involve in the booking clinic?
A
Height, weight, BMI, Urinalysis for protein and bacteria Blood pressure Discuss female genital mutilation Discuss domestic violence
7
Q
What bloods are taken at the booking clinic?
A
Blood group, antibodies, rhesus D status
FBC for anaemia
Screening for thalassemia and sickle cell disease
Patient to will also be offered screening for infectious diseases, by testing antibodies for HIV, Hep B, syphilis.
Screening for Down’s syndrome may be initiated depending on the gestational age, bloods for the combined are taken from 11 weeks onwards l
8
Q
How do you screen for Down syndrome?
A
Combined test is first line
Performed between 11-14 weeks gestation
Combines ultrasound and maternal blood tests
9
Q
What does the combined test involve?
A
Maternal blood tests-
Beta- hCG (the higher the result the higher risk)
Pregnancy associated plasma protein A (lower result indicates a greater risk)
10
Q
What is the triple test and what does it involve?
A
Between 14-20 weeks gestation
Only involves maternal blood tests
Beta hCG (Higher result indicates a greater risk)
Serum oestriol (female sex hormone- lower result indicates a greater risk)
Alpha fetoprotein- lower result indicates a greater risk
11
Q
What does quadruple test mean?
A
Screening for Down syndrome between weeks 14 and 20, it is identical to triple test but also includes inhibin A (Higher means greater risk)
12
Q
What is the verdict of the screening test for Down syndrome?
A
If the risk of the fetid having Down syndrome is greater than 1 in 150 then woman is offered karyotyping for a definitive answer…
- chorionic villus sampling
- amniocentesis
13
Q
What is the difference between amniocentesis and chorionic villus sampling?
A
Chorionic villus sampling involves an ultrasound guided biopsy of the placenta, tissue, this is done earlier in pregnancy (<15 weeks)
Amniocentesis involves ultra sounded guided aspiration of the amniotic fluid, using a need,e and syringe, used later in pregnancy when there is enough amniotic fluid to take a sample.
14
Q
How do you screen for pre eclampsia?
A
Blood pressure and urinalysis should be checked for protein at each antenatal visit
At the booking appointment pre eclampsia risk factors should be determined…
40 years or older? Null Nullparity Pregnancy interval of more than 10 years FH Previous Hx BMI 30kg/M2 or above Pre existing vascular disease- hypertension Pre existing renal disease Multiple pregnancy
15
Q
How many antenatal appointments should each woman have?
A
Uncomplicated nulliparous- 10 appointments should be adequate
Uncomplicated Parous- 7 appointments should be adequate
16
Q
When should symphysis fundal height be measured and recorded?
A
From 24 weeks
Should match the gestational age
17
Q
What are the first, second and third trimester?
A
First is from start until 12 weeks gestation.
Second is 13 weeks to 26 weeks gestation
Third is 27 weeks till birth
18
Q
When do foetal movements start?
A
20 weeks until birth
19
Q
When should the booking clinic take place?
A
Before 10 weeks
20
Q
When and what is the dating scan?
A
An accurate gestational age is calculated from the crown rump length and multiple pregnancies are identified
It is between 10 and 13+6
21
Q
When and what is the antenatal appointment?
A
16 weeks
Discuss the results and plan future appointments
22
Q
When and what is the anomaly scan?
A
An ultrasound used to identify any anomalies like heart conditions
Between 18 and 20+6
23
Q
Routine antenatal appointments are at 25,28,31,34,36,38,40,41 and 42 weeks
What is done at these routine antenatal appointments?
A
symphysis fundal height
Fetal presentation
Urine dipstick for protein for pre eclampsia
Blood pressure for pre eclampsia
Urine for microscopy and culture for asymptomatic bacteriuria
24
Q
What are the two vaccines offered for all pregnant women?
A
Whooping cough (pertussis) from 16 weeks gestation Influenza (flu) when available in autumn or winter.
Live vaccines like the MMR are avoided in pregnancy
25
What lifestyle advice should you give to pregnant women?
Take folic acid
Take vit D supplements
Avoid vit A supplements if eating pate or liver (vit A is tetarogenic in large doses)
Don’t drink alcohol
Don’t smoke
Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (salmonella risk)
Avoid contact sport but can continue moderate exercise
Sex is safe
Flying increases VTE risk
Place car seatbelts above and below the bump
26
What can alcohol in pregnancy lead to?
Miscarriage
Being small for the dates
Preterm delivery
Fetal alcohol syndrome
27
What is fetal alcohol syndrome?
Certain characteristics that can occur in children of mothers that consumed during pregnancy, the features include...
```
. Microcephaly (small head)
. Thin upper lip
. Smooth flat philtrum (groove between the nose and upper lip)
. Behavioural difficulties
. Hearing and vision problems
. Cerebral palsy
. Short palpebral fissure
. Learning difficulties
```
28
What does smoking in pregnancy increase the risk of?
```
Fetal growth restriction
Miscarriage
Still birth
Preterm labour and delivery
Placental abruption
Pre eclampsia
Cleft lip or palate
Sudden infant death syndrome
```
29
When is flying in pregnancy acceptable?
37 weeks in a single pregnancy
32 weeks in a twin pregnancy
(After 28 weeks gestation most airlines need a note from midwife, GP, obstretician to state the pregnancy is going well and there’s no additional risks)
30
What is the combined screening test for Downs syndrome?
It is performed between 11 and 14 weeks
Involves combining results from ultrasound and maternal blood tests
Ultrasound- measures nuchal translucency (the thickness of the back of the neck of the foetus), nuchal thickness greater than 6mm indicates Down syndrome
Blood tests-
Beta hCG (higher result means a greater risk)
pregnancy associated plasma protein A (lower result means a greater risk)
31
The screening test provides a risk score for the foetus having Down syndrome, at what risk is the woman then offered amniocentesis or chorionic villus sampling?
1 in 150 (occurs in around 5% of tested women)
32
What is the risk of hypothyroidism in pregnancy?
Miscarriage, anaemia, small for gestational age and pre eclampsia
33
What drugs can/ can’t be used in hypertension in a pregnant woman?
Medications that should be stopped...
. ACE- I (ramipril)
. ARBs (losartan)
. Thiazide and thiazide like diuretics
Medications which aren’t known to be harmful...
. Labetalol (bets blocker)
. Calcium channel blocker (nifedipine)
. Alpha blockers (doxasozin)
34
What can women who have epilepsy in pregnancy take?
Should take folic acid 5mg daily before conception to reduce the risk of neural tube defects
Levetiracetam, Iamotrigine and carbamazepine are the safer anti epileptic medications in pregnancy.
Should be well controlled in pregnancy
35
What medication is considered safe in pregnancy in terms of rheumatoid arthritis?
Hydroxychloroquine
| Sulfasalazine
36
Should NSAIDS be used in pregnancy?
Generally avoided as they work by blocking prostaglandins, which soften the cervix and stimulate uterine contractions at the time of delivery
Particularly avoided in the 3rd trimester- can cause premature closure of the ductus arteriosus. Can also delay labour.
37
Can beta blockers be used? What effects may they have
Labetalol is the main choose to use in pre eclampsia
However they can cause...
. Foetal growth restriction
. Hypoglycaemia in the neonate
. Bradycardia in the neonate
38
What is congenital rubella syndrome?
Also known as German measles, caused by the maternal infection with the rubella virus in the first 20 weeks of pregnancy, the risk is highest before ten weeks gestation.
39
What are the signs of congenital rubella syndrome to be aware of..
Congenital deafness, cataracts, heart disease (PDA)learning disability, cerebral palsy
40
Why is chickenpox dangerous in pregnancy?
More severe cases in the mother- varicella pneumonitis, hepatitis, encephalitis
Fetal varicella syndrome
Severe neonatal varicella infection
41
What happens if the woman is exposed to chickenpox in pregnancy?
When the woman has previously had chicken pox, they are safe
When they are not sure about their immunity then varicella zoster IgG levels can be tested
When they are not immune they can be treated with IV varicella immunoglobulins as prophylaxis of developing chickenpox, should be given within ten days of exposure.
42
What are the typical features of congenital varicella syndrome?
Fetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes located in specific dermatomes
Limb hypoplasia (underdeveloped limbs)
Cataracts and inflammation in the eye (chorioretinitis)
43
What is listeria typically transmitted by?
Unpasteurised dairy products, processed meats and contaminated foods. Avoid blue cheese and practise good food hygiene
44
What is congenital cytomegalovirus ?
Occurs due to a cytomegalovirus infection in the mother during pregnancy. The virus is mostly spread via. The infected saliva or urine of asymptomatic children. Most cases of cytomegalovirus in pregnancy do not actually cause congenital cytomegalovirus.
45
What are the signs of congenital CMV?
```
Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures
```
46
What is meant by small for gestational age?
An infant with a birth weight which is <10th centile for its gestational age
(Severe SGA <3rd centile)
47
What is fetal SGA?
An estimated fetal weight (EFW) or abdominal circumference <10th centile
(Severe <3rd centile)
48
What is fetal growth restriction?
When a pathological process has restricted genetic growth potential. This can present with features of fetal compromise including reduced liquor volume or abnormal Doppler studies.
(Likelihood of this is higher in a severe SGA foetus)
49
What is meant by low birth weight?
An infant who has a birth weight <2500g
50
What is the KLEIHAUER test?
Checks how much fetal blood has passed into the mothers blood during a sensitisation event, this can be used after any sensitising event past 20 weeks gestation, to assess whether further doses of anti D are needed.
51
What does the KLEIHAUER test involve?
Adding acid to a sample of the mothers blood, fetal haemoglobin is more resistant to the acid, therefore fetal haemoglobin persists in response to the added acid.
52
What measurements are used on ultrasound to assess the fetal size?
Estimated fetal weight
| Fetal abdominal circumference
53
What are the causes of small gestational age?
Constitutionally small, matching the mother and others in the family (customised growth charts are made for each fetus, these are based on the ethnic group, weight, height and parity).
Fetal growth restriction (also known as intrauterine growth restriction)
54
What is fetal growth restriction?
Also known as intrauterine growth restriction
When there is a small foetus (or a foetus not growing as expected) due to a pathology reducing the amount of nutrients and oxygen being delivery to the foetus through the placenta).
55
What can the causes of fetal growth restricted be divided into...?
Placenta mediated growth restriction
| Non placenta mediated growth restriction (baby is small due to a genetic or structural abnormality)
56
What is the cause of placenta mediated growth restriction?
```
Conditions which affect the transfer of nutrients across the placenta..
Idiopathic
Pre eclampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition
Infection
Maternal health conditions
```
57
What are the non placenta mediated growth restriction causes?
Genetic abnormalities
Structural abnormalities
Fetal infection
Errors of metabolism
58
What other signs are there of fetal growth restriction, apart from being small for gestational age?
Reduced amniotic fluid volume
Abnormal Doppler studies
Reduced fetal movements
Abnormal CTGS
59
What are the complications of fetal growth restriction?
Fetal death or stillbirth
Birth asphyxia (deprivation of oxygen to a newborn infant which lasts long enough during the birth process to cause physical harm, usually to the brain).
Neonatal hypothermia
Neonatal hypoglycaemia
60
What are growth restricted babies at long term risk of?
Cardiovascular diseases, particularly hypertension
Type2 diabetes
Obesity
Mood and behaviour problems
61
What are the risk factors for SGA?
```
Previous SGA baby
Smoking
Obesity
Diabetes
Existing hypertension
Pre eclampsia
Older mother (over 35)
Multiple pregnancy
Low pregnancy associated plasma protein A
Antepartum haemorrhage
Anti phospholipid syndrome
```
62
When are women booked for serial growth scans with umbilical artery Doppler?
If at 24 weeks gestation the symphysis fundal height is less than the 10th centile
3 or more minor risk factors
One or more major risk factors
Issues with measuring the symphysis fundal height (large fibroids or a BMI >35)
63
What is measured at the serial growth scans?
Estimated fetal weight and abdominal circumference to determine the growth velocity
Umbilical arterial pulsatility index to measure the flow through the umbilical artery
Amniotic fluid volume
64
What are the critical management steps for a fetus which is SGA?
Identifying those at risk of SGA
Aspirin given to those at risk of pre eclampsia
Treating modifiable risk factors ie: stop smoking
Serial growth scans to monitor growth
Early delivery where growth is static or there are other concerns
65
What investigations are done for SGA?
Blood pressure and urine dipstick for pre eclampsia
Uterine artery Doppler scanning
Detailed fetal anatomy scan by fetal medicine
Karyotyping for chromosomal abnormalities
Testing for infections (toxoplasmosis, cytomegalovirus, syphilis and malaria)
66
What is large for gestational age?
It is also known as macrosomia
When the weight of the newborn is more than 4.5kg at birth
During pregnancy, an estimated fetal weight above the 90th centile is considered large for gestational age
67
What are the causes of macrosomia?
```
Constitutional
Maternal diabetes
Previous macrosomia
Maternal obesity or rapid weight gain
Overdue
Male baby
```
68
What are the risks to the mother of a fetus being large for gestational age?
```
Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery or caesarean
Postpartum haemorrhage
Uterine rupture (rare)
```
69
What are the risks to the baby when it is large for gestational age?
Birth injury (erbs palsy, clavicular fracture, fetal distress and hypoxia)
Neonatal hypoglycaemia
Obesity in childhood and later life
Type 2 diabetes in adulthood
70
What investigations should you perform for a large for gestational age baby?
Ultrasound to exclude Polyhydramnios and estimate the fetal weight
Oral glucose tolerance test for gestational diabetes
71
What does monozygotic mean?
Identical twins (from a single zygote)
72
What is dizygotic?
Non identical (from two different zygotes)
73
What is meant by monoamniotic and diamniotic?
```
Monoamniotic= one amniotic sac
Diamniotic= two amniotic sacs
```
74
What is meant by monochorionic and dichorionic?
Mono- share a single placenta
| Dichorionic- two separate placentas
75
What is ultrasound used to determine for multiple pregnancy?
Gestational age
Number of placentas and amniotic sacs
Risks of Down syndrome (part of the combined)
76
What are the risks to the mother with multiple pregnancy?
```
Anaemia
Polyhydramnios
Hypertension
Malpresentation
Spontaneous preterm birth
Instrumental delivery or caesarean
Postpartum haemorrhage
```
77
What are the risks to the foetuses and neonates of multiple pregnancy?
```
Miscarriage
Stillbirth
Fetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence
Congenital abnormalities
```
78
What is twin twin transfusion syndrome?
This is where the foetuses share a placenta, one fetus (the recipient) will get the majority of the blood from the placenta, while the other fetus (the donor) is starved of the blood. The recipient will become overloaded with fluid with heart failure and Polyhydramnios while the donor has growth restriction, anaemia and oligohydramnios. There will be a discrepancy between the size of the foetuses.
79
How can you treat twin-twin transfusion syndrome?
Laser treatment can be used to destroy the connection between the two blood supplies.
80
What is twin anaemia polycythaemia sequence?
Similar to twin-twin transfusion syndrome, but less acute, one twin becomes anaemic while the other develops polycythaemia (raised Hb).
81
Women with multiple pregnancy require more antenatal care, what extra care do they get?
Additional monitoring for anaemia, with full blood counts at:
. Booking clinic, 20 weeks gestation, 28 weeks gestation
Additional ultrasound scans required to monitor fetal growth restriction, unequal growth and twin-twin transfusion syndrome
2 weekly scans from 16 weeks gestation for monochorionic, while 4 weekly scans from 20 weeks for dichorionic
82
What is the presentation of UTI in pregnancy?
```
Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria
Renal angle tenderness on examination
```
83
What does pyelonephritis present with?
Fever (more prominent than in lower UTI)
Loin, suprapubic or back pain (bilateral or unilateral)
Looking and feeling generally unwell
Vomiting
Loss of appetite
Haematuria
Renal angle tenderness on examination
84
What are the most common causes of UTI?
Eschericia coli
Others...
```
. Klebsiella pneumoniae (gram -ve anaerobic rod)
. Enterococcus
. Pseudomonas aeruginosa
. Staphylococcus saprophyticus
. Candida albicans (fungal)
```
85
What is the management of urinary tract infection in pregnant women?
Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin
86
Can nitrofurantoin be used in pregnancy?
Should be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells)
87
Can you use trimethoprim in pregnancy?
Can’t use in the first trimester as it works as a folate antagonist, folate is important in early pregnancy for the normal development of the fetus
In early pregnancy it can cause congenital malformations particularly neural tube defects (spina bifida) it is not known to be harmful later in pregnancy but is general avoided unless necessary
88
When are women screened for anaemia in pregnancy?
Booking clinic
| 28 weeks gestation
89
Why are pregnant women at risk of anaemia?
The plasma volume increases which results in a reduction in the haemoglobin concentration, the blood is diluted due to the higher plasma volume.
90
What is the presentation of anaemia in pregnancy?
Shortness of breath
Fatigue
Dizziness
Pallor
91
What are the normal ranges of haemoglobin during pregnancy?
At the booking bloods the haemoglobin concentration should be >110g/L
At 28 weeks gestation the haemoglobin concentration should be >105g/l
Post partum the haemoglobin concentration should be >100g/l
92
Mean cell volume can indicate the cause of the anaemia, what do the following indicate..
1) low MCV
2) normal MCV
3) raised MCV
```
Low= iron deficiency
Normal= may just be the physiological anaemia due to increased plasma volume of pregnancy
Raised= B12 or folate deficiency
```
93
What is haemoglobinopathy screening?
Offered to all women at the booking clinic
It screens for..
Thalassaemia (all women)
Sickle cell (women at risk)
94
What is the management of anaemia in pregnancy?
Women with anaemia in pregnancy are started on iron replacement, they also may be started on iron if they have low Ferritin but are not anaemic.
B12
Low b12 levels should be tested for pernicious anaemia (checking for intrinsic factor antibodies)
Intramuscular hydroxocobalamin injections, oral cyanocobalamin tablets
Folate- all women should be taking folic acid 400mcg per day, women with folate deficiency are started on 5mg daily
Thalassaemia and sickle cell anaemia
High dose folic acid, close monitoring, transfusions when required, managed jointly with a specialist haematologist
95
Why are pregnant women more likely to develop VTE?
So for a VTE there are 3 main things which cause one:
- hypercoagulable states
- change in stasis of blood flow
- damage to vessel wall
In pregnancy the woman is in a hyper-coagulable state
96
What are the risk factors for VTE in pregnancy?
```
Smoking
Parity > or equal to 3
Age >35 years
BMI >30
Reduced mobility
Multiple pregnancy
```
```
Pre eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF Pregnancy
```
97
What VTE prophylaxis is offered to pregnant women?
LMWH- enoxaparin, dalteparin, tinzaparin unless contra indicated
It is continued throughout the antenatal period and 6 weeks postnatal, started immediately for very high risk and at 28 weeks for high risk.
98
What can be used in women with contraindications to LMWH?
Anti embolic compression stockings
| Intermittent pneumatic compressions
99
How do DVTs present?
```
Unilateral...
Calf or leg swelling
Dilated superficial veins
Tenderness to the calf
Oedema
Colour changes to the leg
```
100
How can you measure whether leg swelling is significant or not?
Measure the circumference of the calf 10cm below the tibial tuberosity, more than 3cm between calves is significant
101
What can pulmonary embolism present with?
Can present with subtle signs and symptoms...
. Shortness of breath
. Cough with or without blood (haemoptysis)
. Pleuritic chest pain
. Hypoxia
. Tachycardia
. Raised resp rate
. Low grade fever
. Haemodynamic instability causing hypotension.
102
How do you diagnose VTE ?
Doppler ultrasound scan for DVT
CXR and ECG for women with suspected PE
And either V/Q or CTPA
103
Would you do a wells score for a pregnant woman?
A wells score is not validated for use in pregnant women, D dimers are not helpful in pregnant women, as pregnancy is a cause of raised D diner.
104
What is the management of VTE?
LMWH- enoxaparin, dalteparin etc....
| LMWH should be started immediately before confirming the diagnosis
105
How would you manage a pregnant woman with a massive PE and haemodynamic compromise?
Unfractionated heparin
Thrombolysis
Surgical embolectomy
106
What is pre eclampsia?
New high blood pressure (hypertension) in pregnancy with end organ dysfunction, notably with proteinuria
107
When and how does pre eclampsia occur?
It occurs after twenty weeks gestation when the spiral arteries of the placenta form abnormally leading to a high vascular resistance in these vessels.
108
What is the triad of pre eclampsia?
Hypertension
Proteinuria
Oedema
109
What is chronic hypertension?
High blood pressure which exists before 20 weeks gestation, it is long-standing, not caused by dysfunction in the placenta and is not classed as pre eclampsia.
110
What is pregnancy induced/gestational diabetes??
Hypertension occurring after 20 weeks gestation without proteinuria.
111
What is eclampsia?
Where seizures occur as a result of pre eclampsia
112
What are the high risk factors for pre eclampsia?
```
High risk
Pre existing hypertension
Previous hypertension in pregnancy
Excising autoimmune conditions ie: lupus
Diabetes
CKD
```
113
What are the moderate risk factors for pre clampsia?
```
Older than 40
BMI >35
More than ten years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre eclampsia
```
Risk factors are important as they are used to determine which women are offered aspirin as prophylaxis against pre eclampsia
Women are offered aspirin from 12 weeks gestation until birth if they have one high risk factor or two or more moderate risk factors
114
What are the symptoms of pre eclampsia?
```
Headache
Visual disturbance and blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (due to liver swelling)
Oedema
Reduced jeans output
Brisk reflexes
```
115
How can a diagnosis of pre eclampsia be made?
```
Systolic blood pressure >140mmHg
Diastolic blood pressure >90mmHg
Plus any of...
. Proteinuria (1+ on dipstick)
. Organ dysfunction
. Placental dysfunction
```
116
What is placental growth factor used for?
A protein releases by the placenta that functions to stimulate the development of new blood vessels, in pre eclampsia the levels of placental growth factor are low
PIGF should be used between 20 and 35 weeks to rule out pre eclampsia
117
How are pregnant women routinely monitored at every antenatal clinic for evidence of pre eclampsia?
Blood pressure
Symptoms
Urine dipstick for proteinuria.
118
What is the treatment for gestational hypertension (without proteinuria)?
Treating to aim for a blood pressure below 135/85mmHg
Admission for women with a blood pressure above 160/110,mHg
Urine dipstick testing weekly
Monitoring of blood tests weekly
Monitoring fetal growth by serial growth scans
PIGF testing on one occasion
119
What is the management of pre eclampsia when diagnosed?
Scoring systems used to determine whether to admit women- fullPIERs or PREP-s
Blood pressure is monitored closely (at least every 48 hours)
USS monitoring of the fetus, amniotic fluid and Doppler performed 2 weekly
Medical management
Labetolol First line
120
Why are corticosteroids given to women having a premature birth?
They help mature the fetal lungs
121
What should patients with pre eclampsia be given for treatment AFTER delivery?
Enalapril (first line)
Nifedipine/AMLODIPINE (first line in black African or Caribbean patients)
Labetalol or atenolol is third line
122
What is eclampsia and what is used to treat them?
Seizures associated with pre eclampsia
| IV magnesium sulphate
123
What is HELLP syndrome?
Combination of features which occur as a complication of pre eclampsia and eclampsia
H= Haemolysis
E= elevated liver enzymes
L= low platelets
124
What is gestational diabetes?
Diabetes which is triggered pregnancy but resolves after birth. It is caused by reduced insulin sensitivity during pregnancy.
125
What is the most significant immediate complication of gestational diabetes?
A large for dates fetus and macrosomia
| Poses a risk of shoulder dystocia
126
How are women screened for gestational diabetes?
Oral glucose tolerance test at 24-28 weeks gestation
| Women with previous gestational diabetes also have an OGTT soon after the booking clinic.
127
What are the risk factors for gestational diabetes?
```
Previous gestational diabetes
Previous macrosomia baby (> 4.5kg)
BMI >30
Ethnic origin
FH of diabetes (first degree relative)
```
128
What features would suggest gestational diabetes?
Large for dates fetus
Polyhydramnios
Glucose on a Urine dipstick
129
What are normal results of an OGTT?
Fasting <5.6mmol/l
At 2 hours <7.8mmol/l
Can remember by 5678
130
What are the management options for gestational diabetes?
If the fasting glucose is less than 7 then trial diet and exercise for 1-2 weeks, followed by metformin and insulin.
If the fasting glucose is above 7 start metformin and insulin
If the fasting glucose is above 6 plus macrosomia then start insulin +/- metformin.
131
What can be used if the woman can’t tolerate insulin or decline it?
Sulfonyurea
132
In pregnant women with pre existing diabetes what is one really important screening test and when would you do it?
Retinopathy screening after booking and at 28 weeks gestation.
