Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr4 - O&G > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

What happens in first contact with healthcare professional post conception

A

WHEN PRENANCY CONFIRMED
Folic acid supplementation
Vitamin D supplement
Food hygiene - avoid shellfish, unpasteurised milk/cheeses, raw eggs, undercooked meat and tuna
Lifestyle - stop smoking, recreational drugs and alcohol
Exercise - regular activity as long as you feel comfortable and slow down as pregnancy progresses
Explain about antenatal screening and Down’s screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens booking visit

A

8-12 WEEKS
Check BP, urine dipstick (UTI and kidney disease), BMI
Booking bloods - FBC, blood group, rhesus status, RC alloantibodies, haemoglobinopathies, hep B, syphilis, rubella, HIV
Discuss LMP (work out EDD), consider iron if Hb < 110, discuss place of birth, breastfeeding, antenatal classes, antenatal screening and mental health issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens at dating scan

A 
10-13+6 WEEKS
Early scan to confirm dates (CRL)
Exclude multiple pregnancies
Detect neural tube defects
Look at placental site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens at Down’s syndrome screening (Nuchal combined)

A

11-13+6 WEEKS
Nuchal translucency - measures pad at nape of foetal neck
- foetus must be in right position
- detects 85% of Down’s cases and other cardiac abnormalities
- depth > 3mm positive result - discuss CVS/amniocentesis
Beta-hCG
PAPP-A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens at Down’s syndrome screening (quadruple test)

A 
> 14 WEEKS
- only late presenting mothers who missed NCT
AFP
Beta-hCG
Unconjugated oestriol
Inhibin-A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does GDM screening occur

A

16 WEEKS

OGTT for women who are high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens at the anomaly scan

A

18-20+6 WEEKS
Gestational age based on - biparietal diameter, head circumference, abdominal circumference, femur length
Screening for - anencephaly, open spina bifida, cleft lip, diaphragmatic hernia, gastroschisis, exomphalos, cardiac abnormalities, renal agenesis, lethal skeletal dysplasia, Edward’s syndrome, Patau’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do specialist foetal cardiac scans ocurr

A

22-24 WEEKS

Only if indicated by previous scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When does a routine care appointment occur

A

28, 36 AND 38 WEEKS
AND 25, 31 AND 40 WEEKS IF PRIMIP
BP, urine dipstick, symphysis-fundal height
40 WEEKS - discuss induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When dose a plancetal scan occur

A

31 WEEKS

Assess for risk of placenta praevia is concerned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is Anti-D prophylaxis given

A

Given to rhesus negative women at 28 and 34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is LGA

A

Large for Gestational Age
Foetus is above 97th centile
Over 9 pounds 11 at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of LGA

A

Large parents
Large amount of weight mother gains
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Problems associated with LGA

A 
Long time for delivery
Difficult birth
Injury to baby during birth - damage to brachial plexus
Need for C-section
Hypoglycaemia in baby post birth
Higher risk for birth defects
Maternal trouble breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for LGA

A

USS - foetal measurements

Large weight gain in pregnacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management for LGA

A

Prevented by taking care of diabetes, watching weight and following healthcare advice
Early delivery
Blood glucose testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define SGA

A

Small for gestational age

Less than < 10th centile for gestational age

18
Q

Define foetal growth restriction

A

Pathological process has restricted genetic growth potential
- can present with features of foetal comprise including reduced liquor volume or abnormal doppler studies

19
Q

Define low birth weight

A

Infant with birth weight of < 2500

20
Q

Define a normal (constitutionally) small growth restriction

A

Identified by small size at all stages but growth following the centiles
No pathology present
Contributing factors include ethnicity sex and parental height

21
Q

Define placenta mediated growth restriction

A

Growth is usually normal initially but slows in utero
Common cause of FGR
Maternal factors include low pre-pregnancy weight, substance abuse, autoimmune disease, renal disease and chronic hypertension

22
Q

Define non-placenta mediated growth restriction

A

Growth affected by foetal factors such as chromosomal or structural anomaly, an error in metabolism or foetal infection

23
Q

Risk factors for SGA

A 
Minor
- maternal age > 35
- smoker 1-10 a day
- nulliparity
- BMI < 20 or > 25
- IVF singleton
- previous pre-eclampsia
- pregnancy interval < or > 60
- low fruit intact pre-pregnancy
Major 
- maternal age > 40
- smoker > 11/day
- maternal/paternal SGA
- previous SGA
- previous stillbirth
- cocaine use
- daily vigorous exercise
- maternal disease
- heavy bleeding
- low PAPP-A - pregnancy associated plasma protein
24
Q

Diagnosis of SGA

A

USS for diagnosis and surveillance
- EFW and AC plotted on personalised centile charts
Ratio of HC and AC significant
- symmetrically small foetus more likely to be constitutionally small
- asymmetrically small foetus more likely to be caused by placental insufficiency

25
Q

Investigations for SGA

A 
Detailed foetal anatomical survey
Uterine artery doppler
Karyotyping
Screening for infections
- congenital cytomegalovirus
- toxoplasmosis
- syphilis
- malaria
26
Q

Management of SGA

A

Prevention
- smoking cessation and optimising maternal disease
- women at high risk for pre-eclampsia started on 75mg of aspirin
Surveillance
- UAD
Delivery
- if delivery considered between 24-35+6 weeks single course of antenatal steroids given

27
Q

Indication of delivery for SGA

A

< 37 weeks if absent/reverse end-diastolic flow on doppler - c-section
By 37 weeks if abnormal UAD or MCA doppler - can offer induction
At 37 weeks if normal UAD - can offer induction

28
Q

Complications of SGA

A 
Neonatal
- birth asphyxia
- meconium aspiration
- hypothermia
- hypo/hyperglycaemia
- polycythaemia
- persistent pulmonary hypertension
- pulmonary haemorrhage
- necrotising enterocolitis
Long-term
- cerebral palsy
- type 2 diabetes
- obesity
- hypertension
- precocious puberty
- behavioural problems
- depression
- Alzheimer's disease
- cancer
29
Q

Define red blood cell isoimmunisation

A

Production of antibodies in response to an isoantigen present on an erythrocyte

30
Q

Pathophysiology of red blood cell isoimmunisation

A

Maternal isoimmunisation occurs when the mother’s immune system in sensitised to antigens on foetal erythrocytes resulting in production of IgG antibodies
- sensitising event - antepartum haemorrhage or abdominal trauma
In future pregnancies these antibodies can cross the placenta and attack foetal RBCs -> haemolysis and anaemia - haemolytic disease of newborn
Rhesus D isoimmunisation only possible when women who is RhD- with a RhD+ foetus

31
Q

Use of anti-D immunoglobulin

A

If a sensitising event occurs maternal isoimmunisation can be prevented by administration of anti-D immunoglobulin
- binds to RhD+ cells in maternal circulation and no immune response is stimulated

32
Q

Indications for use of anti-D immunoglobulin

A

In rhesus D negative women

  • invasive obstetric testing - amniocentesis or CVS
  • antepartum haemorrhage
  • ectopic pregnancy
  • external cephalic version
  • fall or abdominal trauma
  • intrauterine death
  • miscarriage
  • termination of pregnancy
  • delivery - normal, instrument or caesarean section
33
Q

Investigations for red blood cell isoimmunisation

A

Maternal blood group and antibody screen
- determines ABO and RhD blood groups and detects any antibodies directed against RBC surface antigens
Foeto-maternal haemorrhage test
- assess how much foetal blood has entered maternal circulation to determine how much anti-D to give
After delivery rhesus status of baby determined

34
Q

Dosage of anti-D

A

Routine prophylaxis at 28 and 34 weeks - 500IU
Sensitising events
- less than 20 weeks = 250 IU within 72 hours
- greater than 20 weeks = 500 IU within 72 hours

35
Q

Define prematurity

A

Baby born before 37 weeks

  • late = 34-36 weeks
  • moderate = 32-24 weeks
  • very = less than 32 weeks
  • extremely = before 25 weeks
36
Q

Risk factors for prematurity

A 
Previous premature birth
Pregnancy with twins or more
Less than 6 months between pregnancy
IVF
Smoking
Infections
Chronic conditions such as hypertension and diabetes
Under or over weight
Stress
Physical injury or trauma
37
Q

Complications of prematurity

A

Breathing problems - acute respiratory distress syndrome
Heart problems - patent Ductus arteriosus
Brain problems - haemorrhages
Immature GI system - necrotising enterocolitis
Anaemia
Neonatal jaundice

38
Q

Define prolonged pregnancy

A

Pregnancy persists past 42 weeks gestation

39
Q

Risk factors for a prolonged pregnacy

A 
Nulliparity
Maternal age > 40
Previous prolonged pregnancy
High BMI
FHx of prolonged pregnancies
40
Q

Complications of a prolonged pregnancy

A

Increased risk of

  • stillbirth
  • placental insufficiency
  • meconium aspiration in labour
  • instrumental or caesarean delivery
  • neonatal hypoglycaemia
41
Q

Clinical features of a prolonged pregnancy

A

Diagnosis based on gestational age - some have no clinical features at all
Static growth or potential macrosomia
Oligohydramnios
Reduced foetal movements
Presence of meconium - signs of meconium staining on nails etc
Dry/flaky skin with reduced vernix

42
Q

Management of a prolonged pregnancy

A

Recommend delivery by 42 weeks

  • membrane sweeps - offered from 40+0 for nulliparous and 41+0 for parous women
  • induction of labour - offered between 41+0 and 42+0

Yr4 - O&G (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions