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PRIYA REPRO > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

when should 400mg folic acid be given?

A

400mg from before conception until 12 weeks gestation to reduce the risk of neural tube defects

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2
Q

when should 5mg folic acid be given?

A

individuals with diabetes on anti-epileptic medications and those with BMI >30, previous pregnancy with neural tube defect or mothers with personal history of neural tube defect
take 5mg daily from 12 weeks

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3
Q

when is the combined test carried out?

A

11+0 and 13+6 weeks

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4
Q

what does the combined test involve?

A

US and blood test
US looks at nuchal translucency which assess the amount of fluid collecting within the nape of the fetal neck (normal is <3.5mm)
PAPPA, (low) AFP (low) and Beta-HCG (high)

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5
Q

how does antiD work?

A

when mothers are first exposed to the rhesus antigen, they form IgM antibodies which are too big to cross the placenta and harm the current fetus
however, in future pregnancies when the mother is exposed to the same antigen from the fetus’s RBCs, the body forms IgG antibodies which are smaller and can cross the placenta to harm the fetus, leading to haemolytic disease of the newborn

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6
Q

when can chorionic villus sampling be done?

A

between 11 - 13+6 weeks gestation

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7
Q

when can amniocentesis be done?

A

after 15 weeks

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8
Q

what is non-invasive preatal test - NIPT)?

A

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

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9
Q

what are the 2 variations of zygosity and what does it mean?

A

(the degree of similarity of the alleles in an organism)
monozygotic
dizygotic

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10
Q

what does monozygotic mean?

A

splitting of a single fertilised egg

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11
Q

what does dizygotic mean?

A

fertilisation of 2 ova by 2 sperm

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12
Q

what does chorionicity mean and what are the 2 variations?

A

wether twins in utero share one choirion and placenta (monochorionic) or wether they each have their own (dichorionic)

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13
Q

can dichorionic be monoamniotic?

A

no, always DCDA (dichorionic diamniotic)

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14
Q

what are the variations of monochorionic?

A

depending on the time of splitting of the fertilised ovum, can eithwe be monochorionic monoamniotic, monochoironic diamniotic or conjoined twins

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15
Q

if cleavage occurs on days 1-3 (morula) what is the outcome?

A

dichorionic / diamniotic

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16
Q

if cleavage occurs on days 4-8 (blastocyst) what is the outcome?

A

monochorionic / diamniotic

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17
Q

if cleavage occurs on days 8-13 (implanted blastocyst) what is the outcome?

A

monochorionic . monoamniotic

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18
Q

if cleavage occurs on days 13-15 (formed embryonic disc), what is the outcome?

A

conjoined twins

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19
Q

why do monochorionic / monozygous twins require a 2 weekly US?

A

to pick up the early signs of Twin Twin Transfusion Syndrome (TTTS)

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20
Q

what is the antenatal care of multiple pregnancy?

A
  • attend antenatal clinic every 2 weeks for monochorionic pregnancies and every 4 weeks for dichorionic pregnacies
  • iron, folic acid and low-dose aspirin to prevent hypertensive disorders
  • US done from 16 weeks every 2 weeks
  • anomoly scan done at 18-20 weeks
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21
Q

what is TTTS?

A

a condition where there is disproportionate blood supply to the fetuses in monochorionic pregnancies as they share the same placenta

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22
Q

what happens to each twin in TTTS?

A

donor twin has decreased blood volume, decreased growth and development ldeading to decreased urine output, anaemia and oligohydraminos

blood volume in recipient twin increases leading to increased urinary otput and polyhydraminos, polycytaemia and eventually heart failure

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23
Q

what is the treatment of TTTS?

A

fetoscopic laser ablation before 26 weeks

delivery at 34-36 weeks

24
Q

what is the breech position

A

when the fetus is in longitudinal lie but the presenting part of the fetal buttocks

25
Q

what are the 3 different types of breech positions?

A

complete breech = legs folded with feet at the bottom
footling breech = over or both feet point down so the legs would emerge first
frank breech = legs point up with feet by the baby’s head so the bottom emerges first

26
Q

what happens in fetal hypoxia in terms of the arteries?

A

the umbilical artery increases the fetal hypoxia and the MCS decreases its resistance
the MCA will show an increase peak systolic volume in fetuses with anaemia

27
Q

when are MCA and ductus venosus dopplers used in fetal monitoring?

A

if either the umbilical or uterine artery shows any problems as an additional investigation

28
Q

what is the leading cause of maternal mortality?

A

VTE

29
Q

what is the definition of a still birth?

A

a baby born with no signs of life at or after 28 weeks gestation

30
Q

what are some causes of stillbirth?

A
  • labour complications
  • post-term pregnancy
  • maternal infections eg malaria, HIV
  • maternal disorders eg diabetes, hypertension
  • fetal growth restrictions
  • congenital abnormalities
31
Q

how is hypertension in pregnancy defined?

A

systolic >140mmHg or diastolic >90mHg

or an increase above booking readings of >30mHg systolic or >15mmHg diastolic

32
Q

what is pre-eclampsia?

A

condition seen after 20 weeks gestation characterised by pregnancy induce hypertension together with proteinuria (>0.3mg/24 hours)

33
Q

what are the high risk factors for pre-eclampsia?

A
  • hypertensive disorder
  • CDK
  • SLE or APLS
  • DM
  • first pregnancy
  • chronic hypertension
  • age 40 or older
  • pregnancy interval of more than 10 years
  • BMI >35 at first visit
  • Fx
  • multiple pregnancy
34
Q

what are some features of pre-eclampsia?

A
  • hypertension >170/100mmHg and proteinuria
  • headache (cerebral oedema)
  • papilloedema
  • right upper quadrant / epigastic pain
  • sudden onset oedema
  • hyperreflexia, clonus
  • platelets <100x106/L, abnormal liver enzymes or HELLP syndrome
35
Q

what type of seizures occur in eclampsia?

A

grad mal

36
Q

what can be given to mothers with pre-eclampsia to help mature fetal lungs?

A

IM steroids eg betamethasone or dexamethasone

37
Q

what do IV steroids help to decrease the risk of?

A
  • neonatal death
  • intraventricular haemorrhage
  • necrotising enterocolitis
  • intensive care admission and need for respiratory effort
  • systemic infections
38
Q

what is the WHO definition of gestational diabetes mellitus?

A

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

39
Q

what are the risk factors of GDM?

A
  • previous GDM
  • obesity BMI 30 or more
  • family history of a first degree relative with GDM
  • ethnicity - south east asian, middle eastern, black carribean
  • previous big baby
40
Q

what are some signs of GDM?

A

polyhydramnios

glycosuria

41
Q

what should HbA1c be at during pregnancy?

A

<48mmol/mol (6.5%)

42
Q

how to test for GDM?

A

oral glucose tolerance test in 1st trimester (if normal, do again at 24-28 weeks)

43
Q

how do you do an oral glucose tolerance test?

A

fasting venous FBS
75mg Glucose
2 hour venous glucose

44
Q

what are the SIGN diagnostic values for GDM?

A

fasting > = 5.1mmol/l

2 hour > = 8.5mmol/l

45
Q

what are the glycaemic targets of GDM?

A

fasting 3.5-5.5mmol/l

1 hour <7.8 mmol/l

46
Q

what is the definiton of PPROM?

A

rupture of amniotic sac before onset of labour

47
Q

which antibiotics and at which dose are given to prevent ascending infections leading to chorioamnionitis?

A

erythromycin 250mg orally every 6 hours for 10 days

48
Q

why should co-amixoclav be avoided in neonates?

A

it causes necrotizing enterocolitis

49
Q

if rhesus titre levels are high, how is the fetus checked for anaemia?

A

MCA peak velocity pressure (MCA-PSV)

50
Q

how is placenta praevia defined?

A

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

51
Q

what is placental abruption?

A

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

52
Q

what are the symptoms of placental abruption?

A 
severe, continuous abdominal pain 
backache with posterior placenta
bleeding
preterm labour 
may present with maternal collapse
53
Q

what are the signs of placental abruption?

A 
unwell distressed patient 
uterus large for dates or normal 
uterine tenderness
woody, hard uterus
fetal parts hard to identify
54
Q

what is the management of placental abruption?

A

resuscitate mother
urgent c-section and replacing bloods as well as fetal resusitation if necessary
anti-d if rhesus negative

55
Q

what is vasa praevia?

A

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

56
Q

what are the symptoms of vasa praevia?

A

its fetal blood loss so doenst cause harm to mum
membranes are ruptures followed by a small amount of dark vaginal bleeding and is accompnaied by an acute fetal bradycardia and accelerations becoming a significant fetal mortality rate

PRIYA REPRO (15 decks)

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