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repro > antenatal care > Flashcards

antenatal care Flashcards

1
Q

when should the first booking occur when they know they are pregnant

A

before 10 weeks

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2
Q

what happens during the booking

A

advise about health and lifestyle
vitamins - healthystart programme

folic acid - 400 mcg daily

Food hygiene, including how to reduce the risk of a food-acquired infection

smoking cessation, implications of recreational drug use & alcohol consumption in pregnancy

All antenatal screening- as well as risks and benefits of the screening tests

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3
Q

which food infection increase more in pregnant woman

mx for it

A

listeriosis gram +ve cocci

ampicillin
erythromycin

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4
Q

what foods can increase the infection of listeriosis

A

drinking only pasteurised or UHT milk

not eating ripened soft cheese such as Camembert, Brie and blue‑veined cheese (there is no risk with hard cheeses, such as Cheddar, or cottage cheese and processed cheese)

not eating pâté (of any sort, including vegetable)

not eating uncooked or undercooked ready‑prepared meals.

Pregnant women should be offered information on how to reduce the risk of salmonella infection by:
avoiding raw or partially cooked eggs or food that may contain them (such as mayonnaise), avoiding raw or partially cooked meat, especially poultry.

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5
Q

risks of drinking alcohol for the baby

A

low birth weight, preterm birth, and being small for gestational age may all be increased in mothers drinking above 1-2 units/day during pregnancy.

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6
Q

what clinical examination is carried out in a pregnant women at booking

A

measurement if weight and BMI

if no healthcare at UK before a complete general clinical examnato

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7
Q

what routine tests are offered to pregnant women

A

electrophoresis

  • haemoglobinopathy
  • – sickle cell and Beta thalassaemia

FBC
- anaemia

Blood group and rbc antibody screening

  • rhesus status and risk of rhesus isoimmunisation
  • non rhesus antibodies

Infection screening

  • syphilis, hep B and HIV
  • asymptomatic bacteriuria

Urinalysis
- glycosuria, proteinuria, haematuria

if smoker measure CO levels

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8
Q

what do we screening for infection

A

Asymptomatic bacteriuria- MSU

Serological screening for hep B virus should be offered & effective postnatal interventions offered to decrease the risk of MTCT

Pregnant women should be offered screening for HIV infection early in pregnancy as interventions can reduce MTCT

Syphilis

No evidence that routine screening for GBS, toxoplasmosis, CMV, chlamydia, Hep C, asymptomatic bacterial vaginosis is beneficial

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9
Q

when do we screen for gestational diabetes

A

based on risk assessment
between 24-28 weeks
BMI above 30

previous macrosomic baby weighing 4.5kg or above, previous gestational siabetes

FH of diabetes (first degree relative w diabetes)

family origin with a high prevalence of diabetes

  • south aisan
  • middle eastern
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10
Q

screening for pre eclampsia

A

BP & urinalysis check for protein at each antenatal visit to screen for pre-eclampsia.

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11
Q

risk for preeclampsia

A

Age 40 years or older

Nulliparity

Pregnancy interval of more than 10 years

Family history of pre-eclampsia

Previous history of pre-eclampsia

BMI 30 kg/m2 or above

Pre-existing vascular disease such as hypertension

Pre-existing renal disease

Multiple pregnancy

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12
Q

what symptoms should women at risk of pre eclampsia should be aware of

A

severe headache
problems with vision, such as blurring or flashing before the eyes
severe epigastric or right upper quadrant pain
vomiting
sudden swelling of the face, hands or feet.

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13
Q

At what DBP and SBP levels do you treat

A

DBP of above 100mmHg

two consecutive reading of 90mmHg more than 4 hours apart and/or significant proteinuria should prompt increased surveillance

SBP above 160mmHG

150-159 mmHg on two consecutive readings at least 4 hours apart consider treatment

keep SBP below 150mmHg

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14
Q

When is dating scan done

A

essential to all antenatal care timing, including fetal anomaly testing

first trimester (10-13+6 weeks)

CRL used unless less than 84mm, then HC used

also nuchal translucency scan plus biochem

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15
Q

when is screening for T13, T18, T21 done

A

first trimester by the end (13 weeks 6 days)

the combined test of bloods and US should be done (NT, BhCG, PAPP-).

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16
Q

what happen if women miss the window for scrrening of T13, T18, T21

A

15-20 weeks for late bookers

only serum screening quadruple test is available for these lot
hCG, aFP, uE3 and inhibin-A

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17
Q

if high suspicion of trisomy on screening test what do u do

A

explain the results and tell them when the confirmatory tests would occur

invasive tests

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18
Q

Purpose of the anomaly scan screening

A

identify fetal anomalies and allow

  • reproductive choice - termination of pregnancy
  • parents to prepare (for any treatment/disability/palliative care/ termination of pregnancy
  • managed birth in a specialist centre
  • intrauterine therpauy
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19
Q

what is used to assess rate of growth

A

head circumference
abdomen circumference
femur length

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20
Q

what fetal anomalies can we look for in scan

A

cleft palate
lip anomalies
nasal abridge

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21
Q

for uncomplicated nulliparous women how many appts are required

A

10

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22
Q

for uncomplicated parous women how many appts are requires

A

7

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23
Q

what happens at each visit

A

BP and urine check occurs

from 24 weeks: symphysis - fundal height should be measured and recorded

from 36 weeks check fetal presentation - USS if uncertain

routine auscultation is not normal unless requested

formal fetal movement counting not required

routine antenatal CTG in uncomplicated pregnancy NO BENEFIT

24
Q

At 28 weeks what tests are done

A

FBC for anaemia

red cell alloantibodies

Glucose Transaminase T if infdicated

if mother is rhesus negative offer routine anti D prophylaxis

25
Q

what happens at the third trimester 36 weeks visit

A

breastfeeding info, techniques and good management practises

birth plan, where they want to give birth, pain relief options

recognition of active labour

care of the new baby

vit K prophylaxis

newborn screening tests

postnatal self-care

awarness of baby blies and postnatal depression

risk assessment

26
Q

what is documentation of care

A

structured maternity records should be used for antenatal care

women carry their own case notes

27
Q

when is normal scanning done

A

20 weeks

28
Q

in what circumstances are further scans done in pregnancy

A

low lying placenta at 20 weeks - rescan at 32 weeks

suspected small for dates in clinical examination/customised growth charts

suspected malpresentation (weird position) on clinical examination

from 42 weeks women who decline induction of labour should be offered US estimation of maximum amniotic pool depth

29
Q

postnatally what occurs

A

physical and emotional health and well being

coping strategies adn support

commonhealth problems

encourage the woman and family members to report concerns

mental health problems

30
Q

what test is done to screen for downs and how are the results are interpreted

A

The ‘combined test’ (nuchal translucency, beta-human chorionic gonadotrophin, pregnancy-associated plasma protein-A) should be offered to screen for Down’s syndrome between 11 weeks and 13 weeks 6 days. For women who book later in pregnancy the most clinically and cost-effective serum screening test (triple or quadruple test) should be offered between 15 weeks and 20 weeks.

The presence of an increased nuchal fold (6 millimetres or above) or two or more soft markers on the routine anomaly scan should prompt the offer of a referral to a fetal medicine specialist or an appropriate healthcare professional with a special interest in fetal medicine.

31
Q

when is it not possible to measure nuchal transparency and what alternative test is done

A

owing to fetal position or raised BMI, women should be offered serum screening (triple or quadruple test) between 15 weeks and 20 weeks.

32
Q

what is PROM

A

Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins

33
Q

if PROM occurs before 37 weeks of pregnancy then what is it called

A

preterm premature rupture of membranes (PPROM)

34
Q

factors that contribute TO PROM

A

near the end of pregnancy (term) may be caused by a natural weakening of the membranes or from the force of contractions.

Low socioeconomic conditions (as women in lower socioeconomic conditions are less likely to receive proper prenatal care)

Sexually transmitted infections, such as chlamydia and gonorrhea

Previous preterm birth

Vaginal bleeding

Cigarette smoking during pregnancy

Unknown causes

35
Q

Risks of PROM

A

fetal: prematurity, infection, pulmonary hypoplasia
maternal: chorioamnionitis

  • placental infection (chorioamnioitis)
  • placental abruption (early - detachment of the placenta from the uterus)
  • compression of the umbilical cord
  • cesarean birth
  • postpartum (after delivery) infection.
  • sepsis
  • baby is more likely to be born within a few days
  • (Early in pregnancy) may lead to oligohydramnios.
  • Increased incidence of retained placenta and primary and secondary postpartum haemorrhage.
36
Q

symptoms of PROM

A

Leaking or a gush of watery fluid from the vagina

Constant wetness in underwear

37
Q

how is PROM diagnosed

A

Actually seeing amniotic fluid draining from the cervix and pooling in the vagina after the woman has been lying down for 30 minutes is the most accurate test[5]. Sterile speculum examination: check for liquor and for the umbilical cord.

Testing for insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1 may aid diagnosis but results should not be considered in isolation.

The Vision Amniotic Leak Detector (ALD) is a non-invasive diagnostic liner that can be attached to underwear. I

Testing of the pH (acid or alkaline) of the fluid

Looking at the dried fluid under a microscope (may show a characteristic fern-like pattern)

Ultrasound - check for gestation and liquor volume
Ultrasound may also be useful to show oligohydramnios.

Temperature monitoring at least 12-hourly for ascending infection:

  • — High vaginal swab.
  • – If infection is suspected, check FBC (for WCC), CRP, MSU and blood cultures; start appropriate antibiotic treatment if tests, along with clinical signs, confirm intrauterine infection.

Fetal monitoring.

38
Q

Mx of PROM

A

Hospitalization
P-PROM is suspected.
Ascending infection is suspected: maternal or fetal tachycardia, temperature, abdominal tenderness.

Expectant management (in very few cases of PPROM, the membranes may seal over and the fluid may stop leaking without treatment,

Monitoring for signs of infection, such as fever, pain, increased fetal heart rate, and/or laboratory tests.

Antibiotics (to prevent or treat infections)
- recommends the use of ORAL erythromycin 250 mg qds for 10 days (or until labour is established if this is sooner) following the diagnosis of P-PROM

antenatal steroids should be given if gestation is between 24+0and 34+6 weeks.

If Group B streptococcus is isolated from a swab or if erythromycin is contra-indicated then penicillin or clindamycin is usually recommended

Women with PPROM usually deliver at 34 weeks if stable. If there are signs of abruption, chorioamnionitis, or fetal compromise, then early delivery would be necessary.)

39
Q

risk factors for P-PROM

A

Smoking

previous preterm delivery

vaginal bleeding at any time during the pregnancy

association between lower genital tract infection and P-PROM

40
Q

earliest signs of ascending infection

A

fetal tachycardia

mild increase in maternal temperature

offensive vaginal discharge

41
Q

which AB should not be used prophylatically in P-PROM

A

Co-amoxiclav

42
Q

why are antenatal steroids given in PROM

A

Antenatal steroids are associated with a significant reduction in rates of neonatal death, respiratory distress syndrome and intraventricular haemorrhage and are safe for the mother

43
Q

when should delivery be considered in P-PROM women

A

34 weeks

44
Q

what risks are ass if pregnancy occurs above 36 weeks

A

increased risk of chorioamnionitis and a reduced risk of respiratory problems for the neonate.

45
Q

what is intrapartum fetal monitoring

A

monitoring techniques that are used immediately preceding or during childbirth

46
Q

what is symphysis fundal height

A

measured from the top of the pubic bone to the top of the uterus in centimetres

It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm

47
Q

what is done if the symphysis fundal height is not within recommeded level

A

do US

48
Q

what is folic acid

A

Folic acid is converted to tetrahydrofolate (THF). Green, leafy vegetables are a good source of folic acid.

49
Q

functions of folic acid

A

THF plays a key role in the transfer of 1-carbon units (e.g. methyl, methylene, and formyl groups) to the essential substrates involved in the synthesis of DNA & RNA

50
Q

causes of folic acid deficiency

A

phenytoin
methotrexate
pregnancy
alcohol excess

51
Q

consequences of folic acid deficiency

A

macrocytic, megaloblastic anaemia

neural tube defects

52
Q

how to prevent neural tube defects in all women and high risk women

A

400mcg of folic acid until the 12th week of pregnancy

women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy

53
Q

when are women considered high tisk for Neural tube defect

A
  • either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
  • the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
  • the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
54
Q

causes of increased AFP

A
  • Neural tube defects (meningocele, myelomeningocele and anencephaly)
  • Abdominal wall defects (omphalocele and gastroschisis)
  • Multiple pregnancy
55
Q

causes of decreased AFP

A

Down’s syndrome
Trisomy 18 - Edward’s
Maternal diabetes mellitus

56
Q

anaemia ranges in pregnancy

A

1) first trimester Hb less than 110 g/l
2) second/third trimester Hb less than 105 g/l
3) postpartum Hb less than 100 g/l

Gestation Cut-off
Booking visit < 11 g/dl
28 weeks < 10.5 g/dl

57
Q

increased NT

A

Down’s syndrome
congenital heart defects
abdominal wall defects

repro (28 decks)

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