Antenatal Care Flashcards
What is the role of folic acid in antenatal care?
400mg of folic acid should be taken daily from before conception to 12 weeks
to prevent neural tube defects
Some women need to continue folic acid after 12 weeks, who are these women? How must they take it?
Individuals with…
- diabetes
- on anti-epileptic medication
- BMI >30
- a previous pregnancy affected by neural tube defects
- they themselves or their partner has a neural tube defect
They will need to take 5milligrams from 12 weeks
What is the role of iron supplementation in pregnancy?
Iron is not routinely offered in pregnancy
What is the role of Vitamin D supplementation in pregnancy?
Women can be given 10mg of Vitamin D supplements to be continued when breastfeeding
Is there a ‘safe limit’ on alcohol for women? Why?
No, any amount increases the risk of fetal alcohol syndrome which can manifest in:
- learning and behavioural problems
- poor growth
- facial abnormalities
What needs to be considered for women with substance dependence who are pregnant?
- Consider methadone programme to avoid chaotic lifestyle
- Child protection and social work referral
- Smear history- put measures in place to ensure she gets involved in a screening programme
- Breastfeeding education- in the UK it is advised that women who are HIV-positive formula feed. Advice can be given to women with low titre levels who understand the risk of transmission
- Labour plan regarding analgesia and labour ward delivery
- IV access
- Postnatal contraception plan- start as soon as possible so it’s in place when woman leaves hospital
What are some of the consequences of substance dependence?
- nutritional deficiences
- Hep B, Hep C, HIV
- Venous thromboembolism
- STIs
- Endocarditis/sepsis
- Poor venous access- important in management of labour
- Opiate tolerance/withdrawal- need replacement therapy
- Risk of domestic abuse and suicide
- IUGR, stillbirth, SIDS, pre-term labour
A pregnant woman <20 weeks has been exposed to the chicken pox and does not have immunity.
What do you do?
She should be given Varicella-Zoster immunoglobulin as soon as possible
It is effective up to 10 days post exposure
A pregnant woman >20 weeks has been exposed to chicken pox and is not immune
Either Varicella-Zoster immunoglobulins or oral Aciclovir should be given on day 7 post-exposure for 7 days
(so for days 7-14 post-exposure)
How should chicken pox be managed in pregnant women?
- Firstly, specialist advice should be sought
- oral Aciclovir should be given to women > or equal to 20 weeks presenting within 24 hours of the rash
- if the woman is <20 weeks the aciclovir should be used with caution
What is the most common cause of early onset (<7 days) severe infection in the post-natal period?
Group B streptococcus
What are the risk factors for Group B strep?
- prematurity
- prolonged rupture of the membranes
- previous sibling GBS infection
- maternal pyrexia e.g. secondary to chorioamnioitis
How should women with positive group B strep in a previous pregnancy be managed?
They should be informed their risk of maternal carriage is 50%
They should be offered intra-partum prophylactic antibiotics OR testing and if +ve antibiotics
If women are to have swabs for GBS, when should they get them?
Between weeks 35 and 37
or 3-5 weeks prior to the anticipated delivery date
Who should get IAP (intra-partum antibiotic prophylaxis)?
- Women with GBS in prev. pregnancy who want it/were swabbed and got +ve result
- Women with previous baby with early or late onset GBS disease
- Women in pre-term labour regardless of their GBS status
- Women with a pyrexia (>38) during labour
