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Obs and gynae > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

What do the terms gravida and para mean?

A

Gravida means the number of times the woman has become pregnant
Para is the number of times the pregnancy has progressed beyond 24 weeks
Miscarriages at less than 24 weeks are written as + and then the number of miscarriages

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2
Q

When is the first trimester of pregnancy?

A

This is from conception to 12 weeks

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3
Q

When is the second trimester of pregnancy?

A

From 13 weeks to 26 weeks

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4
Q

When is the third trimester of pregnancy?

A

From 27 weeks to birth

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5
Q

At what age do fetal movements begin?

A

Fetal movements start at around 20 weeks gestation

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6
Q

When does the booking clinic happen and what does it entail?

A

Before 10 weeks and involves baseline assessment and planning the pregnancy

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7
Q

When does the dating scan happen? what is it for?

A

It happens between 10 and 13+6 to determine the crown rump length, this allows an accurate gestational age to be calculated

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8
Q

When does the first antenatal appointment occur?

A

at 16 weeks to discuss results and plan future appointments

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9
Q

When does the anomaly scan occur?

A

between 18 and 20+6 to determine heart conditions etc.

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10
Q

When do antenatal appointments occur after the first one?

A

From 25 weeks increasingly regularly until they are weekly just before birth

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11
Q

What test should be done and when for women with a risk of gestational diabetes?

A

Should have an oral glucose tolerance test done at 24-28 weeks

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12
Q

What are the investigations and things that are covered at most routine antenatal appointments?

A

Symphysis-fundal height - from 24 weeks
Fetal presentation - from 36 weeks
Blood pressure and urine dip for preeclampsia
Urine for microscopy and culture for infections

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13
Q

What 2 vaccines are offered in pregnancy?

A

Pertussis (whooping cough) from 16 weeks

Influenza (flu) in autumn

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14
Q

What are the lifestyle advice recommendations to made in pregnancy?

A 
Women should take folic acid 400mcg from before preganancy to 12 weeks to reduce neural tube defects
Vitamin D
No smoking or alcohol
Avoid blue cheese (listeriosis)
Flying increases VTE risk
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15
Q

When is alcohol worst in pregnancy?

A

In the first 3 months

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16
Q

What are the features of foetal alcohol syndrome?

A 
Microcephaly (small head)
Cerebral palsy
Learning difficulties
Hearing and vision problems
thin upper lip
Smooth flat philtrum (groove between nose and upper lip)
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17
Q

What are the effects on the fetus of smoking in preganancy?

A 
Fetal growth restriction
Miscarriage
Stillbirth
Sudden infant death syndrome
Placental abruption
Pre-eclampsia
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18
Q

What bloods should be booked in the booking clinic?

A

Blood group, antibodies and rhesus D status
FBC for anaemia
Screening for thalassaemia (all women) and sickle cell disease (high risk)
Offered:
-HIV
-Syphilis
-Hep B

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19
Q

What is involved in the combined test for down syndrome and when is it done?

A

done at 11-14 weeks
Involves ultrasound for nuchal translucency - nuchal thickness more than 6mm
Maternal bloods involving hCG and pregnancy associated plasma protein A (PAPPA) - raised hCG and reduced Pappa

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20
Q

If there is a high risk of downs on screening then testing is offered, what does this involve?

A

Chorionic villus sampling or amniocentesis
CVS involves US biopsy of placental tissue for karyotyping usually before 15 weeks
Amniocentesis US guided amniotic fluid and is done after 15 weeks

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21
Q

What is the mechanism behind rhesus sensitivity and haemolytic disease of the newborn?

A

Rhesus negative means that a mother does not have rehesus antigens on her red cells
If her baby has rhesus positive red cells and their blood mixes during the first pregnancy then she will become sensitised produce antibodies against the rhesus antigens
During subsequent pregnancies if her babies are positive then her immune system will attack them causing haemolytic disease of the newborn

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22
Q

What is the treatment for rhesus incompatibility in pregnant women?

A

The main treatment is prevention of sensitisation
Anti-D medications are given then attach to the rhesus positive fetal red cells in the maternal circulation and destroy them before the mother can develop an immune response
They are routinely given at:
-28 weeks
-Birth if the baby is found to be rhesus positive
Anti-D injections should also be given at any time where sensitisation may occur, such as:
-Antepartum haemorrhage
-Amniocentesis procedures
-Abdominal trauma

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23
Q

What is the kleihauer test?

A

This is to tell how much fetal blood has passed into the maternal blood during a sensitisation event

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24
Q

When should an oral glucose tolerance test be done for gestational diabetes? What are the findings?

A 
24-28 weeks
Should be done in the morning after a fast
Remeber the cut offs are 5-6-7-8
IN GD:
Fasting >5.6
At 2 hours >7.8
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25
Q

What is the management of gestational diabetes?

A 
They have 4 weekly fetal growth scans and amniotic fluid volume from 28-36 weeks
The management is:
-Diet and exercise
-Metformin
-Insulin
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26
Q

How are women with preexisting diabetes managed in pregnancy?

A

They should take 5mg folic acid up to 12 weeks
Have retinopathy scans
Changed to metformin and insulin
Planned delivery at 37 and 38+6 for pre-existing diabetes
Sliding scale insulin throughout pregnancy

27
Q

When does gestational diabetes stop after birth?

A

Can stop their medications immediately after birth as it improves rapidly
Need to be cautious of neonatal hypoglycaemia after birth as they are used to lots of glucose

28
Q

What causes gestational diabetes during pregnancy?

A

There is reduced insulin sensitivity during pregnancy

29
Q

When must contraception be started postpartum and what can be used?

A

Must be started after 21 days postpartum even if breastfeeding
Progesterone only pill can be used from day 21

30
Q

What is the diagnostic triad for hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance

31
Q

What is the management of hyperemesis?

A

First line with antihistamines such as promethazine or cyclizine
Ondasetron or metoclopramide can be used second line
IV rehydration can be required

32
Q

Why does pre-eclampsia cause oligohydramnios?

A

There is hypoperfusion of the placenta causing less amniotic fluid to be produced

33
Q

What is the management of chicken pox in pregnancy?

A

If there is doubt of whether the mother has previously had chicken pox then blood should urgently be checked for varicella antibodies
If the women is not immune and less than 20 weeks should be given varicella zoster immunoglobulin (VZIG) urgently
If over 20 weeks then either VZIG or aciclovir 7 to 14 days after exposure

34
Q

At what gestational age should a referral be made to an obstetrician for a mother who has not felt her baby kick?

A

24 weeks

Usually feel kicks by 20

35
Q

How is hypothyroidism managed in pregnancy?

A

It is managed by increasing the levothyroxine dose by 30-50%
This is titrated based on the TSH level
It can cross the placenta and provide thyroxine to the developing foetus

36
Q

Which hypertension medications cannot be used in pregnancy?

A

They cause congenital abnormalities
ACE inhibitors (ramipril)
Angiotensin receptor blockers (losartan)
Thiazide and thiazide like diuretics (indapamide)

37
Q

What medications can be used in hypertension in preganancy?

A 
Beta blockers (labetalol) - contraindicated in asthma
Calcium channel blockers (nifedipine)
38
Q

What is the management of epilepsy in pregnancy?

A

Should thake 5mg of folic acid daily to reduce the risk of neural tube defects
Should ideally be controlled with a single anti-epileptic agent
Levetiracetam, lamotrigine and carbamazepine are more safe in pregnancy

39
Q

Why should NSAIDS be avoided in pregnancy?

A

They inhibit prostaglandin production and prostaglandins are important for maintaining the ductus arteriosus and lack of prostaglandins may delay labour

40
Q

What are the effects of beta blockers on the fetus in pregnancy?

A

They can cause intrauterine growth restriction

They can lead to fetal bradycardia

41
Q

What effects do angiotensin receptor blockers and ace inhibitors have on the fetus in pregnancy?

A

They can cross the placenta and cause reduced urine output and hence reduced amniotic fluid
They can also cause hypocalvaria (incomplete formation of the skull bones)

42
Q

What is the result of opiates on the foetus during pregnancy?

A

They cause withdrawl symptoms in the neonate that usually present as irritability, high temperatures, difficulty feeding and tachypnoea between 3 and 72 hours after birth
This is called neonatal abstinence syndrome

43
Q

What is the effect of warfarin in preganacy?

A

Leads to conginital abnormalities particularly craniofacial abnormalities
Also leads to bleeding and loss of fetus

44
Q

What is the effect of lithium use in pregnancy?

A

In the first trimester of pregnancy it causes congenital cardiac abnormalities, particularly ebsteins anomaly - tricuspid valve is lower on the right side of the heart
Lithium is also contraindicated in breast feeding as it is toxic to the foetus

45
Q

What are the effects of SSRIs in pregnancy?

A

They cross the placenta and can cause congenital heart defects and malformations
They can also cause persistent pulmonary hypertension in the third trimester and withdrawl
This means the the risks and benefits of continuing them in pregnancy needs to be considered

46
Q

What precautions should be taken to reduce risk of rubella infection and how would this affect preganacy?

A

Ensure they have had MMR pre pregnancy, it is a live vaccine so can’t be given during pregnancy
Risk of causing congenital rubella syndrome:
-Congenital deafness
-Congenital cataracts
-Congenital heart disease (pulmonary stenosis)
-Learning disability

47
Q

What is the risk of chickenpox in pregnancy?

A

It can cause neonatal varicella syndrome
Varicella pneumonitis or hepatitis in the mother
Neonatal varicella infection

48
Q

How should mothers that are exposed to chickenpox in preganancy be managed?

A

Test antibodies to see if immune - VZV IGG
If not immune then give varicella IV immunoglobulins within 10 days of exposure as propylaxis
Or give aciclovir if rash has already started

49
Q

What is neonatal varicella syndrome?

A 
When infection in first 28 weeks:
Fetal growth syndrome
Microcephaly, hydrocephalus, learning disability
Cataracts
Limb hypoplasia (not forming properly)
50
Q

What can lead to listeria infection in pregnancy?

A

unpasteurised dairy products lead to it

Can cause miscarriage and fetal death

51
Q

What is the triad of features seen in congenital toxoplasmosis?

A

Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)

52
Q

What is the risk of Parvovirus B19 or slapped cheek syndrome in pregnancy?

A

Miscarriage or fetal death
Severe fetal anaemia
Hydrops fetalis (fetal heart failure)
Maternal pre-eclampsia-like syndrome

53
Q

What counts as low birth weight?

A

Less than 2500g

54
Q

What measurements are made on ultrasound to measure fetal growth?

A

Estimated fetal weight

Fetal abdominal circumference

55
Q

What are the causes of fetal growth restriction?

A 
Placenta mediated:
-Idiopathic
-Pre-eclampsia
-Maternal smoking
-Maternal alcohol
-Anaemia
-Malnutrition
-Infection
Non-placenta mediated:
-Genetic abnormalities
-Structual abnormalities
-Fetal infection
-Errors of metabolism
56
Q

What are the short and long term complications of fetal growth restriction?

A 
Short term:
Fetal death
Fetal hypothermia
Fetal hypoglycaemia
Long term:
Cardiovascular disease
Obesity
Diabetes
Mood disorders
57
Q

What are some of the causes for small for gestational age?

A 
Previous SGA baby
Pre eclampsia
Diabetes
smoking
obesity
Multiple pregnancy
antiphospholipid syndrome
58
Q

What monitoring do women have for intrauterine growth restriction?

A

If they are low risk then they should have symphysis fundal height at antenatal appointments
If they are high risk then they should have serial growth scans and umbilical artery doppler

59
Q

What do serial ultrasound scans measure?

A

Estimated fetal weight (EFW) and abdominal circumference (AC) to determine the growth velocity
Umbilical arterial pulsatility index (UA-PI) to measure flow through the umbilical artery
Amniotic fluid volume

60
Q

What medication should be given when early delivery is considered for a fetus with intrauterine growth restriction?

A

Corticosteroids

61
Q

When is UTI tested for in pregnancy?

A

They are tested throughout pregnancy

Treat even if asymptomatic as at risk of preterm labour

62
Q

What is the treatment of UTI in pregnancy?

A

7 days antibiotics
Nitrofurantoin (avoid in third trimester)
Or amoxicillin only once sensitivities are known

63
Q

What does nitrofurantoin cause in the third trimester?

A

Neonatal haemolysis

64
Q

What does trimethoprim cause in the first trimester?

A

Folate antagonist so causes neural tube defects

Obs and gynae (8 decks)

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