Antenatal care Flashcards
What do the terms gravida and para mean?
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
When is the first trimester of pregnancy?
This is from conception to 12 weeks
When is the second trimester of pregnancy?
From 13 weeks to 26 weeks
When is the third trimester of pregnancy?
From 27 weeks to birth
At what age do fetal movements begin?
Fetal movements start at around 20 weeks gestation
When does the booking clinic happen and what does it entail?
Before 10 weeks and involves baseline assessment and planning the pregnancy
When does the dating scan happen? what is it for?
It happens between 10 and 13+6 to determine the crown rump length, this allows an accurate gestational age to be calculated
When does the first antenatal appointment occur?
at 16 weeks to discuss results and plan future appointments
When does the anomaly scan occur?
between 18 and 20+6 to determine heart conditions etc.
When do antenatal appointments occur after the first one?
From 25 weeks increasingly regularly until they are weekly just before birth
What test should be done and when for women with a risk of gestational diabetes?
Should have an oral glucose tolerance test done at 24-28 weeks
What are the investigations and things that are covered at most routine antenatal appointments?
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
What 2 vaccines are offered in pregnancy?
Pertussis (whooping cough) from 16 weeks
Influenza (flu) in autumn
What are the lifestyle advice recommendations to made in pregnancy?
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
When is alcohol worst in pregnancy?
In the first 3 months
What are the features of foetal alcohol syndrome?
Microcephaly (small head) Cerebral palsy Learning difficulties Hearing and vision problems thin upper lip Smooth flat philtrum (groove between nose and upper lip)
What are the effects on the fetus of smoking in preganancy?
Fetal growth restriction Miscarriage Stillbirth Sudden infant death syndrome Placental abruption Pre-eclampsia
What bloods should be booked in the booking clinic?
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
What is involved in the combined test for down syndrome and when is it done?
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
If there is a high risk of downs on screening then testing is offered, what does this involve?
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
What is the mechanism behind rhesus sensitivity and haemolytic disease of the newborn?
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
What is the treatment for rhesus incompatibility in pregnant women?
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
What is the kleihauer test?
This is to tell how much fetal blood has passed into the maternal blood during a sensitisation event
When should an oral glucose tolerance test be done for gestational diabetes? What are the findings?
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
What is the management of gestational diabetes?
They have 4 weekly fetal growth scans and amniotic fluid volume from 28-36 weeks The management is: -Diet and exercise -Metformin -Insulin