antenatal care and risk factors during pregnancy Flashcards
what is the action for a female with a high risk of VTE?
LMWH
what is the action for a female with a high risk of pre-eclampsia?
low-dose of aspirin (75mg) and increased blood pressure monitoring.
if BP >150/100 then treatment, if >160/110 then urgent treatment is required
what is the action for a female with a high risk of chromosomal abnormalities?
non-invasive pre-natal diagnosis or invasive testing
what is the action for a female with a high risk of fatal growth restriction
serial USS of fatal growth. if the child is dropping off, this baby needs to be delivered ASAP
what is the action for a female with a high risk of gestational diabetes?
oral glucose tolerance test
What is the normal weight gain during pregnancy?
what pre-pregnancy BMI is the mother and fetus more at risk of complications?
10-15kg is normal
if >30BMI (those females need to have a glucose oral tolerance test (25wks)
what are the changes in the genital tract during pregnancy?
uterus weight increases
muscle hypertrophy, increase in blood flow and contractility
cervical softening,
what are the changes in the circulating blood?
increase by 50% in circulating volume
Red cell mass increases
Hb decreases (probably due to dilution effects, should be no lower than 11)
WBC increaases
what are the changes encountered by the CVS during pregnancy?
cardiac output increases by 40%
a reduction in peripheral vascular resistance
a drop in BP during the 2nd trimester of pregnancy
what are the changes in the pulmonary system that occur during pregnancy
respiratory rate should not chance
40% increase in tidal volume
important: females may report increasing shortness of breath, but their RR should not change
what are the changes in thyroid, GI and renal system
thyroid enlargement occurs (bHCG?)
GI motility is reduced hence more constipaton
GFR increases by 40%. Cr:Urea decrease
At the booking assessment what are the risks for SGA?
heavy smoking cocaine use previous Hx of SGA or stillbirth heavy daily exercise maternal illness (e.g. diabetes) parental SGA
What is a uterine/umbilical artery doppler?
This measures the velocity of blood within the umbilical circulation.
During pregnancy the uterine artery have less resistance, however, if this resistance is increased this could be suggestive of IUGR or pre-eclampsia
Resistance is described in relation to end-diastolic flow:
high resistance >95th gentile
absent (AEDF) or Reversed (REDF) the latter two correlate with severe foetal compromise
what are the limitations of an umbilical artery doppler?
Can be used alone at <34 weeks, if >34 weeks, needs to be used with Middle cerebral artery doppler to give a more accurate representation of IURG. in those cases cerebroplacental ratio is used (CPR)
what is doppler waveform of cerebral circulation?
this uses to assess the resistance or velocity in MCA.
if there’s foetal compromise the MCA has less resistance in comparison with other arteries, to cause a ‘head-sparring’ effect.
resistance in MCA also decreases in foetal anaemia
Therefore the pulsalitity index in MCA: PI index in UmbA can be used to give us an indication of foetal compromise >34wks.
