antenatal care and screening Flashcards
physiological changes in the mother associated with normal pregnancy
pregnancy affects multiple systems of the body
can be difficult to determine which symptoms are physiological and which are pathological
cardiac pregnancy blood problems (3)
HR increases from 70-90bpm
palpiations are common
blood pressure drops in the 2nd trimester - usually returns to normal in 3rd trimester
what is blood flow to the uterus at term
must exceed 1L/min
why does BP drop in the 2nd trimester
expansion of the uteroplacental circulation
fall in systemic vascular resistance
reduction in blood viscosity
reduction in sensitivity to angiotensin
urinary pregnancy problems
increased urine output
UTI
why is there increased urine output during pregnancy
renal plasma flow increases by 25-50%
GFR increases by 50%
serum urea and creatinine decrease
why do UTIs occur during pregnancy
increase in urinary stasis
hydronephrosis is physiological in 3rd trimester - pyelonephritis is more common
can be associated with preterm labour so important to treat
haematology pregnancy problems
anaemia
why does anaemia occur during pregnancy
plasma volume increases by roughly 50% and RBC mass by 25%
this means a drop in Hb dilution from 133-121g/L
iron requirements are increased by 1g during pregnancy
WBC increase slightly to 9000-12000/µL
platelet count falls by dilution
respiratory problems during pregnancy
nose bleeds
SOB
runny nose
why do resp problems occur during pregnancy
progesterone acts centrally to reduce CO2 - increased tidal volume, increased resp rate, increased plasma pH
O2 consumption up by 20%
plasma PO2 is unchanged
hyperaemia of resp mucous membrances
GI problems during pregnancy
heartburn
GORD
constipation
why do GI problems occur during pregnancy
reduced oesophageal peristalsis
gastric emptying slows
cardiac sphincter relaxes
GI motility is reduced due to increased progesterone and reduced motilin
pre-pregnancy counselling
ideally for all women
in scotland 1/3 of pregnancies are unplanned
causes of maternal mortality - heart disease
heart disease - can occur for the first time during pregnancy
older, smokers, diabetes, FHx - greater risk of heart disease
signs - severe chest pain, SB when resting and lying flat
causes of maternal mortality
heart disease - most common
blood clots
epilepsy and stroke
other physical conditions
sepsis
mental health conditions
bleeding
cancer
pre-eclampsia
inequalities in maternal mortality
ethnicity - BAME groups at higher risk
age - older mothers more at risk
living in a more deprived area
what does pre-pregnancy counselling involve
done in 1y care for all women
general health measures - improve diet, optimise BMI, reduce alcohol consumption
smoking cessation advice
folic acid - 400mcg standard or 5mg high dose, ideally start 3mths before pregnancy
vot D - 10mcg daily
pre-pregnancy counselling - known medical problems
e.g. with diabetes/epilepsy
optimise maternal health
psychiatric health is important
stop/change any unsuitable drugs
advise regarding complications associated with maternal medical problems
occasionally advise against pregnancy
pre-pregnancy counselling - previous pregnancy problems - maternal
counsel re. risk of recurrence - C section, DVT, pre-eclampsia
actions to reduce risk of recurrence - thromboprophylaxis, low dose aspirin
pre-pregnancy counselling - previous pregnancy problems - fetal
counsel re. risk of recurrence - pre-term delivery, intrauterine growth restriction, fetal abnormality
actions to reduce risk of recurrence - treatment of infection, high dose folic acid, low dose aspirin