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y3 repro > antenatal care and screening > Flashcards

antenatal care and screening Flashcards

1
Q

physiological changes in the mother associated with normal pregnancy

A

pregnancy affects multiple systems of the body
can be difficult to determine which symptoms are physiological and which are pathological

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2
Q

cardiac pregnancy blood problems (3)

A

HR increases from 70-90bpm
palpiations are common
blood pressure drops in the 2nd trimester - usually returns to normal in 3rd trimester

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3
Q

what is blood flow to the uterus at term

A

must exceed 1L/min

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4
Q

why does BP drop in the 2nd trimester

A

expansion of the uteroplacental circulation
fall in systemic vascular resistance
reduction in blood viscosity
reduction in sensitivity to angiotensin

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5
Q

urinary pregnancy problems

A

increased urine output
UTI

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6
Q

why is there increased urine output during pregnancy

A

renal plasma flow increases by 25-50%
GFR increases by 50%
serum urea and creatinine decrease

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7
Q

why do UTIs occur during pregnancy

A

increase in urinary stasis
hydronephrosis is physiological in 3rd trimester - pyelonephritis is more common
can be associated with preterm labour so important to treat

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8
Q

haematology pregnancy problems

A

anaemia

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9
Q

why does anaemia occur during pregnancy

A

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

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10
Q

respiratory problems during pregnancy

A

nose bleeds
SOB
runny nose

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11
Q

why do resp problems occur during pregnancy

A

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

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12
Q

GI problems during pregnancy

A

heartburn
GORD
constipation

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13
Q

why do GI problems occur during pregnancy

A

reduced oesophageal peristalsis
gastric emptying slows
cardiac sphincter relaxes
GI motility is reduced due to increased progesterone and reduced motilin

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14
Q

pre-pregnancy counselling

A

ideally for all women
in scotland 1/3 of pregnancies are unplanned

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15
Q

causes of maternal mortality - heart disease

A

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

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16
Q

causes of maternal mortality

A

heart disease - most common
blood clots
epilepsy and stroke
other physical conditions
sepsis
mental health conditions
bleeding
cancer
pre-eclampsia

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17
Q

inequalities in maternal mortality

A

ethnicity - BAME groups at higher risk
age - older mothers more at risk
living in a more deprived area

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18
Q

what does pre-pregnancy counselling involve

A

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

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19
Q

pre-pregnancy counselling - known medical problems

A

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

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20
Q

pre-pregnancy counselling - previous pregnancy problems - maternal

A

counsel re. risk of recurrence - C section, DVT, pre-eclampsia
actions to reduce risk of recurrence - thromboprophylaxis, low dose aspirin

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21
Q

pre-pregnancy counselling - previous pregnancy problems - fetal

A

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

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22
Q

why is antenatal examination important

A

high quality antenatal care reduces fetal and maternal mortality
aims to identify problems - mother, fetus, social

also mental health

23
Q

what does antenatal examination involve

A

routine enquiry - feeling well, feeling fetal movements after 20wks - can be an indication something isn’t right with baby
BP - detect elevating hT
urinalysis

24
Q

antenatal examination - abdominal palpitation

A

assess symphyseal fundal height - SFH - pubic symphysis to top of fundus, not always possible e.g. high BMI, fibroids on uterus etc
estimate size of baby
estimate liquor volume
determine fetal presentation - breech, vertex
listen to fetal heart

25
Q

antenatal screening

A

women are offered screening but it isn’t compulsory
appropriate counselling prior to screening is important
allows conditions to be detected early in a symptomless population to be treated for mother/baby

26
Q

screening for infection

A

hep B - if infected can provide passive and active immunisation for baby
syphilis - easily treated with penicillin
HIV - maternal treatment and careful planning reduces vertical transmission
MSSU - UTI

27
Q

screening for anaemia and isoimmunisation at 12 and 28 wks

A

iron deficiency anaemia - can affect maternal health
isoimmunisation - rhesus disease, anti C, anti Kell

28
Q

first visit scan - screening for anomalies by US

A

ensure pregnancy viable
multiple pregnancy and what type of multiple pregnancy
identify abnormalities incompatible w/ life - counselling about options
offer and carry out Down’s syndrome screening
- anencephaly

29
Q

detailed anomaly scan - screening for anomalies by US

A

systematic structural review of baby
not possible to identify all problems

can only identify structural issues
can identify problems that need intrauterine or postnatal treatment

30
Q

screening for trisomy 13, 18 and 21

A

multiple screening tests available
women and their partners must be aware prior to any screening taking place that tests for fetal abnormality only provide a risk of their baby being affected
further testing will be offered to definitively tell if a baby is affected
embarking on prenatal screening may sometimes result in parents having to make a difficult decision regarding termination of pregnancy

31
Q

first trimester screening

A

carried out at 10-14 weeks gestation
uses maternal risk factors, serum beta human chorionic gonadotropin (beta-HCG) and pregnancy associated plasma protein A (PAPP-A) and fetal nuchal translucency (NT) measurement

32
Q

detection rate of trisomy 21 in first trimester screening

A

~90%
invasive testing rate of 5%

33
Q

Nuchal translucency measurememnts

A

area of fluid behind the baby’s neck that can be measured

very difficult to measure therefore must only be done if you can properly get an accurate measurement

taken between crown rump lengths of 45-84mm

34
Q

how does nuchal translucency change

A

increases with gestational age
incidence of chromosomal and other abnormalities is related to the size rather than the appearance of NT

35
Q

what happens with a high risk result in first trimester screening

A

further testing is offered if risk of Down’s syndrome is >1/150

36
Q

options for further testing

A

CVS
amniocentesis
non-invasive prenatal testing

37
Q

what is non-invasive prenatal testing

A

maternal blood taken
can detect fetal cell free DNA released from the placenta
no risk of miscarriage
not diagnostic, if a high risk result is received, parents are offered CVS/amniocentesis

38
Q

when is CVS carried out
what is the risk of miscarriage

A

between 10-14 wks
1-2% risk of miscarriage

39
Q

when is amniocentesis carried out and what is the risk of miscarriage

A

15wks onwards
~1% risk of miscarriage, closer to 0.5% now

40
Q

is screening for neural tube defects routinely offered?

A

not since the introduction of 1st trimester screening

41
Q

who is at risk of neural tube defect (NTD)
what preventative measures can be taken

A

personal or family hx at increased risk

advised to take 5mg of folic acid to reduce the risk

42
Q

screening for NTD

A

1st trimester US to detect anencephaly and sometimes spina bifida - variants of NTD
2nd trimester biochemical screening
2nd trimester US - 20wks, will detect >90% of NTD

43
Q

2nd trimester biochemical screening for NTD

A

carried out if not able to get NT measurement
maternal serum is tested for alpha fetoprotein
>2.0MoM is high risk and warrants investigation

44
Q

2nd trimester US

A

purpose - detect fetal abnormality
good screening test for major structural abnormalities

45
Q

disadvantages of 2nd trimester US

A

poor test for chromosomal abnormalities - some babies with with major defects can have completely normal scans
50% w/ T21 will have normal detailed USS
17% w/ T18
9% w/ T13

46
Q

what is being measured here

A

nuchal translucency

47
Q

what test is this

A

CVS - chorionic villous sampling

sample of placenta taken

48
Q

what test is this

A

aminocentesis

49
Q

what is shown in these US scans

A

US markers for NTD

  1. lemon sign, lemon shaped skull, typical spine of spina bifida
  2. banana sign, cerebellum is slightly tapered
  3. spina bifida, often no seen as clearly
50
Q

what abnormality is shown

A

hypoplastic L heart - failure of LV to grow, major abnormality, babies will need multiple surgeries after birth

normal heart also

51
Q

what abnormality is shown here

A

exomphalos - protrusion of bowel coming out with the umbilical cord, can be in a sac or can be loops without a sac, 30% association w/ underlying abnormalities

normal also - umbilical cord going into the tummy

52
Q

what abnormality is shown

A

cleft lip

from L to R - bottom lip, top lip, nose

easily treatable following birth with surgery

53
Q

what condition is shown here

A

anencephaly

y3 repro (47 decks)

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