Antenatal Care and screening Flashcards
How much does the cardiac output and heart rate increase in pregnancy?
CO - 30-50%
HR - from 70 to 90bpm
What does the blood flow to the uterus have to be?
over 1L per minute at term
What happens to blood pressure in pregnancy?
the uteroplacental circulation expands, so blood pressure DROPS in SECOND trimester, it usually returns to NORMAL in THIRD trimester.
What happens to blood viscosity during pregnancy?
Blood viscosity reduces
What happens to urine output in pregnancy?
Renal plasma flow increases by 25-50%
GFR increases by 50%
serum urea and creatinine decrease (increased plasma volume dilutes it)
3rd trimester - bladder capacity decreases (pressure from uterus)
What happens with UTI’s in pregnancy?
urinary stasis increases
3rd trimester - hydronephrosis occurs and makes pyelonephritis more common
What is a side effect of pyelonephritis in pregnancy?
Associated with preterm labour.
What happens to levels of haemoglobin, platelets and WBC’s in pregnancy?
Plasma volume increases 25-50%
RBC only increases 25%
^This causes a drop in haemoglobin and platelets in blood by dilution.
WBCs increase slightly.
When should iron supplements be given?
If haemoglobin is:
<110 at booking
<100 at 28 weeks
(Normal is 121-151)g/L
What respiratory changes happen in pregnancy?
- 02 consumption increases by 20% (plasma PO2 is unchanged)
- Progesterone causes increased rate and depth of breathing (this leads to decreased PCO2 and increase in pH).
What GI changes happen in pregnancy?
- Oesophageal peristalsis is reduced
- GI emptying slows
- Cardiac sphincter relates
Caused by increased progesterone and decreased motion
How many Scottish pregnancies are unplanned?
1/3
How many women die in Scotland during pregnancy or up to 6 weeks after?
9.2 women per 100,000.
What sound be prescribed to women with risk factors for pre-eclampsia?
Aspirin from 12 weeks or pregnancy.
How much folic acid is prescribed during pregnancy?
400mcg is standard dose.
5mg for BMI>30, taking sodium valproate, previous babies.
How much vitamin D is prescribed during pregnancy?
10mcg daily.
When should you start to feel foetal movements?
After 20 weeks, if not this might signify a problem.
What is SFH?
Symphyseal fundal height - measures top of the fundus to the pubic symphysis and Is plotted on a chart.
It can detect intrauterine growth restrictions.
What is ECV in pregnancy?
External cephalic version, offered when baby is still in breech position after 36 weeks. if this fails a cesarian will be done.
Which infections are screened for?
Syphilis
HIV
Hep B
UTI
Which trisomies are screened for?
13 - Patau’s syndrome
18 - Edwards syndrome
21 - downs syndrome
When is the first trimester screening done?
10-14 weeks gestation.
What is Nuchal Translucency?
the collection of fluid under the skin behind the metal neck in the first trimester.
It increases with age
The higher the Nuchal translucency, the higher the risk of trisomy and cardiac problems.
What are the types of sampling for trisomies?
Chorionic villus sampling (1-2% risk of miscarriage)
Amniocentesis (15 risk of miscarriage)
Maternal blood (no risk of miscarriage)
what are the signs of Neural tube defects in screening?
Banana sign of the cerebellum.
Lemon shaped skull sign.
What is the second trimester ultrasound good for?
Good - picking up major structural abnormalities
Poor - at picking up trisomies
Which medication must be stopped before pregnancy?
Ramipril (all ACE inhibitors contraindicated in pregnancy).
