Antenatal Care and Screening Flashcards
1
Q
Risk factors in pregnancy
A
- Age
- Teenagers more at risk of social deprivation, lack of support, smoke more and may not receive antenatal care
- Older women (especially over 40), more prone to pre-existing medical condition, chromosomal disorders
- Parity
- Pre-eclampsia most commonly occurs in nulliparity (first pregnancy)
- Post-partum haemorrhage in grand multiparity (4 or more deliveries)
- Occupation
- Jobs which expose mother and foetus to risk
- Busy jobs with inadequate rest
- Exposure to harmful substances causing foetal anomalies
- Substance misuse
- Heroine, methadone, benzodiazepines are addictive to foetus
- Requires slow withdrawal post borsht
2
Q
Alcohol in pregnancy
A
- Can cause foetal abnormalities → foetal alcohol syndrome
- Distinctive facial features and learning difficulties
3
Q
Obesity in pregnancy
A
- Higher rates of poor outcomes e.g. miscarriage and stillbirth
- Difficulty monitoring fundal height for foetal growth
- VTE much more common
4
Q
Pre-pregnancy counselling
A
- Ideally for all women however ⅓ of pregnancies are unplanned
- Especially for women with previous health or pregnancy problems
- e.g obesity and alcoholism
- Predominately done in primary care
- Involves
- General health measures: improving diet, optimise BMI, reduced alcohol intake
- Smoking cessation
- Folic acid requirements
- Confirm immunity to rubella
5
Q
Gastrointestinal changes in pregnancy
A
- Reduced oesophageal peristalsis
- Slowed gastric emptying
- Relaxed cardiac sphincter (LOS)
- Reduced GI motility (increased progesterone and decreased motilin)
6
Q
Respiratory changes in pregnancy
A
- Pregnancy causes physiological respiratory alkalosis due to progesterone acting on central respiratory centres
- Increased tidal volume
- Increased respiratory rate
- Increased plasma PH
- O2 consumption increased
- Plasma PO2 unchanged
7
Q
Anaemia in pregnancy
A
- Increased plasma volume and RBC mass → drop in haemoglobin dilution
- Iron requirements in pregnancy increase by 1g
- Iron supplements required at checkup if ferritin below 110 at 28 weeks
8
Q
Increased risk of UTI’s in pregnancy
A
- Increased urinary stasis → easier path for ascending infection → pyelonephritis
- Physiological hydronephrosis in trimester III → pyelonephritis
- Increased incidence of pre-term labour (MSSU and antibiotics more indicated)
9
Q
Cardiac problems
A
- Palpitations
- Increase in cardiac output
- Drop in blood pressure in second trimester
- Expanded uteroplacental circulation
- Fall in systemic vascular resistance
- Reduced blood viscosity
- Reduced sensitivity to angiotensin
10
Q
Hyperemesis gravidarum
A
- Much worst than morning sickness
- Presentation
- Prolonged and severe nausea
- Dehydration (unable to keep fluids down)
- Ketosis → build up of acidic chemicals in blood and urine
- Weight loss
- Low blood pressure
- May not get better after 16 weeks
11
Q
Morning sickness
A
- Affects majority of pregnant women
- Worse with conditions of high hGH (twins, molar pregnancy
- Can progress to hyperemesis gravidarum
- Usually gets better by 16 weeks
12
Q
Pregnancy problems considered in pre-pregnancy counselling
A
- Foetal
13
Q
Second trimester scan
A
- Recommended around 20 weeks
- Purpose to detect foetal anomalies
- Poor test for structural abnormalities
14
Q
Anecephaly
A
- Neural tube defect causing failure of skull vault to develop
- Brain matter unprotected and is worn away
- Incompatible with extrauterine life
15
Q
First scan visit
A
- Approximately at 12 weeks
- Functions
- Ensure pregnancy is viable
- Multiple pregnancies
- Identify anomalies incompatible with life → anencephalic foetus
- Establish crown rump length
- Offer screening for Down’s syndrome
- Diagnose miscarriage
- Diagnose ectopic pregnancy
- Examine maternal ovaries
16
Q
Function of the ultrasound scan in pregnancy
A
- Viewing morphology of the pregnancy against checklist of normal views
- Show the first signs of pregnancy
- Thickened lining of the womb
- 4.5 weeks → fluid filled intrauterine sac
- 5 weeks → yolk sac within uterus
- 6 weeks → foetal heart pulsation
17
Q
Isoimmunisation
A
- Development of antibodies against particular blood groups
- Commonly rhesus disease (anti-d antibodies)
- Occurs with woman is rhesus negative and carries rhesus positive baby
- Anti-D antibodies develop if foetal blood cells enter maternal circulation (miscarriage, termination, ectopic pregnancy)
- Higher risk of in subsequent pregnancies
- Offered anti D IbG to all rhesus negative women prophylactically after sensitising event
18
Q
What forms part of the antenatal screening
A
- Hepatitis B → provide active or passive immunisation for baby
- Syphilis → causes intrauterine growth restriction, hepato-splenomegaly, anaemia, thrombocytopenia, skin rashes, treated with penicillin
- HIV screening → use ARV and avoidance of breast feeding to reduce vertical spread
- Iron deficiency anaemia → iron tablets
- Isoimmunisation → development of antibodies against blood groups
19
Q
Function of antenatal screening
A
- Testing symptomless population to detect disease in early stages for better outcomes
- Not compulsory and requires adequate counselling before
- Allows conditions to be treated in mother and foetus in early stages
20
Q
External cephalic version (ECV)
A
- Manual procedure where baby is turned from buttocks/ foot to head first
- Normally offered if baby remains breech after 36 weeks
- If this doesn’t work, baby usually delivered by elective caesarean (safer outcomes)
- Listen to foetal heart
21
Q
Purpose of abdominal palpation
A
- Determine the lie of the baby
- Certain lies more associated with poor outcomes during delivery → ie. placenta praaevia
- Foetal lies
- Longitudinal lie
- Transverse lie
- Breech
- Vertex
22
Q
Ante-natal examination
A
- Routine questions (feeling well, foetal movements after 20 weeks)
- Blood pressure (hypertension and urinalysis)
- Abdominal palpitation (symphysial fundal height, size of baby, liquor volume)
23
Q
Indication for a caesarean
A
- If a patient has had a previous Caesarean section
- Only if she has had one for a non-recurring cause (breech position)
- Customary to delivery by elective caesarean after 2 previous caesarean
24
Q
Previous pregnancy problems to counsel regarding the recurrence of
A
- Mother
- Caesarean section
- DVT → thromboprophylaxis
- Pre-eclampsia → low dose aspirin
- Foetus
- Pre-term labour → treatment of infection
- Intrauterine growth restriction
- Foetal abnormality → foetal abnormality
*
25
Q
Existing health conditions and pregnancy
A
- Phenyketonuria (PKU)
- Inability to metabolise phenylalanine causing high levels
- Causes mental developmental impairments
- Mother with PKU requires low phenylalanine diet to prevent it reaching foetus
- Hypothyroidism
- Increased metabolic demand in pregnancy
- Increased demand of thyroxine especially for foetal brain development
- Increased dosage required
- Hyperthyroidism
- Small percentage with Graves disease
- Thyroid stimulating antibodies can cross placenta
- Requires treatment to lower thyroid levels
- Pre-existing diables
- Optimised glucose control
- Switch from oral hypoglycaemic medications to insulin
- Higher risk of preeclampsia, stillbirth, macrosomic infants
- Renal patients
- Higher risk of pre-eclampsia especially with pre-existing proteinuria and hypertension
- Renal transplant indicated
- Epilepsy
- Anti-epileptic medications → teratogenic
- Higher rates of spina bifida with sodium valproate
- Ideally women would not take any medications during pregnancy
