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Reproductive System > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

Why is physiological adaptation necessary in pregnancy?

A

To allow the body to cope with the added strain of pregnancy

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2
Q

What are physiological changes in pregnancy responsible for?

A

So called minor ailments of pregnancy

Worsening of pre-existing illness

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3
Q

What percentage of women are affected by morning sickness?

A

80-85%

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4
Q

In what conditions is morning sickness worse?

A

Conditions where human chorionic gonadotrophin is higher e.g. twin pregnancy, molar pregnancy

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5
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum (this risk is also increased when HCG is increased)

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6
Q

By what week of pregnancy does morning sickness usually improve?

A

16

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7
Q

How much does cardiac output increase by during pregnancy? Why is this?

A

30-50%

Due to combination of increase in SV and HR

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8
Q

What can the increase in heart rate in pregnancy be associated with?

A

Feeling of palpitations

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9
Q

At term, what must the blood flow to the uterus exceed?

A

1L/min

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10
Q

When does blood pressure drop in pregnancy?

A

During second trimester

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11
Q

Why does blood pressure drop during the second trimester?

A

Expansion of uteroplacental circulation
Fall in systemic vascular resistance
Reduction in blood viscosity
Reduction in sensitivity to angiotensin

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12
Q

When in pregnancy does BP usually return to normal?

A

In third trimester

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13
Q

Why does urine output increase in pregnancy, particularly in third trimester?

A

Bladder capacity is reduced in third trimester due to pressure in the pelvis from the expanding uterus

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14
Q

What is the increase in renal plasma flow and glomerular filtration rate in pregnancy?

A

Renal plasma flow increases by 25-59%

GFR increases by 50%

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15
Q

What is the change in serum urea and creatinine in pregnancy?

A

Both decrease

Due to increased GFR and dilutional effect of increased plasma volume

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16
Q

Why is there an easier path for ascending infection and increased pyelonephritis in pregnancy?

A

There is increased urinary stasis

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17
Q

When is hydronephrosis phsyiological in pregnancy?

A

In third trimester

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18
Q

Why is there a low threshold for MSSU and antibiotics for UTI in pregnancy?

A

UTI increases incidence of pre-term labour

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19
Q

Why is the incidence of anaemia increased in pregnancy?

A

Increased iron requirement from foeto-placental unit

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20
Q

When should iron supplements be given in pregnancy?

A

When Hb is < 110 at booking or < 100 on routine testing at 28 weeks

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21
Q

What is the increase in plasma volume and RBC mass in pregnancy?

A

Plasma volume 50%

RBC mass 25%

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22
Q

What is the increase in iron requirements in pregnancy?

A

1g

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23
Q

What does WBC increase to in pregnancy?

A

9,000-12,000

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24
Q

What does progesterone reduce?

A

CO2

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25
Q

What is the change in tidal volume, respiratory rate, plasma pH, O2 consumption and plasma PO2 in pregnancy?

A 
TV - increases 
RR - increases 
plasma pH - increases 
O2 consumption - increases
Plasma PO2 - unchanged
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26
Q

What is the change in oesophageal peristalsis and gastric emptying in pregnancy?

A

Oesophageal peristalsis is reduced

Gastric emptying slows

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27
Q

What happens to the cardiac sphincter in pregnancy?

A

Relaxes

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28
Q

What happens to GI motility in pregnancy? Why?

A

GI motility is reduced due to increased progesterone and decreased motilin

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29
Q

Ideally, who should be given pre-pregnancy counselling?

A

All women

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30
Q

How many pregnancies in Scotland are unplanned

A

1/3rd

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31
Q

For what women is pregnancy counselling vital?

A

Women with any previous health or pregnancy problems

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32
Q

In what ways are the causes of maternal deaths changing?

A

BMI is increasing, weight related causes more common
Death from cardiac disease is relevant in an age group where it wasn’t relevant before
Thrombosis would have been a cause of death in pregnancy but there are drugs which can prevent this and can be used in pregnancy so screening is important

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33
Q

What general health measures should be taken in pregnancy?

A 
Improve diet 
Optimise BMI 
Reduce (stop) alcohol consumption 
Smoking cessation 
Folic acid
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34
Q

What might you need to consider when counselling a pregnant woman on smoking cessation?

A

Whether the partner/surrounding family smoke - will be more difficult for the woman to quit if she is surrounded by other smokers

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35
Q

What dose of folic acid should be given to pregnant women? Why?

A

400mcg, ideally for 3 months before becoming pregnant and then throughout pregnancy to reduce the risk of neural tube defects

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36
Q

How does obesity affect pregnancies?

A

Increased rates of poor outcomes including stillbirth and miscarriage
Affects function of uterus in pregnancy
Venous thromboembolic events more common

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37
Q

What does foetal alcohol syndrome cause?

A

Typical facial appearance

Learning difficulties

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38
Q

What is the routine advice given to pregnant women regarding alcohol?

A

Avoid alcohol consumption completely during pregnancy

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39
Q

What ages of the fertile population carry worse pregnancy outcomes?

A

At either end - teenagers and older women

40
Q

Why are teenagers more likely to have worse pregnancy outcomes?

A

May have less social support
Less antenatal care
Poor general health due to smoking and alcohol

41
Q

Why are older women more likely to have worse pregnancy outcomes?

A

More prone to pre-existing medical conditions and complications of pregnancy
Increase in chromosomal disorders with maternal age

42
Q

Why should blood pressure be monitored in pregnancy?

A

For signs of pre-eclampsia

43
Q

When does pre-eclampsia usually occur?

A

In a woman’s first pregnancy

44
Q

What does grand multiparity predispose a woman to?

A

Postpartum haemorrhage

45
Q

What substances can cause withdrawal syndrome in the baby when it is born and “cut off” from its supply?

A

Heroin
Methadone
Benzodiazepines

46
Q

What should be done/considered in women with known medical problems during pregnancy?

A

Optimise maternal health
Remember psychiatric health
Stop/change any unsuitable drugs
Advise mother regarding complications associated with her medical problems
Occasionally may need to advise against pregnancy
Women with diabetes and epilepsy need to be counselled

47
Q

What is phenylketonuria?

A

Error of protein metabolism which results in high levels of the amino acid phenylalanine

48
Q

What does untreated phenylketonuria cause?

A

Mental development impairment

49
Q

What needs to be done if a woman with PKU is pregnant?

A

She needs to re-start her low phenylalanine diet to prevent high levels reaching the developing foetal brain

50
Q

How is the demand for thyroxine in women with hypothyroidism affected by pregnancy?

A

Demand is increased so dose may need to be increased

51
Q

Why are normal thyroxine levels needed in pregnancy?

A

Needed for foetal brain development

52
Q

Ideally, when should glucose control in women with diabetes be optimised?

A

Prior to conception

53
Q

What changes need to be made in medication of women with diabetes who are taking oral medications?

A

Medications need to be switched to insulin

54
Q

What pregnancy complications are diabetic mothers more at risk of?

A

Pre-eclampsia
Stillbirth
Macrosomic infant

55
Q

Where should diabetic pregnant women be cared for in pregnancy?

A

Joint diabetic-obstetric antenatal clinic

56
Q

What are renal patients more likely to develop in pregnancy than normal women?

A

Pre-eclampsia

57
Q

Why might pre-eclampsia be difficult to diagnose in women with pre-existing renal problems?

A

They may already have proteinuria and hypertension

58
Q

What effect does renal transplantation have on fertility?

A

Restores fertility as well as renal function

59
Q

What is the main concern for women with epilepsy in pregnancy?

A

The effect of their anti-epileptic medication on the developing foetus - some medications e.g. sodium valproate are extremely teratogenic

60
Q

What are the rules regarding sodium valproate treatment of epilepsy in women of child-bearing age?

A

Sodium valproate should not be given to women of child-bearing age where there is an alternative

61
Q

Why is it important to review a patient’s medication history when pregnant/trying to conceive?

A

In order to identify any drugs contraindicated in pregnancy and see if drugs can be safely discontinued or modified

62
Q

How does a previous Caesarean section delivery affect a woman’s safest mode of delivery for subsequent pregnancies?

A

If a caesarean was given for a non-recurring cause such as breech presentation the woman will normally be fine to undergo normal labour, if a woman has had 2 previous caesarians it is customary to deliver by elective caesarean again

63
Q

What might a previous pregnancy indicate?

A

How a woman is likely to progress in subsequent pregnancies

64
Q

Why is antenatal care important?

A

High quality antenatal care reduces foetal and maternal mortality

65
Q

What do antenatal examinations aim to identify?

A

Problems with the mother and foetus, and any social problems

66
Q

What problems are important to detect in the mother?

A

Pre-existing or developing illness

Problems of pregnancy e.g. anaemia

67
Q

What does examination of the foetus allow?

A

Detection of some foetal abnormalities and foetuses that are small for their gestational age

68
Q

What is included in routine enquiry after 20 weeks of pregnancy?

A

Asking the mother about foetal movements

69
Q

What is done at every antenatal appointment?

A

Blood pressure and urinalysis

70
Q

What does abdominal palpation of a pregnant woman allow?

A 
Asses symphyseal fundal height 
Estimate size of baby 
Estimate liquor volume 
Estimate foetal lie 
Determine foetal presentation

Can also listen to foetal heart during this examination

71
Q

What is important to tell patients when talking about screening for foetal abnormality?

A

Women are offered screening but it is not compulsory

Patients should be aware of potential repercussions

72
Q

What does screening allow?

A

Conditions to be detected in a symptomless population

73
Q

What infections can be screened for in pregnancy?

A

Hepatitis B
Syphilis
HIV
UTI

74
Q

Why is it important to identify hepatitis B in pregnant women?

A

If women are infected you can provide both active and passive immunisation to the neonate at birth
Can also alert healthcare workers of the woman’s infectious status

75
Q

What does congenital syphilis cause?

A

Intrauterine growth restriction, hepato-splenomegaly, anaemia, thrombocytopaenia and skin rashes

76
Q

How does HIV infection affect pregnancy?

A

Prior knowledge of HIV status allows the use of antiretrovirals to reduce viral load
Delivery is usually by Caesarean section and breastfeeding is avoided to reduce vertical spread

77
Q

What can happen when a rhesus-negative woman is carrying a rhesus-positive baby? (Due to the father being rhesus-positive)

A

The woman develops anti-D antibodies if the foetal red blood cells enter the maternal circulation, these cause the baby to become anaemic and can cause foetal death

78
Q

What is offered to all rhesus-negative women? When?

A

Anti-D IgG, both prophylactically and after potentially sensitising events

79
Q

What is the aim of the first visit ultrasound scan?

A

Ensure pregnancy is viable
Identify multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down syndrome screening

80
Q

What is the purpose of the detailed anomaly scan?

A

Systematic structural review of the baby to identify problems that need intrauterine or postnatal treatment, not possible to identify all problems

81
Q

What is the overall risk of Down syndrome?

A

1 in 700

82
Q

What is the biggest risk factor for having a baby with Down syndrome?

A

Increasing maternal age

83
Q

What must women and their partners be aware of prior to any screening taking place for foetal abnormality?

A

Screening only provides a risk of their baby being affected, not a definite answer

84
Q

When is first trimester screening carried out?

A

At 10-14 weeks gestation

85
Q

What does first trimester screening involve?

A

Maternal risk factors
Serum beta human chorionic gonadotrophin
Pregnancy associated plasma protein A
Nuchal translucency measurement

86
Q

What is the detection rate of trisomy 21 in first trimester screening?

A

90%

87
Q

What causes nuchal translucency to increase?

A

Increases with gestational age

Incidence of chromosomal abnormalities is related to size of nuchal translucency (rather than the appearance)

88
Q

When is further testing for Down syndrome offered?

A

If risk is > 1 in 150

89
Q

What are the options of further testing methods for Down syndrome?

A

Chorionic villus sampling
Amniocentesis
Non-invasive prenatal testing

90
Q

When is CVS offered and what is the risk of miscarriage with this procedure?

A

Between 10-14 weeks

1-2% risk

91
Q

When is amniocentesis offered and what is the risk of miscarriage with this procedure?

A

15 weeks onwards

Around 1% risk

92
Q

How does non-invasive prenatal testing work?

A

Maternal blood taken

Can detect foetal cell free DNA and use this to look for chromosomal trisomies

93
Q

What screening tests are available for neural tube defects?

A

Ultrasound

Biochemical screening - maternal serum tested for alpha fetoprotein

94
Q

What is the purpose of the second trimester ultrasound?

A

Detecting foetal abnormality

Good screening test for major structural abnormalities but poor test for chromosomal abnormalities

95
Q

What percentage of foetuses with T21 will have a normal detailed second trimester US?

A

50%

96
Q

What percentage of foetuses with T18 will have a normal detailed second trimester US?

A

17%

97
Q

What percentage of foetuses with T13 will have a normal detailed second trimester US?

A

9%

Reproductive System (33 decks)

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