Antenatal care and screening Flashcards
When is morning pregnancy worse?
when hCG is high eg molar pregnancy and twins
what percentage of women experience morning sickness?
80-85%
What is a molar pregnancy?
sperm fertilises an empty egg and the placenta grows
What is hyperemesis gravidarum?
excess nausea and vomiting - severe morning sickness
Cardiac problems in pregnancy
CO increases and so does HR –> palpitations
5 steps in bp dropping in 2nd trimester
uteroplacental circulation expands
fall in systemic vascular resistance
reduced blood viscosity
reduced sensitivity to angiotensin
When does bp return to normal?
3rd trimester
What happens to GFR, urea and creatinine in pregnancy?
GFR up
urea and creatinine down
Why are UTI’s more common in pregnancy?
urinary stasis
hydronephrosis in 3rd trimester -> pyelonephritis
Why is it important to treat UTI in pregnancy?
associated with pre term labour
Explain anaemia in pregnancy simply
RBC increases but so does plasma volume so is a relative dilution - platelets drop
need more iron in pregnancy
WBC increase
GI problems in pregnancy
GORD, heartburn
GI motility, gastric emptying and peristalsis reduced
Why does GI motility reduce in pregnancy
progesterone is increased and motilin is decreased
Resp problems in pregnancy
oxygen consumption increases and increased plasma pH - increased resp rate
hyperaemia
List some main causes of maternal deaths
cardiac problems sepsis thrombosis psychiatric pre eclampsia
3 general health measures in pre-pregnancy counselling
optimise BMI
improve diet
reduce alcohol consumption
3 steps in pre-pregnancy counselling taken
smoking cessation
folic acid 400mcg
confirm immunity to rubella
known medical problems measures in pre-pregnancy counselling
stop or change unsuitable drugs eg valproate
occasionally give advice against pregnancy eg aortic stenosis
counsel regarding risks of recurrence - maternal
caesarean
DVT
pre-eclampsia
counsel regarding risk of recurrence - fetal
pre-term delivery
intra uterine growth restriction
abnormality
actions to reduce risk of recurrence - maternal
thromboprophylaxis
low dose aspirin
actions to reduce risk of recurrence - fetal
treatment of infection
high dose folic acid
low dose aspirin
problems identified with a - mother b - fetus c - social at antenatal examination
a - illness, minor pregnancy problems eg anaemia
b - small for gestational age, abnormality
c - support, violence, psychiatric
Routine enquiry at antenatal examination
feeling well
baby movements - over 20 weeks
Other tests undertaken at antenatal examination
blood pressure
urinalysis
3 things you are doing on abdominal examination of a pregnant woman
assess symphysial fundal height estimate size of baby estimate liquor volume listen to fetal heart fetal presentation eg breech
What can be offered if a baby is In the breech position?
ECV
Is antenatal screening compulsory?
no
Screening for infection - antenatally
Hep B - passive and active immunisation for baby
syphilis - easily treat with penicillin
HIV - maternal treatment and planning reduces vertical transmission
MSS for UTI
isoimmunisation
development of antibodies against blood groups
2 isoimmunisation in pregnancy
rhesus disease
anti-c, anti-kell
How is iron deficiency anaemia handled?
picked up on FBC - additional iron
4 aims of 1st visit scan
ensure pregnancy viable
multiple pregnancy
abnormalities incompatible with life eg anencephaly
offer and carry out down’s syndrome screening
aims of detailed anomaly scan
systematic structural review of baby
identify problems requiring intra-uterine or postnatal treatment
downs syndrome - trisomy …?
21
risk of downs syndrome
1 in 700
High risk of downs syndrome is…
1 in 150
risk of downs syndrome at maternal age of 20 and 45
1 in 1667
1 in 30
2 main determinants of downs syndrome
maternal age
FH of chromosomal abnormality
What does screening for downs syndrome provide and what is needed after?
a risk
definitive test – termination??
What week is first trimester screening carried out?
10-14 weeks
What 4 things does first trimester screening use?
maternal risk factors
serum beta hCG
PAPP-A
fetal nuchal translucency
nuchal translucency
the size not the appearance
crown to rump length of 45-84mm
increases with gestational age
What happens with a high risk downs syndrome result?
further testing if >1 in 150
options - CVS, amniocentesis, non invasive prenatal testing
CVS weeks carried out and risk of miscarriage
10-14 weeks
1-2% miscarriage
amniocentesis weeks carried out and risk of miscarriage
15 weeks +
about 1% miscarriage
Explain non-invasive prenatal testing
maternal blood taken and detect fetal cell free DNA and detect chromosomal trisomies
not on NHS
still high risk? invasive testing
Screening for NTD
increase to 5mg folic acid if high risk
1st trimester USS
2nd trimester biochemical screening
2nd trimester biochemical screening for NTD
not able to measure NT
alpha fetoprotein >2.0Mom high risk and investigate
What % of NTD will 2nd trimester USS detect?
> 90%
Second trimester USS
detect fetal abnormality eg hypoplastic left heart, cleft lip, exomphalos
poor for chromosomal abnormalities
