Antenatal care and screening Flashcards
What problems are associated with pregnancy?
Morning sickness
UTI
Anaemia
Acid reflux
Who is morning sickness seen in?
80-85% women
When is morning sickness worse?
When human chorionic gonadotrophin i higher i.e. twins or molar pregnancies
What can morning sickness progress to?
hyperemesis gravidarum
When is morning sickness usually better by?
16 weeks
What causes UTIs in pregnancy?
Increase in urinary staiss
What renal conditions are more common during pregnancy?
UTI
Pyelonephritis
What is pyelonephritis in pregnancy associated with?
Hydronephrosis in 3rd trimester
Preterm labour
When is anaemia treated in pregnancy?
If Hb is <110 or less than 100 on routine testing at 28 weeks
What counselling is done for all women hoping to get pregnant?
General health- improve diet, optimise BMI, reduce alcohol consumption
Smoking cessation
Folic acid- 3 months pre pregnancy
Confirm immunity to rubella
Who is a pre pregnancy screening vital in?
Women with previous health or pregnancy problems
What is essential to do pre pregnancy in women with previous health problems?
Optimise maternal health Psych Stop/change any unsuitable drugs Advice regarding complications associated with maternal medical problems Occasionally advise against
What is advised in women with a previous section?
1 section for non recurring cause= can trial labour
2 sections or recurring cause= opt to section
How is risk of recurrence of DVT or pre-eclampsia reduced?
Low dose aspirin
Thromboprophylaxis
Monitor
What is done for women with foetal problems in previous pregnancy?
Counsel regarding risk of recurrence
Reduce risk of recurrence-treat infection, high dose folic acid, low dose aspirin
What are the direct causes of maternal death?
Sepsos Thrombosis Haemorrhage Pre-eclampsia Amniotic fluid embolism Anaesthesia Other
What are the indirect causes of maternal death?
Cardiac disease Neuro Psych Sepsis Other
What is done on abdominal palpation in an antenatal exam
Fundal height Size of baby Liquid volume Foetal presentation Foetal heart rate
What antenatal screening is done?
Hep B Syphilis HIV MSSU for UTI Iron deficiency anaemia Isoimmunisation for Rhesus disease, anti C and anti Kell US
Why is rhesus disease screened for?
When a rhesus - woman has a rhesus + baby, she will develop antibodies agains the foetal red blood cells during labour
If she has another rhesus + baby, this will kill it in utero
What is done on a first US and when?
10-14 weeks Ensure pregnancy viable Multiple pregnancy Identify anomalies incompatible with life Offer Down's screening
What is the risk of having a baby with Down’s at age 20 and at age 45?
1 in 1667
1 in 30
What are the Down’s screening tests?
1st trimester screening
CVS
Amnioscentesis
When is the first trimester screening for Down’s carried out?
10-14 weeks
What is assessed on the 1st Down’s screening test?
Maternal risk factors
serum BTa human chorionic gonadotrophin
Pregnancy associated plasma protein a PAPPA
Foetal nuchal translucency
When is further testing for down’s offered?
if risk >1 in 150
When is CVS done and what is the miscarriage rate?
10-14 weeks
1-2%
Whenis amniocentesi done and what is the miscarriage rate?
15 weeks on
1%
When is a 2nd US done?
18-20 weeks
What is done on a 2nd US?
Normal growth and development
Major physical abnormalities
When is screening test for neural tube defect done?
FH of neural tube defect
What is used to reduce risk of neural tube defect?
5mg folic acid
What are the screenings for neural tube defect?
1st US- ancephaly and sometimes spina bifida
2nd trimester biochemistry screening- maternal serum tested for alpha fetoprotein
anomaly scan will detect >90% neural tube defects
What is seen as “high risk” biochemistry for neural tube defect?
> 2 materna serum alpha fetoprotein
