Antenatal care and screening Flashcards
What percentage of woman are affected by morning sickness?
80-85%
Which conditions can make morning sickness worse?
Anything that raises human chorionic gonadotrophin e.g. twins or hydatidiform molar pregnancy
What can morning sickness progress to?
Hyperemesis gravidarum
When does morning sickness usually get better?
After the first trimester (Or after the first 16 weeks)
What happens to cardiac output during pregnancy? Why is there a change?
Cardiac output increases by 30-50% due to an increase in the heart rate from 70 to 90bpm
In terms of cardiac issues what is a common complaint during pregnancy and why can this be an issue?
Palpitations, differentiating between changing physiology and pathology can be hard.
What happens to blood pressure throughout the pregnancy?
It rises during the second trimester but returns to normal by the third
Why does the blood pressure rise during the second trimester?
> Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin
What happens to the bladder capacity during pregnancy, when does this occur?
The bladder capacity is reduced during the third trimester due to the increase in pressure of the pelvis by the ever expanding uterus.
What happens to urine output during pregnancy?
Increases
Why does urine output increase during pregnancy
> Renal plasma flow increases by 25-50%
> Glomerular Filtration Rate increases by 50%
What changes to serum urea and creatinine are their during pregnancy and why does this occur?
There is a decrease due to the increase in glomerular filtration rate and partly due to the dilution effect of increased plasma volume.
What urinary condition other than increased urine output are pregnant woman at higher risk of?
1) Urinary tract infections
2) Pyelonephritis
Why are pregnant woman at higher risk of UTI’s?
There is an increase in urinary stasis
Why are pregnant woman at higher risk of pyelonephritis?
As hydronephrosis is physiological during the third trimester which increases the risk of pyelonephritis.
What can UTis/pyelonephritis increase the risk of?
Preterm labour
During pregnancy what happens to plasma volume?
Increases by roughly 50%
During pregnancy what happens to RBC mass?
Increases by roughly 25%
What does an increase in the plasma volume and RBC mass lead to?
A drop in the haemoglobin by dilution from 133 to 121g/L
What happens to the iron requirement during pregnancy and why?
Increase by 1g, most of increased iron requirement is for the fetoplacental unit
When should iron supplements be given in pregnancy ?
If HB is <110 on routine testing at 28 weeks
What happens to the platelet count during pregnancy and why?
Falls by dilution
What happens to the white blood cell count in pregnancy?
Increases slightly from 9000 to 12000 uL
What is the effect of progesterone on the respiratory system?
Acts to centrally reduce CO2 by:
> Increasing tidal volume
> Increasing respiratory rate
> Increasing plasma PH
What effect does pregnancy have on O2 consumption?
Increase by roughly 20%
What effect does pregnancy have on plasma PO2?
None, its unchanged
What effect does pregnancy have on the respiratory mucous membranes?
Hyperaemia
What effect does pregnancy have on peristalsis?
> Reduces oesophageal peristalsis
> Gastric emptying is also slowed
Why is GI motility reduced during pregnancy?
1) Increase in progesterone
2) Decrease in motilin
In Scotland, what percentage of pregnancies are unplanned?
33%
When is pre-planning pregnancy vital?
Ideally everyone would be screened.
However for those with pre-existing health issues or past issues with pregnancy it is vital
What are the major causes of death during pregnancy?
> Cardiac issues
Sepsis
Thrombosis
Neurological issues
What is more common in obese pregnancies?
> Miscarriage > Still borns > Uterus dysfunction during Labour > Venous thromboembolic events > Issues in routine measurements
What is done/talked about during pre-pregnancy counselling?
> General health measures:
- Diet
- BMI
- Alcohol consumption
> Smoking cessation advice
> Folic acid levels
> Confirm Rubella immunity
> Risk assessment:
- Age (Old or young)
- Parity (Pre-eclampsia)
- Occupation
- Substance misuse
> Medication review
> Pschiatric assessment
> Advice on current and future medical problems
What is phenylketonuria and what does it put a newborn baby at risk of?
An inborn error of protein metabolism of the essential amino acid phenylalanine.
It increases the risk of mental developmental disorders.
If a mother has phenylketonuria what should she do during pregnancy?
Have a low phenylalanine diet to prevent high levels reaching the developing fetes and putting it at risk of mental development disorders.
What is the most common thyroid disease encountered during pregnancy? What should be taken into account?
Hypothyroidism, the patient will require a higher dose of thyroxine. Normal levels are required for the fatal brain development
If a type two diabetic woman gets pregnancy what needs to be done?
> Diabetic mothers are at higher risk of eclampsia, stilbirth and amcrosomic infants.
> They should have their oral medications changed to insulin.
> There should be tight control of the blood glucose levels.
What are renal patients more likely to develop when pregnant?
Pre-eclampsia, this can be hard to diagnose due to already having proteinuria and pre-existing hypertension
What is the main concern of patients with epilepsy and pregnancy?
Their medications on the developing fetus.
What is Sodium valproate associated with in pregnancy?
An increased risk of spina bifida for the baby
After how many caesarian birth is it customary to choose elective caesarian delivery?
After 2 c-sections
What is the role of the antenatal examination?
Aims to identify problems of the mother, fetus or social issues
What may be tested in an antenatal examination?
> Routine enquiry
> BP
> Urinanalysis
> Diabetes
> Abdominal palpitation:
- Asses how baby lies (Fetal presentation)
- Symphyseal fundal height (SFH)
- Size of baby
- Liquor volume
> Listen to metal heart
> Screen for infection
> Iron-deficiency anaemia
> Isoimmunisation:
- Rhesus disease
- Anti-C, Anti-Kell
If a baby is still breeched at 36 weeks what is usually done?
Firstly ECV is offered. If this fails then elective caesarian is then offered.