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Reproduction > Antenatal Care And Screening > Flashcards

Antenatal Care And Screening Flashcards

1
Q

Morning sickness

A
  • afffects around 80-85% women
  • worse in conditions where Human Chorionic gonadotrophin is higher eg twin, molar pregnancy
  • can progress to hyperemesis gravidarum
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2
Q

Cardiac problems

A
  • Cardiac output (CO) increases by 30-50% during pregnancy
  • Palpitations are a common complaint
  • At Term blood flow to the uterus must exceed 1L/min
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3
Q

Why does blood pressure drop in the second trimester?

A
  • Expansion of the uteroplacental circulation
  • A fall in systemic vascular resistance
  • A reduction in blood viscosity
  • A reduction in sensitivity to angiotensin
  • BP usually returns to normal in the third trimester
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4
Q

Why does urine output increase during pregnancy?

A
  • Renal plasma flow increases by 25-50%
  • Glomerular Filtration Rate increases by 50%
  • Serum urea and creatinine decrease
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5
Q

UTI in pregnancy

A
  • There is an increase in urinary stasis
  • Hydronephrosis is physiological in the third trimester and makes pyelonephritis more common
  • Can be associated with preterm labour so important to treat
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6
Q

Haematological changes during pregnancy

A
  • Plasma volume increases by about 50% and RBC mass by about 25% - This results in a drop in haemoglobin by dilution from 133-121g/L
  • WBC increase slightly
  • platelets fall by dilution
  • 2-3 fold increase in requirement for iron
  • 10-20 fold increase in folate requirements
  • hypercoaguable
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7
Q

Respiratory problems during pregnancy

A
  • Progesterone acts centrally to reduce CO2
    • Tidal volume
    • Respiratory rate
  • Plasma pH -O2 consumption ↑ by 20%
  • Plasma PO2 is unchanged
  • Hyperaemia of respiratory mucous membranes
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8
Q

Gastrointestinal problems during pregnancy

A
  • Oesophageal peristalsis is reduced
  • Gastric emptying slows
  • Cardiac sphincter relaxes
  • GI motility is reduced due to ↑ progesterone and ↓ motilin
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9
Q

Pre-pregnancy counselling for all women

A
  • General health measures
  • Improve diet
  • Optimise BMI
  • Reduce alcohol consumption
  • Smoking cessation advice
  • Folic acid - 400 micro grams
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10
Q

Previous maternal pregnancy problems

A
  • Caesarian section
  • DVT
  • pre-eclampsia
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11
Q

Actions to reduce risk of reoccurrence of previous maternal pregnancy problems

A
  • Thromboprophylaxis
  • low dose aspirin
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12
Q

Previous foetal pregnancy problems

A
  • Pre-term delivery
  • Intrauterine growth restriction
  • Foetal abnormality
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13
Q

Actions to reduce risk of recurrence of previous foetal pregnancy problems

A
  • Treatment of infection
  • High dose folic acid
  • Low dose aspirin
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14
Q

Antenatal Examination

A
  • Routine enquiry
    • Feeling well
    • Feeling foetal movement (after 20 weeks)
  • Blood Pressure - Detect evolving hypertension
    • Urinalysis
  • Abdominal Palpation
    • Assess symphyseal fundal height (SFH)
    • Estimate size of baby
    • Estimate liquor volume
    • Determine foetal presentation
  • Listen to the foetal heart
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15
Q

Screening for infection

A
  • Hepatitis B
    • If infected can provide passive and active immunisation for baby
  • Syphilis
    • Easily treated with Penicillin
  • HIV
    • Maternal treatment and careful planning reduces vertical transmission
  • MSSU
    • Urinary tract infection
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16
Q

Other screening during pregnancy

A
  • Iron deficiency anaemia
  • Isoimmunisation
  • Rhesus disease
  • Anti C, anti Kell
17
Q

First ultrasound scan (12 weeks)

A
  • Ensure pregnancy viable
  • Multiple pregnancy
  • Identify abnormalities incompatible with life
  • Offer and carry out Down’s syndrome screening
18
Q

Detailed anomaly scan (20 weeks)

A
  • Systematic structural review of baby
  • Not possible to identify all problems
  • Can identify problems that need intrauterine or postnatal treatment
19
Q

First trimester screening for Down syndrome

A
  • Carried out at 10-14 weeks gestation
  • Uses maternal risk factors, serum β-human chorionic gonadotrophin (β-hCG) and pregnancy associated plasma protein A (PAPP-A) and foetal nuchal translucency (NT) measurement
20
Q

Down syndrome further investigation options

A
  • Further testing is offered if risk of Down’s syndrome is >1 in 150
  • Options:
    • CVS (chorionic villus sampling)
    • Amniocentesis
    • Non-invasive Prenatal testing
21
Q

CVS (chorionic villus sampling)

A
  • 10-14 weeks
  • ~1-2% chance of miscarriage
22
Q

Amniocentesis

A
  • 15 weeks onward
  • ~1% chance of miscarriage
23
Q

Non-invasive prenatal testing

A
  • Maternal blood taken
  • Can detect foetal cell free DNA
  • Can look for chromosomal trisomies
  • Not offered on NHS
  • If high risk, still recommended to have invasive testing to confirm
24
Q

Second trimester biochemical screening for neural tube defect

A
  • carried out if not able to get NT measurement
  • maternal serum is tested for alpha fetoprotein
  • >2MoM is high risk and warrants investigation
25
Q

Give examples of structural abnormalities that can be detected at the second trimester ultrasound.

A
  • hypoplastic left heart
  • exomphalos
  • cleft lip
26
Q

General changes experienced surging pregnancy.

A
  • Metabolism - ketones produced much earlier into fast (12 hours)
  • Fatigue - particularly in early pregnancy
  • Oedema - in 80% of women
  • Thyroid - beta hCG resembles TSH so can result in hyperthyroidism
  • General state of immunosupression
  • Weight gain - average 14kg
27
Q

Breast changes in pregnancy

A
  • Increased size and vascularity - warm, tense and tender
  • Increased pigmentation of the areola and nipple
  • Secondary areola appears
  • Montgomery tubercules appear on the areola
  • Colostrum like fluid can be expressed form the end of the 3rd month
28
Q

Intrapartum cardiovascular changes

A
  • Autotransfusion of contractions
  • Pain - increasing catecholamines
  • CO increases by 10% in labour and by 80% in 1st post delivery hour
29
Q

Postpartum cardiovascular changes. Comment on blood volume, BP, SVR, HR.

A
  • return to normal by 3 months
  • blood volume decreases by 10% 3 days post delivery
  • BP initially falls then increases again days 3-7 (pre-pregnancy levels by 6 weeks)
  • systemic vascular resistance increases over first 2 weeks to 30% above delivery levels
  • HR returns to pre pregnancy levels over 2 weeks
30
Q

Lab values for Hg, WCC, platelets, CRP, ESR during pregnancy.

A

Hg ↓

WCC ↑

Platelets ↓

CRP ↔

ESR ↑

31
Q

Lab values for urea, creatinine, urate during pregnancy.

A

All ↓ but urate increases with gestation

32
Q

Lab values for 24 hour protein, total protein, albumin during pregnancy.

A

24 hour protein ↑

Total protein ↓

Albumin ↓

33
Q

Lab values for GGT/ALT/AST, alkaline phosphatase, bile acids, D dimer during pregnancy.

A

GGT/ALT/AST ↓

Alkaline phosphatase ↑↑

Bile acids ↔

D dimer ↑

Reproduction (34 decks)

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