Antenatal care and screening Flashcards
- To understand the physiological changes associated with normal pregnancy in the mother
- To understand pre-pregnancy counselling
- To understand the procedure and implications of the antenatal examination
- To understand the basis of screening for fetal abnormality
- To know what screening tests are offered to women and understand their limitations
- To be aware of the ethical dilemmas associated with detection of fetal abnormalities
listen to the PODCAST on Hyperemesis Gravidarum
Morning sickness is worse in conditions where what is increased
Human Chorionic gonadotrophin (hCG) - higher in twin pregnancies
Physiological changes in normal pregnancy
Cardio
- CO increases
- BP drops in 2nd trimester
Renal
- Increased urine output
- Increase in urinary stasis –> higher UTI risk
Haematology
-Anaemia - plasma volume increases by 50% but RBC mass only by 25%; iron only given if Hb low
Resp
-reduced CO2 output, increased O2 consumption
GI
-reduced GI motility
What is physiological in the 3rd trimester, making pyelonephritis more common
Hydronephrosis - build up of urine in kidneys because bladder capacity reduced due to pressure from expanding uterus
GI motility is reduced in pregnancy due to a increase and decrease in which hormones
Increased progesterone
Decreased motilin
Why is pre-pregnancy counselling important
To consider any existing health or previous pregnancy problems that could factor in to new pregnancy
What does pre-pregnancy counselling involve discussion of
General measures
- improve diet
- optimise BMI
- avoid alcohol
Stop smoking
Folic acid supplements
What risks should be assessed in pre-pregnancy counselling
Age
Parity - nulliparity (never having completed a pregnancy beyond 20 wks) predisposes to pre-eclampsia, grand multiparty (4+ deliveries predisposes to postpartum haemorrhage)
Occupation - busy jobs not good or those exposed to dangerous substances
Substance misuse - alcohol or drugs
Those with known medical problems should discuss what in pre-pregnancy counselling
Optimise maternal health
Psychiatric health is important
Stop/Change any unsuitable drugs
Advise regarding complications associated with maternal medical problems
Occasionally advise against pregnancy
Antenatal examination aims to identify what problems in the MOTHER
pre-exisiting or developing illness
‘minor’ problems of pregnancy such as anaemia
Antenatal examination aims to identify what problems in the FOETUS
Small for gestational age
Foetal abnormality
Antenatal examination aims to identify what SOCIAL problems
Domestic violence
Psychiatric Illness
What to do on antenatal examination
Inspection
- size
- scars, stretch marks
Abdo palpation
- assess symphyseal fundal height
- assess lie (longitudinal or transverse)
- estimate liquor volume
- assess engagement/presentation (breech or cephalic)
Auscultate
Is antenatal screening compulsory
No, just offered but appropriate counselling should be given prior to screening
What screening tests are offered to women (7)
Hep B Syphilis Rubella HIV MSSU Anaemia - iron deficiency anaemia Isoimmunisation (antibodies against blood groups) - commonest is rhesus disease