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Reproductive System > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

How many women get morning sickness?

A

85%

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2
Q

When is morning sickness worse and what do we call the extreme form?

A

Worse when Human Chorionic Gonadotrophin is high e.g. in twins or molar pregnancies

Can progress to Hyperemesis Gravidarum (XS nausea and vomiting)

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3
Q

After how many weeks does morning sickness tend to improve?

A

Much better by 16 weeks

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4
Q

Why does pregnancy increase Cardiac Output?

A

Normal pregnancy raises CO from 30-50% due to HR rising from 70-90BPM (CO = SV x HR)
This is to maintain a high blood flow to the foetus.

This can present as palpitations.

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5
Q

What is the require rate of blood flow to the uterus during term?

A

Over 1L/min

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6
Q

How does blood pressure change physiologically during pregnancy and why?

A

Drops during the 2nd trimester

A mixture of effects:
• Uteroplacental circulation expands
• Systemic vascular resistance drops
• Blood viscosity drops
• Angiotensin sensitivity drops
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7
Q

In which trimester does blood pressure usually return to normal?

A

3rd

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8
Q

Why does urine output increase in pregnancy?

A
  • Renal plasma flow increase by 25-50%
  • GFR increases by 50%
  • Serum Urea and Creatinine also decrease
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9
Q

What does serum urea and creatinine decrease during pregnancy?

A

Partly due to increased GFR but partly due to dilutional effect of increased plasma volume

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10
Q

Why are pregnant women more at risk of UTIs?

A

Urinary stasis increases –> Hydronephrosis (swollen kidney due to build up) is physiological in the 3rd trimester.

This makesUTIs and pyelonephritis very common

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11
Q

What is the major danger of a UTI to a pregnant woman?

A

Preterm labour.

So very important to treat them.

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12
Q

Why are pregnant women at risk of anaemia?

A

Because plasma volume increases by 50% but RBC mass only goes up by 25%

This lowers Haemoglobin by dilution from 133-121g/L.

So a lower Haemoglobin is normal in pregnancy but you still want to ensure it doesn’t drop too low.

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13
Q

How does pregnancy affect blood cell counts?

A
  • WBC increases slightly 9000-12000/uL

* Platelet count falls (due to rise in blood volume not loss of platelets - dilution)

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14
Q

How do iron requirements change during pregnancy and how are they addressed?

A

Increased by 1g

Give Iron supplements if Hb is <110 or <100 on routine testing at 28weeks

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15
Q

How does pregnancy affect the lungs?

A

Progesterone acts to reduce CO2 by:
• Increasing tidal volume
• Increased Resp rate
• Increases plasma pH

This increases O2 consumption by 20% but plasma PO2 is unchanged

You also get hyperaemia of the resp mucous membranes

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16
Q

What GI/resp problems are common during pregnancy?

A
  • Nose bleeds
  • SOB
  • GORD
  • Runny nose
  • Heartburn
  • Constipation
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17
Q

What is the drug can you give for heartburn during pregnancy?

A

Ranitidine

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18
Q

What drug is given during pregnancy that can cause heartburn?

A

Aspirin

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19
Q

What hormones cause GI motility to be decreased in pregnancy?

A
  • Increased Progesterone

* Decreased Motilin

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20
Q

What are some normal symptoms of physiological changes in pregnancy? (i.e. symptoms mothers get in normal pregnancies?)

A

Nose bleeds from resp mucous membrane hyperaemia

SOB from progesterone increases resp rate etc

Constipation and GORD from reduction in GI motility and pressure of foetus

Palpitations from increased HR

21
Q

Whats included in pre-pregnancy counselling?

A 
General health measures:
• Diet
• Optimise BMI
• Alcohol reduction
• Smoking cessation
  • Folic Acid supplements (400mcg)
  • Rubella immunisation (if needed)
  • Optimise maternal health, mental health and change unsuitable medications
  • Advise on maternal complications
  • Advise against pregnancy (high risk cardiac/renal problems)
22
Q

When would you advise against pregnancy in pre-pregnancy counselling?

A

In certain conditions like Diabetes or Epilepsy

23
Q

Many maternal issues may recur in the next pregnancy, give 3 examples of these that are important in pre-pregnancy counselling?

A

Maternal:
• Caesarean section
• DVT
• Pre-eclampsia

Fetal:
• Pre-term delivery
• Intrauterine growth restriction
• Fetal Abnormality

24
Q

What metal abnormalities in alcohol associated with?

A

Fetal alcohol syndrome which produces a typical facial appearance and affects learning.

The routine advice given to pregnant women is to avoid alcohol although there is no evidence of harm from minimal alcohol consumption during pregnancy

25
Q

Name four factors investigated in a risk assessment during pre-pregnancy counselling

A

• Age
Younger tend to smoke, lack support and don’t receive antenatal care. Older women prone to pre-existing condition and develop complications. Chromosomal abnormalities risk increase with age.

• Parity
Pre-eclampsia is predominantly a condition of nulliparity, occurring in the first pregnancy. Grand multiparity (4 or more deliveries) predisposes women to postpartum haemorrhage.

• Occupation

• Substance misuse
Heroin, methadone and benziodiazapines are addictive to the fetus and cause a withdrawal syndrome in the baby when it is cut off from its supply at birth. Cocaine and crack are associated with abruption resulting in fetal death. Women see specialist MDT.

26
Q

Whan can we do at pre-regnancy counselling to reduce the risk of previous problems recurring?

A

Maternal:
Thromboprophylaxis if h/o DVT aka low dose aspirin

Fetal:
• Treat any infections
• High dose folic acid to reduce abnormalities
• Low dose aspirin

27
Q

Whats involved in a routine antenatal exam?

A
  • Feeling well?
  • Feeling fetal movements (>20wks)
  • BP (detect pre-eclampsia)
  • Urinalysis (detect diabetes, UTI)
  • Abdominal palapation
  • Listen to fetal heart
28
Q

Abdominal palpation is an important part of an antenatal exam, what can it tell us?

A
  • Fetal presentation
  • Sympheseal Fundal height (SFH)
  • Estimate baby size
  • Estimate Liqour volume
29
Q

What are the two fetal presentations?

A

Breech and vertex

30
Q

Is antenatal screening used and why is it important?

A

Women are offered screening but this is not compulsory

Appropriate counselling prior to screening is important

Allows conditions to be detected early in a symptomless population to be treated for mother/baby

31
Q

What is looked for on an Antenatal screen?

A
  • Hepatitis B
  • Syphilis
  • HIV
  • MSSU for UTI
  • Rubella
  • Fe-deficient Anaemia
  • Isoimmunisation e.g. Rhesus disease, anti-c and anti-cell

US scans for physical abnormalities
Down syndrome
Neural Tube defects

32
Q

How do we treat if a basic antenatal screen throws up an infection in the mother?

A

Hep B give passive and active immunisation to baby

Syphilis give penicillin

HIV give maternal treatment to prevent vertical transmission

33
Q

What are the aims of the first ultrasound scan?

A
  • Ensure pregnancy viable
  • Multiple pregnancy
  • Identify abnormalities incompatible with life
  • Offer and carry out Down’s syndrome screening
34
Q

What can be identified by a detailed anomaly USS?

A
  • Systematic structural review of baby
  • Not possible to identify all problems
  • Can identify problems that need intrauterine or postnatal treatment
35
Q

How many US scans are women offered?

A

One in their first and 1 in their second trimesters

36
Q

When is down syndrome testing offered?

A

10-14 weeks gestation

37
Q

What is Down syndrome and what is the risk?

A

It’s a chromosomal abnormality characterised by 3 copies of chromosome 21

  • Overall risk is 1 in 700
  • Usual cut off for ‘high risk’ reporting is 1 in 150
38
Q

What maternal factors increase risk of baby having Down Syndrome

A

Maternal age:
• 1 in 1667 risk at age 20yrs
• 1 in 30 risk at age 45yrs

• Personal or family history of chromosomal abnormality

39
Q

Can screening for Downs syndrome provide a diagnosis?

A

No

Women and their partners must be aware prior to any screening taking place that tests for fetal abnormality only provide a risk of their baby being affected.

Further testing will be offered to definitively tell if a baby is affected

Embarking on prenatal screening may sometimes result in parents having to make a difficult decision regarding termination of pregnancy

40
Q

How do we initially test for Down’s Syndrome?

A
  • Maternal risk factors
  • Serum B-human Chorionic Gonadotrophin (Beta-hCG)
  • Pregnancy associated plasma protein A (PAPP-A)
  • Fetal Nuchal Translucency (NT)
41
Q

How accurate is the screening?

A

Detects 60% fetuses with Trisomy 21 for a false positive rate of 5%

Detects 85-90% fetuses with T21 for a false positive rate of 5%

42
Q

How does fetal nuchal translucency help identify Down’s Syndrome?

A

Nuchal translucency increases with gestational age
and the incidence of chromosomal and other
abnormalities is related to the size, rather than the
appearance of NT.

43
Q

From initial tests how do we decide if a fetus requires further testing for Down’s?

A

Initial screening give a 1 in something risk of Down’s.

Further invasive tests are offered if risk is estimated at > 1 in 150

44
Q

What further tests are available for Down’s?

A
  • Chorionic Villus sampling (CVS) (10-14wks)
  • Amniocentesis (>15wks)
  • Non-invasive Prenatal Testing

These all have a small but significant risk of miscarriage (<1 -> 2%)

45
Q

How does Non-invasive prenatal testing for Down’s Work?

A

Its done after initial testing if high risk

  • Maternal blood taken
  • Can detect fetal cell free DNA
  • Can look for chromosomal trisomies
  • Not offered on NHS
  • If high risk, still recommended to have invasive testing to confirm
46
Q

How do we screen for neural tube defects?

A

Part of the first trimester US, should pick up anencephaly and sometimes Spina bifida

2nd trimester biochemical screening

2nd trimester (20wk) US detects >90% of NTD

47
Q

What are the risk factors for NTD in babies and what is given to reduce the risk?

A

Personal or family history of NTD are at increased risk

Should be advised to take 5mg folic acid to reduce risk

48
Q

Why and how would we do 2nd trimester biochemical screening?

A

Carried out if not able to get NT measurement

Maternal serum is tested for alpha fetoprotein

> 2.0MoM is high risk and warrants investigation

49
Q

What does and doesnt show on a 2nd trimester US?

A

Picks up >90% of major structural abnormalities e.g. exomphalos and cleft palate

But misses a number of chromosomal abnormalities such as T21 (Downs), T13 or T18

Reproductive System (26 decks)

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