Antenatal Care and Screening Flashcards
How common is morning sickness?
80-85% of women
What is morning sickness associated with?
Higher levels of HCG (twins, molar pregnancy)
Morning sickness can progress to what?
Hyperemesis gravidarium
Morning sickness typically settles at what point?
16 weeks
What cardiac changes are seen in pregnancy?
Cardiac output increased by 30-50%
Blood pressure drop in 2nd trimester
The increase in cardiac output in pregnancy typically manifests as what?
Palpitations
What blood flow is needed for healthy perfusion of the uterus?
> 1L/min
What is the cause in blood pressure decrease in pregnant women?
Expansion of utero-placental circulation Reduction in SVR Reduction in blood viscosity Decreased angiotensin sensitivity Return to normal in 3rd trimester
What urinary system changes are seen in pregnancy?
Increased urine output
Increased UTI occurrence
What is the cause of increased urine output in pregnancy?
Increased renal plasma flow
Increased GFR (+50%)
Serum urea + creatinine decrease
What is the cause of increased UTI in pregnancy?
Increased urinary stasis
Physiological hydronephrosis in third trimester
Associated with preterm labour
UTI in pregnancy is associated with increased risk of what outcome?
Preterm labour
Why is pyelonephritis more common in pregnancy?
Physiological hydronephrosis (easier path for ascending infection)
Why is anaemia more common in pregnancy?
Increased plasma volume 50%, decreased haemoglobin concentration
Increased iron requirements
WBC increase to 12000/uL
Platelet count fall by dilution
Which haematological condition is more common in pregnancy?
Anaemia
At what Hb levels should Iron supplements be given in pregnancy?
Hb<110 at booking
<100 at 28wks
What respiratory issues are associated with pregnancy?
Progesterone centrally reduces CO2
Increased O2 demand
Plasmas PO2 unchanged
Why does Progesterone lead to a reduction of central CO2?
Increased tidal volume
Increased respiratory rate
Increased plasma pH
What GI problems are associated with pregnancy?
Heartburn
Reduced GI motility
Why is pregnancy associated with heartburn?
Reduced oesophageal peristalsis
Slowed gastric emptying
Cardiac sphincter relaxation
Why is pregnancy associated with reduced GI motility?
Increased progesterone
Decreased motilin
What are the 5 most common causes of maternal death?
Cardiac disease Thrombosis/thromboembolism Indirect Neurological Psychiatric Sepsis Haemorrhage
What general counselling advice can be given to all women?
General Health measures - Improve diet - Optimise BMi - Reduce alcohol consumption Smoking cessation advice Folic acid (400ug)
Which maternal conditions should be counselled for recurrence?
C-section
DVT
Pre-eclampsia
Which fetal conditions should be counselled for recurrence?
Pre-term delivery
Interuterine growth restriction
Fetal abnormality
Which actions should be taken to reduce risk of maternal previous pregnancy coagulation conditions?
Thromboprophylaxis
Low dose aspirin
Which actions should be taken to reduce risk of fetal previous pregnancy conditions?
Treat infections
High dose folic acid
Low dose aspirin
Which types of problems should be identified in antenatal examination?
Mother - Pre-existing illness - Minor problems of pregnancy (anaemia) Fetus - SGA - Fetal abnormality Social - Support - Domestic violence - Psych illness
What should be checked in antenatal examination?
Routine enquiry Blood pressure Urinalysis Abdominal palpation Fetal presentation Fetal heart Down's First trimester ultrasound
What can be found via abdominal palpation in antenatal examination?
Assess symphyseal-fundal height
Estimate size of baby
Fetal lie
Estimate liquor volume
What are the benefits of antenatal examination?
Allows conditions to be detected in a symptomless population
What infections should be screened for in pregnancy?
Hepatitis B Syphilis HIV UTI Rubella
Congenital rubella can cause what?
Mental handicap
Blindness
Deafness
Heart defects
Congenital syphilis causes what?
Growth restriction
Anaemia
Thrombocytopaenia
Skin rashes
How is syphilis treated?
Penicillin
How is maternal HIV managed to reduce vertical transmission?
Anti-retrovirals to reduce viral load
C-section delivery
Avoidance of breastfeeding
What haematological conditions should be screened for in pregnancy?
Iron-deficiency anaemia
Isoimmunisation (rhesus, anti-c, anti-Kell)
How are anomalies found in pregnancy?
First visit scan
- ensure viable/multiple
- Down’s syndrome screen
Detailed anomaly scan
What is down’s syndrome?
Trisomy 21
1:700 risk
Increases with maternal age
Increases with FH
How does the risk of Down’s syndrome change with maternal age?
1 in 1700 at 20yrs
1 in 30 at 45yrs
Outline First Trimester Screening for Down’s?
10-14 weeks Maternal risk factors B-hCG PAPP-A Fetal nuchal translucency
What is Nuchal Translucency?
Measurement of Nuchal thickness
Taken between Crown-Rump Lengths of 45-84mm
Nuchal translucency varies with what?
Increases with gestational age
Increases with incidence of chromosomal abnormalities
What further testing options are offered for high risk of downs?
Risk >1 in 150
- CVS
- Amniocentesis
- Non-invasive testing
When is CVS offered?
Between 10-14 weeks
What risk is associated with CVS?
1-2% risk of miscarriage
When is amniocentesis offered?
15 weeks onwards
What risk is associated with amniocentesis?
~1% risk of miscarriage
What is non-invasive prenatal testing?
Maternal blood taken
Detect fetal cell-free DNA
Look for chromosomal trisomies
High risk - invasive testing still recommended
What is the screening for Neural Tube Defect?
Personal/family history
First trimester USS - (anencephaly, spina bifida)
Second trimester biochem
Second trimester ultrasound (>90% of NTD)
What advice is given to families with a history of Neural Tube defect?
Folic acid supplements
What is the purpose of the Second Trimester USS?
Detecting Fetal Abnormality (poor for chromosomal abnormalities) Hypoplastic heart Exomphalos Cleft lip
What are the normal USS rates in T21, T18 and T13?
T21 - 50%
T18 - 17%
T13 - 9%
