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Yr 3 - Reproduction > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

How common is morning sickness?

A

80-85% of women

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2
Q

What is morning sickness associated with?

A

Higher levels of HCG (twins, molar pregnancy)

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3
Q

Morning sickness can progress to what?

A

Hyperemesis gravidarium

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4
Q

Morning sickness typically settles at what point?

A

16 weeks

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5
Q

What cardiac changes are seen in pregnancy?

A

Cardiac output increased by 30-50%

Blood pressure drop in 2nd trimester

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6
Q

The increase in cardiac output in pregnancy typically manifests as what?

A

Palpitations

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7
Q

What blood flow is needed for healthy perfusion of the uterus?

A

> 1L/min

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8
Q

What is the cause in blood pressure decrease in pregnant women?

A 
Expansion of utero-placental circulation
Reduction in SVR 
Reduction in blood viscosity
Decreased angiotensin sensitivity 
Return to normal in 3rd trimester
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9
Q

What urinary system changes are seen in pregnancy?

A

Increased urine output

Increased UTI occurrence

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10
Q

What is the cause of increased urine output in pregnancy?

A

Increased renal plasma flow
Increased GFR (+50%)
Serum urea + creatinine decrease

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11
Q

What is the cause of increased UTI in pregnancy?

A

Increased urinary stasis
Physiological hydronephrosis in third trimester
Associated with preterm labour

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12
Q

UTI in pregnancy is associated with increased risk of what outcome?

A

Preterm labour

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13
Q

Why is pyelonephritis more common in pregnancy?

A

Physiological hydronephrosis (easier path for ascending infection)

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14
Q

Why is anaemia more common in pregnancy?

A

Increased plasma volume 50%, decreased haemoglobin concentration
Increased iron requirements
WBC increase to 12000/uL
Platelet count fall by dilution

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15
Q

Which haematological condition is more common in pregnancy?

A

Anaemia

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16
Q

At what Hb levels should Iron supplements be given in pregnancy?

A

Hb<110 at booking

<100 at 28wks

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17
Q

What respiratory issues are associated with pregnancy?

A

Progesterone centrally reduces CO2
Increased O2 demand
Plasmas PO2 unchanged

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18
Q

Why does Progesterone lead to a reduction of central CO2?

A

Increased tidal volume
Increased respiratory rate
Increased plasma pH

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19
Q

What GI problems are associated with pregnancy?

A

Heartburn

Reduced GI motility

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20
Q

Why is pregnancy associated with heartburn?

A

Reduced oesophageal peristalsis
Slowed gastric emptying
Cardiac sphincter relaxation

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21
Q

Why is pregnancy associated with reduced GI motility?

A

Increased progesterone

Decreased motilin

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22
Q

What are the 5 most common causes of maternal death?

A 
Cardiac disease
Thrombosis/thromboembolism
Indirect
Neurological 
Psychiatric
Sepsis 
Haemorrhage
23
Q

What general counselling advice can be given to all women?

A 
General Health measures
 - Improve diet
 - Optimise BMi
 - Reduce alcohol consumption
Smoking cessation advice
Folic acid (400ug)
24
Q

Which maternal conditions should be counselled for recurrence?

A

C-section
DVT
Pre-eclampsia

25
Q

Which fetal conditions should be counselled for recurrence?

A

Pre-term delivery
Interuterine growth restriction
Fetal abnormality

26
Q

Which actions should be taken to reduce risk of maternal previous pregnancy coagulation conditions?

A

Thromboprophylaxis

Low dose aspirin

27
Q

Which actions should be taken to reduce risk of fetal previous pregnancy conditions?

A

Treat infections
High dose folic acid
Low dose aspirin

28
Q

Which types of problems should be identified in antenatal examination?

A 
Mother
 - Pre-existing illness
 - Minor problems of pregnancy (anaemia)
Fetus
 - SGA
 - Fetal abnormality
Social
 - Support 
 - Domestic violence
 - Psych illness
29
Q

What should be checked in antenatal examination?

A 
Routine enquiry
Blood pressure
Urinalysis
Abdominal palpation
Fetal presentation
Fetal heart
Down's 
First trimester ultrasound
30
Q

What can be found via abdominal palpation in antenatal examination?

A

Assess symphyseal-fundal height
Estimate size of baby
Fetal lie
Estimate liquor volume

31
Q

What are the benefits of antenatal examination?

A

Allows conditions to be detected in a symptomless population

32
Q

What infections should be screened for in pregnancy?

A 
Hepatitis B
Syphilis
HIV
UTI 
Rubella
33
Q

Congenital rubella can cause what?

A

Mental handicap
Blindness
Deafness
Heart defects

34
Q

Congenital syphilis causes what?

A

Growth restriction
Anaemia
Thrombocytopaenia
Skin rashes

35
Q

How is syphilis treated?

A

Penicillin

36
Q

How is maternal HIV managed to reduce vertical transmission?

A

Anti-retrovirals to reduce viral load
C-section delivery
Avoidance of breastfeeding

37
Q

What haematological conditions should be screened for in pregnancy?

A

Iron-deficiency anaemia

Isoimmunisation (rhesus, anti-c, anti-Kell)

38
Q

How are anomalies found in pregnancy?

A

First visit scan
- ensure viable/multiple
- Down’s syndrome screen
Detailed anomaly scan

39
Q

What is down’s syndrome?

A

Trisomy 21
1:700 risk
Increases with maternal age
Increases with FH

40
Q

How does the risk of Down’s syndrome change with maternal age?

A

1 in 1700 at 20yrs

1 in 30 at 45yrs

41
Q

Outline First Trimester Screening for Down’s?

A 
10-14 weeks
Maternal risk factors
B-hCG
PAPP-A
Fetal nuchal translucency
42
Q

What is Nuchal Translucency?

A

Measurement of Nuchal thickness

Taken between Crown-Rump Lengths of 45-84mm

43
Q

Nuchal translucency varies with what?

A

Increases with gestational age

Increases with incidence of chromosomal abnormalities

44
Q

What further testing options are offered for high risk of downs?

A

Risk >1 in 150

  • CVS
  • Amniocentesis
  • Non-invasive testing
45
Q

When is CVS offered?

A

Between 10-14 weeks

46
Q

What risk is associated with CVS?

A

1-2% risk of miscarriage

47
Q

When is amniocentesis offered?

A

15 weeks onwards

48
Q

What risk is associated with amniocentesis?

A

~1% risk of miscarriage

49
Q

What is non-invasive prenatal testing?

A

Maternal blood taken
Detect fetal cell-free DNA
Look for chromosomal trisomies
High risk - invasive testing still recommended

50
Q

What is the screening for Neural Tube Defect?

A

Personal/family history
First trimester USS - (anencephaly, spina bifida)
Second trimester biochem
Second trimester ultrasound (>90% of NTD)

51
Q

What advice is given to families with a history of Neural Tube defect?

A

Folic acid supplements

52
Q

What is the purpose of the Second Trimester USS?

A 
Detecting Fetal Abnormality
(poor for chromosomal abnormalities) 
Hypoplastic heart
Exomphalos
Cleft lip
53
Q

What are the normal USS rates in T21, T18 and T13?

A

T21 - 50%
T18 - 17%
T13 - 9%

Yr 3 - Reproduction (37 decks)

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