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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
Which fetal conditions should be counselled for recurrence?
Pre-term delivery Interuterine growth restriction Fetal abnormality
26
Which actions should be taken to reduce risk of maternal previous pregnancy coagulation conditions?
Thromboprophylaxis | Low dose aspirin
27
Which actions should be taken to reduce risk of fetal previous pregnancy conditions?
Treat infections High dose folic acid Low dose aspirin
28
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 ```
29
What should be checked in antenatal examination?
``` Routine enquiry Blood pressure Urinalysis Abdominal palpation Fetal presentation Fetal heart Down's First trimester ultrasound ```
30
What can be found via abdominal palpation in antenatal examination?
Assess symphyseal-fundal height Estimate size of baby Fetal lie Estimate liquor volume
31
What are the benefits of antenatal examination?
Allows conditions to be detected in a symptomless population
32
What infections should be screened for in pregnancy?
``` Hepatitis B Syphilis HIV UTI Rubella ```
33
Congenital rubella can cause what?
Mental handicap Blindness Deafness Heart defects
34
Congenital syphilis causes what?
Growth restriction Anaemia Thrombocytopaenia Skin rashes
35
How is syphilis treated?
Penicillin
36
How is maternal HIV managed to reduce vertical transmission?
Anti-retrovirals to reduce viral load C-section delivery Avoidance of breastfeeding
37
What haematological conditions should be screened for in pregnancy?
Iron-deficiency anaemia | Isoimmunisation (rhesus, anti-c, anti-Kell)
38
How are anomalies found in pregnancy?
First visit scan - ensure viable/multiple - Down's syndrome screen Detailed anomaly scan
39
What is down's syndrome?
Trisomy 21 1:700 risk Increases with maternal age Increases with FH
40
How does the risk of Down's syndrome change with maternal age?
1 in 1700 at 20yrs | 1 in 30 at 45yrs
41
Outline First Trimester Screening for Down's?
``` 10-14 weeks Maternal risk factors B-hCG PAPP-A Fetal nuchal translucency ```
42
What is Nuchal Translucency?
Measurement of Nuchal thickness | Taken between Crown-Rump Lengths of 45-84mm
43
Nuchal translucency varies with what?
Increases with gestational age | Increases with incidence of chromosomal abnormalities
44
What further testing options are offered for high risk of downs?
Risk >1 in 150 - CVS - Amniocentesis - Non-invasive testing
45
When is CVS offered?
Between 10-14 weeks
46
What risk is associated with CVS?
1-2% risk of miscarriage
47
When is amniocentesis offered?
15 weeks onwards
48
What risk is associated with amniocentesis?
~1% risk of miscarriage
49
What is non-invasive prenatal testing?
Maternal blood taken Detect fetal cell-free DNA Look for chromosomal trisomies High risk - invasive testing still recommended
50
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)
51
What advice is given to families with a history of Neural Tube defect?
Folic acid supplements
52
What is the purpose of the Second Trimester USS?
``` Detecting Fetal Abnormality (poor for chromosomal abnormalities) Hypoplastic heart Exomphalos Cleft lip ```
53
What are the normal USS rates in T21, T18 and T13?
T21 - 50% T18 - 17% T13 - 9%

Yr 3 - Reproduction (37 decks)

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