Antenatal Care and Screening Flashcards
What are the problems with morning sickness?
- It affects around 80-85%
- Worse when HCG levels are higher e.g. twins, molar pregancy
- Can progress to hyperemesis gravidarum
What happens to cardiac output and HR in pregnancy?
CO increases by 30-50%
HR increases
Palpitations are common
What happens to blood pressure in pregnancy and why?
It drops in the second trimester (expansion of the uteroplacental circulation, a fall in systemic vascular resistance, reduction in blood viscocity and a reduction in sensitivity to angiotensin)
BP usually returns to normal in the third trimester
What happens to urine output in pregnancy and why?
Urine output is increased: renal plasma flow increases by 25-50%, GFR increases by 50% and serum urea/creatinine decrease
Why is there an increased risk of infection and pyelonephritis in pregnancy?
There is an increase in urinary stasis. Hydronephrosis is physiological in the 3rd trimester (makes pyelonephritis more common)
Can be associated with preterm labour
What is the reason for anaemia in pregnancy?
Plasma volume increases by roughly 50% and the RBC mass by 25% which results in a drop in haemaglobin. Iron requirements increase by 1g during pregnancy. WBCs also increase slightly and platelet count falls by dilution
What happens to respiration in pregnancy?
- Progesterone acts centrally to reduce CO2
- Tidal volume, resp. rate and plasma pH all increase
- O2 consumption increases by 20%
- Plasma PO2 is unchanged
- Hyperaemia of resp. mucus membranes
What happens to the GI system in pregnancy?
Oesophageal peristalsis is reduced, gastric emptying slows, cardiac sphincter relaxes and GI motility is reduced (caused by progesterone and motilin)
What are the components of pre-pregnancy counselling?
General health measures: improve diet, optimise BMI and reduce alcohol consumption
Smoking cessation advice
Folic acid (400mcg)
Known medical problems/current medication/possibly advise against pregnancy
Previous pregnancy problems
What does an antenatal exam consist of?
Routine Enquiry: feeling well and feeling fetal movements (after 20wks)
BP and urinalysis
Abdominal Palpations: assess symphyseal fundal height, fetal presentation, estimate size of baby, estimate liquor volume and listen to the fetal heart
Which infections are pregnant women screened for?
HepB, syphilis, HIV, rubella and UTIs
What does the 1st ultrasound show?
Viable pregnancy
Multiple pregnancy
Abnormalities incompatible with life
Down’s Syndrome screening is also offered
What can be seen on a detailed anomaly scan?
Systematic structural review of the baby
Some problems that need intrauterine or postnatal treatment
What are the risk factors for Downs Syndrome?
Extremities of maternal age and personal/FH history of chromosomal abnormality
What is tested in 1st trimester trisomy screening?
Serum B-hCG, PAPP-A and fetal nuchal translucency measurement
