Antenatal Care/ Early Pregnancy Bleeding/ Miscarriage/ Termination Of Pregnancy Flashcards
When are foetal movements first felt?
Primigravida: 17-20 weeks
Multigravida: 16-18 weeks
What should be checked each antenatal visit?
Weight gain Blood pressure U/A (protein/ sugar) Fundal height Foetal HR Foetal movements Presentation and position of foetus Presence of oedema
What should the patient do if they experience reduced foetal movements?
If daily movements exceed 10 and the regular pattern has not changed significantly hen usually the fetus is at no risk. If the movements drop to fewer than 10 per day the patient should be referred to hospital for foetal monitoring
What should be done about early pregnancy bleeding
Serial quantitative HCG (should double every 2 days).
If HCG >1500 then should show on u/s
What should be done about early pregnancy bleeding 6-8 weeks
Ultrasound will exclude ectopic pregnancy
What should be done about early pregnancy bleeding >8 weeks
Normal ultrasound is reassuring as miscarriage rate is only 3%
What could a small bleed at 18-24 weeks indicate?
Cervical ‘weakness’ and warrants a speculum exam plus foetal assessment
Who are high risk obstetric patients?
Elderly primigravida (>35) Grand multigravida (fifth or greater pregnancy) Those with a poor obstetric history Previous unplanned caesarean Severe social disadvantage Hypertension +/- chronic kidney disease Obesity Short stature Diabetes mellitus Prolonged infertility Heavy smoking/ alcohol Little or no weight gain in first half of pregnancy Pregnancy complications eg multiple pregnancy, antepartum haemorrhage, preeclampsia Abnormal presentation Abnormal foetal growth
What spot test should be done for preeclampsia?
Spot urinary albumin- creatinine ratio
What antihypertensives are contraindicated in pregnancy?
ACE-I and diuretics
What indications for urgent hospital referral in preeclampsia?
Progressing preeclampsia including development of proteinuria
Inability to control BP
Deteriorating liver, blood (platelets), renal function
Neurological symptoms/ signs (headache, drowsy and confused, twitching, rolling eyes, vomiting, visual disturbances, hyper reflexia)
What is a normal haemoglobin in pregnancy?
Greater than 110g/L
What effects can diabetes in pregnancy have in the fetus?
Macrosomia Foetal abnormalities Hypoxia and intrauterine death Miscarriage Mal presentation IUGR Preterm delivery Early hypoglycaemia, jaundice, respiratory distress syndrome after delivery
What effects can diabetes in pregnancy have on the mother?
Increased risk of preeclampsia Diabetic ketoacidosis Polyhydramnios Inter current infection First trimester miscarriage Obstructed labour
What sound be discussed when a woman comes in for preconception advice?
Optimal nutrition and diet
Weight control
Regular exercise
Discouragement of smoking, alcohol and drugs
Folic acid at least 1 (preferably 3) month prior to conception
Pap smears up to date
Check rubella serology +/- immunise 3 months prior to conception
Ask about varicella history and consider serology/ vaccination
Genetic counselling based on past obstetric/ family history, advanced maternal age.
What follow up is required after gestational diabetes?
Glucose tolerance test at 6 weeks postpartum and then every 5 years.
Gestational diabetes is likely in subsequent pregnancies and there is a 30% lifetime risk of developing diabetes.
What is the usual cause of hyperthyroidism in pregnancy?
Grave’s disease
True or false: 90% of murmurs in pregnancy are physiological
True
Which patient require antibiotic prophylaxis cover in labour?
Patients with a structural cardiac malformation eg valvular problems
Patients with an increased risk of bacterial endocarditis (especially rheumatic heart disease)
What is acute cholestasis of pregnancy?
Due to oestrogen sensitivity
Symptoms of low grade jaundice and pruritis during latter half of pregnancy
Can be associated with foetal death, distress and preterm delivery
Perform LFTs and consider vit K supplements
Refer for monitoring of fetus and delivery if unfavourable
The condition clears up rapidly after delivery but often recurs in future pregnancies or if given OCP (which is contraindicated)
What is antepartum haemorrhage?
Bleeding from the genital tract after the 24th week of gestation and before the onset of labour
True or false: do not perform a vaginal examination for antepartum haemorrhage
True
What are the main causes of antepartum haemorrhage?
Placenta praevia and placental abruption
What is the usual presentation of placenta praevia?
Painless bleeding at 28-30 weeks with a high presenting part on examination
What are risk factors for endometrial cancer
Age Obesity Nulliparity Late menopause Diabetes mellitus PCOS Drugs eg unopposed oestrogen Family history (lynch syndrome)
What are risk factors for endometrial cancer
Age Obesity Nulliparity Late menopause Diabetes mellitus PCOS Drugs eg unopposed oestrogen Family history (lynch syndrome)
