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Womens Health > Antenatal Care & Maternal Medicine > Flashcards

Antenatal Care & Maternal Medicine Flashcards

1
Q

When is the “dating scan”?

A

8-14 weeks

ideally 10-14 weeks to T21 screening can be offered

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2
Q

When is the usual window for the booking appointment?

A

8-12 weeks

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3
Q

When is the best time for pregnant people to have the whooping cough vaccine?

A

after the anomaly scan and before 32 weeks gestation

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4
Q

When is the “anomaly scan”?

A

18-20 weeks

often called the 20 week scan

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5
Q

People who are pregnant for the first time will be offered extra midwife appointments, when are these?

A

25 weeks
31 weeks
40 weeks

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6
Q

When is the first anti-D treatment offered for Rhesus negative pregnant people?

A

28 weeks

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7
Q

At what weeks will people usually have routine antenatal check ups with a midwife or doctor?

A 
8-12 weeks - booking
16 weeks
28 weeks
34 weeks
36 weeks
38 weeks
41 weeks
42 weeks
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8
Q

Which three infectious diseases are recommended to be screened for in pregnancy?

A

HepB
HIV
Syphilis

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9
Q

What does the “20 week scan” look for?

A

looks in detail at baby’s bones, heart, brain, spinal cord, face, kidneys and abdomen to assess for 11 rare conditions:

  • anencephaly
  • open spina bifida
  • cleft lip
  • diaphragmatic hernia
  • gastroschisis
  • exomphalos
  • serious cardiac abnormalities
  • bilateral renal agenesis
  • lethal skeletal dysplasia
  • Edwards (T18)
  • Patau (T13)
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10
Q

What is the combined screening test in pregnancy?

A
  • screening for T13, 18, 21
  • a combination of blood test and USS to determine nuchal translucency
  • can happen between 10 weeks and 14 weeks
  • not diagnostic, just estimates risk: results are lower chance or higher chance
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11
Q

If someone gets a “higher chance” result from the combined screening test, what are their options for further testing?

A

diagnostic tests:
- amniocentesis (15+ weeks)
- chorionic villus sampling (11-14 weeks)
further risk assessment:
- non-invasive prenatal testing (NIPT) blood test to determine risk more accurately

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12
Q

When should screening for sickle cell and thalassaemia take place in pregnancy?

A
  • ideally before 10 weeks
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13
Q

If screening shows there is a chance a pregnancy could have sickle cell or thalassaemia, what are the options for further tests?

A

diagnostic tests:

  • amniocentesis (15+ weeks)
  • chorionic villus sampling (11-14 weeks)
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14
Q

What is the purpose of the dating scan?

A
  • check how many weeks pregnant the individual is and work out the EDD
  • determine if this is a multiple pregnancy
  • check the pregnancy is in the uterus
  • check the pregnancy’s development
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15
Q

What are the recommendations about using supplements in pregnancy?

A
  • anyone who is pregnant or thinks there’s a chance they could be pregnant should take 400micrograms of folic acid every day from before conception to 12 weeks gestation to reduce the chance of neural tube defects
  • pregnant people should also take a daily vitamin D supplement
  • they should avoid supplements containing cod liver oil or vitamin A (retinol)
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16
Q

Who should take higher-dose folic acid?

A

Anyone who’s pregnancy has a higher chance of being affected by neural tube defects, e.g.

  • mum or dad have a neural tube defect
  • mum or dad have a family history of neural tube defects
  • mum had a previous pregnancy affected by a neural tube defect
  • mum has diabetes
  • mum takes anti-epilepsy medicine
  • mum takes anti-retroviral medicine for HIV
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17
Q

What are the two doses of folic acid recommended in pregnancy?

A
  • 400micrograms if low risk for neural tube defects

- 5mg if higher risk

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18
Q

What is the Healthy Start scheme?

A

If you’re pregnant or have children under the age of 4 you can get free vouchers or payments every 4 weeks to spend on:
- cow’s milk
- fresh, frozen or tinned fruit and vegetables
- infant formula milk
- fresh, dried, and tinned pulses
You can also get free Healthy Start vitamins

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19
Q

When do foetal movements start?

A

around 20 weeks and continue until birth

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20
Q

What lifestyle advice should be given to pregnant people?

A

Avoid:
- alcohol (risk of miscarriage, small for dates, preterm delivery, foetal alcohol syndrome)
- smoking (many risks)
- unpasteurised dairy (risk of listeriosis)
- undercooked or raw poultry (risk of salmonella)
- contact sports
- live vaccines
Safe:
- sex
- moderate exercise
Be aware:
- flying increases risk of VTE, most airlines need note from a medical professional after 28 weeks
- seatbelts should go above or below bump, not across

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21
Q

What are the risks associated with smoking in pregnancy?

A
  • FGR
  • miscarriage
  • stillbirth
  • preterm labour and delivery
  • placental abruption
  • pre-eclampsia
  • cleft lip or palate
  • SIDS
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22
Q

What are the features of foetal alcohol syndrome?

A
  • microcephaly
  • thin upper lip
  • smooth flat philtrum
  • short palpebral fissure
  • learning disability
  • behavioural difficulties
  • hearing and vision problems
  • cerebral palsy
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23
Q

What risks are associated with underrated hypothyroidism in pregnancy?

A
  • miscarriage
  • anaemia
  • small for gestational age
  • pre-eclampsia
24
Q

How should hypothyroidism be treated in pregnancy?

A
  • titrate levothyroxine to achieve a low-normal TSH
  • dose usually needs to be increased 25-50mcg compared to pre-pregnancy requirement
  • levothyroxine does cross the placenta
25
Q

How should existing hypertension be managed in pregnancy?

A
  • stop teratogenics: ACEi, ARB, thiazides

- use labetalol, calcium channel blockers, alpha blockers instead

26
Q

How should epilepsy be managed in pregnancy?

A
  • ideally achieve symptom control using a pregnancy-safe single therapy before conception (levetiracetam, lamotrigine, carbamazepine)
  • advise that seizure control may worsen during pregnancy but that seizures in themselves are not harmful to baby
  • avoid sodium valproate (neural tube defects and developmental delay) and phenytoin (cleft lip and palate)
27
Q

How should rheumatoid arthritis be managed in pregnancy?

A
  • ideally achieve good symptom control for three months before conception
  • avoid methotrexate (miscarriage and congenital abnormality)
  • hydroxychloroquine is safe and first-line in pregnancy, sulfasalazine is also considered safe
  • steroids can be used during flare ups
  • advise that sx are likely to improve during pregnancy and flare after delivery
28
Q

Prescribing in pregnancy: NSAIDs

Ok to use?

A
  • generally avoid unless absolutely necessary
  • use in third trimester can cause premature closure of the ductus arteriosis
  • they’re use can also delay labour
29
Q

Prescribing in pregnancy: beta blockers

Ok to use?

A
  • labetalol is most commonly used in pregnancy
  • can cause foetal growth restriction, hypoglycaemia and bradycardia in the neonate
  • risks of pre-eclampsia outweigh risks of medication
30
Q

Prescribing in pregnancy: ACEi and ARBs

Ok to use?

A
  • avoid

- risks of oligohydramnios, neonatal renal failure and miscarriage/foetal death

31
Q

Prescribing in pregnancy: opiates

Ok to use?

A
  • can be used
  • can result in withdrawal sx in the neonate: neonatal abstinence syndrome (NAS)
  • NAS presents 3-72 hours after birth with irritability, tachypnoea, fever and poor feeding
32
Q

Prescribing in pregnancy: warfarin

Ok to use?

A
  • avoid

- teratogenic: risk of foetal loss, congenital malformations, bleeding during pregnancy

33
Q

Prescribing in pregnancy: sodium valproate

Ok to use?

A
  • avoid

- teratogenic: neural tube defects and developmental delay

34
Q

Prescribing in pregnancy: lithium

Ok to use?

A
  • can be used as a last resort in the second or third trimester
  • first trimester use is associated with congenital cardiac abnormalities including Ebsteins anomaly
  • need levels monitored regularly
  • cannot be used in breastfeeding as it is toxic to the infant
35
Q

Prescribing in pregnancy: SSRIs

Ok to use?

A
  • the most commonly used antidepressants in pregnancy
  • risk/benefit assessment should be made
  • risks:
  • – first trimester: congenital heart defects (especially paroxetine)
  • – third trimester: persistent pulmonary hypertension in the neonate, neonates can experience withdrawal symptoms
36
Q

Prescribing in pregnancy: isotretinoin

Ok to use?

A
  • avoid

- highly teratogenic: miscarriage and congenital defects

37
Q

Prescribing in pregnancy: chlorphenamine

Ok to use?

A
  • safe but limit use, especially in third trimester
38
Q

Prescribing in pregnancy: paracetamol

Ok to use?

A

safe

39
Q

Prescribing in pregnancy: laxatives

Ok to use?

A
  • mainly ok
  • advise increasing water and fibre in the first instance
  • if needing medication favour lactulose, Senna or bulk forming laxatives
40
Q

Prescribing in pregnancy: antacids

Ok to use?

A

safe expect sodium bicarbonate

41
Q

Prescribing in pregnancy: PPIs

Ok to use?

A

safe

42
Q

What is pre-eclampsia?

A 
triad of:
- proteinuria
- hypertension
- oedema
after 20 weeks gestation
43
Q

What causes pre-eclampsia?

A

abnormal spiral arteries of the placenta causing high vascular resistance

44
Q

What is chronic hypertension in pregnancy?

A
  • high BP

- that pre-exists pregnancy

45
Q

What is pregnancy-induced hypertension or gestational hypertension?

A
  • new, high BP
  • after 20 weeks gestation
  • without proteinuria
46
Q

What is eclampsia?

A

seizures resulting from pre-eclampsia

47
Q

What are the risk factors for pre-eclampsia?

A

High:

  • pre-existing HTN
  • previous HTN in pregnancy
  • AI conditions
  • diabetes
  • CKD

Moderate:

  • age >40
  • BMI >35
  • more then 10 years since previous pregnancy
  • multiple pregnancy
  • first pregnancy
  • FH of pre-eclampsia
48
Q

What are the risk factors for pre-eclampsia used to determine?

A
  • whether a pregnant person should be offered prophylactic aspirin from 12 weeks gestation until birth to prevent pre-eclampsia
  • it should be offered if 1 high risk factor or multiple moderate risk factors
49
Q

What are the symptoms of pre-eclampsia?

A
  • headache
  • visual disturbance
  • nausea and vomiting
  • epigastric pain
  • oedema
  • reduced UO
  • brisk reflexes
50
Q

What is the management for eclampsia seizures?

A

IV magnesium sulphate

51
Q

What is HELLP syndrome?

A
  • a combination of features that occur as a complication of pre-eclampsia and eclampsia
  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets
52
Q

What are the complications of gestational diabetes?

A
  • large for dates foetus
  • macrosomic baby (risk of shoulder dystocia)
  • long term higher risk of T2DM for mum
53
Q

What are the risk factors for GDM?

A
  • previous GDM
  • previous macrocosmic baby (>4.5kg BW)
  • BMI >30
  • not Caucasian
  • FH of diabetes in a first-degree relative
54
Q

Who should be screened for GDM?

A

anyone with risk factors

55
Q

How does one screen for GDM?

A
  • OGTT at 24-38 weeks

- fasting glucose >5.6 or glucose at +2 hours >7.8 is diagnostic for GDM

56
Q

What is the management of GDM?

A

Fasting glucose:
<7 - diet/exercise, then metformin, then insulin
>7 - insulin +/- metformin
>6 with complications - insulin +/- metformin

57
Q

How is existing T2DM managed in pregnancy?

A
  • metformin and insulin
  • stop all other OHA and injectables
  • aim for same sugars as GDM

Womens Health (3 decks)

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