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Y5 OG Procedures and Other Stuff > Antenatal care pt1 > Flashcards

Antenatal care pt1 Flashcards

1
Q

What are the 3 trimesters?

A 
T1 = <12 wks
T2 = 12-26 wks
T3 = 26-37 wks
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2
Q

What antenatal urine tests are done?

A

MSU MC&S

Urinalysis

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3
Q

Which UTI medication can you not give in pregnancy?

A

Trimethoprim can’t be given in first 2 Trimesters
Nitro can’t be given in 3rd
Co-amoxiclav is chosen for 3rd trimester

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4
Q

Why should we monitor blood pressure in pregnancy?

A

Falls a little in T1 but returns to normal in T2

T1 measurement can identify undiagnosed hypertension which requires treatment (antiHTN and aspirin)

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5
Q

What are the booking tests in pregnancy?

A 
FBC
MSU
Blood group and antibody screen
Haemoglobinopathy screen
Infection Screen (Current not past)
Dating scan and first trimester screen
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6
Q

What vaccines do you give at 27-36 weeks?

A

DtaP and influenza

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7
Q

When is DTaP and influenza Vx given?

A

27-36wks

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8
Q

What is anaemia in pregnancy in T1, T2 and T3?

A

T1 - <110
T2 - <105
T3 - <100

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9
Q

What are you looking for in platelets?

A

· Gestational thrombocytopaenia rarely presents in first trimester (more common >28 weeks)

· So, a low platelet count in the first trimester warrants further investigation

· A baseline platelet count is also useful later in pregnancy if the patient is suspected of having developed pre-eclampsia or HELLP syndrome

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10
Q

What are the causes of Microcytic anaemia in pregnancy?

A 
T - Thalassaemia
A - ACD
I - IDA
L - Lead poisoning
S - Sideroblastic anaemia
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11
Q

What are the causes of Normocytic anaemia in pregnancy?

A

M-Marrow Failure
R- Renal Failure

I- early IDA

C- aCd
A - Aplastic anaemia, acute loss
L- Leukaemia
M - Myelofibrosis

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12
Q

What are the causes of Macrocytic anaemia in pregnancy?

A 
A- Alcohol
M- Myeloid neoplasms
H- Hypothyroid/ Haemolytic anaemia
L- Liver failure
F- Folate/ B12 deficiency
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13
Q

What do you look for in blood group analysis?

A

§ Identify Rhesus D -ve women

§ Anti-D (250 IU) administered <72 hours of sensitising events (e.g. CVS, amniocentesis, trauma)

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14
Q

When do you give Anti D in early pregnancy?

A

§ In pregnancy <12 weeks, anti-D prophylaxis indicated if:

Ectopic pregnancy

Molar pregnancy

Therapeutic TOP

Uterine bleeding (repeated, heavy or with abdominal pain)

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15
Q

When do you normally give anti D?

A

§ Otherwise, give anti-D at 28 weeks (single large dose 1,500 IU or two at 28 and 34 weeks)

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16
Q

What do you do if you find glycosuria on dipstick?

A

2 hour 75g OGTT (immediate + HbA1c testing for pre existing diabetes mellitus)

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17
Q

What do you do if a woman has had previous gestational diabetes or any risk factors?

A

§ Previous GDM -> 2-hour 75g OGTT (immediate -> if normal, again at 24-28 weeks)

§ Any RF on clerking (not prior GDM) -> 2-hour 75g OGTT (at 24-28 weeks)

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18
Q

How do you diagnose gestational diabetes?

A

· Fasting plasma glucose >5.6 mmol/L

· 2-hour OGTT >7.8 mmol/L

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19
Q

What do you do after a diagnosis of GDM?

A

If diagnosed, offer a review at a joint diabetes and antenatal clinic within 1 week

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20
Q

How do you diagnose thalassaemia?

A

§ Autosomal recessive

§ Family Origins Questionnaire ± Hb electrophoresis

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21
Q

Who get’s sickle cell?

A

§ Carrier rate of Sickle Cell Trait (HbAS) in Afro-Caribbean is 1 in 10

§ Carrier rate of HbAC trait is around 1 in 30

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22
Q

What is the most serious sickle cell genotype?

A

HbSS

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23
Q

What does HbSS cause?

A

Chronic haemolytic anaemia and acute sickle cell crises

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24
Q

How is HbSC different from HbSS?

A

Milder features but still can have crisis

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25
Q

What investigations do you do for sickle cell?

A

· Bloods – FBC (low Hb, reticulocytes [HIGH = haemolytic crisis, LOW = aplastic crisis]), U&Es

· Blood film – Sickle cells, anisocytosis, [target cells, Howell-Jolly bodies = hyposplenism]

· Sickle solubility test – increased turbidity on dithionate addition to blood

· Hb electrophoresis – determines presence of HbS and trait/homozygous

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26
Q

What is the management of SSD crisis?

A

· Hydration

Oxygen

· Analgesia

Screen for infection (urinary, respiratory)

· Blood transfusion

Exchange transfusion

· Prophylactic antibiotics

Prophylaxis against thrombosis (heparin)

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27
Q

What can you not give pregnant women with SSD?

A

Hydroxyurea- stop 3 months before pregnancy

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28
Q

What do you give to SSD women?

A

Low dose aspirin for 12 wks

Serial growth scans every 4 weeks from 24 weeks

Delivery IOL at 38 weeks

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29
Q

What postnatal care do you do for SSD women?

A

LMWH (hospital and 7 days post discharge, 6 weeks after C section)

Contraception (POP, Depo provera or LNG IUS)

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30
Q

What is in the first trimester infection screen?

A

Syphilis

Hep B

HIV

(Hep C if High risk)

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31
Q

If a baby is born to a woman with active hepatitis B, what do you give the child?

A

Hep B vaccine within 12 hours, 1 month and 6 months

One dose of HBV IVIG within 12 hours

32
Q

What should you do if a mother is HIV positive?

A

o Initiation of ART by 24 weeks if naive

o Planned elective C-section if viral load > 50 copies/mL at 36 weeks

o Exclusive formula feeding from birth

Women who decline initial screening should be offered screening again at 28 week

33
Q

What does the USS do in T1?

A

Dating
Multiple pregnancy
Trisomy screen
Gross abnormalities of the foetus

34
Q

What do you measure at 12 wks (11+3 to 13+6)?

A

Crown rump length (45-84 mm)

Head circumference after 14 weeks

35
Q

What tests can you do after 10 weeks?

A

NIPT for Trisomy 21, 18 and 13 (>98% sensitivity)

36
Q

What do you do 11-14 weeks?

A

Combined- NT, bHCG and PAPP-A

37
Q

What do you find out in the combined test?

A

Tests for Trisomy 21, 18 and 13

38
Q

What is in the combined test?

A

§ Nuchal translucency (NT)

§ Maternal b-hCG Combined test is only these 3

§ PAPP-A (pregnancy-associated plasma protein
· Trisomy 21 -> High b-hCG, Low PAPP-A

A) Maternal age used in calculation

39
Q

What is done 14-20 weeks?

A

Quadruple test (for Down’s)

40
Q

What is in the Quadruple test?

A

AFP
Oestriol
bHCG
Inhibin A (not in the triple test)

41
Q

What happens if you miss the combined test?

A

Mid pregnancy scan for Patau’s (13) and Edwards (18)

42
Q

If a positive result is found what should be done?

A

§ Chorionic villous sampling -> 11-14 weeks (99% accurate)

§ Amniocentesis -> 15-20 weeks (99% accurate)

43
Q

What would be fond in antenatal screening in Down’s?

A 
Low AFP
Low oestriol
Low PAPP A
High bHCG
thickened NT
44
Q

What causes increased AFP?

A

Neural tube defects
Abdominal wall defects
Multiple pregnancy

45
Q

What causes decreased AFP?

A

Trisomy 21
Trisomy 18
Maternal DM

46
Q

How do you manage a woman with pre eclampsia risk?

A

§ 75mg aspirin OD from 12 weeks to delivery (if high risk)

§ Screened at every antenatal visit with BP and urinalysis

47
Q

How do you identify a woman with pre term birth risk?

A

Previous pre term birth
Previous late miscarriage
Multiple pregnancy
Cervical surgery

48
Q

How do you manage a woman with IUGR risk?

A

§ SFH at all antenatal appointments from 24 weeks

§ USS to check for IUGR if suspected

49
Q

How do you manage a woman with Vit D Deficiency risk?

A

§ Not routinely screened

§ All pregnancy women should take 10ug of vitamin D OD

50
Q

What do you screen for in T2?

A 
Anomaly scan (18-21 wks)
Gestational DM
51
Q

What does the anomaly scan check for?

A

Spina bifida
Diaphragmatic hernia
Major congenital anomalies
Renal Agenesis

52
Q

What are the RFs for GDM?

A 
Previous GDM
Raised BMI
Asian, black Caaribbean or middle eastern
Previous macrosomia
1st degree relative with diabetes
53
Q

What is the USS schedule?

A

o 10-14 weeks -> booking scan (gestational age, multiple pregnancy, NT test)

o 18-21 weeks -> anomaly scan (structural abnormalities, TOP options if required)

54
Q

What are sensitising events in RhD negative women?

A

o 0-12 weeks -> 250 IU if needed:

§ Foetal blood volume small so sensitisation is unlikely

§ Anti-D is only indicated following: ectopic pregnancy, molar pregnancy, therapeutic TOP and in cases of uterine bleeding which is heavy/repeated or accompanied by abdominal pain

o 12-20 weeks -> 250 IU (<72 hours) -> Kleihauer test

o 20+ weeks -> 500 IU (<72 hours) ->Kleihauer test

55
Q

Summarise sensitising events

A

§ Delivery of RhD+ infant

Any TOP

§ Miscarriage if > 12 weeks

Ectopic pregnancy (if managed surgically)

§ External cephalic version

Antepartum haemorrhage

§ Amniocentesis, CVS, foetal blood sampling

Abdominal trauma

56
Q

What supplementation do women need?

A

Folic acid (400 mcg or 5mg)

Vit D (10mcg)

57
Q

Who needs high dose folic acid?

A 
Women whove had a previous child with NTD
DM
HIV on co trimoxazole
Epileptics
SCD
IBD
Obese
Thalassaemia
58
Q

When should first movements be?

A

Primigravida 20 wks
Multiparous 16-18wks

latest 24 wks

59
Q

How do the nips change?

A

Nipples darken and breasts enlarge around 12w (highest oestrogen and human placental lactogen / hPL)

60
Q

What is hPL?

A

homologue to GH and prolactin (unsure of role); made from placenta

61
Q

What does hPL do?

A

o Decrease insulin sensitivity (-> i.e. multiple pregnancy, more placenta, more hPL, more chance of GDM)

o Increase lipolysis -> FFA release for ketogenesis for mother’s energy use -> more glucose available for baby

o Decrease glucose utilisation

62
Q

What is bHCG?

A

Homologue to TSH

63
Q

What does bHCG do?

A

Thyroid enlargement

T4 production

64
Q

What visits do only primigravida patients get?

A

25wks: routine care: BP, urine dip, symphysis fundal height

31 wks: routine care: BP, urine dip, symphysis fundal height

40 wks: routine care: BP, urine dip, symphysis fundal height, Discussion about prolonged pregnancy

65
Q

When is the booking visit?

A

8 - 12 weeks

Ideally <10w

66
Q

What happens during the booking visit?

A

Booking visit
• General information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
• BP, urine dipstick, check BMI

Booking bloods/urine
• FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
• Hepatitis B, syphilis, HIV
• Urine culture to detect asymptomatic bacteriuria

67
Q

When is the early scan? what does it tell us?

A

10 - 13+6 weeks

Early scan to confirm dates, exclude multiple pregnancy

68
Q

When do you screen for Down’s?

A

11 - 13+6 wks

69
Q

What happens at 16 weeks?

A

Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron

Routine care: BP and urine dipstick

70
Q

When is the anomaly scan?

A

18-20+6 wks

71
Q

What happens at 28 weeks?

A

Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb <10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women

72
Q

In which week is routine care, second anti D dose and information on labour and birth plan?

A

34 weeks

73
Q

What happens at 36 weeks?

A

Routine care: BP, urine dipstick, SFH
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’

74
Q

What happens at 38 weeks?

A

Routine care: BP, urine dipstick, SFH

75
Q

What happens at 41 weeks?

A

Routine care: BP, urine dipstick, SFH

Discuss labour plans and possibility of induction

Y5 OG Procedures and Other Stuff (26 decks)

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