Antenatal Care & Screening Flashcards
Physiological changes during pregnancy
MORNING SICKNESS
CARDIAC = CO INCREASE (due to HR increase - causes palpitations, pre-eclampsia); BP DECREASE in 2ND TRIMESTER + NORMALISES in 3RD TRIMESTER
URINARY = INCREASED URINE OUTPUT (freq. of emptying increases - may not completely void bladder; urea > 4 worrying); UTI (urinary stasis, hydronephrosis in 3rd trimester)
HAEMATOLOGY = ANAEMIA (plasma vol. increase + RBC mass increase - haemodilution; iron given if Hb < 10.5 or 105)
GI = HEARTBURN (slower gastric emptying, peristalsis slows - reduced GI motility due to increased progesterone + reduced motilin)
RESPIRATORY = progesterone acts centrally to reduce CO2 - increased tidal vol., RR, plasma pH, increased O2 consumption, hyperaemia of respiratory mucus membranes)
Antenatal examination - procedure + implications
- HIGH QUALITY ANTENATAL CARE REDUCES FOETAL & MATERNAL MORTALITY
- AIMS TO IDENTIFY PROBLEMS (mother - pre-existing/developing disease; foetus - IUGR, foetal abnormality; social - support, domestic violence, psychiatric illness)
- ROUTINE ENQUIRY - feeling well, feeling foetal movements > 20weeks
- BP + URINALYSIS (pre-eclampsia, UTI, gestational diabetes)
- ABDOMINAL PALPATION - symphysial fundal height, lie, presentation, engagement
- AUSCULTATION to foetal heartbeat
Screening for foetal abnormality
- NOT COMPULSORY, but does allow for CONDITIONS to be DETECTED EARLY in SYMPTOMLESS POPULATION for TREATMENT in MOTHER/BABY
- APPROPRIATE COUNSELLING PRIOR to SCREENING is IMP.
INFECTION - HEP B, RUBELLA, SYPHILIS, HIV, UTI
ANAEMIA + ISOIMMUNISATION - ROUTINE FBC at BOOKING + 28/40 WEEKS GESTATION; RHESUS DISEASE (ANTI-D IgG offered to all women prophylactically + after potentially sensitising events), ANTI-C, ANTI-KELL
ANOMALIES via USS - 1ST VITIS USS (11 - 14 weeks) - viability, multiple pregnancy, abnormalities incompatible w/ life, down’s syndrome screening, DETAILED ANOMALY SCAN (major structural abnormalities) - systematic structural review of baby, cannot identify all problems (but can identify those need intrauterine/postnatal rx)
DOWN’S SYNDROME- 1ST TRIMESTER SCREENING (10 - 14 weeks gestation) - maternal risk factors, serum b-HCG, PAPP-a, foetal nuchal translucency measurement; HIGH RISK (risk > 1 in 150 or woman chooses) - chorionic villous sampling, amniocentesis, non-invasive prenatal testing
NTD - 1ST TRIMESTER USS (anencephaly, spina bifida), 2ND TRIMESTER BIOCHEMICAL SCREENING (maternal serum tested for alpha fetoprotein), 2ND TRIMESTER (20 weeks) USS for major structural abnormalities; personal/FHx of NTD - increased risk, 5mg folic acid
