Antenatal Growth Chart, Multiple Gestation, Eclampsia and Labour Analgesia Flashcards
list some causes for a small baby (estimated fetal weight < 10th centile)
- uteroplacental insufficiency
- chromosomal abnormalities
- fetal abnormalities
- fetal infections
list some causes for a big baby (estimated fetal weight > 90th centile)
- gestational diabetes
- insulin-dependent diabetes
what is eclampsia?
Eclampsia is when severe pre-eclampsia is complicated by generalised convulsions.
- can happen in antepartum (50%), intrapartum (30%) or postpartum (20%) period.
what is pre-eclampsia?
a hypertensive disorder of pregnancy with multi-organ involvement characterised by new onset, raised blood pressure and proteinuria, usually seen after 20 weeks of gestation.
what causes eclampsia?
happens as a result of cerebral edema and/or cerebral haemorrhage
clinical features of eclampsia
- headache
- BP > 160 systolic
- hyperreflexia
- visual changes
- tonic clonic seizures
eclampsia management
- ABC approach: get a secure airway, IV access and take bloods (LFTs, U&Es, coagulation, FBC)
Management:
- magnesium sulfate
- antihypertensives - labetolol, hdralazine
- delivery of child
how does magnesium sulfate work to treat and prevent eclampsia?
- causes cerebral dilatation
- competitively blocks calcium at synaptic nerve endings
- should be continued for 24 hrs after delivery
if toxicity from magnesium sulfate develops, what antidote is given?
calcium gluconate
list the complications of eclampsia
- HELLP syndrome
- Disseminated intravascular coagulation (DIC)
- ARDS
- pulmonary oedema
- aspiration
- fetal hypoxia
- increased maternal mortality
what medication is given to decrease the risk of pre-eclampsia in subsequent pregnancies?
low-dose aspirin from 12 weeks gestation
list the resons for multiple gestation
- if more than 1 egg released during 1 menstrual cycle
- if the zygote divides after fertilisation > identical twins
- IVF treatments > often transfer more than 1 embryo to uterus
describe amnionicity
- the no. amnions (inner membranes) that surround babies in a multiple pregnancy
- pregnancies with 1 amnion aredescribed as monoamniotic; pregnancies with 2 amnions are diamnitoic.
describe chorionicity
- the no. chorionic (outer) membranes (placenta) that surround babies in a multiple pregnancy.
- if there is only 1 membrane, the pregnancy is described as monochorionic; if there are 2, the pregnancy is dichorionic.
list some maternal complications of multiple births
- pre-term labour
- hyperemesis
- anameia in pregnancy
- hypertension
- gestational diabetes
- postpartum haemorrhage
list some fetal complications of multiple gestation
- growth restriction
- prematurity
- increased birth complications
- increased perinatal mortality/morbidity
what are some complications specific to monochorionic twins?
- twin-twin transfusion syndrome: when blood moves from one baby to the other due to a shared placenta, that baby then loses blood and is called the donor twin.
- selective growth restriction
- twin anaemia polycythaemia sequence
- twin reversed arterial perfusion (TRAP)
- single twin death
what does antenatal care for multiple gestation consist of?
- routine care including trisomy 21 screening/structural scans
- specialist clinic with regular scans to monitor growth and identify complications
- dichorionic diamniotic require at least 8 AN visits
- monochorionic require at least 11 AN visits
- monitor BP/commence oral iron if required
list some drug-free pain relief techniques used during labour
- use of birthing ball
- birthing pool
- TENS machines
- hypnobirth
- aromatherapy
list some simple drug therapies used for pain relief in labour
- entonox (gas and air), used when contractions start, not used in between contractions
- diamorphine
benefits of entonox (gas and air)
- widely used
- safe
- you are in control
- works quickly
- wears off quickly
disadvantages of entonox
- can make you feel dizzy, dry mouth, nausea
- helps you cope but does not take all pain away
- takes practise to time breathing of entonox with contractions
benefits of diamorphine used as pain relief in labour
- works in 30 mins
- lasts up to 4 hours
- helps relieve pain, relaxes you and helps you cope with pain better
disadvantages of diamorphine use in labour
- can make you feel sick, sleepy and slows breathing
- has similar effects on baby
list some advanced pain relief techniques used during labour
- remifentanil patient controlled analgesia (PCA) pump
- epidural
benefits of remifentanil PCA used during labour
- you are in control
- works quickly, wears off quickly
- strong pain relief
disadvantages of remifentanil PCA used during labour
- may slow breathing
- extra oxygen and monitoring
- drowsy, sick, itchy
- cannot use if you have had diamorphine withing last 4 hours
benefits of epidural
- 8/10 women works really well
- unlikely to affect baby
- you are in control
- can be used in theatre
disadvantages of epidural
- can slow pushing phase
- increased risk of needing forceps/suction cup
- drop in blood pressure
- itching, fever
- sore area on back
- headache 1/100
- rare severe complications ranging from nerve problems to infection in back
