Antenatal health Flashcards
What are the 6 main aims of antenatal care
- The care must follow a definite plan
- The care must be problem oriented
- Risk factors from the previous pregnancies
- Common complications that can occur are each age (time that the person visits)
- Fetal condition must be continually assessed
- Health education must be provided
When will a pregnancy test test positive
By the time that the patient misses their first period
What are the characteristics of an intrauterine pregnancy
- Size of the uterus is appropriate for the duration of the pregnancy
- There is no lower abdominal pain or bleeding
How do you diagnose an extrauterine pregnancy
- The uterus is smaller than what is expected for the pregnancy duration
- There is a lot of lower abdominal pain and tenderness
When should a pregnant patient first present to the antenatal clinic
When they have missed 2 periods [i.e. 8 weeks pregnant]
What are the 5 main aims that should be achieved in the first antenatal visit
- Full history should be taken
- Physical exam must be done
- Duration of the pregnancy should be established
- Screening tests should be done
- High risk patients should be identified
What is the key information that should be taken on the patients history
- Previous obstetric history
- Present obstetric history
- Medical history
- HIV status
- History of medications and allergies
- Surgical history
- Family history
- Socioeconomic circumstances
What is important previous obstetric history that should be take
- Gravidity [no. of pregnancies]
- Parity [pregnancies that are viable]
- Miscarriages TOP and ectopics
What is meant by grande multiparity
This is when the patient has had multiple pregnancies that have reached a viable age
What is the possible cause of 3 consecutive first trimester pregnancies losses
Genetic abnormalities in the mother or the father
What are the possible causes of a second (mid) trimester loss
Incompetent internal cervical os
What does a baby larger than 4 kg suggest
Maternal diabetes
What could a previous pregnancy that is assisted with forceps or vacuum extraction suggest
It would suggest a degree of cephalopelvic distortion in the mother
What is the only type of c section incision that should be sent for a NVD
Transverse lower segment insision
What obstetric history on the current pregnancy should be taken
- When was the first day of the last known menstrual period
- Any problems since the start of the pregnancy
- Minor symptoms
- Is it a planned pregnancy
- If the patient is in the final trimester then attention should be given to the condition of the fetus
What are the considerations that should be taken in a patient when estimating the gestational age using the patients last known period
- The patients cycle must be regular
- If the last period was a normal period
Why is it significant if the last known period is different from normal periods and why can it not be used for the estimation of the gestational age
This is because this is an implantation bleed vs a normal period
Why is important to know the drugs that a patient is taking when they are pregnant
- Regular use of some medications will allow you to understand the cause
- Some drugs are teratogenic
- Some drugs are dangerous to the fetus if take closer to term e.g. Warfarin
- Allergies are important
What is significant on breast exam of a patient that is pregnant
- Inverted nipples should be diagnosed and treated to allow for breastfeeding
- Blood stained discharge should be checked for tumors
Who should have a pap smear
- All patients over the age of 30 who have not had a normal one
- Any patient that has had an abnormal pap smear
- All patients with HIV that have not had a pap smear in the last year
What are the 4 most common methods of determining pregnancy duration
- Last normal menstrual period
- Size of the uterus on bimanual palpation up to 18 weeks
- Height of the fundus at or after 18weeks
- US
What is the symphysis-fundus height measurement
The measurement from the pubic bone to the top of the uterus
After how many weeks is the symphysis-fundus height measurement and the number of weeks the same
After about 20 weeks the measures should line up, thus the number of weeks and the cm are the same
What are the cause that could result in the menstrual date and the uterus size being different i.e. the uterus is bigger than expected for the date
- Multiple pregnancies
- Polyhydramnios
- Diabetes mellitus
What could cause the uterus to be smaller than what the date suggests 4
- Intrauterine growth restriction
- Oligohydramnios
- Intrauterine death
- Rupture of the membrane
Which 2 side room tests should be done as a standard on pregnant patients
- Hb
- Urine tests for protein and glucose
Which lab based tests should be done on a pregnant patient
- Syphylis testing
- Rh testing
- HIV screening
- Pap smear
- UTI testing
Why should an ultrasound be done in a patient when the gestational age is already known
- It allows for accurate determination of the gestational age
- Allows for multiple pregnancies to be diagnosed
- Allows for the identification of the site of the placenta
- Allows for the diagnosis of severe congenital abnormalities
What would be the indications of having an US at 11-13 weeks
- If the patient is over the age of 37 as there is a significant risk of chromosomal abnormalities
- Patients with a known family history of genetic abnomalities
What are the indications for patient between 18 and 22 weeks
- If the patient needs an elective delivery [They have had 2 C sections, previous perinatal death, previous vertical uterine incision, diabetes or hypertension]
- Gross obesity
- Previous pre-eclampsia or preterm labour
- Rhesus sensitive patients
When should a patient be seen after the booking visit
In 1-2 weeks to discuss the results and then if everything is normal the second visit can be omitted
What are the 3 possible outcomes for a syphilis test
- If either the VDRL or the RPR test is negitive then the patient does not have syphilis and no treatment is needed
- If the titre is higher than 1:16 then the patient should be treated for syphilis
- If the titre is 1:8 or lower then a TPHA or a FTA should be done for the patient. If either come back positive then the patient has syphilis. If negative then negative and if underdetermined then treat as if positive
What does the diagnosis via a rapid test tell you about syphilis
It means that the patient either has an active infection or has had syphilis in the past and they should do a VDRL or RPR to confirm
What is the standard treatment for syphilis
2.4 million units of benzathine penicilin given weekly for 3 weeks. Given as 1.2 mill in each butt
What is the treatment given if the patient is allergic to penicillin
500mg of erythromycin 6hourly for 14 days
How should an HIV test be done and how do you interpret the results
- If the rapid test is negative then the patient is most likely negative
- If it is positive then the test should be repeated with a test from another manufacturer
- If the first test is positive and the second negative then the patients status is unknown and an ELISA should be done
What is the standard procedure if a patient is Rh negative
- If there are no anti-D antibodies in the patient then they have never been sensitised and so they will not attach the baby but the test should be repeated at 26, 32 and 38 weeks
- It the titre is above 1:16 then the patient must be referred
What is meant by placenta praevia
This is were the placenta forms over the cervical os
What should be done if placenta praevia is found in a patient at their US
In most cases the placenta will move as the pregnancy progresses
What are the 3 categories of risk in a pregnant patient
- Low risk: This is where there are no maternal or fetal risk factors present and the patient can recieve care from a midwife
- Intermediate risk: There are some non significant risk factors
- High risk patients: There are patients that require continuous additional monitoring
What does the appointment schedule look like for a low risk pregnancy
Every 6 weeks until 26 weeks
then at 30 and 34 and then every 2 weeks after that
What are the main things that are looked for at the 26 week vist
- Antepartum haemorrages
- Pre-eclampsia
- Cervical changes
- Symphysis fundal height is below the 10th persentile then there is poor growth of the fetus
- Anaemia
- Glucose profile to check for gestational diabetes
- Umbilical artery is checked with doppler
What is meant by Abruptio placentae
This is where the placenta is partially or fully separated from the uterus before birth
What is an antepartum hemorrhages
Antepartum hemorrhage (APH) is bleeding from the genital tract that occurs after 20 weeks of pregnancy and before the onset of lab
What is the significance of an antepartum haemorrage
- It could indicate Abruptio placentae
- It could be a warning of placenta praevia
What are the tests that should be done at week 30
- Syphyis and HIV tests should be redone
- The lie of the fetus should be checked
- Patients with previous c sections should be checked to see what the best mode of delivery is
- Patients breasts should be examined
What are the 3 complications that a patient is at risk of if their pregnancy extends beyond 40 weeks
- Intrapartum fetal distress
- Meconium aspiration
- Intrauterine death
What are 3 symptoms that indicate abruptio placentae
- Vaginal bleeding
- Persistant abdominal pain
- Decreased fetal movements
What are the 4 symptoms that could suggest pre- eclamsia
- Persistant headaches
- Flashes in the eyes
- Sudden swelling of the legs
- SOB
What supliments should be taken
- Iron supplements
- Calcium: Decreases the risk of preeclampsia [1-1.5g]
- Folic acid [5mg]
What are the classification or HIV infections
Stage 1: Clinically well
Stage 2: Mild clinical problems
Stage 3: Moderate clinical problems
Stage 4: Severe clinical problems/AIDS
What is the normal CD4 count
700- 1100 cells/ mm^3
How do you know that stage 1 HIV has progressed to stage 2
Stage 2 includes things like repeated or chronic mouth or genetal ulcers, extensive skin rashes, repeated upper resp. infections and shingles
What are some of the features of a stage 3 HIV infection
- Unexplained weight loss
- Oral candidiasis
- TB
- Bacterial pneumonias
- Chronic diarrhea
What are some of the features of a stage 4 HIV infection or AIDS
- Severe weight loss
- Severe pneumonias
- Kaposi sarcomas
- Extrapulmonary TB
What anti-retroviral treatment should be given to pregnant patients
TLD
Should pregnant women with HIV be transfered
No only those that are in stage 3 or 4 and need more specialised care
In patients with chronic renal disease what is the HIV therapy given
In these patients TDF is replaced with abacavir 600 mg per day or AZT 300mg twice daily
What are the effects of pregnancy on HIV
In a women that is pregnant there is no significant effects but if the women is already symptomatic then it can lead to faster progression of the disease
