Antenatal period Flashcards
Physiological changes during pregnancy:
- Cardiovascular
- Respiratory
- Hormones
- Renal
- Blood
- Skin
- Reproduction: uterus, myometrium, cervix, vagina
Physiological changes during pregnancy:
- Cardiovascular : inc blood volume + vasodil. Means dec diast bp then in t3 inc back to normal
- Respiratory : inc rr + tidal vol
- Hormones : inc cortisol, prolactin, MSH, prog/oest, calcium
- Renal : inc egfr, inc na/h20 reab
- Blood : inc rbcs but as also does plasma dilutional, inc alp, inc clotting factors
- Skin: linea nigra
- Reproduction: uterus, myometrium, cervix, vagina : myometrium hypertrophy, inc discharge
Booking clinic:
- Hx
- Ex
- Ix
- Mx
- Other important dates for other appointments
- done at 10 weeks. bp, bmi, urine dip + culture. fbc/blood group/rh/hemoglobinopathies/hepb/syphilis, offer hiv
- 10-14 weeks: uss - multiple preg, gest age
- 18-20: uss - placenta, fetal abnormalities
10 appointments if first preg, 7 if not
10mcg vit d, VIT A SUPPLEMENT TERATOGENIC
give anti d at 28 weeks and within 72 hours if stillborn, termination, ectopic, miscarriage >12 weeks, ext cephalic, haemorrhage, amnio/chorio, abdo trauma. Causes hydrops fetalis, jaundice, anaemia, hepatosplen, kernicterus
Smoking: inc risk miscarriage, premature, stillbirth
Fetal alcohol syndrome: learning difficulties, iugr. Face abnormal: epicanthic folds, microcephaly, small palpebral fissures
Obese: inc risk vte, miscarriage, pre-ec, gest, pph. Fetal risks macros, prem, stillbirth. If >35 bmi obstetric lead birth
UTI:
- Definition
- Organism causes
- Management
UTI:
- Definition
- Organism causes
- Management : cefalaxin. No nitro T3 (hemolysis), No trimeth (t1, nt defects)
Anaemia:
- Why inc risk in pregnancy
- Levels in T1, T2/3, postmenopausal
- Investigations
- Management
- Complications - to mum, to fetus
Anaemia:
- Why inc risk in pregnancy : dilutional, blood loss, inc requirements, diet
- Levels in T1, T2/3, post birth: <110, 105, 100
- Investigations: fbc
- Management: ferrous fumarate for 3 months after ferritin has normalised, folic acid 5mg
- Complications - to mum, to fetus
mum: depression, dec milk production, inc need for transfusion, immunosuppression
baby: anaemia in first 3 months, prem/lbw, dec psychomotor dev
VTE:
- Reasons why inc risk in pregnancy (3)
- Risk factors in pregnancy
- Investigations
- Management
VTE:
- Reasons why inc risk in pregnancy (3): venous stasis as pressure on pelvic vein, trauma during delivery, hypercoag as inc clotting factors
- Risk factors in pregnancy : prev, smoking, bmi >30, age >35, prolonged labour, multiparity, pre-ec, fx unprovoked, ivf
- Investigations: compression duplex uss, ecg, cxr (ctpa inc risk breast ca, v/q inc risk childhood ca)
- Management : lmwh for 3 months
- prevention: if 3 or more risk factors: from 28 weeks to 6 weeks pp lmwh but stop in labour
Maternal sepsis:
- Causes (2)
- Signs
- Investigations
- Management
Maternal sepsis:
- Causes (2): uti, chorioamnionitis
- Signs: sepsis signs, uti signs, tender abdo pain, discharge
- Investigations: MEOW
- Management : oxy, fluids, piperacillin + amoxicillin + gentamicin, prompt delivery of
Oligohydramnios:
- Definition + why is it bad
- Causes (5)
- Assessment: hx, ex, ix
- Management
Oligohydramnios:
- Definition + why is it bad : too little amn <5th centile fluid bad as pul hypoplasia
- Causes (5): prom, iugr, post term, pre-eclamp, potter seq (renal angenesis + pul hypoplasia)
- Assessment: hx, ex, ix
- Management : if ruptures labour should start in 48 hours and if not deliver at 36 weeks
Polyhydramnios:
- Definition + why is it bad
- Causes
- Investigations
- Management
- Complications: to mum, to baby
Polyhydramnios:
- Definition + why is it bad : >95th centile
- Causes : idiopthic, oesoph atresia, anaemia, twin-twin transfusion syndrome, genetic
- Investigations
- Management: indomethacin before 32 weeks (PDA closes), amnioreduction if sob
- Complications: to mum, to baby:
mum: sob/resp distress, utis, gord, pph
baby: umbilical cord prolapse, congen malform, preterm
Small fetus:
- Definition
- Causes
- Complications (6)
- Investigations
- Management
Small fetus:
- Definition : <10th centile/<2500g
- Causes : constit, chromo abnormalities, infection (cmv), smoking, malnutrition, pre-ec, multiple preg, wrong dates
- Complications (6): stillbirth, hypothermia, hypoglyc, rds, nec
- Investigations: uss every 3-4 weeks, umbilical arthritis doppler from 26-28 weeks, bp, urine, torch, karyotyping
- Management
Large fetus:
- Definition
- Causes
- Complications: to mum, to baby
- Management
Large fetus:
- Definition : >90% centile, >4.5kg
- Causes : fibroids, multiple preg, polyhyd, obesity, overdue, constit
- Complications: to mum, to baby
Mum: tear, instrument, pph
Baby: erbs, fracture, hypoglyc, obesity/t2dm - Management
Folic acid
- causes of deficiency
- complications
- mx
Folic acid
- causes of deficiency: phenytoin, methotrexate, preg, alc excess
- complications: macrocytic megaloblastic anaemia, NT defects
- mx: all women 400 mcg folic acid until 12th week preg, 5mg if high risk (ntd f, antiep drugs, coaeliac, thalasemia, bmi >30, gest diab)
Downs screening
- ix
11-14 weeks: combined test
USS assessing nuchal translucency (inc - also inc in CHD, abdo wall defects), serum bhcg (inc), PAPPA (reduced)
15-20 weeks: quadruple test
hcg, afp (dec), uncong oestriol (dec), inhibin a (inc)
Then either high chance (>1/150) or low (<1/150)
If high chance then offered NIPT: blood test
Or diagnostic test amniocentesis if >15 weeks or chorionic villus sampling >10 weeks
Reduced fetal movements
- when should you feel them
- risk factors
- mx
Reduced fetal movements
- when should you feel them: around 18 weeks then plateaus at 32. Less then 10 movements within 2 hours past 28 weeks needs further assessment
- Risk factors: posture sitting/standing, distraction, position baby or placenta, alcohol/opiates, obese, amn fluid volume, fetal size
- mx: handheld doppler. If heart beat then ctg 20 mins. If still concerned then uss within 24 hours. If no heart beat then immediate uss
If no movements by 24 weeks refer to maternal fetal med unit
antepartum haemorrhage - vasa praevia
- definition
- risk factors
- symptoms
- mx
antepartum haemorrhage - vasa praevia
- definition: umbilical cord runs across int os
- risk factors: ivf, multiple preg, low lying placenta
- symptoms: painless bleed, bradycardia
- mx: deliver 34-26 weeks, if fetus is already presenting can try push back into uterus to avoid compression. Or go on all 4 untils c section + tocolytics to stop contractions + fill bladder
Stages of preg - t1, t2, t3
gravida vs parity
t1: 0-12 weeks
t2: 13-26
t3: >27
gravida: total no preg
paritty: no times given birth after 24 hours
