Antenatal Progress Flashcards
1
Q
What is essential to know prior to pregnancy/booking visits?
A
- Age, PMH + surgical hx, MH, allergies
- Smoking (in last 12 months), alcohol, anyone smoke at home, drug use
- Any previous pregnancies?
- Regular periods (LMP) or problems with sexual intercourse
- What is her weight?
- FH of any conditions or problems in pregnancy
- Ethnicity - some ethnicities are more likely to have haematological issues e.g. sickle cell, certain countries have higher risk of FGM
- Include psychological hx - mental health disorders increase risk of postpartum depression/psychosis
- Past obs and gynae hx, including smears
2
Q
What advice do you give to women for pregnancy?
A
- Optimise health prior to pregnancy e.g. weight loss, or assess chronic health conditions
- All women should be recommended dietary supplementation with folic acid and some Vit D supplements
- Asian women have increased chance of vit D deficiency due to decreased sun exposure - offer vit D supplementation
- Folic acid supplementation is recommended - higher dose with high BMI, prvious hx or FH of NTD, taking AEDs, diabetes or other medical problems (bowel disease)
- Anyone with medical problems e.g. diabetes, epilepsy, cardiac/respiratory/GI disease or psychiatric disorder would ideally seek pre-pregnancy counselling where health can be optimised for pregnancy
3
Q
What are high risk factors for complications?
A
- Advanced maternal age i.e. >/= 40 or low age <20
- Hx of any medical problems
- Previous surgery
- IVF treatment
- Previous caesarean section
- Previous problems in pregnancy e.g. HTN, growth restriction, diabetes, fetal abnormalities
4
Q
What is a booking appointment?
A
At 8 weeks, mum attends booking appointment with midwife:
- Measures BP and does urine sample + blood tests
- Tests for Hb, platelets, infections (HIV, syphilis, HepB), blood group and antibody status, rhesus status, sickle cell and thalassaemia (if high risk)
5
Q
What check-up is done at 12 weeks?
A
- Attends dating scan where an USS is done and the due date is estimated - takes ~15 mins, but can take 45 mins if complications
- Checks baby is growing well and exclude abnormalities like spina bifida or heart defects
- Check nuchal translucency for Down’s syndrome, if positive, offer ‘combined test’ which is nuchal translucency, PAPP-A and HCG
- If nuchal translucency unavailable can do quad test - blood test checking for AFP (alpha-fetoprotein), inhibin A, oestriol and Beta-HCG (done at 14-20 wks pregnancy)
- Diagnostic test - chorionic villus sampling or an amniocentesis
- There is cell free foetal DNA tests available privately (non-invasive)
6
Q
What check-up is done at 20 weeks?
A
- Anomaly USS
- Checks heart, brain, kidneys, bladder etc for abnormalities
7
Q
What check-up is done at 26 weeks?
A
- Glucose tolerance test (GTT)
- GTT is done if booking appointment shows woman at high risk
- High risk: BMI >30, certain ethnic groups e.g. Black-African, Indian, 1st degree FH, PCOS, previous baby >4.5kg at delivery, previous gestational diabetes
- 2hr glucose >/= 7.8 mmol/l OR fasting glucose >/=5.6 - indicates gestational diabetes
8
Q
What are the physiological changes of early pregnancy?
A
- Anaemia - greater plasma to RBC ratio causes this
- Increased CO - more blood to placenta (due to increased HR + SV)
- Increased red cell volume
- Hypotension
- Slight hyperventilation - increased tidal volume (more diaphragmatic breathing)
- Increased plasma volume > peripheral oedema
- Increased clotting factors and reduced anticoagulant factor Protein S (hypercoagulable state > DVT)
9
Q
Why is age a risk factor in pregnancy?
A
- Women at extremes of age e.g. <18yrs or >40yrs are at a higher risk of having problems with the growth of their baby
- Women >40 are more likely to have other health problems or develop health problems in their pregnancy such as high BP or diabetes
- Extra growth scans or tests can be arranged to identify these problems early if they arise
10
Q
Why is ethnicity a risk factor in pregnancy?
A
- Certain ethnicities are at increased risk of diabetes and may be offered screening tests for this
- Some ethnicities are more likely to have haematological disorder such as Thalassaemia or Sickle Cell Disease therefore blood tests are offered based on a family origin questionnaire women are asked to complete
- Women from certain countries are high risk for FGM and it is important to identify this
11
Q
What events in a previous pregnancy could impact on the current?
A
- Premature labour
- Fetal growth restriction
- Antepartum haemorrhage
- Gestational HTN/pre-eclampsia, diabetes, thrombocytopenia
- Type of delivery - caesarean section, forceps, ventouse
- 3rd or 4th degree tear
- Postpartum haemorrhage
- Previous stillbirth, late miscarriage or neonatal death
12
Q
Why is Rhesus -ve a problem in pregnancy?
A
- Any woman who is Rhesus-D Negative has a risk of Rhesus disease of the newborn. If a fetus is Rh +ve, then the mother will produce anti-rhesus antibodies. These antibodies will destroy rhesus +ve foetuses that occur later on from further pregnancies.
- Mothers are counselled to report potential ‘sensitising events’ which may increase passage of fetal blood cells into the maternal circulation, where a reaction may take place.
- Giving anti-D can prevent the mother from making her own anti-rhesus antibodies that could destroy future fetuses
13
Q
What are sensitising events for rhesus?
A
- Spontaneous miscarriage
- Termination of pregnancy
- Invasive procedures
- Traumatic events
- Placental abruption
- Fetomaternal haemorrhage
- Blood transfusions
14
Q
What is given to protect rhesus mothers and fetuses?
A
- The passage can occur without any warning so prophylactic Anti-D (1500iu dose) given at 28 weeks.
- 2nd dose given at 34 weeks
- The Kleihauer-Betke test detects the presence of foetal red cells in maternal circulation. If there is >5ml estimated feto-maternal haemorrhage then a further dose of anti-D is needed
- Baby’s blood tested at birth - if also Rh -ve then risk is very low
15
Q
How do you measure the Symphysis-Fundal Height (SFH)?
A
- Make sure the mother has emptied bladder as this can add 2-3cm onto measurement
- Find the top of the belly where the baby starts by palpation. The highest point may not always be in the midline, it could be displaced more left or more right, depending on how the uterus was aligned before pregnancy.
- Keeping a hand there, find the pubic symphysis
- Measure the distance with a tape measure
- If height is inconsistent with normal growth chart (customised to maternal height, weight and ethnicity), then refer mother for USS to determine foetal estimated height
