Antenatal Screening Flashcards
Cardiac physiology of pregnant women?
- Cardiac output increases by 30-50%
- Blood pressure drops in 2nd trimester (expansion of uteroplacental circulation, fall in systemic vascular resistance)
Urinary physiology of pregnant women?
- Increased urine output (increased renal plasma flow)
- UTI (can be associated with preterm labour, must treat)
Blood physiology of pregnant women?
- Anaemia (plasma volume up, RBC up but not as much)
- Iron requirements increase by 1g during pregnancy
- WBC increases slightly
Respiratory physiology of pregnant women?
- Progesterone reduces CO2
- O2 consumption increases
- Plasma PO2 unchanged
GI physiology of pregnant women?
- Oesophageal peristalsis reduced
- Gastric emptying slows, cardiac sphincter relaxes (GORD + heartburn)
- GI motility reduced (constipation)
What are the general aspects of pre-pregnancy counselling?
- General health - Smoking, alcohol, diet, BMI
- Folic acid optimisation
- Up to date cervical smear
- Optimise maternal health - control existing conditions e.g. diabetes
- Stop/change unsuitable (e.g. ACEi, sodium valproate)
- Advise regarding complications
- Advise against pregnancy if significant risk to maternal health
How to monitor/manage Pre-eclampsia?
Aspirin 150mg during pregnancy and regular BP check
How to monitor/manage Gestational diabetes?
HbA1c at booking and OGTT at 28 weeks
How to monitor/manage Previous C-section?
Consider elective C-section or vaginal birth after C-section (VBAC)
How to monitor/manage DVT or PE?
Consider antenatal thromboprophylaxis and 6 weeks postnatal treatment
How to monitor/manage Intrauterine growth restriction?
Aspirin 150mg during pregnancy and serial US scan
How to monitor/manage Preterm birth?
Consider transvaginal cervical length scan or cervical suture
What infections are screened for in antenatal care?
Hep B
UTI
Syphilis
HIV
How to monitor/manage these infections?
Hep B - passive and active immunisation for the baby
UTI - take MSSU
Syphilis - Penecillin
HIV - Maternal treatment and careful planning reduces risk of vertical transmission
What blood disorders are screened for in antenatal care?
Iron deficiency anaemia
Haemolytic disease of newborn
Rhesus -ve women can attack Rhesus +ve baby. They are offered anti-D at 28 weeks and/or following any sensitising event (e.g. vaginal bleeding, amniocentesis) to reduce the risk of passage of antibodies.