Antenatal screening Flashcards
_____ is the process of identifying apparently healthy people who may have an increased chance of a disease or condition.
Screening
Antenatal
Anytime during pregnancy up until delivery
Puerperium
6 week period after delivery
Liquor
Amniotic fluid around the baby
Lochia
Normal blood loss after delivery
Intrapartum
Delivery of the baby
What are some infectious diseases screened for in pregnancy?
HIV
Heb B
Syphilis
Why are blood tests conducted in antenatal appointment?
Screening for sickle cell and thalassaemia screening.
What are some risks that could be identified and acted on during pregnancy?
Venous thromboembolism
Pre-eclampsia and hypertension
Gestational diabetes
Foetal growth
Pre-existing medical conditions
Mental health
What are some important risks of smoking to pregnancy?
Premature birth
Increased miscarriage
(affects blood flow through placenta)
What is response to pregnant smokers?
Smoking cessation advice
Growth scans
How is pre-eclampsia or Pregnancy Induced Hypertension (PIH) managed?
Aspirin throughout pregnancy
Expedited delivery (37 weeks) if pre-eclampsia diagnosed.
How is gestational diabetes managed?
Growth scans
Diabetes team
What are risk factors for Post-Partum Haemorrhage?
High BMI
Previous PPH
When are the routine dating scans done?
11+2 to 14+1 weeks
Nuchal translucency done here
When are anatomy scan done?
18+0 to 20+6 weeks
Screens for 11 crucial structurally visible conditions
What is the most common cause of death in maternal mortality in the UK?
VTE
What is maternal death defined as?
Death of a patient while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by pregnancy or its management.
Stillbirth rate increases according to the level of _____
deprivation
True or false: both progesterone and oestrogen spike just before childbirth and then drop down.
True
Immediately following delivery, uterus contracts to what level?
The level of umbilicus
Fundal height decreases in size by _cm per day post birth
1cm
The uterus returns to pre-pregnancy size at _ weeks
6
the muscle layer of the uterus reduces to normal thickness post-birth through ischaemia, a_____ and p_____
autolysis
phagocytosis
Decidua is shed as ____
lochia
GP checks up postnatally at _ weeks
6 weeks
Sepsis red flags
Supplemental oxygen required
High heart rate
High resp rate
High lactate
Purpuric rash
Low systolic bp
V or less on AVPU
What are the Give 3, Take 3 of managing sepsis?
Give Fluids
Give Oxygen
Give antibiotics
Take cultures
Take lactate (blood tests)
Take fluid balance (accurate hourly monitoring)
Primary PPH is over 500ml blood loss within what time frame?
24 hours of delivery of the baby
Minor PPH is estimated blood loss (EBL) or less than _____mls and no clinical signs of shock
1000mls
Major PPH definition
EBL of 1000mls + and continuing to bleed or clinical shock
For patients of 70kg, blood loss of more than __% of their total blood volume is generally regarded as life threatening
40%
Secondary PPH is abnormal or excessive bleeding between 24 hours and __ weeks postnatally
12
Causes of Primary PPH
4 Ts:
Tone - uterine atony
Tissue - retained placental tissue
Trauma - damage to reproductive tract eg tears
Thrombin - coagulopathies
Managing Primary PPH
A to E approach
IV access (2 wide bore cannulae)
Identify and treat cause
Lab bloods
Crossmatch at least 2 units.
How to manage primary PPH caused by tone
Bimanual compression, oxytocin analogues
Surgical measures
Common Causes of Secondary PPH
Endometriosis (uterine infection)
Retained placental fragments
Abnormal involution of placental site
Arteriovenous malformations
Managing secondary PPH
A to E approach if haemodynamically unstable.
Assess blood loss and full examination
Send swabs
Pelvic USS
Risk factors of VTE are scored using…
TRAF system
TRAF system allows risk stratification to guide whether to give prophylactic _____
dalteparin
How long is dalteparin given for in those with high TRAF score?
6 weeks
How long is dalteparin given for in those with an intermediate TRAF score?
10 days
How long is dalteparin given for in those with lowTRAF score?
No dalteparin prescription
What is definition of pre-eclampsia?
Hypertension
Significant proteinuria (> 300mg in 24 hours)
> 20 week gestation
What is eclampsia?
Seizure that occurs if pre-eclampsia worsens
What is monitored in those identified with pre-eclampsia?
Blood pressure
What medication is commonly used for blood pressure in those with pre-eclampsia
labetalol
What medication is given if eclampsia develops?
MgSO4
What are Baby Blues?
Brief period of feeling emotional/ tearful 3-10 days after giving birth.
Very common.
What is post-natal depression?
A depressive episode within first 12 months postpartum
Less common
Severity various
What is Puerperal psychosis?
Severe form of mental illness which usually starts days to weeks following delivery
Presentation variable
About 1 in 1000
Rate of recurrence is about 50%
