Antepartum care Flashcards
Name 3 investigations to do in prepregnancy counselling
Rubella and varicella serology, Pap smear
Name 3 common medications that are C/I in pregnancy and what alternative management you can use for a woman on these medications
Sulfonylureas - switch to metformin or insulin
Warfarin - switch to enoxaparin
Sodium valproate - can cease Rx if no seizure for > 2 years
Name 2 comorbid medical conditions where pregnancy is C/I (as prognosis for mother is terrible)
Pulmonary HT
Severe renal failure (creatinine > 0.3)
Name 2 pieces of pharmacological and behavioural advice to give women in prepregnancy counselling
Pharmacological - folate supplements (500mg for 3 months before pregnancy), avoid teratogenic drugs
Behavioural - how to get pregnant (frequent intercourse up to ovulation), cease alcohol/smoking etc
What are the 6 main steps in the first antenatal visit?
Confirm pregnancy Confirm gestational age Screen for problems Manage problems Give general advice Make bookings
Name 4 things on Hx suggestive that a woman is pregnant
Missed period
Increased urinary frequency
Nausea
Breast tenderness
At what gestational ages should you be able to tell that the woman is pregnant on abdominal vs vaginal exam?
Abdominally - 12 weeks
Vaginally - 8 weeks
Name 1 Ix to do in a first antenatal visit
Serum beta-HCG
Why is serum beta-HCG more accurate than urine beta-HCG?
Urine beta-HCG crossreacts with LH = greater false positives (also is only a qualitative, not quantitative reading)
What are two ways of determining the gestational age of a foetus? Which is more accurate?
Menstrual dating (Naegele’s rule) - 9 months + 1 week from last normal menstrual period (to estimate delivery date)
U/S scan - more accurate, menstrual dating affected by irregular cycles or if woman is on hormonal contraception
What is Naegele’s rule?
A way of estimating the gestational age of a foetus from menstrual dates - add 9 months + 1 week from last normal menstrual period to estimate delivery date
What U/S parameter is most accurate at determining the gestational age of a foetus between 6-12 weeks, and between 12-20 weeks? Why the difference?
6-12 weeks - crown rump length
12-20 weeks - biparietal diameter. CRL not as accurate as foetus starts to flex and extend head
Is U/S as accurate at determining gestational age of a foetus above 20 weeks as it is when foetus is
No - foetuses will all grow the same rate up to 20 weeks, but not beyond (depending on size of mum)
What are the 6 main types of investigations you should order for a woman in her first antenatal Hx/during the first 20 weeks of pregnancy? Give examples of each type
Blood tests (haematological) - Hb, platelets, MCV (look for thallassaemia)
Blood bank - blood grouping, screen for ITP antibodies
Microbiology/serology - rubella, varicella, syphilis, HBV, HCV, HIV, MSU MCS (asymptomatic bacteriuria)
Cytology - pap smear
Biochemistry - tests for Down Syndrome (PAPP-A and beta-HCG, or NIPT)
Imaging (U/S) - 12 week nuchal translucency and 19 week morphology
Name 7 pieces of general/lifestyle advice you can give a woman in her first antenatal visit
Diet - avoid raw poultry, mayonnaise, soft serve icecream, unpasteurised milk (risk of listeria)
Mineral/Vit supplementation - potential need for Fe, Calcium, Vit D, Folate, iodine, multivitamin supplements
Exercise - moderate exercise good, strenuous can = foetus SGA
Smoking and alcohol - no no
Sex - OK!
Work - most usually work until 34 weeks unless complication
Medications - paracetamol, metoclopromide (Maxalon), penicillins OK
