blood tests in pregnancy- screening for diabetes, UTI and anaemia Flashcards
what are the main appointments pregnant ladies will have?
booking clinic at 10 weeks to offer baseline assessment and plan the pregnancy
10-13 weeks- dating scandal
16 weeks- antenatal appointment to discuss future appointments
18-20 weeks- anomaly scan
when would they do the glucose tolerance test and for who?
- 24-28 weeks
when do they give anti-D injections?
28-34 weeks
which things are covered ate every antenatal visit?
- Symphysis–fundal height measurement from 24 weeks onwards
- Fetal presentation assessment from 36 weeks onwards
- Urine dipstick for protein for pre-eclampsia
- Blood pressure for pre-eclampsia
- Urine for microscopy and culture for asymptomatic bacteriuria
which type of vaccines should be avoided in pregnancy?
Live vaccines, such as the MMR vaccine, are avoided in pregnanc
which 2 vaccines are offered to all women?
Whooping cough (pertussis) from 16 weeks gestation Influenza (flu) when available in autumn or winte
how much folic acid is recommended to be taken and from when?
Take folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
how much vitamin D is it recommended to take in pregnancy?
Take vitamin D supplement (10 mcg or 400 IU daily)
which supplement should be avoided in pregnancy?
Avoid vitamin A supplements and eating liver or pate (vitamin A is teratogenic at high doses)
what type of dietary advice should be given to pregnant women?
void unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (risk of salmonella)
when is flying allowed in pregnancy?
The RCOG advises flying is generally ok in uncomplicated healthy pregnancies up to:
37 weeks in a single pregnancy
32 weeks in a twin pregnancy
After 28 weeks gestation, most airlines need a note from a midwife, GP or obstetrician to state the pregnancy is going well and there are no additional risks.
- there is increased risk of VTE
why are NSAIDS not recommended in pregnancy?
NSAIDS are generally avoided in pregnancy unless really necessary (e.g. in rheumatoid arthritis).
They are particularly avoided in the third trimester, as they can cause premature closure of the ductus arteriosus in the fetus. They can also delay labour.
prostaglandins usually keep the ducts open, soften the cervix and induce contractions
what are the risks of taking beta blockers?
Beta-blockers can cause:
Fetal growth restriction
Hypoglycaemia in the neonate
Bradycardia in the neonate
- -but labetalol is used in pre-eclampsia
what is the effect of ACE inhibitors on the foetus?
ACE inhibitors and ARBs, when used in pregnancy, can cause:
- Oligohydramnios (reduced amniotic fluid)
- Miscarriage or fetal death
- Hypocalvaria (incomplete formation of the skull bones)
- Renal failure in the neonate
- Hypotension in the neonate
it crosses the placenta and mainly affects fetal kidneys
A mother was taking opiates in pregnancy- baby develops with irritability, tachypnoea high temp and poor feeding the next morning- what is it?
neonatal abstinence syndrome (NAS). NAS presents between 3 – 72 hours after birth with irritability, tachypnoea (fast breathing), high temperatures and poor feeding.
what is the risk of taking sodium valporate?
in pregnancy causes neural tube defects and developmental delay.
why is lithium avoided in the first trimester?
Ebstein’s anomaly, where the tricuspid valve is set lower on the right side of the heart (towards the apex), causing a bigger right atrium and a smaller right ventricle.
can lithium be used in breast feeding?
no- toxic to baby
what is the risk of taking warfarin in pregnancy?
- Fetal loss
- Congenital malformations, particularly craniofacial problems
- Bleeding during pregnancy, postpartum haemorrhage, fetal haemorrhage and intracranial bleeding
how often should lithium be monitored if it is used in pregnancy?
every four weeks, then weekly from 36 weeks
what are the risks of taking SSRI in pregnancy?
- First-trimester use has a link with congenital heart defects
- First-trimester use of paroxetine has a stronger link with congenital malformations
- Third-trimester use has a link with persistent pulmonary hypertension in the neonate
- Neonates can experience withdrawal symptoms, usually only mild and not requiring medical management
how long do you give abX in pregnancy if someone has UTI?
7 days
what are the options of abs for a UTI in pregnancy?
Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin
why is nitrofurantoin avoided in the third trimester?
risk of neonatal haemolysis (destruction of the neonatal red blood cells).
why is timethoprim avoided in the first trimester?
its a folate antagonist- can lead to spina bifida
what is the management for women that have had GBS detected in a previous pregnancy?
- there is a 50% chance they will have GBS in this pregnancy
- they should be tested in late pregnancy and given interpartum antibiotics if positive again- offered at 35-7 weeks
