Clinical Management of Pregnancy Flashcards
What is the defintion of antenatal care
is a planned examination and observation of the woman from conception till the birth
What is the risk of maternal mortality of northern europe compared to africa
the lifetime risk of death as a result of pregnancy or childbirth
Africa: 1 in 23
Northen europe: 1 in 7000
What is the difference between low risk and high risk women
How does NHS catagoirse women
Low risk
-no problems in previous pregancies
-no significant past medical history
-seen by midwife
-typically have less appointments
High risk
-significant past medical history
-problems
-usually have more appointments
-obestrictan care
How many antental appointments are given
7 appointments for women who have given birth
10 for first pregnancies
What is the commonest of maternal mortality
-thromboembolism
-pre-eclampsia + eclampsia
-cardiac disease
most causes are able to be prevented
Why did maternal mortality decrease from 1960
-improvements in nutrition, santiation
-antenatal care
-skilled attendants, antibiotics, banked blood and surgical improvements (drastically improved health)
What questions are on the antenatal form to work out if they are low or high risk
-mental health
-physical health
-risk factors
-social history :smoking drugs
-ethniciity etc
-
What happens at teh first appointment
advice
-folic acid supplementation
-reccommend vitamin D
-food hygeien (raw meat, unpastursied cheese)
-avoid vitamin A (retinol)
-lifestyle -talk about smoking cessation, drugs, alcohol (reccommend to cut it out
-avoid long haul flights (can cause deep vein thrombosis, because coagulation risk is higher)
-screening (HIV, hep B, urine testing)
-check blood group and rheusus status
-use booking weight to calucate drugs and check height and weight
-check urine dip for infection
-screen for women who have FGM (to ensure care is in place)
-look at sickcle cell, thalamseemia
rhesus negative -> give anti D later
If you have UTI in early pregnancy it increases risk of poor outcomes e.g.. Miscarriage
at around 18-20 weeks what happens at that scan
check for fetal anaomlies
Give examples of things that would make a woman high risk
endocrine disorders
autoimmune
malignant disease
HIV or HBV
obesity
severe asthma
haemtological disorders
renal disease
others inc drugs, vulnerable women
What can happen in a previous pregnancy that makes women high risk
-reccurent miscarrige
-preterm birth
-severe preecalmpsia
-rhesus
-uterine surgery inc c section
-still or neonatal death
-large for gestaonal age
-baby below 2.5 and above 4.5
What happens at 16, 25, 28, 31,34
around 25 weeks measure symphysis fundal height and continue until birth
subsuqent appointment: urine check, for proteinura, anaemia, blood pressure,
What is pre-aclampsia
-presents in third trimester (around 20 weeks)
-causes vasospasm -> which causes increase BP, headaches
coagulation -> leads to reduce platlets, and DIC leading to reduce organ perfusion
Kidney
-can cause odema
-reduced urine output
-proteinuria,
-hyperuricemia
Liver
-raised liver enxymes (cause epigastric pain)
Placenta
-can cause IUGR
-can cause abruption -> placenta comes of uterus wall
-fetal death
Brain
-occiptal love ischemia
-covulsions
-can lead to visual disturbances
How do we manage preaclampsia
-Anti-hypertensives e.g. labetalol,
nifedipine, (methyldopa, hydralazine)
-Fluid restrict (85 mls / hour)
-Magnesium sulphate to prevent and treat seizures
-Delivery – depending on how many weeks mother is
What factors can lead to poor antenatal care
- Poverty
- Illiteracy
- Population explosion
- Low socioeconomic status
- Poor health facilities (no big hospitals, with theatres, scanning, bloods, pain releif)
- transport to hospital
- Poor social status of woman
- Lack of political will
