Clinical Management of Pregnancy Flashcards

1
Q

What is the defintion of antenatal care

A

is a planned examination and observation of the woman from conception till the birth

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2
Q

What is the risk of maternal mortality of northern europe compared to africa

A

the lifetime risk of death as a result of pregnancy or childbirth

Africa: 1 in 23
Northen europe: 1 in 7000

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3
Q

What is the difference between low risk and high risk women

How does NHS catagoirse women

A

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

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4
Q

How many antental appointments are given

A

7 appointments for women who have given birth
10 for first pregnancies

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5
Q

What is the commonest of maternal mortality

A

-thromboembolism
-pre-eclampsia + eclampsia
-cardiac disease

most causes are able to be prevented

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6
Q

Why did maternal mortality decrease from 1960

A

-improvements in nutrition, santiation
-antenatal care
-skilled attendants, antibiotics, banked blood and surgical improvements (drastically improved health)

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7
Q

What questions are on the antenatal form to work out if they are low or high risk

A

-mental health
-physical health
-risk factors
-social history :smoking drugs
-ethniciity etc
-

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8
Q

What happens at teh first appointment

A

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

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9
Q

at around 18-20 weeks what happens at that scan

A

check for fetal anaomlies

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10
Q

Give examples of things that would make a woman high risk

A

endocrine disorders
autoimmune
malignant disease
HIV or HBV
obesity
severe asthma
haemtological disorders
renal disease

others inc drugs, vulnerable women

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11
Q

What can happen in a previous pregnancy that makes women high risk

A

-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

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12
Q

What happens at 16, 25, 28, 31,34

A

around 25 weeks measure symphysis fundal height and continue until birth

subsuqent appointment: urine check, for proteinura, anaemia, blood pressure,

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13
Q

What is pre-aclampsia

A

-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

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14
Q

How do we manage preaclampsia

A

-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

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15
Q

What factors can lead to poor antenatal care

A
  • 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
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16
Q

How do women die

A

-bleeding during childbirth
-infections
-lack of training
-transport to health facilities

tablets more affective to stop bleeding
need gloves, fluid, ABs,
need trained people to deliver healthcare, so people can have knowledge and skills to treat complications