Clinical Management of Pregnancy and Parturition Flashcards
Define antenatal care
a planned examination and observation of a woman from conception till the birth
What is antenatal care trying to prevent?
- maternal and perinatal mortality and morbidity
- ## maternal mortality is the health indicator that shows the greatest differential between developing and industrialised counties
Why is antenatal care important?
- To ensure that the pregnant woman and her foetus are in the best possible health
- to detect early and treated properly complications, identify women at risk and give midwife of obstrecian led care accordingly
- offering education for parenthood
- to greater the woman for labour, lactation an care of her infant
Why do mothers die in the UK?
- thromboembolism
- pre-eclampsia and eclampsia
- cardiac disease
What has changed the trend in maternal mortality in the UK?
- imporvements in nutrition and sanitation
- antenatal care
- skilled attendant, antibiotics, banked blood, surgical improvements
What is the green booklet?
An antenatal booklet given to every pregnant woman in the UK
Assess physical/social risk factors associated with her pregnancy
Which women receive additional antenatal care in the NHS?
- previous problems in pregnancy
- hypertensives
- diabetics
- complex social factors
- preexisiting medical conditions
- multiple pregnancy (twins/triplets)
- interventional procedures for some complications in pregnancy
What are the basic principles of antenatal care?
- midwives and GPs take care of uncomplicated pregnancies
- appointment location should be easily accessible
- maternity records should be structured, standardised, national maternity records helming by the woman
- uncomplicated pregnancies, 10 appointments for nulliparous women, 7 for parous women
- each antenatal appointment should have a structure and focus
- where possible, incorporate routine tests into appointments
- women should be comfortable to discuss sensitive issues and disclose problems
What are the NICE guidelines for the first contact with a healthcare professional?
Give specific information on:
- folic acid supplements
- food hygiene, including how to reduce the risk of food-acquired infection
- lifestyle, including smoking cessation, recreational drug use and alcohol consumption
- all antenatal screening, including risks, benefits and limitations of the screening tests
What new screening programmes have been introduced?
Screening for haematological conditions - sickle cell, thalassaemias Screening for foetal anomalies - regional congenital anomaly registers - combined test: bhCG, PAPP-A, nuchal translucency
What examinations are routinely performed on women?
- blood pressure every visit
- sonicaid –> foetal heart rate
- symphsiofundal height
Describe symphysiofundal height
at 20 weeks, the uterus is at the level of the umbilicus
every cm = 1 week
32cm = 32 weeks
What lifestyle advice should we give pregnant women?
- Work - continue working, identify risk of occupation, maternity rights and benefits
- Nutritional supplements - not VitA, no multivitamins, 400mg folic acid, Vit, no iron supplementation
- Avoiding infection: toxoplasmosis, salmonella, listeria
- Medicines - prescribe as few medications as possible, use OTC’s as little as possible
How is preeclampsia diagnosed?
raised blood pressure (>140/90 mmHg)
proteinuria (at least 1+ on urine dipstick testing)
presents after 20 weeks
What happens in preeclampsia?
Reduced organ perfusion = vasospasm, increased BP, headaches, coagulation, reduced platelets, DIC Kidneys - reduced urine output - proteinuria - hyperuricaemia - oedema Liver - raised liver enzymes - liver capsule stretch Placenta - IUGR - abruption - fetal death Brain - occipital lobe ischaemia - convulsions -
