Considerations from booking visit Flashcards
Who should be offered GTT just after booking visit?
Previous Gestational diabetes
Who should be offered GTT at 28 weeks?
- Prv Hx of GDM
- Previous fetus > 4.5kg
- Prv unexplained stillbirth
- 1st degree relative with GDM
- BMI > 30
- family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
advise for type 1 & type 2 diabetes
- High risk pregnancy: consultant led care
Risk to baby: high birth weight (problems with delivery), preterm labor, congenital abnormality
Risk to you: risk of pre-eclampsia, increased risk of CS & instrumental deliver
Diabetes: ↑ insulin requirements, diabetic nephroptathy & retinopathy
Importance of tight blood glucose control.
- Joint diabetes & antenatal clinic
- ↓ BMI (if over 27), smoking and alcohol
- Folic acid 5 mg
- Stop oral hypoglycaemic (except metformin) commence insulin
- Control BP (labetalol)
- Home monitoring ‘glucometer’ < 6 mmol/L
- 12 weeks aspirin 75mg daily
Fetus:
- Detailed 20 week scan: fetal echo
- Growth scans
- Delivery at 39 weeks
Maternal diabetic complications
- Renal function
- Retinae screened for retinopathy
Labour:
- Glucose measure hourly
Who should be offered 75 mg daily from 12 week - full term to reduce risk of pre-eclampsia.
women at high risk are those with any of the following:
- Prv hypertensive disease in preg
- chronic kidney disease
- autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
- type 1 or type 2 diabetes
- chronic hypertension
women with 1 + moderate factors: - first pregnancy - age 40 years or older - pregnancy interval of more than 10 years - body mass index (BMI) of 35 kg/m2 or more at first visit - family history of pre-eclampsia - multiple pregnancy
Name maternal conditions (not obstetric) that indicate additional care
obesity diabetes hypertension chronic disease (renal, autoimmune, resp) infections prev surgery VTE
Problems during this pregnancy that require additional care
multiple pregnancy small for gestational age placenta praevia gestational diabetes pre-eclampsia
Obstetric issues in previous pregnancy that indicate extra care
CS Preterm delivery recurrent miscarriage still birth pre-eclampsia GDM 3rd degree tear High parity & low interval pregnancy interval
Social factors that require additional care
Teenage pregnancy Maternal age > 35 Alcohol intake smoking substance misuse
If someone tells you they smoke.
Inform smoking is very bad for baby. Smoking can stop baby getting enough oxygen due to high levels of CO and nicotine in the blood. Can stop baby growing properly. Risk preterm, still birth, death.
- Advise on stopping, referal to smoking cessation services
- Measure CO blood level
At the first antenatal visit, urinalysis occurs & a it tests positive for nitrites and leucocytes but the mother is not experiencing any symptoms.
Describe further investigations and management.
= Asymptomatic bacteriuria:
- Take second urine sample for culture. If positive:
- Tx with 7 days of antibiotics.
Options in order of preference:
Amoxicillin 250mg TDS, 7D
Nitrofurantoin 50mg QDS 7D (do not use at term)
Trimethoprim 200mg BD 7D (Avoided in 1st trimester, if used must increase folic acid to 5mg)
- Send urine culture at every antenatal visit until delivery
What do you do if the urine culture is positive for group B streptococcus is isolated
Prophylactic antibiotics offered during labour
What does TORCH test for?
Which ones are routinely offered at booking visit?
Viral infections
Toxoplasmosis. (enters through mouth, cat litter, undercooked meat & raw eggs). Infants don’t show symptoms for many years.
Other (HIV, syphilis, Hep B, measles, mumps, chicken pox)
Rubella: causes a rash in adult, in child = heart defects, vision problems, delayed development
Cytomegalovirus: hearing loss, epilepsy, intellectual disability
Herpes Simplex: pass to infant: brain damage, breathing problems, seizure in 2nd week of life.
These disease can cross the placenta to cause birth defects in the newborn.
HIV, Hep B, Syphilis
If a women shows symptoms of any of these diseases during pregnancy.
Who receives serial growth scans?
any high risk pregnancy
A mid trimester (16-24 weeks) USS has showed a cervical length <25mm with no Hx of preterm birth. How would you manage this?
Offer prophylactic vaginal progesterone
A mid trimester (16-24 weeks) USS has showed a cervical length <25mm + Hx of P-PROM or cervical trauma
Cervical cerclage
