Embryology and Preconception Care (W/S 2) Flashcards
Why should men be involved in preconception care?
- They contribute ½ of genetic material.
Sperm take three months to develop. Sperm counts have gone down by over 25% in the last 50 years.
What medical history should be obtained during preconception care?
- PAP smear (cervical incompetence, Ca) anatomy
- Pre-existing medical issues
- Family history
- Genetic screening
Examples:
- Accidents/diseases affecting the pelvis
- Antibodies to Anti-D (miscarry) rhesus neg women who have partners who are rhesus positive
- Medical conditions reducing likelihood of falling pregnant
- Recent vaccination
- Dental health
What social history may be relevant to know during preconception care?
- Housing
- Previous/current trauma (e.g. DV)
- Age (teenagers are more likely to be anaemic, leading to IUGR, higher mortality AND >35 more risk of T21, GDM, SB - many obstetric issues)
- Cultural influences
What physical and wellbeing information should be covered during preconception care?
- Diet
- Exercise
- Avoid stress and practice relaxation
- Pelvic floor health
Consider BMI BMI less than 20 underweight 20-24.9 = desirable 25-29.9=overweight 30-34= obesity 35 and above severe obesity
*Example Question - “What supplements would you advise a woman to start taking before becoming pregnant and why?”
Folic acid for all women preconception
- 400–500 µg daily for at least four weeks prior to pregnancy and for the first 12 weeks of gestation
5 mg daily for at least four weeks prior to pregnancy and for the first 12 weeks of gestation
- (Encourage and support women to eat healthy foods containing folate alongside supplementation e.g. green leafy vegetables, broccoli, oranges, avocado, or fortified breads and cereals).
- Why? Prevention of NTD such as spina bifida and anencephaly.
Iodine
- Why? Essential for brain development and the nervous system.
- Encourage women with pre-existing thyroid conditions to seek advice from their doctor before taking an iodine supplement.
Any vitamins or minerals woman is deficient in, for example:
Iron - to prevent anaemia
Zinc - optomise fertility, important for oocyte (egg cell) development
Calcium - prevention of preeclampsia
What screening would you conduct / order for a woman planning to become pregnant?
BP baseline
- Weight
- Cardio/resp function
- TFT (thought field therapy) -cognitive
- Pap smear
- FBP - anaemia
- Vit D - bone devlopment
- HbA1C (to help diagnose and monitor people with diabetes, tells BSLs over last 2-3 months), BSL
- Screening for immunity to measles, mumps, rubella, varicella zoster and hepatitis B should be performed.
- Rubella booster - avoid pregnancy for 3 months
(higher risk for birth defects)
- Varicella-booster avoid pregnancy for 3 months (1 in 3
spont mis)
- *Other recommended vaccinations include diphtheria, tetanus and pertussis (dTpa), and influenza.
- MSU / Urine -underlying kidney issues
- TB
- Sexual screening
- Dental
When would you recommend a woman stop taking contraception if she is planning on becoming pregnant and why?
3 months prior
Stop hormonal – continue barrier methods until ready to conceive
Why?
- To regulate hormones, ensure synthetic hormones are out of system and replenish mineral stores
What advice regarding medication should be given to women planning on becoming pregnant, and why?
- Medication should avoid medication where possible, including over the counter/alternative therapies.
- Review any medications with doctor.
Most medicines cross the placenta.
There is a categorisation system for prescribing medicines in pregnancy. It takes into account the known harmful effects of medicines on the developing baby, including the potential to cause:
- birth defects
- unwanted pharmacological effects around the time of birth, which may or may not be reversible
- problems in later life
Toxins/chemicals present at home/workplace can be considered as part of preconception care such as:
- Smoking
- Alcohol
- Gases
- Infection
- Cats – someone else to change litter box (to avoid
toxoplasmosis) - Small children (cytomegalovirus)
- Lambs (chlamydiosis. toxoplasmosis, listeriosis, Q fever)
Preconception care checklist (RACGP & RANZCOG)
Diet
- Nutritional requirements including folic acid supplementation
- Advice on a healthy diet
Weight
- Measurement of body mass index and appropriate advice
Exercise
- Advise 150 minutes of exercise per week or 30 minutes on most days
Pregnancy history
- Screen for any modifiable risk factors
Genetic screening
- If indicated from personal/family history or ethnic background
Smoking/alcohol/illicit drugs
- Assess of intake and provide appropriate advice
Psychosocial aspects
- Screen for domestic violence
- Screen for mental health conditions
Medical conditions
- Review current disease status and medications
- Referral/correspondence with specialist if required
Environmental
- Assess work, home and recreational environments
Contraception/family planning
- Offer appropriate contraception advice for those not desiring pregnancy
Breast examination
Dental health check
Screening for sexually transmissible infections and other infectious diseases
Measles, mumps, rubella, varicella zoster, hepatitis B
Human immunodeficiency virus and hepatitis C with appropriate pre-test counselling
Cervical screening
What vitamin (supplement) should be avoided during pregnancy and why?
Vitamin A due to increased risk of miscarriage and CNS malformations.
Why should mercury containing fish be limited/avoided during preconception / pregnancy?
Increased risk of negative effects on fetal brain and CNS.
Embryogenesis has been completed by how many weeks?
8 weeks
Example exam question - “What supplements would you advise a woman to start taking before becoming pregnant and why?”
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