Exam 3- pregnancy Flashcards
When does the booking visit typically occur?
Before 12 weeks gestation
Bloods taken at booking visit (5)
Full blood count ABO/Rh Red cell alloantibodies Haemoglobinopathies Coagulation screen
When is the dating scan carried out?
8-14 weeks. Confirms viability, number of foetuses, gestational age (crown-rump length)
Downs risk assessment
a) before 14 weeks
c) between 14 and 20 weeks
a) combined test- nuchal thickness + hCG/PAPP-A
b) quadruple test (hCG, AFP, uE3, inhibin A)
Further investigations for Downs syndrome
a) after 12 weeks
b) after 15 weeks
a) CVS
b) amnio
When does the anomaly scan take place?
18-21 weeks
First-line treatment for antenatal nausea and vomiting
Antihistamines (e.g.promethazine)
Recommended folic acid intake in pregnancy?
400 micrograms/day (5mg in those taking anti-epileptic drugs)
Definition of small for gestational age
Birthweight less than the 10th percentile
Methods of assessing foetal growth
Symphyseal-fundal height (in cm should roughly correspond to gestational age)
Ultrasound
Normal cardiotocography patterns (3)
Rate 110-160bpm
Baseline variability 5-25bpm
Accelerations associated with movements/contractions
Worrying sign on CTG
Late decelerations
What does umbilical artery doppler measure? What is an adverse sign?
Flow in the umbilical artery;
reduced or reversed end-diastolic flow (suggests placental resistance)
Diagnosis of multiple pregnancy (2)
Usually at dating scan
High AFP and exaggerated pregnancy symptoms
Blood pressure changes in pregnancy
Falls to nadir at about 22-24 weeks, rises again steadily until term
Risks associated with pre-existing hypertension in pregnancy (3)
Pre-eclampsia and eclampsia
Growth restriction
placental abruption
Triad of pre-eclampsia
Hypertension
Proteinuria (more than 0.3g/l)
Oedema
What is HELLP syndrome?
Complication of pre-eclampsia
Stands for haemolysis, elevated liver enzymes, low platelets
Drugs used to control hypertension and their class/mechanism (4)
Methyldopa (central alpha agonist)
Labetolol (alpha and beta antagonist)
Nifedipine (Calcium blocker)
Hydralazine (vasodilator)
What is eclampsia?
Tonic-clonic seizures with hypertension in pregnancy
Management of pre-eclampsia (2)
IV labetalol/hydralazine
Magnesium sulfate for seizures
Why should the use of ergometrine in the third stage be avoided in eclampsia?
Can further increase the blood pressure
Management of pre-existing diabetes in pregnancy (4)
Stop all oral hypoglycaemics except metformin
Commence insulin
Folic acid 5g/day
Detailed anomaly scan at 20 weeks
Screening for GDM- diagnostic values?
OGTT close to booking appointment
a) fasting- more than 5.6
b) 2 hour- more than 7.8
How should GDM be managed? (2)
Trial of diet and exercise if fasting glucose is less than 7.0
If targets arent met, or initial fasting glucose is more than 7- Metformin + insulin
Complications of diabetes in pregnancy
a) maternal (3)
b) neonatal (5)
a) polyhydramnios, pre-eclampsia, pre-term labour
b) malformation risk, neonatal hypoglycaemia, macrosomia + shoulder dystocia, RDS
Potential causes of jaundice in pregnancy (3)
Intrahepatic cholestasis of pregnancy
Acute fatty liver of pregnancy
HELLP syndrome
Features of acute fatty liver of pregnancy (3)
Raised ALT
Abdominal pain
Jaundice
Why is vitamin K prescribed in intrahepatic jaundice of pregnancy?
Cholestasis leads to impaired fat absorption, and vit K is fat soluble
What process does bilirubin undergo to make it water soluble?
Conjugation with glucoronic acid
How is rhesus sensitization prevented routinely?
anti-D immunoglobulin. Either:
a) 2x500 at 28 and 34 weeks
b) 1500 at 28 weeks
How are anti-D antibodies detected in rhesus negative women?
Indirect Coombs test (womens serum with antibodies, and donor rh+ samples)
Clinical presentation of haemolytic disease of the newborn (4)
Jaundice
Hepatosplenomegaly
Kernicterus
Hydrops fetalis
What is kernicterus?
Bilirubin encephalopathy
Management of haemolytic diease of the newborn
a) in utero
b) post-natal (2)
a) intra-uterine transfusions
b) tranfusion, phototherapy
Hypertension in pregnancy occuring before 20 weeks is…
Pre-existing hypertension
