Identifying women at risk of complications Flashcards
Women at risk of pre-eclampsia major indicators
HTN during pregnancy CKD AID (SLE/APLS) DM Chronic HTN
Treatment for women at risk of pre-eclampsia
75mg aspirin OD
w/dinner (no impact on delivery but for routine)
Moderate risk of pre-eclampsia
Need 2 mod. RF to treat:
- primip
- > 40yo
- pregnancy interval >10y
- BMI >35 at booking
- FHx pre-eclampsia
- multifoetal Hx
Pre-eclampsia screening for all women
Every antenatal visit BP and urinalysis
Women at risk of preterm birth
Previous preterm
Previous late miscarriage
Multifoetal Hx
Cervical sx (cone biopsy)
What do you offer women at risk of pre-term birth
serial cervical length screening +/- foetal fibronectin
Womwn at risk of foetal growth restriction
Recommend SFH measurements at every appointment from 24wks
If concerns USS
Women at risk of vitamin D deficiency
NO routine screening Risk groups (skin colour, obesity) offered cholecalciferol
NICE recommendation for pregnant and breastfeeding women wrt vitamin D
10ug supplement daily
Second trimester: what is used to find women at risk?
Anomaly scan (20-22w) GDM screening
Conditions assessed using anomaly scan
Spina bifida
Major congenital anomalies
Diaphragmatic hernia
Renal agensis
Assessment of GDM risk
RFs: prev. GDM, prev. macrosomia, high BMI, first-degree relative, asian, black, middle-eastern
Diagnosis GDM
Fasting glucose >5.6mmol/L
2-hour plasma glucose >7.8mmol/L
If RFs of GDM present?
2 hour 75g OGTT at 24-28wk
Summary of USS schedule
10-14wk: dating, multiple preg., NT as part of screening
18-21wk: structural anomalies, offer reproductive choice
Sensitising events in Rh-ve women T1
Foetal blood volume small so sensitisation unlikely
Anti-D only indicated in ectopic, molar, TOP and heavy/repeated uterine bleed+adbo pn
250iU given
12-20 weeks Mx of sensitising events
Minimum 250IU within 72hrs
Kleihauer test, give more anti-D if indicated
> 20wks Sensitising events management
Minimum 500IU within 72hrs
Kleihauer to dtermine dose
Summary of Rh Sensitising events
Delivery of Rh+ve infant any TOP Miscarriage >12wks Ectopic managed surg. External cephalic version Antepartum haemorr. Amnio/CVS/FBS Abdo trauma
