Integration day stuff Flashcards
Pregnancy checks
Blood pressure
FBC
Rhesus D status and antibody screen
Haemoglobinopathies
Ultrasound
Oral glucose in high risk groups
Pregnancy checks
Blood pressure
FBC
Urinalysis
Rhesus D status and antibody screen
Haemoglobinopathies
Ultrasound
Oral glucose in high risk groups
Ultrasound checks for baby
Viability - 6 weeks
Dating
Combined screening
all done before 14 weeks
What is combined screening used for?
Chromosomal abnormalities - nuccal thickness
95% accurate
Risk assessment when use
Vulnerbale mothers
Risk to self or others
MDT meeting - holistiic, shared decision making
What can sertraine cause in baby?
Persistent pulmonary hypertension
Withdrawal in baby
High risk mental health refer in pregnancy
Bipolar
Schizophrenia
Fmaily history of these esp related to pregnancy
Post natal risk factors that increase mental health
Lack of sleep
Stress of new responsibility
Physiological changes
Social isolation from normal life/routine
What medications for mental health are safe in pregnancy?
None - transplacental transfer
Breast feeding - if dont then withdrawal
Contraindicated mental health medications in pregnancy
Sodium valproate
Conditions for taking soidum valproate
Long term refractory bipolar
Long term contraception in place
Yearly check ups
Slight contraindication in pregnancy mental health
Lithium
Carbamazipine
New generation antipsychotics
What thoughts can be normal and not qualify as a depressive episode?
Suicidal, harming the baby
Low self esteem
What mental health condition can often occur after pregnancy and pose risk to baby and mother?
Depression and psychosis
What is quite safe in pregnancy?
ECT
SSRIs
What is quite safe in pregnancy?
ECT
SSRIs
MSE
Appearance
S
E
Perecption
Thoughts
Insight
Cognition
MSE
Appearance
Speech
Emotions
Perecption
Thoughts
Insight
Cognitione
Postpartum psychosis
Restless - pacing etc
Hallucinations/delusions
Where do mothers with significant mental health problems to?
Mother and baby units
Target for referral for new mother mental health issue
2-4 weeks
Signs of domestic abuse in pregnancy
Multiple DNAs
Late presentation
Multiple presentations with vague symptoms and no findings
Demeanour
When do you have to refer for safeguarding?
Pregnancy or child involved
Risk of public harm eg violence, STI and not getting treatment, driving
When women involved on own get consent, if none then still alert
What can tocophobia lead to?
Intense dread of children that can lead to:
Women avoiding pregnancy
Terminating an otherwise wanted pregnancy
Demanding a C section in fist or subsequent pregnancies
Impact of tocophobia
May decrease chance of uncomplicated vaginal delivery
May preduct postntala depression
Psychological input beneficial - counselling/CBT
Elective X section
What is primary tocophobia?
Nulliparous women
Transmission of fear of childbirth over generations
History of sexual assault or traumatic gynaecological examination
What is secondary tocophobia
Following prev traumatic delivery
Occurs with depressive illness, anxiety or PTSD
What website to use for teratogenic drug check?
BUMPs - Best use of medicines in pregnancy
What can sodium valproate cause in a foetus?
Foetal Valproate Syndrome - FVS
What does foetal valproate syndrome cause?
Birth defects
Lifelong alterations to learning and behaviour
Ranges from mild to serious
Birth defects linked to exposure to sodium valproate in the womb
spina bifida, heart defects, cleft lip and palate, hypospadias (where the hole in the penis is in the wrong place), and abnormalities of the finger
ASD, ADHD
When is most risky time to take teratogenic drug in prengnanxy?
First 12 weeks - internal organs form
Any stagenfor neurological comps incl learning and behavioural chages
Can you cannulate pregnant women in emergency situations with severe needle phobia?
Yes - deemed not to have capacity as needle phobia dominating thinking - amounts to involuntary compulsion therefore should not be prevented from safe delivery because of this. Most of the time patient is too unwell to consent anyway.
