Maternal wellbeing (review) Foetal development and wellbeing ….as the foetus grows and develops

Question 1

What does preconceptial care include?

When is the embryo at most risk?

Answer 1

Identifying potential enviromental toxin exposure in women and men along with avoidance advice

Embryo is most at risk when women dont know theyre pregnant.3-14/40 most susceptible period

Question 2

What is the difference between structural and functional abnormalities ?

Answer 2

Structural abnormality = problem with body parts i.e cleft lip, NTD

Functional abnormality= how a body part or system works i.e developmental disabilities

Question 3

What can anti-epileptic drugs do to the embryo?

Answer 3

Cleft lip and palate

Question 4

What can rubella do to the developing foetus?

Answer 4

20% risk if contracted during early pregnancy = cataracts; heart defects; mental retardation

Question 5

What foods must you avoid when pregnant? What is the risk associated with them?

Answer 5

mould-ripened soft cheeses & blue-veined cheese due to listeria bacterium and associated risks of miscarriage, stillbirth and sick neonate

Question 6

What can toxoplasmosis cause? Where is it found?

Answer 6

can cause miscarrage; found in soil; don’t change the cat litter!

Question 7

What particualr histories do you need obtain in a pregnant woman?

Answer 7

CVS/Blood : Hx of CVS disease; BP; Iron; Anaemia; Hx of thrombosis; Travel advice; Regular blood tests

Respiratory: Hx of respiratory disease; smoking

Urinary/Renal: Hx of renal disease; urinalysis; BP; Bloods; oedema

Glucose metabolism: Risk assessment; weight; nutrition; exercise; screening for GDM

Question 8

How often does hyperemesis gravidarum in pregnancies?

Answer 8

3.6 % of pregnancies

Question 9

How long does frequent micturition occur in pregnancies? Why does it occur?

Answer 9

Frequency of micturition due to the vascularity of the bladder and lasts until about 16/40 when the gravid uterus rises out of the pelvic girdle

Question 10

What is gravidity?

Answer 10

the total number of pregnancies including the current one if pregnant (gravidity would count as 1 with twins)

Question 11

What is parity?

Answer 11

the number of livebirths or stillbirths after 24 weeks gestation (Parity would count as 2)

Question 12

How many births are premature?

Answer 12

up to 10%

Question 13

What are the reasons of most still births?

Answer 13

Most remain unexplained but there does seem to be a link to IUGR/Foetal Growth Restriction (FGR)

Question 14

how can you assist in looking after the foetus?

Answer 14

Monitor growth to identify intrauterine growth restriction

Identify anomalies

Question 15

What is classed as a small, average and large baby?

Answer 15

Question 16

What is classed as a premature baby?

Answer 16

37 weeks.

But there are different categories levels of prematurity and these carry their own risks:

• Extremely preterm (less than 28 weeks)
• Very preterm (28 to 32 weeks)
• Moderate to late preterm (32 to 37 weeks)

Question 17

What can we do if there is a risk of prematurity? explain why

Answer 17

Magnesium sulphate as it is neuroprotectant to reduce the risk of cerebral palsy

Steriods- it stimulates the sythesis of surfactant which lubricates the lungs and allows the air sacs to glide against each other without sticking;

prevent bleeding in the brain (6 of 100 babies);

lower risk of necrotizing enterocolitis (4 of 100 babies)

24-34 weeks (double dose 24 hours apart)

34-37 weeks (single dose)

Question 18

What do biometric tests do?

Answer 18

They are designed to predict foetal size at a point in gestation. If performed periodically can indicate growth but not foetal well being.

Question 19

What do biophysical tests do?

Answer 19

(Doppler / liquor assessment) can predict foetal well being but not growth

Question 20

What biometric parameters do you use in the second trimester scan?

Answer 20

Biparietal diameter (BPD)

Head circumference (HC)

Abdominal Circumference (AC)

Femur Length (FL)

Question 21

What are the risk assosciated with interuterine growth restriction babies?

Answer 21

Risks: Stillbirth

Low birth weight (LBW)

Decreased O2 levels

Hypoglycaemia

Hypothermia

Less resistant to infection

Difficulty handling vaginal delivery

How is the placenta doing?