Monitoring and Pregnancy Advice Flashcards
1
Q
What nutritional supplements are advised in pregnancy?
A
- Folic acid: Prevention of neural tube defects during pregnancy
- Vitamin D:‘women should be advised to take a vitamin D supplement (10 mcg per day). Particular care should be taken with higher risk women (i.e., those with darker skin or who cover their skin for cultural reasons, obese women or those with bad diets)
2
Q
What should be avoided during pregnancy?
A
- Vitamin A supplementation (intake above 700 micrograms): might be teratogenic. Liver consumption should be avoided
- Alcohol
- Smoking (cannabis as well)
- Listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
- Salmonella: avoid raw or partially cooked eggs and meat, especially poultry
- Cocaine
- Heroin: Risk of neonatal abstinence syndrome
3
Q
What are causes and consequences of deficiency in folate?
A
-
Causes
- Phenytoin
- Methotrexate
- Pregnancy
- Alcohol excess
-
Consequences
- Macrocytic, Megaloblastic Anaemia
- Neural tube defects
4
Q
What is the purpose of folate in the body?
A
- Converted to Tetrahydrofolate (THF). THF plays key role in transfer of 1-carbon units to the essential substrate involve in synthesis of DNA & RNA
- Green, leafy vegetable is a good source.
5
Q
How is Folate taken during pregnancy?
A
- All women should take 400mcg of folic acid until 12th week of pregnancy
- Women at a higher risk of conceiving a child with neural tube defects should take 5mg of folic acid before conception until 12th week of pregnancy
6
Q
Which women are at a higher risk of folate deficiency during pregnancy?
A
- Either partner has NTD, previous pregnancy affected by NTD or have a family history of NTD
- Woman taking antiepileptic drugs
- Woman has coeliac disease
- Diabetic
- Woman has thalassaemia trait or sickle cell disease
- Woman is obese [BMI of 30kg/m2 or more]
7
Q
What is advise regarding alcohol in pregnancy?
A
The government recommend pregnant women should not drink.
- May be a major risk factor for Fetal alcohol syndrome (FAS). Features are:
- Learning difficulties
- Characteristic face: smooth philtrum, thin vermilion, small palpebra fissures, epicanthic folds, microcephaly
- IUGR & postnatal restricted growth
8
Q
What are risks regarding smoking in pregnancy?
A
Risks include:
- Low birthweight
- IUGR
- Stillbirth
- Preterm birth
- Sudden unexpected death in infancy
- Miscarriage
9
Q
How is smoking managed in pregnancy?
A
- NRT may be used but women must have stopped smoking and risks/benefits need to be discussed.
- Neither varenicline nor bupropion should be offered to pregnant or breastfeeding women
10
Q
What is general life advice for pregnancy?
A
-
Work:
- Inform women of their maternity rights and benefits. For the majority of women, it is safe to continue working. Women should be asked whether they work. The Health and Safety Executive should be consulted if there are any concerns about possible occupational hazards during pregnancy
-
Exercise in pregnancy:
- Women should be informed that beginning or continuing moderate exercise is not associated with adverse outcomes. Certain activities should be avoided e.g., high-impact sports where there is a risk of abdominal trauma and scuba diving
-
Air travel during pregnancy
- Women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
- Women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
- Associated with increased risk of venous thromboembolism. Wearing correctly fitted compression stockings is effective at reducing the risk
11
Q
What are risks for Cocaine use in pregnancy?
A
Maternal risks
- Hypertension in pregnancy including pre-eclampsia
- Placental abruption
Foetal risk
- Prematurity
- Neonatal abstinence syndrome
12
Q
What causes increased and decreased AFP?
A
Increase AFP
- Neural tube defects (meningocele, myelomeningocele and anencephaly)
- Abdominal wall defects (omphalocele and gastroschisis)
- Multiple pregnancy
Decreased AFP
- Down’s syndrome,
- Trisomy 18
- Maternal Diabetes Mellitus
13
Q
What is Human chorionic gonadotropin (hCG)?
A
- hCG is a hormone first produced by the embryo (syncytiotrophoblast) and later the placental trophoblast. Main role is to prevent the disintegration of the corpus luteum
- hCG levels double approximately every 48 hours in the first few weeks of pregnancy. Levels peak at around 8-10 weeks gestation.
- hCG levels measured in many pregnancy testing kits
14
Q
What is the rule to calculate Estimated date of delivery (EDD)?
A
Naegele Rule to calculate EDD
- First, determine the first day of your last menstrual period.
- Next, count back 3 calendar months from that date.
- Lastly, add 1 year and 7 days to that date.
15
Q
What is the procedure for antenatal visits in pregnancy?
A
- 10 antenatal visits in 1st pregnancy and 7 antenatal visits in subsequent pregnancies if uncomplicated.
- Consultant care is not required if pregnancy is uncomplicated
16
Q
How is Down syndrome screening conducted?
A
-
Combined Test is standard (11-13+6 weeks) ➜ [Nuchal translucency measurement] + [Serum B-HCG] + [Pregnancy-associated plasma protein A (PAPP-A)]
- Diagnosis indicated by ↑ b-HCG, ↓ PAPP-A, thickened nuchal translucency. Trisomy 18 and 13 give similar results but PAPP-A tends to be lower
-
Triple or Quadruple test offered if booked later in pregnancy between 15-20 weeks
- Triple Test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin
- Quadruple Test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A
17
Q
How is Symphysis-fundal height conducted?
A
- Measure from top of pubic bone to top of the uterus in centimetres
- Should match gestational age in week to within 2cm after 20 weeks
18
Q
How is anaemia screening in pregnancy?
A
Cut offs for oral iron therapy at screening
- Booking visit (8-10 weeks): <11 g/dl
- 28 weeks: <10.5 g/dl
19
Q
What are the medical conditions for antenatal screening?
A
All
- Anaemia
- Bacteriuria
- Blood group, Rhesus status and anti-red cell antibodies
- Down’s syndrome
- Fetal anomalies
- Hepatitis B
- HIV
- Neural tube defects
- Risk factors for pre-eclampsia
- Rubella immunity
- Syphilis
The following should be offered depending on the history:
- Placenta praevia, Psychiatric illness, Sickle cell disease, Tay-Sachs disease, Thalassaemia
