Normal antenatal process Flashcards
Folic acid in pregnancy (3)
- Normal: 400 microgram
- Increased dose: 5 milligrams
- Should be taken whilst trying to get pregnant + in first 12 weeks of pregnancy
Patient that require ↑ dose of folic acid (7)
- Previous baby with NTD
- Mother or father has NTD
- Family hx of NTD
- Taking anti-epileptic medication
- Diabetes
- Obesity
- Bowel disease (Coeliac, Crohns)
Smoking: Associated health problems in pregnancy (5)
- Premature birth
- Low birth weight
- Sudden Infant Death syndrome (SIRS)
- Miscarriage
- Wheeze/breathing problems in first 6 months of life
FGM: Definitions + Health Complications (8)
Definition: The practice of partially/totally removing the external genitalia of girls and young women for non-medical reasons.
Health complications:
- Excessive bleeding
- Swelling of genital tissue
- Problems urinating
- Severe infections
- Shock
- Death
- Complications in childbirth
- ↑ risk of perinatal deaths
FGM: Classification (4 TYPES)
TYPE I: Partial or total removal of the clitorsis and/or the prepuce (clitoridectomy)
TYPE II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)
TYPE III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)
TYPE IV: All other harmful procedures to the female genitalia.
Pregnancy: Booking visit (Hx taking)
- Full name
- Age
- Address
- Ethnic background
- Partners details (or next of kin)
- PMH/PSH
- Medication hx
- Allergies
- Family hx (illness or problems in pregnancy)
- Travel/migration hx
- Social hx (smoking hx, any smokers at home)
- Alcohol hx
- Other illicit drug use
- Obs hx
- Gynae hx (inc. smears)
- Last Menstrual Period (LMP)
Advice for patient wanting to get pregnant (4)
- Optimise health (e.g. weight loss)
- Dietary supplementation (Vit D, folic acid)
- Higher dose of Folic acid (if required)
- Pre-pregnancy counselling for existing conditions
Pre-existing conditions that require pre-pregnancy counselling (6)
- Diabetes
- Epilepsy
- Cardiac disease (Hypertension)
- Respiratory disease (Asthma)
- GI disease (Crohns, coealic disease)
- Psychiatric disorder
Factors that ↑ risk of pregnancy (6)
- Advanced maternal age (>40) or low age (<20)
- History of any medical problem
- Previous surgery
- IVF
- Previous c-section
- Previous problems in pregnancy (e.g. hypertension, growth restriction, diabetes, foetal abnormalities)
Events in previous pregnancy that can impact current pregnancy (10)
- Premature labour
- Foetal growth restriction
- Antepartum haemorrhage
- Gestational hypertension/preeclampsia
- Diabetes
- Thrombocytopaenia
- Type of delivery (c-section, forceps, ventouse)
- 3rd/4th degree tear
- Postpartum haemorrhage
- Previous stillbirth/ late miscarriage/ neonatal death
Domestic violence + abuse (DVA) in pregnancy:
1 in 4 women experience domestic abuse/violence at some point in their lives.
Many forms (can be a combination):
- Physical
- Sexual
- Psychological
- Financial
DVA ↑ risk of:
- Miscarriage
- Infection
- Premature birth
- Injury/death of baby
Screening + monitoring in pregnancy: Booking bloods (5)
- Haemoglobin
- Platelets
- Infections: HIV, syphilis, Hep B
- Blood group + antibody status
- Sickle cell + thalassaemia
Screening + monitoring in pregnancy: Screening tests
Definition: The screening tests offered during pregnancy in England are either ultrasound scans or blood tests, or a combination of both.
Blood tests:
- Sickle cell
- Thalassaemia
- HIV
- Hep B
- Syphilis
Blood tests + scans:
- Down’s syndrome (T21)
- Edward’s syndrome (T18)
- Patau’s syndrome (T13)
Sickle cell anaemia: Definition
Definiton: Disease of red blood cells caused by an autosomal-recessive single gene defect in the beta chain of haemoglobin (HbA), which results in sickle cell haemoglobin (HbS).
Thalassaemia: Definition
- Characterised by decreased or absence of synthesis of one of the two polypeptide chains (α or β) that form the normal adult human haemoglobin molecule (HbA, α2/β2).
- Results in reduced haemoglobin in red cells, and anaemia.
- Recessive autosomal condition.
- β-globin gene defects may give rise to β thalassaemia, while mutations of the α globin gene may cause α thalassaemia.
Pathophysiology of rhesus disease
- Mother = Rh(-ve) and baby = Rh(+ve)
- Foetal cells cross into maternal circulation during normal pregnancy.
- This results in sensitisation (IgM immune response).
- IgM cannot cross the placenta.
- Therefore current pregnancy not affected.
- However, re-exposure in subsequent pregnancy.
- Causes primed B-cells to produce IgG.
- This actively crosses into foetal circulation.
- IgG binds to + destroys foetal red blood cells.
Rhesus isoimmunization (immune hydrops): Definition
Defintion: Occurs when a maternal antibody response is mounted against fetal red cells. These immunoglobulin (IgG) antibodies cross the placenta and cause fetal red blood cell destruction. The ensuing anaemia, if severe, precipitates fetal hydrops, which is often referred to as immune hydrops.
Potential sensitizing events for Rhesus disease (7)
- Spontaneous miscarriage
- TOP
- Invasive procedures
- Traumatic events
- Placental abruption
- Fetomaternal haemorrhage
- Blood transfusions
Prevention of rhesus (D) disease
If sufficient anti-D immunoglobulin is given to the mother it will bind to any fetal red cells in her circulation carrying the D antigen.
This prevents her own immune system from recognizing them and therefore becoming sensitized.
Anti-D (1500IU) is given to all women who are rhesus –ve (d/d):
- routinely at 28wks
- within 72h of any potentially sensitizing event
- after delivery if the neonate is found to be rhesus +ve (D/d).
