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Obstetrics and Gynaecology > Obstetric Monitoring > Flashcards

Obstetric Monitoring Flashcards

1
Q

How many antenatal appointments should a nulliparous woman have?

A

10

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2
Q

How many antenatal appointments should a multiparous woman have?

A

7

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3
Q

What is routinely done at all appointments?

A

Plot symphysis fundal height
Measure BP
Urine dip - proteinuria

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4
Q

What should pregnant women be informed about at first contact with a healthcare professional?

A

Folic acid supplementation
Food and nutrition
Lifestyle advice
Antenatal screening information

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5
Q

What folic acid supplementation should pregnant women take?

A

400 micrograms per day before pregnancy and for first 12 weeks

5mg if BMI >30

Folic acid reduce neural tube defects

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6
Q

What food and nutrition advice should pregnant women be given?

A

How to avoid food poisoning:
Listeria - only pasteurised or UHT milk, avoid soft cheese
Salmonella - avoid raw/partially cooked eggs and meat

Avoid vit A - found in eating liver products
Supplement vit D

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7
Q

What lifestyle advice are pregnant women given?

A

Risks of smoking, alcohol and recreational drugs
Avoid long haul flights
Seatbelt above and below bump when in car

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8
Q

When should booking for pregnancy be done?

A

Within first 10 weeks

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9
Q

What happens at the booking appointment?

A

Inform about baby development
Reiterate diet, lifestyle, nutrition etc.
Exercise - pelvic floor
Reiterate screening and book these
Discuss place of birth
Pregnancy care pathway
Breastfeeding workshops and information
Antenatal classes
Discuss mental health
Measure BMI, BP, urine dip, urine culture
Bloods - infection screen, Hb, blood group, haemoglobinopathies

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10
Q

What appointments do all women have?

A 
16 weeks
18-20 weeks
28 weeks
34 weeks
36 weeks
38 weeks
41 weeks
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11
Q

What happens are the 16 week appointment?

A

Review and discuss screening

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12
Q

What happens are the 18-20 week appointment?

A

Fetal anomaly scan - if woman chooses

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13
Q

What happens are the 28 week appointment?

A

Second haematological condition screening

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14
Q

What happens are the 34 week appointment?

A

Prepare for labour

Help recognise active labour

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15
Q

What happens are the 36 week appointment?

A 
Check presentation and offer ECV (external cephalic version) if necessary
Information about:
Breastfeeding
Labour
Vit K prophylaxis
Baby blues
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16
Q

What happens are the 38 week appointment?

A

Options for managing prolonged pregnancy

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17
Q

What happens are the 41 week appointment?

A

Membrane sweep and induction of labour

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18
Q

What additional appointments do nulliparous women have?

A

25, 31 and 40 week routine care appointments

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19
Q

When is a gestational age assessment made?

A

USS between 10+0 and 13+6 weeks

Measure crown rump length - if >84cm then use head circumference

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20
Q

What are the benefits of antenatal screening?

A

Choice of termination
Time to prepare for disabilities - costs and treatments
Birth in specialist setting
Intra-uterine therapy

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21
Q

What are the limitations of antenatal screening?

A

Detection rates vary - anomaly, fetal position, woman BMI
May lead to tough decisions - further tests and termination
Emotional turmoil - false negative/positive

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22
Q

What diagnostic tests are done in antenatal screening?

A

Chorionic villus sampling

Amniocentesis

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23
Q

What happens in chorionic villus sampling and when?

A

Fine needle take sample of tissue from placenta - tested

11-14 weeks

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24
Q

What risks are associated with chorionic villus sampling?

A

Miscarriage
Rhesus sensitisation
Uterine infection

25
Q

What happens in amniocentesis and when?

A

Fine needle passed through mothers abdomen into uterus to collect sample of amniotic fluid

Fluid contain baby’s cells which can be tested

Done after 15 weeks

26
Q

What risks are associated with amniocentesis?

A

Miscarriage
Rhesus sensitisation
Uterine infection
Club foot if done <15 weeks

27
Q

What haematological conditions are screened for antenatally?

A

Anaemia
Blood group and rhesus D status
Atypical red-cell alloantibodies

28
Q

When are haematological conditions screened for antenatally?

A

Booking and 28 weeks

29
Q

What is the risks and outcomes of finding anaemia on antenatal screening?

A

Trial oral iron supplements

Risk - low birth weight, preterm

30
Q

What is the risks and outcomes of finding blood group and rhesus D status on antenatal screening?

A

Anti-D prophylaxis to all rhesus -ve women who aren’t sensitised at 28-34 weeks

Risk of haemolytic disease of newborn

31
Q

What is the risks and outcomes of finding atypical red cell alloantibodies on antenatal screening?

A

Refer to specialist care

Risk of haemolytic disease of newborn

32
Q

What fetal abnormalities are screened antenatally?

A

Haemoglobinopathies
Fetal anomaly
Down’s, Edward’s and Patau’s syndrome

33
Q

When and how are haemoglobinopathies screened?

A

By 10 weeks

Blood test if area of high prevalence, questionnaire if low prevalence

Dad need blood test if mum carrier, if both carriers then diagnostic testing req.

34
Q

When and how are fetal anomalies screened?

A

Between 18+0 and 20+6 weeks

Scan with echo - 4 chamber view, open spina bifida, diaphragmatic hernia, cleft lip, gastroschisis, bilateral renal agenesis, cardiac abnormalities

35
Q

When and how are down’s, patau’s and Edward’s syndrome screened?

A

By 13+6 weeks

Combined test - Nuchal translucency, B-HCG and plasma protein A
Serum screening used if large BMI stop nuchal translucency or booking late

If chance <1/150 then low risk and no further tests, if >1/150 then further testing

36
Q

How are infections screened antenatally?

A

Blood test at booking

37
Q

What infections are screened for antenatally?

A

HIV
Hep B
Syphilis

38
Q

What is the outcome of finding an infection on screening?

A

HIV - specialist care and treatment, birth plan to avoid transmission, avoid breast feeding

Hep B - B vaccinations given to baby between birth and 1 year

Syphilis - Specialist team - Abx, Baby need blood test and poss Abx at birth

39
Q

What is Naegele’s rule?

A

Rule to calculate delivery day

Date of first day of LMP
+ 7 days
- 3 months
+ 1 year

40
Q

Where can women give birth?

A

Midwifery led unit
Home
Obstetric unit

41
Q

When is giving birth in a midwifery led unit particularly suitable?

A

Low risk pregnancy as rate of interventions lower and outcome is same as obstetric unit

42
Q

What is the outcome for the baby if a woman chooses to give birth at home?

A

Small increase risk of adverse outcome

43
Q

When should birth be planned in an obstetric unit?

A

Higher rate of interventions

Conditions that place pregnancy as high risk

44
Q

What interventions can be done in birth?

A

Instrumental vaginal birth
C section
Episiotomy

45
Q

What conditions can place a pregnancy as high risk?

A 
Cardiac disease
Hypertension
Haemoglobinopathies
VTE
Hyperthyroidism
Diabetes
Infections - Hep, HIV
Abnormal renal function
Epilepsy
Previous/current pregnancy complication
46
Q

What observations of the woman are done on initial assessment of labour?

A

Review antenatal notes
Ask about contractions - length, frequency, strength
Ask about pain relief
Review obs - pulse, BP, temperature, urinalysis
Record vaginal loss (if any)

47
Q

What observations of the unborn baby are done on initial assessment of labour?

A

Ask about baby movements in last 24hr
Palpate woman’s abdomen - fundal height, baby lie, presentation, position, engagement
Auscultate fetal heart rate

48
Q

When can you offer vaginal examination in assessment of labour?

A

Uncertainty about whether woman is in established labour

Woman appear in established labour

49
Q

What maternal red flags in labour would require transfer to an obstetric unit?

A 
Pulse >120 on 2 occasions, 30 mins apart
BP >160/110 OR >140/90 on 2 occasions 30 mins apart
2+ protein on urinalysis and BP >140/90
Temp >38 or >37.5 on 2 occasions 1hr apart
Vaginal blood loss
Presence of significant meconium
Pain different from normal contraction
Delay in 1st or 2nd stage labour
Request of regional anaesthesia
50
Q

What fetal red flags in labour would require transfer to an obstetric unit?

A

Abnormal presentation - inc. cord presentation
Transverse or oblique lie
High or free floating head in nulliparous woman
Suspected fetal growth restriction or macrosomia
Suspected anyhydramnios or polyhydramnios
Fetal HR <110 or >160
Deceleration in fetal heart rate heard

51
Q

What non pharmacological pain relief is considered in labour?

A

Breathing exercises
Immersion in water
Massage

52
Q

What pharmacological pain relief options are there for labour?

A

Entonox
IV/IM opioids
Regional anaesthesia

53
Q

What is entonox? What are its advantages and disadvantages?

A

Mix of O2 and NO
Under patient control, act quickly and wear off quickly
Can cause nausea and light-headedness

54
Q

What opioids are used in labour?

A

Pethidine
Diamorphine
Others

55
Q

What are the ads and disads of opioid pain relief in labour?

A

Effective within 15 mins

Debate of effectiveness
SE for mum and resp depression and drowsiness in fetus
Cant use birthing pool for 2 hrs after administration

56
Q

What regional anaesthesia can be used in labour?

A

Bupivicaine and fentanyl given either epidural or combined spinal epidural

57
Q

What are the ads and disads of regional anaesthesia?

A

Most effective pain relief for labour, can avoid greater analgesia or GA if instrumental or C section needed

Dizziness, shivering, hypotension
Increased rate of operative vaginal delivery
Have to be in obstetric unit with CTG monitoring
Associated with longer 2nd stage of labour

58
Q

What happens following full cervical dilatation in a woman with an epidural?

A

Delay pushing for 1 hour

Obstetrics and Gynaecology (21 decks)

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