Obstetrics Flashcards
When should the booking visit occur? What is its purpose
At or before 10 weeks.
Needs of pregnancy assess and plan antenatal care (specific clinical, consent for antenatal screening)
When is the first ultrasound scan? What is its purpose?
10-14 weeks
Confirms pregnancy
Accurately dates it (gives EDD)
Identify multiple pregnancies
screens for chromosomal abnormality (nuchal translucency measurement)
How is foetal growth measured:
a) before 13+6 weeks
b) 14-20 weeks
what happens after 20 weeks
a) crown rump length (CRL)
b) head circumference
a) + b) can be plotted on standard foetal chart
Before 20 weeks growth is fairly standardised between pregnancies. After 20 weeks genes & environmental factors alter the rate.
Which ages are at higher risk of obstetric complications
<17 or >35
> 35= chromosomal abnormality
Which PMHx (not including obstetric) require additional care?
- Hypertension
- Diabetes
- Psychiatric disorders
- Epilepsy
- Recreational drugs use
- Thromboembolic disease
- Obesity
- Age >40
- Vulnerable women
- HIV/HEP B
Which Obstetric Hx requires additional care?
- Recurrent miscarriage
- Pre preterm birth
- Prv pre-eclampsia
- Prv c-section
- Prv puerperal psychosis
- Grand multip (>6)
- Still birth/neonatal death
- Baby with congenital abnormality
- Babe <2.5kg or >4.5kg
Gynae Hx in book visit
- Subfertilty? ↑ perinatal risk
- Assisted conception, higher risk multiple pregnancy
- Prev uterine surgery → elective CS
- Cervical smear Hx (should not occur if due during pregnancy, 12 week postpartum_
Book examination
General:
BMI, BP
Abdo exam: uterus palpable form 12 weeks, foetal heart can be oscillated with sonic aid.
What blood are taken at the booking visit?
FBC
Haemoglobinopathies
Blood group + antibody screen
Infection screening: HIV, Hep B, Syphilis
What should the FBC be? When is it repeated?
>
- 28 weeks
Which haemoglobinpathies are test for? Why?
sickle cell: carriers can test partner and prenatal diagnosis offered
thalassaemia:
Why ABO
What is the rhesus status used for
ABO- crossmatch in case of emergency
Resus negative are offered Anti-D prophylaxis to prevent rhesus D iso-immunisation & haemolytic disease of future feotus. Anti D given at 28 weeks, after any traumatising event (trauma, haemorrhage) and at delivery.
If baby is Rhesus positive give anti D within 72 hours
How to manage HIV in pregnancy
↓Risk of vertical transmission: – > antiretrovirals throughout pregnancy & up to 6 weeks for newborn
> C section delivery
> Avoidance of breastfeeding
Risk 30% → 1%
Higher risk of pre-eclampsia, stillbirth & IUGR
Do not write diagnosis in hand help notes
How to manage Hep B
Notifiable disease: contact HPA
Refer to hepatology
Neonatal immunisation: 5 dose treatment
Immunoglobulins for high risk
Complications of syphilis and treatment
miscarriage, severe congenital abnormality
Refer to GUM & prompt treatment with benzylpenicillin
Mother must receive treatment > 4 weeks before delivery otherwise baby must go under IV therapy
Chlamydia & gonorrhoea: prevalence in pregnancy, presentation and effects of each
5%, asymptomatic
Chlamydia: neonatal conjunctivitis (30%) & neonatal pneumonia (15%)
Gonorrhoea: postpartum endometriosis, chorioamnionitis, neonatal ophthalmia 40-50%
In the booking visit what health and promotion advice should be given? Include Drugs & Lifestyle advice
Folic Acid: 400 micrograms/day → 12 wks
Vit D: if BMI >3O, south asian or afrocaribbean
Iron supplements: not routine
Anti-epileptics: carbamazepine & lamatrigine are safest.
Diet: well balanced 2500 calories, no alcohol
Smoking: nicotine replacement
Infection advise: Listeriosis is avoid by only drinking pasteurised milk. Avoid soft or blue cheese & uncooked/partially cooked foods. Cook eggs & chicken thoroughly to avoid salmonella
What medication is recommended to those with pre-eclampsia in previous pregnancies?
Low dose aspirin (75mg)