Obstetrics - Antepartum Flashcards
Combined screening test for Down’s - when and what markers does it measure
11-14 weeks PAPPA Beta HCG AFP uE3 Inhibin A Nucchal transulcency USS
Triple/quadruple screening test for Down’s - when and what markers does it measure
15-20 weeks
AFP
uE3
hCG
Anomaly scan
18-21 weeks
Booking visit with midwife
10 weeks
Appointments for nullip
x10
10, 16, 25, 28, 31, 34, 36, 38, 40,41 weeks
Appointments for multip
x7
10, 16, 28, 34, 36, 38, 41
Anti-D given
28 weeks, 34 weeks
Diagnostic testing for Down’s
10-15 weeks, CVS
After 15 weeks, amniocentesis
Booking appointment - infectious disease screening (4)
Rubella - if non-immune, avoid all infectious contacts and wait until after this pregnancy until being immunised
Hep B - if positive, newborn immunisation
HIV - antenatal ART, elective CS, no breast feeding
Syphilis - maternal ABx
Booking appointment - other bloods (3)
FBC
ABO
Rh
When to test for gestational diabetes
If risk factors, OGTT at 24-28wks
Common antenatal problems (6)
Constipaion Reflux Haemorrhoaids Varicose veins Oedema Nausea/vomiting
Respiratory changes in pregnancy (3)
Increased tidal volume
Reduced residual volume
Compensated respiratory alkalosis
Cardiovascular changes in pregnancy (3)
Increased blood volume
Increased CO
Decreased BP
GI changes in pregnancy (5)
Nausea Altered appetite Reflux (delayed emptying) Gallstone predisposition Liver signs (difficulty metabolising progesterone and oestrogen)
Genitourinary changes in pregnancy (4)
Increased GFR
Increased sodium
Reduced bladder capacity
Mild hydronephrosis
Haematological changes in pregnancy (2)
Increased fibrinogen, F VII, VIII, IX, X
Decreased protein S, antithrombin III
Endocrine changes in pregnancy (2)
Reduced calcium
Increased aldosterone and cortisol
MSK changes in pregnancy (1)
Exaggerated lumbar lordosis (leads to lower back strain)
Dermatological changes in pregnancy (2)
Hyperpigmentation of umbilicus, areolae, midline (linea nigra)
Liver skin signs
High risk pregnancies (5)
Problems in current pregnancy: Problems in labour Pre-existing conditions Problems in previous pregnancy Social
High risk pregnancy: problems in current pregnancy (5)
IUGR Multiple pregnancy Hypertension Diabetes Thromboembolism
High risk pregnancy: problems in labour (3)
Meconium/bloody liquor
Pathological CTG
Lack of progress
High risk pregnancy: pre-existing conditions (5)
Diabetes Hypertension VTE Obesity Mental illness
High risk pregnancy: problems in previous pregnancy (6)
Pre-eclampsia Previous CS Recurrent miscarriage Preterm, stillbirth Gestational diabetes Tears
High risk pregnancy: social (5)
Teenage Domestic violence Low SEC Alcohol, drugs Maternal age >40
HELLP
Haemolysis
Elevated Liver enzymes
Low Platelets
Presentation of HELLP
RUQ/epigastric pain
N&V
Headaches
Antiphospholipid syndrome in pregnancy - treatment
Aspirin
LMWH
Screening for gestational diabetes
Previous gestational diabetes - OGTT at 16-18 weeks
Risk factors - OGTT at 24-28 weeks
Management gestational diabetes
Change in diet and exercise (works in 80%)
Metformin or insulin if complications or poor control
Management pre-existing diabetes
Stop all oral hypoglycaemics apart from metformin, start insulin
Causes of increased nuchal translucency
Down’s syndrome
Congenital heart defects
Abdominal wall defects
Causes of hyperechogenic bowel
CF
Down’s syndrome
CMV
Vomiting in pregnancy - treatment
Antihistamines e.g. promethazine
CTG: causes of early decelerations (3)
Head compression,
Cord compression
Foetal hypoxia
CTG: causes of variable decelerations (1)
Cord compression
CTG: causes of late decelerations (1)
Foetal hypoxia
CTG: causes of reduced variability (4)
Baby sleeping
Depressants e.g. opiates
Thumb sucking
Maternal dehydration
CTG: normal foetal heart rate
110-150
CTG: causes of foetal tachycardia (5)
Foetal hypoxia Chorioamnionitis (does mother have fever?) Hyperthyroidism Foetal/maternal anaemia Foetal tachyarrhythmia
CTG: causes of foetal bradycardia (7)
Post-date presentation OP or transverse presentation Prolonged: Prolonged cord compression Cord prolapse Epidural/spinal Rapid foetal descent Maternal seizures
CTG: management early decelerations
Physiological - no management required
CTG: management variable decelerations
Change maternal position
Shouldering is reassuring
CTG: management late decelerations
Foetal blood sample for pH
If acidotic, emergency LSCS
CTG management prolonged decelerations
Foetal blood sample for pH
If acidotic, emergency LSCS
CTG: management sinusoidal pattern
(Smooth, regular, wavy)
Immediate C section
