Pre Pregnancy Counselling Flashcards
Vaccination recommendations
Take a history of vaccination for MMR, varicella zoster, diphtheria, tetanus, and pertussis.
Consider hepatitis B, rubella and varicella for those with incomplete immunity, prior to conception.
Folic acid
Recommended for at least one month prior to conception and for first three months of pregnancy.
Standard/minimum dose is 0.4mg daily. (In NZ the starting dose is 0.8mg)
High dose (5mg) should be used for those at high risk of NTD such as those on anticonvulsants, pre-pregnancy diabetes, personal or family history of NTD, BMI>35
Vaccinations that should be given in pregnancy
Influenza
And dTap for pertussis is recommended as a single dose during the third trimester of each pregnancy. The optimal timing is 28-32 weeks.
What is excessive caffeine consumption?
> 300mg/day
(Equivalent to 3-4 cups of brewed coffee/day)
This should be avoided pre and during pregnancy.
Iodine recommendations
NHMRC recommends women should start 150mcg/day prior to a planned pregnancy or as soon as possible after finding out they are pregnant.
Smoking advice
Smoking should be stopped prior to conception including paternal smoking.
Paternal tobacco consumption has been associated with DNA damage and increased risk of malignancy in their children.
Travel and environmental risks
Avoid travel to affected areas (in relation to infectious diseases) while attempting conception.
In relation to Zika virus, if avoiding travel is not possible then couples should take all precautions to prevent mosquito bites and use condoms consistently when having sex in that country including use for vaginal, oral and anal sex.
Summary of points to cover with pre-pregnancy counselling
- Clinical assessment
- Medical history
- Genetic/family history
- Medication use
- Vaccinations
- Lifestyle recommendations
- Supplementation
- Healthy environment
- Investigations if indicated from any of the above
Effects of smoking on fertility and pregnancy
- toxic to gametes causing morphological abnormalities in sperm and oxidative damage in oocytes and embryos
- direct correlation between number of cigarettes smoked and risk of infertility.
- Brings forward the age of menopause therefore may effect ovarian reserve
- IVF 40% less successful
- 20-30% risk of T1 miscarriage
- 50% risk of PTB
- 2x increased risk of IUGR
- Increased risk of SUDI
Aetiology of miscarriage
- 50% are chromosomally abnormal
- Infection
- Second trimester miscarriage can be due to uterine anomalies, cervical incompetence, BV
- Unexplained
Success rate for expectant management of miscarriage
70% within 3 weeks
Location of ectopic pregnancies
> 95% tubal (55% ampullary, 25% isthmus, 17% fimbrial, 2% interstitial).
<5% cervical, ovarian, Caesarean section scar, abdominal, cornual.
Risk factors for GTD
Asian or Far Eastern
Extremes of reproductive age
Previous GTD
Diets deficient in protein, folic acid and carotene
Women of blood group A with blood group O partners
Women who are blood group AB have a worse prognosis
Obesity and GDM risk?
6-7%
Obesity and PIH/PET risk?
7-10%
