Pregnancy Flashcards
When do you give anti-D to non-sensitised Rh -ve mother’s?
28 and 34 weeks
In what situations should an anti-D be given within 72 hours
delivery of a Rh +ve infant, whether live or stillborn
termination of pregnancy > 10 weeks
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
Tests for rehusus sensitisation ?
all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test
Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
Kleihauer test: add acid to maternal blood, fetal cells are resistant (do after a sensitisation event to see if further foses of anti-d are required)
How will an affected fetus present - rhesus sensitisation
oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
jaundice, anaemia, hepatosplenomegaly
heart failure
kernicterus
treatment: transfusions, UV phototherapy
Missed miscarriage
the fetus is no longer alive, but no symptoms have occurred
or
fetus no longer alive but closed os
Threatened miscarriage
vaginal bleeding with a closed cervix and a fetus that is alive
Inevitable miscarriage
vaginal bleeding with an open cervix
Incomplete miscarriage
retained products of conception remain in the uterus after the miscarriage
Complete miscarriage
a full miscarriage has occurred, and there are no products of conception left in the uterus
Anembryonic pregnancy
a gestational sac is present but contains no embryo
Diagnosing miscarriage
transvaginal ultrasound
Gravida (G)
is the total number of pregnancies a woman has had
Primigravida
refers to a patient that is pregnant for the first time
Multigravida
refers to a patient that is pregnant for at least the second time
Para (P)
refers to the number of times the woman has given birth after 24 weeks
Nulliparous (“nullip”)
refers to a patient that has never given birth after 24 weeks gestation
Primiparous
technically refers to a patient that has given birth after 24 weeks gestation once before (see below)
The term primiparous, or “primip” is a bit confusing. Technically, it refers to a woman that has given birth once before. However, it is often used on the labour ward to refer to a woman that is due to give birth for the first time (and has never given birth before). You may hear patients referred to on the labour ward as a “primip” when they have never given birth before.
when do fetal movements start?
20 weeks
If fetal movements have not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit
vaccines in pregnancy?
Whooping cough (pertussis) from 16 weeks gestation
Influenza (flu) when available in autumn or winter
Live vaccines, such as the MMR vaccine, are avoided in pregnancy.
what is part of ‘booking bloods’ antenatal?
A set of booking bloods are taken for:
Blood group, antibodies and rhesus D status
Full blood count for anaemia
Screening for thalassaemia (all women) and sickle cell disease (women at higher risk)
Patients are also offered screening for infectious diseases, by testing antibodies for:
HIV
Hepatitis B
Syphilis
Screening for Down’s syndrome may be initiated depending on the gestational age. Bloods required for the combined test are taken from 11 weeks onwards.
What congenital abnormality is lithium associated with, especially in first trimester?
ebsteins anomaly
features of congenital rubella
Congenital deafness
Congenital cataracts
Congenital heart disease (PDA and pulmonary stenosis)
Learning disability
chickenpox in pregnancy complications
More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis
Fetal varicella syndrome
Severe neonatal varicella infection (if infected around delivery)
exposure to chicken pox during pregnancy? Investigation and management
When they are not sure about their immunity, test the VZV IgG levels. If positive, they are safe.
When they are not immune, they can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox. This should be given within ten days of exposure.