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Pregnancy Flashcards

1
Q

Termination of Preganancy (TOP) legal framework

A

1967 Abortion Act

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2
Q

TOP gestational restrictions

A

< 24weeks

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3
Q

When can TOP be carried out >24weeks

A
  • Continuing the pregnancy is likely to risk the life of the woman
  • Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
  • There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
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4
Q

Legal requirements for an abortion

A
  • 2 registered medical practitioners must sign to agree abortion is indicated
  • It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
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5
Q

Medical Abortion Tx

A
  1. Mifepristone
  2. Misoprostol 48hours later
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6
Q

Anti-D prophylaxis indication in Abortions

A
  1. Medical TOP: Rh-ve/ >10 wks gestation
  2. Surgical TOP: Rh-ve
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7
Q

TOP Surgical Tx

A
  • Cervical dilatation and suction of the contents of the uterus (up to 14wks)
  • Cervical dilatation and evacuation using forceps (14 - 24 wks)
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8
Q

Post TOP pregnancy test

A

Urine preg test 3wks post TOP

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9
Q

Abortion pill at home criteria

A

No more than 10wks gestation

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10
Q

Abortion pill at clinic criteria

A

10 - 24 wks gestation

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11
Q

TOP complications

A
  • infection of the womb (uterus) ( PID)
  • some of the pregnancy remaining in the womb
  • excessive bleeding
  • damage to the womb or entrance of the womb (cervix) Cervical incompetence
  • Failure of the abortion (pregnancy continues)
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12
Q

Pre TOP Ix

A
  • Preg testing to confirm pregnancy
  • Assess Rhesus status
  • May require blood group, FBC, haemaglobinopathies
  • VTE assessment: coagulation screen
  • STI screening and give prophylaxis treatment against chlamydia and anaerobes
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13
Q

Define TOP / Abortion

A

A procedure to end a pregnancy

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14
Q

Antenatal care initiation

A

through GP / self-referral to hospital of choice

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15
Q

When should the booking clinic occur?

1st mid-wife appt

A

Prior to 10wks of gestation

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16
Q

Drugs to avoid during preg

A
  • Teratogenic: Roaccutane, methotrexate
  • Chemotherapeutics: teratogenic in the 1st trimester
  • Statins: can cause oligohydramnios
  • Valporate: neurodevelopmental delay
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17
Q

1st Antenatal scan

Optional

A

Dating Scan

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18
Q

When is the dating scan performed during preg?

A

11-13wks + 6D

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19
Q

Dating Scan purpose

A
  • Establish viability
  • Date the pregnancy
  • ?multiple pregnancy
  • Measuring nuchal translucency
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20
Q

Combined screening

occurs at dating scan

A
  • USS: Nuchal translucency
  • Blood tests
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21
Q

4 factors

Aneuploidy Screening factors

A
  • NT measurement w/gestational age
  • Maternal age
  • serum Beta hCG high
  • PAP A (Pregnancy associated plasma protein A) low
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22
Q

Aneuploidy Screening high risk features

A
  • Thick NT measurement
  • Increase maternal age
  • High beta-hCG
  • Low PAP A
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23
Q

When is the most accurate time/sreening to screen for Down’s during pregnancy?

A
  • 1st trimester
  • Combined screening
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24
Q

Sensitivity of the combined screening for Down’s in the 1st trimester

A
  • > 90% of T21 fetuses
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25
2nd trimester screenings for Down's
1. **Triple**: B-HCG, Alpha feto-protein, Estriol (65% sensitivity) 2. **Quadruple**: B-HCG, Alpha feto-protein, Estriol and inhibin-A (70% sensitivity)
26
When would invasice diagonostic be offered for Down's during pregnancy
High risk: >1 in 150
27
Invasive diagnostics for T21 high risk
1. Chorionic villous sample (10 - 14 wks) 2. Amniocentesis (16 - 20 wks) 3. Maternal serum Non-invasive prenatal testing (Free fetal DNA)
28
2nd Antenatal Scan
Routine Anomaly Scan
29
When is the Anomaly scan performed during pregnancy
18 - 21 wks
30
Anomaly scan purpose
- To determine whether lethal/severe abnormalities of the feotus - determine placenta site
31
Antenatal Screening at 28 wks
Bloods: FBC / Red cell Ab repeat scan
32
When is the baby's growth assess during pregnancy?
From 25 OR 28 weeks onwards ## Footnote w/ tape OR USS
33
34
CO level screening
1st: Dating Scan appt 2nd: At 36 wks
35
Common Sx in preg
- Fatigue / dizziness (Anaemia) - Constipation - Backache - Carpal Tunnel Syndrome - Thrush - Heartburn - Varicose veins
36
Twins in pregnancy Screening
1. Dating Scan: establish chorionicity
37
What is a breech presentation?
When the feotus is positioned in the uterus with feet/bottom facing downwards
38
When/where should External cephalic version be performed?
- after 36 wks of gestation - Labor ward
39
maternity leave from work
12 wks off work
40
When do labour and delivery normally occur?
37 - 42 wks gestation
41
Normal Labour staging
**1st stage**: from the onset of labour (true contractions) until 10cm cervical dilatation **2nd stage**: from 10cm cervical dilatation until delivery of the baby **3rd stage**: from delivery of the baby until delivery of the placenta
42
Cervical dilation rate in primiparous women
1cm every 2 hours
43
Cervical dilation rate in multiparous women
1cm in every hour
44
1st stage of labour Sx
- Regular, painful contractions - Progressive cervical dilation - Passage of blood-stained mucus, also known as ""show"" - Rupture of membranes - Descent of the foetal head into the pelvis
45
Define Braxton-Hicks Contractions
Occ. irregular contractions of the uterus
46
When is Braxton-Hicks Contractions usually felt?
2nd/3rd trimester
47
How to reduce Braxton-Hicks Contractions?
- Stay hydrated - Relaxing
48
Hallmark signs of the 2nd stage of labour
- Foetal head **flexion, descent, and engagement** into the pelvis - Foetal internal rotation to face the maternal back - Foetal head extension to deliver the head - Foetal external rotation (restitution) after delivery of the head, positioning the - shoulders in the AP position - Delivery of the anterior shoulder first, followed by the rest of the foetus - Maternal desire to push ## Footnote Normal mechanism of labour
49
Progress in labour, 3Ps
- **Power:** uterine contractions - **Passenger:** size, presentation and position of the foetus - **Passage:** shape and size of the pelvis and soft tissues
50
2nd stage of labour stages
- Passive: Not pushing - Active: mother pushing
51
Delayed passive in 2nd stage of pregnancy
Primi: >60 mins Multi: >30 mins
52
Define Tokophobia
Fear of contractions
53
Placenta grivia
embedded to cover cervical os
54
as the uterus contracts and the cervix gets shorter and then opens
55
Ways of going to into labour
- Spontaneous - Induction of Labour: Misoprostol, prostaglandin, mechanical, membrane sweep (stretch the cervix)
56
Bishop score
6 or above = ready for deliver
57
Preterm
<37 wks
58
Term preg
- >37 wks
59
Intrapartum monitoring
- 1:1 support - Partogram: low maternal risk - fetal HR listened to every 15mins - Liquor: clear, red, yellow - Molding: skull bone overlapped - Cervial dilation and descent should be opposite on the partogram -
60
How many contractions should maternal have for IOL
4 in 10mins
61
Intermitten auscultation
1st stage: Every 15mins 2nd stage: Every 5mins ## Footnote ALWAYS measure the maternal pulse
62
High risk labour
Monitor fetal HR w/ CTG
62
What examinating during labour
- Dilatation, length of cervix - caput, molding and station of the baby (using ischimus spine as reference) - feel maternal abdo for foetal engagement
63
Acute 3rd stage Mx
No more than 30mins - oxytocin
64
Physiological 3rd stage
No more than 60mins
65
Acute 3rd stage indication
haemorrhage
66
Delayed labour 1st stage
- Artificial rupture of membrane - oxytocin by IV to induce contractions
67
Delayed 2nd stage of labour
- Assisted vaginal birth
68
Station indication for vaginal birth during delayed labour
+1/+2 station score better for vaginal birth
69
Episiotomy indications
- Primips - To provide extra space - Expected OASI - just when the fetal head is crowning - local anaesthetic injection
70
Pethidine contraindication
- when mother is fully dilated - ONLY at early delayed labour - SEs: Sickness/ baby drowsiness
71
Epidural
- can be top up if need theatre for c-section
72
>40 wks
See midwife weekly
73
Hx taking for preg women
- When was the last time you felt tha baby move? - Regular pattern or has it change in any way - 16 - 21 - Have you had any vaginal bleeding - Have you notice any swelling any where on your body?
74
Antepartum Haemorrhage APH
- Bleeding after 24wks geatation
75
Placenta Abruption concealed
Within the uterus
76
Still birth
a death of the fetus in the uterus after 20 wks of preg but before or during birth
77
Still birth causes
- Fetal growth restriction - Placental problems - Umbilical cord issues - Maternal infections - Fetal genetic problems
78
1. C x **D** 2. C 3. A 4. B 5. C 6. C 7. A x **B** 8. D x **B** 9. C 10. C
79
Gravidity
No. of pregnancies woman has
80
Parity
No. of births after 20 wks of geastation ## Footnote multiple birth and still births = 1
81

Obs & Gynae (26 decks)

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