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Primary Care > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Preconception advice?

A
  • Nutrition and healthy diet
  • Avoid being overweight
  • Regular exercise
  • Cease smoking, EtOH, drugs
  • Reduce or stop caffeine intake
  • Avoid potential sources listeria infection
  • Review current medications with your GP
  • Take folic acid 3 months prior to conception
  • Ensure rubella immunity
  • Have regular breast check and pap smear
  • Consider genetic and FHx
  • Consider health insurance cover
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2
Q

What are potential sources listeria infection?

A

Avoid

  • unpasteurised dairy products
  • soft cheeses
  • cold meats
  • raw seafoods
  • chilled ready to eat foods
  • TA foods
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3
Q

When should folic acid be commenced?

A

Folic acid (0.5mg) recommended

  • ~1/12 prior to conception to
  • 12 weeks post conception
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4
Q

Folic acid dose women at risk?

A

5mg/day for at least 1, preferably 3, months prior to conception

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5
Q

Preconception examination?

A
  • Height and weight
  • BP
  • Cardiac status
  • Urinalysis
  • Cervical smear
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6
Q

What are the primary immunities to determine pre conception and how?

A
  • Rubella: estimated and immunise 3/12 prior to conception if required. (avoid immunisation early pregnancy). Test immunity 3 months later.
  • Ask history re Varicella; serology and vax if required
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7
Q

What vaccinations should be considered?

A
  • Boostrix (DTP)
  • MMR
  • Varicella
  • Influenza
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8
Q

First antenatal visit structure?

A

-Confirm pregnancy (urine / serum HCG)
-Previous obstetric Hx
-PHx
-FHx
-Psychosocial Hx
-M/A
Other:
-establish date of confinement
-first trimester combined screening test and feasibility of amnio / chorionic villus sampling; NIPT
-Ix possible rubella exposure

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9
Q

Points to elicit in first visit obstetric Hx?

A
  • Gestation, length of labour, mode of delivery, birthweight of each baby
  • Previous problems: foetal or neonatal abnormalities or deaths; pre term or growth retarded infants
  • Abortions: ?any termination of pregnancies or spontaneous abortions
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10
Q

Important points to elicit in PHx?

A
  • DM (past evidence, past gestational)
  • TB, rubella, rheumatic fever
  • heart or kidney disease
  • transfusions and rhesus status
  • anemia
  • jaundice
  • depression
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11
Q

FHx to determine first visit?

A

-Multiple pregnancies
-HTN
-DM
If any first degree relatives consider OGTT or screening

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12
Q

Drugs history to elicit?

A
  • Nicotine, EtOH
  • Aspirin
  • Illicit drugs
  • OTC and prescribed drugs
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13
Q

PEx first antenatal visit?

A
  • General fitness, colour
  • Height, weight, BP, UA
  • Head and neck: teeth, gums, thyroid
  • Chest: inc breast
  • Abdo: palpate for uterine size, listen to foetal heart (if indicated)
  • Legs: oedema or varicose veins
  • Speculum exam: pap smear and swab; bimanual exam
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14
Q

What are the four classic techniques of palpation?

A
  1. Fundal palpation
  2. Lateral abdo palpation
  3. Pawlik palpation
  4. Deep pelvic palpation
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15
Q

What is first trimester combined screening?

A

-Blood at 10-12w (range 9-13.6 weeks)
-U/S at 12/52 (range 11-13.6)
Shows RISK of Down Syndrome or Trisomy 18

-Increased risk will be offered CVS or amnio

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16
Q

Who should have antenatal screening?

A

Should be discussed with all pregnant women so they can make an informed decision about whether to proceed with testing. 80% of pregnant women have antenatal tests.

17
Q

Can women with twins have antenatal screening?

A

Yes. Higher order multiples cannot however.

18
Q

What is required for second trimester screening?

A

Blood test 14-20.6w

Blood in plain vial with no anticoagulant.

19
Q

What is important to tell the pt about antenatal screening?

A
  • Explanation of process
  • Only screen for certain conditions - does not guarantee “normal” child
  • RISK estimate only
  • Discuss what they would do in different scenarios
  • Out of pocket costs
20
Q

How are risks calculated for first trimester screening?

A
  • fbhhCG and PAPP-A for Down Syndrome

- U/S allows measurement of nuchal translucency (thickness of fluid filled region in foetus’ neck)

21
Q

U/S result suggestive of DS?

A
  • Nuchal thickness increased >2.5mm

- Ossified nasal bone conveys lesser risk of DS

22
Q

What is tested for in second trimester screening?

A

“quadruple test”

  • alpha-feto protein
  • HCG
  • unconjugated estriol
  • inhibin A
23
Q

What is the routine schedule of antenatal visits?

A
  • Initial first trim: 8-10w
  • Up to 28w: every 4-6w
  • Up to 36w: every 2w
  • 36w - delivery: weekly
24
Q

What should be recorded at each pregnancy visit?

A
  • Weight, BP
  • UA
  • Uterine size, fundal height
  • Foetal heart (US, steth at 25-28w)
  • Foetal mvts
  • Position of foetus (T3)
  • Presence of any oedema
25
Q

What should be routinely screened for in the first antenatal visit?

A

-FBE and ferritin
-Blood group and Ab screen
-Rubella Ab status
-Cervical cytology
-HBV and HCV serology
-HIV serology
-Syphilis serology
-Urine MCS
Discuss first trimester combined screening

26
Q

Weight gain in pregnancy?

A

Important to gain about 12kg

27
Q

Is vaginal bleeding in early pregnancy common

A
  • Yes, 10% normal pregnancies will have vaginal bleeding

- but about 15% recognised pregnancies will miscarry

28
Q

How should vaginal bleeding be investigated in early pregnancy?

A

-8weeks: normal ultrasound reassuring as miscarry rate 3%

29
Q

Contraception advice post partum?

A

OCP: delay for 21d given risk of thrombosis (OCP) and bleeding (POP).
-Mini pill (progestogeon only) 350mcg/d
or
levonorgestrel 30mcg/day
Transfer to COC when breastfeeding completed.
Consider IUD after 6 weeks.

30
Q

What are the important factors in establishing breast feeding?

A
  1. Positioning and attachment of the baby on the breast.
  2. Milk ejection reflex
  3. Supply and demand
  4. Intact milk ducts and sensory nerves
  5. Sufficient glandular breast tissue
  6. Infant being able to feed
31
Q

advice to mother re poor feeding?

A
  1. Practice relaxation techniques
  2. Put baby to breast as often as it demands (chest to chest, chin on breast)
  3. Feed more often than usual, with at least one night feed.
  4. Feed at first signs of readiness to feed
  5. Express after feeds - the emptier the breasts, the more milk produced
  6. Get adequate rest, eat well, drink ample fluids, get home help.
  7. Visit doctor if overly tired

Primary Care (3 decks)

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