Pregnancy, antenatal care and screening Flashcards
List three physiological changes in pregnancy
increased HR, CO, SV, plasma volume, RR, oxygen consumption, larygeal oedema
decreased residual capacity and arteria PCO2
By how much does oxygen consumption increase in pregnancy
20%
What happens to the systemic and pulmonary resistance during pregnancy?
decrease
risk of hypotension
What happens to conc of serum iron and transferrin TIBC?
serum iron falls
increase in TIBC and transferrin
What is a consequence of plasma volume increase?
dilutional anaemia, increase in EPO
How does pregnancy affect renal blood flow and GFR?
50-60% increase
What happens to levels of urea, creatinine, urate, and bicarbonate in pregnancy?
decrease
Why is there an increased risk of UTIs in pregnant women?
bladder smooth muscle relaxation, enlarging uterus may put pressure on ureters, increase in residual urine
Why can mild glycosuria and/or proteinuria occur?
increase in GFR may exceed the ability of the renal tubules to reabsorb glucose and protein
List two reasons why pregnant women experience GORD, N+V, and constipation
decreased lower oesophageal sphincter pressure
decreased gastric peristalsis
delayed gastric emptying
increased small and large bowel transit times
List one dermatological change in pregnancy
hyperpigmentation of umbilicus, nipples, face, abdominal midline
spider naevi
palmar erythema
stria gravidarum= stretch marks
What is linea nigra?
abdominal midline
Name one MSK change in pregnancy
increased ligamental laxity due to relaxin- back pain
shift in posture- exaggerated lumbar lordosis
When is the first appointment with the midwife made in pregnancy?
by week 10
List two aims of the first appointment during first trimester
ID risks e.g. domestic abuse
screen for abnormalities
provide key health promotion- smoking, dietician, folic acid, alcohol
social work
build rapport
initial obs- BMI, HR, BP, urinalysis, abdo exam
What is Naegele’s rule?
Add 9 months + 7 days to the first day of the last menstrual period
OR
LMP + 1 year - 3 months + 7 days
List three risk factors for problematic pregnancy
age>40 age <18 extremes BMI low socioeconomic status drug and alcohol prev obstetric problems vulnerable groups and asylum seekers pre existing medical problems e.g. diabetesm epilepsy, HTN
Name three investigations to screen the mother during pregnancy
FBC (anaemia, thrombocytopaenia)
Blood group
Sickle cell and thalassaemia
Hep B/C/HIV/syphilis
Which fetal screening test is offered for everyone?
combined test- Down’s, edward’s, and patau’s syndrome
At what time is the combined test carried out?
11-14 weeks
If there is a high risk from the combined test, which test is then offered?
NIPT= non-invasive pre natal test
ID fetal DNA from the maternal circulation
If NIPT is positive, which tests are then offered?
chorionic villus sampling
amniocentesis
When can amniocentesis be offered
15 weeks
When can CVS be conducted
from 11 weeks
When can a foetal anomaly scan be carried out?
18-22 weeks
What is the timeframe for the second trimester?
14-28 weeks
When can foetal heart be ausculated?
from 18 weeks
List four common problems encountered during the second trimester
N/V constipation pelvic girlde/sciatica/back pain anaemia carpal tunnel syndrome bleeding gums fatigue itching rashes vaginal discharge
What is the time frame for the third trimester?
28 weeks- term
What should you ask about in the history during third trimester?
pain, vaginal loss
common problems in pregnancy
fetal movements
What should you assess during third trimester assessment?
BP, urinalysis, auscultate foetal heart
abdo exam
evaluation of foetal growth
When is foetal growth assessed?
24 weeks +
How is foetal growth assessed?
symphyseal-fundal height
List three antenatal complications
Polyhydramnios
Oligohydramnios
Hypertension and Pre-eclampsia
Anaemia
Impaired Glucose Tolerance
Mental Health Problems
What are the signs of polyhydramnios?
large for dates tense abdomen can't feel foetal parts Amniotic fluid index>90th centile single deepest vertical poll>8cm
Which complications can arise from polyhydramnios?
placental abruption cord prolapse malpresentation postpartum haemorrhage premature bitrh and perinatal death
What is polyhydramnios?
excessive accumulation of amniotic fluid
What is oligohydamnios?
too little amniotic fluid
What is the AFI and DVP in oligohydramnios?
AFI <5 cm
DVP < 2cm
List three causes of oligohydramnios
pre eclampsia
premature rupture of membranes
intrauterine growth restriction
List three symptoms of pre-eclampsia
headache
visual disturbance
severe upper abdo pain
significant facial/hand/ankle oedema
List three risk factors for pre-eclampsia
P0 FH Extremes of maternal age Obesity Medical conditions Obstetric factors
List two medical conditions that are risk factors for pre-eclampsia
HTN renal disease thrombophilia SLE diabetes
List two obstetric factors that are risk factors for pre-eclampsia
multiple pregnancy
prev pre-eclampsia
hydatidiform mole
hydrops
What is the definition of anaemia in pregnancy
Hb <105
List two risk factors for impaired glucose tolerance
FH diabetes BMI >40 Ethnicity with high prevalence Previous macrosomic baby Prev gestational diabetes
Name one leading cause of maternal death in the UK?
suicide
Name two complications of oligohydramnios
Fetal renal congenital abnormalities
May cause hypoxia due to cord compression
Poor perinatal outcomes
Prolonged pregnancy
List four assessments/investigations during antenatal appointment
blood presure urinalysis oedema height of uterus fetal lie fifths palpable baby's heartbeat baby's movement felt blood tests
What happens to the respiratory rate during pregnancy?
unchanged but tidal volume increases
When is the fetal anomaly scan conducted?
20 weeks
How many total checks should primigravida versus parous women have?
10 antenatal checks prim
7 parous
When is the first antenatal visit?
ideally <10 weeks
When is down’s screening performed?
11-13+6 weeks
When would the first dose of anti-D prophylaxis be given to rhesus negative women?
28 weeks
IM injection
When is external cephalic version offered?
36 weeks
What are the three pathways of antenatal care?
green- low risk
amber- moderate
red- high risk
Why does haemodilution occur in pregnancy??
higher increase in plasma volume relative to red cell mass, therefore physiological anaemia of pregnancy
What happens to WBCs in pregnancy?
neutrophilia
thrombocytopaenia= gestational (low platelet count)
Why is there a hypercoagulable state in pregnancy?
increase in coag factors
increase fibrinogen
decrease in antithrombin III activity
Why does peripheral vascular resistance decrease in pregnancy?
vasodilatory effects of progesterone
What is supine hypoventilation syndrome?
compression of IVC decreases venous return decreases CO decrease in BP - faint and dizzy + fetal distress
What should you advise to prevent supine hypoventilation syndrome?
lie in left lateral position
List two changes to the heart during pregnancy
may have third heart sound
innocent murmur
heart axis shifted anteriorly to the left
hypertrophy and dilation of LV and LA
State two changes in ECG of pregnanc woman
tachycardia
LAD
Shorter PR interval
Mother and father are both rhesus negative. Do you need to give anti-D?
no!
Mother is rhesus positive. Do you need to give anti-D?
No!
Mother is rhesus negative. Do you need to give anti-D?
yes!!
24+2 with GBS has negative urine and blood infection but positive in swabs. Do you give antibiotics?
prophylactic antibiotic treatment at time of delivery (for baby’s health)
Three causes of polydramnios?
foetal anomalies- anything obstructing or preventing swallowing= oesophageal atresia
Foetal anaemia - lack of red blood cells in foetus
Blood group incompatibility of mother (Rh negative)and child(Rh positive)
Twin to twin transfusion - pregnancy with identical twins and blood supply to one twin is more than the other twin
Placental blood vessel abnormality
Maternal gestational diabetes
Infectious conditions such as toxoplasmosis, herpes simplex, cytomegalovirus, and rubella
Hypertension
Pre-eclampsia
What is liquor?
Amniotic fluid is a liquid of a clear or a little yellow color that is found in the uterus of pregnant women, which can becalled liquor amnii. The amniotic liquid surrounding the fetus is quite essential to the baby’s development.
Why is liquor/amniotic fluid important?
foetal lung development
