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1 Obs & Gyn > Pregnancy, antenatal care and screening > Flashcards

Pregnancy, antenatal care and screening Flashcards

1
Q

List three physiological changes in pregnancy

A

increased HR, CO, SV, plasma volume, RR, oxygen consumption, larygeal oedema

decreased residual capacity and arteria PCO2

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2
Q

By how much does oxygen consumption increase in pregnancy

A

20%

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3
Q

What happens to the systemic and pulmonary resistance during pregnancy?

A

decrease

risk of hypotension

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4
Q

What happens to conc of serum iron and transferrin TIBC?

A

serum iron falls

increase in TIBC and transferrin

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5
Q

What is a consequence of plasma volume increase?

A

dilutional anaemia, increase in EPO

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6
Q

How does pregnancy affect renal blood flow and GFR?

A

50-60% increase

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7
Q

What happens to levels of urea, creatinine, urate, and bicarbonate in pregnancy?

A

decrease

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8
Q

Why is there an increased risk of UTIs in pregnant women?

A

bladder smooth muscle relaxation, enlarging uterus may put pressure on ureters, increase in residual urine

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9
Q

Why can mild glycosuria and/or proteinuria occur?

A

increase in GFR may exceed the ability of the renal tubules to reabsorb glucose and protein

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10
Q

List two reasons why pregnant women experience GORD, N+V, and constipation

A

decreased lower oesophageal sphincter pressure
decreased gastric peristalsis
delayed gastric emptying
increased small and large bowel transit times

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11
Q

List one dermatological change in pregnancy

A

hyperpigmentation of umbilicus, nipples, face, abdominal midline

spider naevi
palmar erythema
stria gravidarum= stretch marks

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12
Q

What is linea nigra?

A

abdominal midline

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13
Q

Name one MSK change in pregnancy

A

increased ligamental laxity due to relaxin- back pain

shift in posture- exaggerated lumbar lordosis

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14
Q

When is the first appointment with the midwife made in pregnancy?

A

by week 10

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15
Q

List two aims of the first appointment during first trimester

A

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

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16
Q

What is Naegele’s rule?

A

Add 9 months + 7 days to the first day of the last menstrual period

OR

LMP + 1 year - 3 months + 7 days

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17
Q

List three risk factors for problematic pregnancy

A 
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
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18
Q

Name three investigations to screen the mother during pregnancy

A

FBC (anaemia, thrombocytopaenia)
Blood group
Sickle cell and thalassaemia
Hep B/C/HIV/syphilis

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19
Q

Which fetal screening test is offered for everyone?

A

combined test- Down’s, edward’s, and patau’s syndrome

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20
Q

At what time is the combined test carried out?

A

11-14 weeks

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21
Q

If there is a high risk from the combined test, which test is then offered?

A

NIPT= non-invasive pre natal test

ID fetal DNA from the maternal circulation

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22
Q

If NIPT is positive, which tests are then offered?

A

chorionic villus sampling

amniocentesis

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23
Q

When can amniocentesis be offered

A

15 weeks

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24
Q

When can CVS be conducted

A

from 11 weeks

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25
When can a foetal anomaly scan be carried out?
18-22 weeks
26
What is the timeframe for the second trimester?
14-28 weeks
27
When can foetal heart be ausculated?
from 18 weeks
28
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 ```
29
What is the time frame for the third trimester?
28 weeks- term
30
What should you ask about in the history during third trimester?
pain, vaginal loss common problems in pregnancy fetal movements
31
What should you assess during third trimester assessment?
BP, urinalysis, auscultate foetal heart abdo exam evaluation of foetal growth
32
When is foetal growth assessed?
24 weeks +
33
How is foetal growth assessed?
symphyseal-fundal height
34
List three antenatal complications
Polyhydramnios Oligohydramnios Hypertension and Pre-eclampsia Anaemia Impaired Glucose Tolerance Mental Health Problems
35
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 ```
36
Which complications can arise from polyhydramnios?
``` placental abruption cord prolapse malpresentation postpartum haemorrhage premature bitrh and perinatal death ```
37
What is polyhydramnios?
excessive accumulation of amniotic fluid
38
What is oligohydamnios?
too little amniotic fluid
39
What is the AFI and DVP in oligohydramnios?
AFI <5 cm | DVP < 2cm
40
List three causes of oligohydramnios
pre eclampsia premature rupture of membranes intrauterine growth restriction
41
List three symptoms of pre-eclampsia
headache visual disturbance severe upper abdo pain significant facial/hand/ankle oedema
42
List three risk factors for pre-eclampsia
``` P0 FH Extremes of maternal age Obesity Medical conditions Obstetric factors ```
43
List two medical conditions that are risk factors for pre-eclampsia
``` HTN renal disease thrombophilia SLE diabetes ```
44
List two obstetric factors that are risk factors for pre-eclampsia
multiple pregnancy prev pre-eclampsia hydatidiform mole hydrops
45
What is the definition of anaemia in pregnancy
Hb <105
46
List two risk factors for impaired glucose tolerance
``` FH diabetes BMI >40 Ethnicity with high prevalence Previous macrosomic baby Prev gestational diabetes ```
47
Name one leading cause of maternal death in the UK?
suicide
48
Name two complications of oligohydramnios
Fetal renal congenital abnormalities May cause hypoxia due to cord compression Poor perinatal outcomes Prolonged pregnancy
49
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 ```
50
What happens to the respiratory rate during pregnancy?
unchanged but tidal volume increases
51
When is the fetal anomaly scan conducted?
20 weeks
52
How many total checks should primigravida versus parous women have?
10 antenatal checks prim | 7 parous
53
When is the first antenatal visit?
ideally <10 weeks
54
When is down's screening performed?
11-13+6 weeks
55
When would the first dose of anti-D prophylaxis be given to rhesus negative women?
28 weeks | IM injection
56
When is external cephalic version offered?
36 weeks
57
What are the three pathways of antenatal care?
green- low risk amber- moderate red- high risk
58
Why does haemodilution occur in pregnancy??
higher increase in plasma volume relative to red cell mass, therefore physiological anaemia of pregnancy
59
What happens to WBCs in pregnancy?
neutrophilia | thrombocytopaenia= gestational (low platelet count)
60
Why is there a hypercoagulable state in pregnancy?
increase in coag factors increase fibrinogen decrease in antithrombin III activity
61
Why does peripheral vascular resistance decrease in pregnancy?
vasodilatory effects of progesterone
62
What is supine hypoventilation syndrome?
``` compression of IVC decreases venous return decreases CO decrease in BP - faint and dizzy + fetal distress ```
63
What should you advise to prevent supine hypoventilation syndrome?
lie in left lateral position
64
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
65
State two changes in ECG of pregnanc woman
tachycardia LAD Shorter PR interval
66
Mother and father are both rhesus negative. Do you need to give anti-D?
no!
67
Mother is rhesus positive. Do you need to give anti-D?
No!
68
Mother is rhesus negative. Do you need to give anti-D?
yes!!
69
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)
70
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
71
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.
72
Why is liquor/amniotic fluid important?
foetal lung development

1 Obs & Gyn (31 decks)

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