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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
Q

When can a foetal anomaly scan be carried out?

A

18-22 weeks

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26
Q

What is the timeframe for the second trimester?

A

14-28 weeks

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27
Q

When can foetal heart be ausculated?

A

from 18 weeks

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28
Q

List four common problems encountered during the second trimester

A 
N/V
constipation
pelvic girlde/sciatica/back pain
anaemia
carpal tunnel syndrome
bleeding gums
fatigue
itching
rashes
vaginal discharge
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29
Q

What is the time frame for the third trimester?

A

28 weeks- term

30
Q

What should you ask about in the history during third trimester?

A

pain, vaginal loss
common problems in pregnancy
fetal movements

31
Q

What should you assess during third trimester assessment?

A

BP, urinalysis, auscultate foetal heart
abdo exam
evaluation of foetal growth

32
Q

When is foetal growth assessed?

A

24 weeks +

33
Q

How is foetal growth assessed?

A

symphyseal-fundal height

34
Q

List three antenatal complications

A

Polyhydramnios

Oligohydramnios

Hypertension and Pre-eclampsia

Anaemia

Impaired Glucose Tolerance

Mental Health Problems

35
Q

What are the signs of polyhydramnios?

A 
large for dates
tense abdomen
can't feel foetal parts
Amniotic fluid index>90th centile
single deepest vertical poll>8cm
36
Q

Which complications can arise from polyhydramnios?

A 
placental abruption
cord prolapse
malpresentation
postpartum haemorrhage
premature bitrh and perinatal death
37
Q

What is polyhydramnios?

A

excessive accumulation of amniotic fluid

38
Q

What is oligohydamnios?

A

too little amniotic fluid

39
Q

What is the AFI and DVP in oligohydramnios?

A

AFI <5 cm

DVP < 2cm

40
Q

List three causes of oligohydramnios

A

pre eclampsia
premature rupture of membranes
intrauterine growth restriction

41
Q

List three symptoms of pre-eclampsia

A

headache
visual disturbance
severe upper abdo pain
significant facial/hand/ankle oedema

42
Q

List three risk factors for pre-eclampsia

A 
P0
FH
Extremes of maternal age
Obesity
Medical conditions
Obstetric factors
43
Q

List two medical conditions that are risk factors for pre-eclampsia

A 
HTN
renal disease
thrombophilia
SLE
diabetes
44
Q

List two obstetric factors that are risk factors for pre-eclampsia

A

multiple pregnancy
prev pre-eclampsia
hydatidiform mole
hydrops

45
Q

What is the definition of anaemia in pregnancy

A

Hb <105

46
Q

List two risk factors for impaired glucose tolerance

A 
FH diabetes
BMI >40
Ethnicity with high prevalence
Previous macrosomic baby
Prev gestational diabetes
47
Q

Name one leading cause of maternal death in the UK?

A

suicide

48
Q

Name two complications of oligohydramnios

A

Fetal renal congenital abnormalities
May cause hypoxia due to cord compression
Poor perinatal outcomes
Prolonged pregnancy

49
Q

List four assessments/investigations during antenatal appointment

A 
blood presure
urinalysis
oedema
height of uterus
fetal lie
fifths palpable
baby's heartbeat
baby's movement felt
blood tests
50
Q

What happens to the respiratory rate during pregnancy?

A

unchanged but tidal volume increases

51
Q

When is the fetal anomaly scan conducted?

A

20 weeks

52
Q

How many total checks should primigravida versus parous women have?

A

10 antenatal checks prim

7 parous

53
Q

When is the first antenatal visit?

A

ideally <10 weeks

54
Q

When is down’s screening performed?

A

11-13+6 weeks

55
Q

When would the first dose of anti-D prophylaxis be given to rhesus negative women?

A

28 weeks

IM injection

56
Q

When is external cephalic version offered?

A

36 weeks

57
Q

What are the three pathways of antenatal care?

A

green- low risk
amber- moderate
red- high risk

58
Q

Why does haemodilution occur in pregnancy??

A

higher increase in plasma volume relative to red cell mass, therefore physiological anaemia of pregnancy

59
Q

What happens to WBCs in pregnancy?

A

neutrophilia

thrombocytopaenia= gestational (low platelet count)

60
Q

Why is there a hypercoagulable state in pregnancy?

A

increase in coag factors
increase fibrinogen
decrease in antithrombin III activity

61
Q

Why does peripheral vascular resistance decrease in pregnancy?

A

vasodilatory effects of progesterone

62
Q

What is supine hypoventilation syndrome?

A 
compression of IVC
decreases venous return
decreases CO
decrease in BP 
- faint and dizzy + fetal distress
63
Q

What should you advise to prevent supine hypoventilation syndrome?

A

lie in left lateral position

64
Q

List two changes to the heart during pregnancy

A

may have third heart sound
innocent murmur
heart axis shifted anteriorly to the left
hypertrophy and dilation of LV and LA

65
Q

State two changes in ECG of pregnanc woman

A

tachycardia
LAD
Shorter PR interval

66
Q

Mother and father are both rhesus negative. Do you need to give anti-D?

A

no!

67
Q

Mother is rhesus positive. Do you need to give anti-D?

A

No!

68
Q

Mother is rhesus negative. Do you need to give anti-D?

A

yes!!

69
Q

24+2 with GBS has negative urine and blood infection but positive in swabs. Do you give antibiotics?

A

prophylactic antibiotic treatment at time of delivery (for baby’s health)

70
Q

Three causes of polydramnios?

A

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
Q

What is liquor?

A

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
Q

Why is liquor/amniotic fluid important?

A

foetal lung development

1 Obs & Gyn (31 decks)

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