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MIDW5008 > Pregnancy Care & Screening (W/S - 4&5) > Flashcards

Pregnancy Care & Screening (W/S - 4&5) Flashcards

1
Q

What are the aims of antenatal care? (7)

A
  • To establish a COLLABORATIVE RELATIONSHIP between the woman and the HCPs involved in her care.
  • To inform the woman about the MODELS OF CARE available for pregnancy and birth, empowering her to make an informed choice.
  • To assess the woman’s level of SOCIAL SUPPORT and her PHYSICAL, PSYCHOLOGICAL and EMOTIONAL WELLBEING.
  • To ascertain BASELINE RECORDINGS for later comparisons.
  • To IDENTIFY RISK FACTORS for the pregnancy.
  • To provide SUPPORT and make appropriate REFERRALS.
  • To provide HEALTH EDUCATION promoting and reinforcing healthy lifestyle habits in pregnancy.
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2
Q

What are the principles of antenatal care?

A
  • It should be flexible, adaptable and readily available, offering choice, control and continuity of individualised woman centred care.
  • It’s effectiveness should be evaluated and the patterns and methods used continually monitored.
  • There should be collaboration, cooperation and good communication resulting in a partnership between the HCPs and the woman.
  • The midwife should make optimal use of knowledge and skills to empower the woman.
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3
Q

What might inhibit communication channels?

A

Appearing “too busy”
Being opinionated and judgemental
Butting in without stories or allowing a third party to

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4
Q

What are ways to involve women in their antenatal care?

A
  • The woman-held national antenatal record (feel better informed, more involved in and exercise control over their maternity care).
  • Make sure they understand what is written about them.
  • Always finish Consult with “Is there anything else I can help you with?”
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5
Q

What is the traditional schedule of visits pattern?

A

4 weekly to 28 weeks, 2 weekly to 36 weeks, weekly to birth.

There is no national policy or consistency re number of visits. NICE recommends fewer but more informative antenatal visits and that healthy women be offered 10 appts for first pregnancy and 7 during subsequent pregnancies.

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6
Q

What is the suggested schedule of visits in the woman’s hand held record?

A 
16 weeks
18-20
24
28
32
34
36
38
40 (for women having first baby)
41 (for women who have not yet given birth)
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7
Q

What does gravid mean?

A

Pregnant

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8
Q

What does para mean?

A

Having given birth.

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9
Q

What does nulligravida mean?

A

A woman who has never been pregnant

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10
Q

What does gravida mean?

A

A woman who is or has been pregnant (primigravida first pg, multigravida subsequent pgs)

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11
Q

What does nullipara mean?

A

A woman who has not completed a pregnancy beyond 20 weeks or 400g

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12
Q

What does primipara mean?

A

A woman who has given birth once beyond 20 weeks or 400g

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13
Q

What does multipara mean?

A

A woman who has completed 2 or more pregnancies beyond 20 weeks.

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14
Q

What does grande multipara mean?

A

A woman who has given birth 5 or more times.

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15
Q

How to calculate EDB?

A
  • Menstrual history
  • Contraceptive history
  • Physical signs of pregnancy
  • Woman’s own knowledge of conception date
  • Dating scan: earlier is more accurate
  • Ngaegele’s rule (first day of LMP, +7 days and 9 months for EDB or + 1 year - 3 months + 1 week)
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16
Q

During a booking visit, what history needs to be obtained?

A

Demographic profile

  • social
  • medical
  • surgical
  • psychological
  • previous obstetric history including infections
  • gynaecological including family planning and pap smear history
  • family
  • current pregnancy
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17
Q

What is included in the booking visit?

A
  • EDB calculation
  • Options of care
  • History taking
  • Weight and height (and BMI calc)
  • Screening for domestic violence
  • Routine blood screen
  • Other screening (MSU, pap smear if not tested in previous 2 years)
  • Screening for abnormalities
  • Screening for depression (EPDS)
  • Information about diet, exercise, self breast examination, dental hygiene, smoking, AOD, education classes, working during pregnancy, sexual intercourse during pregnancy, travel (seat belt under bump, support tights for flights.
  • Physical checks - BP, urinalysis (blood, protein, glucose), fundal height.
  • Information about minor discomforts of pregnancy.
  • Summary to women (document findings and explain, provide info leaflets, explain where to access additional info, advise re: further appts)
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18
Q

What is the BMI calculation?

A

Weight / Height^2

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19
Q

If BMI at booking visit is below X or above Y additional care is “required”.

A 
X = 18
Y = 30-35
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20
Q

Risk of caesarean section is not significantly increased until height is less than Xcm.

A

X= 140cm

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21
Q

When is the screening for domestic violence completed?

A

Booking appt and again in 3rd trimester

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22
Q

What is being tested in the full blood picture/ count?

A
  • white blood cell (WBC, fight infection, part of immune system) count
  • white blood differential (looks at different types of WBCs)
  • red blood cell (RBC, carry O2 around body) count
  • haemoglobin (iron containing, oxygen carrying protein in RBCs)
  • platelets (important in blood clotting, too few can lead to bruising or bleeding)
  • mean platelet volume (MPV, measures average size of platelets)
  • haematocrit (measures percentage of RBCs in the total blood)
  • mean corpuscular volume (MCV, measures average size of RBCs)
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23
Q

If Hb is below X g/l, recommend iron treatment to women.

A

110 g/l

24
Q

Who is Anti-D prophylaxis offered to and when?

A

All non-sensitised women who are RhD negative.

At 28-30 weeks, 34-36 weeks and also after any vaginal bleeding or abdominal trauma. And within 72 hours of delivery of a RhD-positive fetus, (or following other obstetric events associated with a risk of fetal-to-maternal haemorrhage).

RhD negative women carrying an RhD-positive fetus are at risk of becoming sensitised, producing antibodies against the RhD antigen if fetal cells enter the maternal circulation. Sensitisation places the RhD-positive fetus and future RhD-positive pregnancies at risk of haemolytic disease of the fetus and newborn (HDFN). If undiagnosed and/or untreated, HDFN carries significant risk of perinatal morbidity and mortality. HDFN is a blood disorder that causes your baby’s red blood cells to break down quickly. When red blood cells break down it is called hemolysis.

25
Q

When is haemoglobinopathy conducted?

A

If at risk (African: sickle cell, Mediterranean: thalassaemia.

26
Q

When is vitamin d status checked antenatally and when is supplementation recommended?

A

Not routinely. Testing is only considered for women at high risk of suboptimal levels (veiled women, very dark skin.

Supplementation reccomended if levels are lower than 50nmol/L or for pregnant women at higher risk (without testing).

27
Q

What routine screening is reviewed / reccomended at the booking visit?

A
  • Blood group and Rhesus factor
  • FBP
  • Iron studies
  • Rubella serology
  • Hepatitis serology, B and C
  • Syphilis
  • HIV serology
  • Chlamydia (first stream urine)
28
Q

What is considered iron deficiency?

A

Low iron stores (ferritin < 15ug/L) and reduced MCV <80fL (mean corpuscular volume - measures average size of RBCs) but normal haemoglobin (Hb) concentration
OR
Serum ferritin 15-30ug/L, plus two of the following:
serum iron < 10umol/L; total iron binding capacity > 68micromol/L; serum transferrin > 3.5g/L or transferrin
saturation < 15%

29
Q

Why is MSU screening offered at the first visit?

A

Asymptomatic bacteria is the major risk factor for developing UTIs in pregnancy.
Treatment reduces risk of preterm birth.

30
Q

When are women screened for bacterial vaginosis?

A

Not routinely - insufficient evidence.

Screening (swabs) reccomended for women with abnormal vaginal discharge. Woman can take swab herself.

Bacterial vaginosis present in 20% women during pregnancy - associated with poor perinatal outcomes, increased risk of pre-term birth

31
Q

When are pap smears conducted antenatally?

A

Only if not tested in previous 2 years or symptoms suggestive of cervical pathology.

32
Q

What are the options for screening for fetal abnormalities in the first trimester?

A

1st trimester combined scan and blood tests (nuchal translucency, beta hCG, pregnancy associated plasma protein-A) at 11-13 weeks for Down’s Syndrome.

Non-invasive perinatal testing (NIPT aka cell-free DNA testing)

33
Q

What does NIPT stand for?

A

Non invasive prenatal testing

34
Q

What does non invasive prenatal testing look at?

A

Trisomy 21 (Down Syndrome), also 18, 13 and 45X. Will not detect all the chromosomal abnormalities which are found by amniocentesis.

Fetal sex (presence of Y chromosome)

Rhesus D blood group

Chromosomal abnormality from the woman could be discovered

35
Q

What dietary information should be offered to women?

A
  • Nutritional advice..
  • Supplementation with folic acid (500mcgs per day), before conception and up to 12 weeks gestation reduces risk of NTD (neural tube defects)
  • Iron supplements should not be routine
  • Make sure reheated food is heated thoroughly
  • Make sure all food is washed thoroughly
  • Watch Vit A intake (>700mcg/day)
  • What foods to avoid
36
Q

What foods should we recommend women avoid?

A
  • Soft, blue, goats, sheeps, unpasteurised cheeses
  • Pates (and liver in large quantities)
  • Uncooked / cold / smoked seafood
  • Raw eggs (home made mayo, chocolate mousse / coleslaw)
  • Soft serve ice-cream/thick shakes
  • Cold deli meats (such as diced chicken, salami, ham)
37
Q

Why is a baseline blood pressure taken in early pregnancy?

A
  • Identify women at increased risk
  • Early pregnancy baseline measurement will differentiate chronic hypertension from gestational hypertension and pre-eclampsia
  • BP generally falls at 12 weeks and rises
    slightly at 36 weeks
38
Q

What occurs at an 8 week appointment?

A
  • Dating scan if unsure of dates
  • Serial HCG
  • Discuss first trimester screening
  • Complete any booking information or documentation
  • Order or check booking bloods
  • BP and urinalysis
  • Discuss/advise early pregnancy symptoms
  • Advise flu vacc
39
Q

What occurs at a 12 week appointment?

A
  • Fundal height (clinical estimation)
  • Fetal heart rate (if woman agrees)
  • BP and urinalysis
  • Ensure completion of or check results of FTS
  • Order Second Trimester Screening if FTS not done: Maternal serum screening (Triple Test) for Down Syndrome (Trisomy 21) and Neural Tube Defects. If book later 15-20 weeks - less predictive
40
Q

What occurs at an 18 week appointment?

A
  • Fundal height – clinical estimation
  • Fetal heart rate (if woman agrees)
  • BP and urinalysis
  • Check results of Second Trimester Screening
  • Advise to book anatomy scan for 18-20 week
41
Q

What occurs at a 20 week appointment?

A
  • Fundal height – clinical estimation
  • Fetal heart rate
  • BP and urinalysis
  • Check anatomy scan results
  • Fetal movements: Maternal awareness of fetal activity is simple, inexpensive and may prevent fetal death
42
Q

When is the Edinburgh Postnatal Depression Score (EPNDS) conducted and when is referral for further assessment by a psychologist recommended?

A
  • Administered at first antenatal visit and
    repeated at 32 weeks
  • Routine screening score of 12+ requires
    referral for further assessment by
    psychologist
43
Q

What occurs at a 25 week appointment?

A
  • Physical exam (BP, urinalysis, oedema)
    – Fundal height
    – Fetal movements
    – Information/leaflets re diabetes testing and bloods
    – Forms for 28 week blood tests: GTT/OGCT (family history, ethnicity, weight), FBP, iron studies, blood group and antibodies
44
Q

What occurs at a 30 week appointment?

A
  • Physical exam (BP, urinalysis, oedema)
  • Full palpation: inspection, palpation, fundal height, lie, presentation, position, engagement, attitude, auscultation
  • Fetal movements
  • Check 28 week blood results
  • Anti D advised for Rh – women
  • Certificate of confinement required?
  • Information and advice re feeding including previous experience
45
Q

What occurs at the 33 week appointment?

A
  • Physical exam (BP, urinalysis, ?oedema)
  • Full palpation
  • Fetal movements
  • Second EPNDS
  • Information re GBS screening
  • Advise pertussis vacc
46
Q

What occurs at the 36 week appointment?

A 
- Physical exam (BP, urinalysis, ?oedema)
– Full palpation
– Fetal movements
– GBS screening
- Optimal fetal positioning and spinning babies for OP positions
- Discuss birth plan
- Information re Vit K and Hep B
- Second Anti D for Rh Neg women
47
Q

What occurs at 38+ week appointments?

A
  • Physical exam (BP, urinalysis, oedema)
  • Full palpation
  • Fetal movements
  • When to come in in labour
  • Who to contact
  • What to bring
  • Postdates appointments
  • Information and leaflets re: SIDS, safe travel, newborn screening, contraception, support at home, postdates
    management
48
Q

What are some management / treatment options for morning sickness?

A
  • Small meals, simple carbs
  • Dry biscuits
  • Fizzy drinks
  • Ginger
  • Acupressure
49
Q

What are some management / treatment options for constipation?

A
  • Increase fluids
  • Increase exercise
  • Increase fibre: bran/cereals, vegetables
50
Q

What are some management / treatment options for haemorrhoids?

A
  • Increase fluids, fibre, exercise
  • Avoid straining on the toilet
  • Pelvic floor exercises
  • Proctosedyl ointment for 7 days treatment
51
Q

What are some management / treatment options for varicose veins - legs?

A
  • Keep legs elevated
  • Support tights: (from chemist or possible refer to physio for measurement)
  • Leg exercises
52
Q

What are some management / treatment options for varicose veins - vulval varicosities?

A
  • Rest
  • Pelvic floor exercises
  • Support
53
Q

What are some management / treatment options for backache?

A
  • Low shoes
  • Use legs rather than back to lift
  • Avoid lifting, pushing, pulling as much as possible
  • Don’t slouch, lean
  • Roll onto side to sit up
  • Refer to physio
54
Q

What are some management / treatment options for heartburn?

A
  • Avoid fatty, spicy foods and caffeine
  • Drink yoghurt, coconut milk, cold milk.
  • Avoid tobacco and alcohol
  • Eat smaller meals slowly
  • Antacids: Gaviscon, Gastrogel
55
Q

What are some management / treatment options for cramps?

A
  • Pull toes up to chin
  • Take a Magnesium supplement
  • Increase sodium intake (slightly)
56
Q

What are some management / treatment options for tiredness?

A
  • Listen to your body
  • Rest when you can
  • Usually only lasts for 12 weeks
57
Q

Example exam question - “Adewale has just discovered she is pregnant. Link the hormonal changes in the first 3 months of pregnancy with the effects Adewale might experience?”

A

…

MIDW5008 (15 decks)

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