Pregnancy CLINICAL

Question 1

Obstetric exam key points

Note obstetric dating is from LMP, meaning conception would have occurred at least 2 weeks after.

Answer 1

Length of pregnancy
Parity
Social history
Previous medical history
Current medications
Nature of mothers pregnancy( gestational diabetes, preeclampsia)
Smoke/drink
Type of delivery wanted
Age

Question 2

What scans would you perform?

Answer 2

12 weeks: would do nuchal translucency

20 weeks : anatomy scan

Question 3

What is part of the fetal welfare assessment?

Answer 3

Closed cervix; babies bladder; placenta (whiter structure); head and abdominal circumference; fetal stomach; fetal blood flow with doppler of umbilical artery. May also do cerebral doppler

Question 4

What is key with pre-pregnancy planning?

Answer 4

Have good health (obesity is a risk factor), also limit alcohol etc. Take folate, as NT closes at week4/4.5

Question 5

What factors will someone be bringing into pregnancy?

Answer 5

Parity: if first time, BP so preeclampsia
Family history
Other medical conditions
Mental health
Age
Partners age/history

Question 6

What are you trying to detect with fetal scans?

Answer 6

Preeclampsia; fetal growth restriction; gestational diabetes; fetal abnormalities; risk of preterm birth; trisomy 21; congenital abnormalities

Question 7

What screening tests are there and when do we do them?

Answer 7

1st tri: Serum PAPP-A and BHcg + nuchal translucency

2nd tri: Quad test, uES, alpha FP, bHCG, inhibin A, NIPT aneuploidy

Question 8

What physiological changes are there in preeclampsia? (high BP)

Answer 8

Normally, feto-placental cells inade deep into the decidua.
In preeclampsia, the trophoblast invades poorly, meaning decreased utero-placental perfusion. Also endothelial dysfunction.
Syncytial knots?

Question 9

Doppler and preeclampsia

Answer 9

Abnormal placental development- abnormal umbilical doppler, fetal hypoxemia, redistribution of flow, myocardial dysfunction