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Repro and Sexual Health > Pregnancy Tutorial > Flashcards

Pregnancy Tutorial Flashcards

1
Q

What is the purpose of an early pregnancy scan?

A

Viable pregnancy
Multiple pregnancies
Intrauterine
Gestational age; CRL (if over 12 weeks; use head circumference)
Placental position
Any obvious anomalies (anencephaly, gastroschisis, limb defects, major heart anomalies)

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2
Q

What is the gestation of 6.64cm CRL?

A

12 + 2 weeks

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3
Q

How is the robustness of a screening test assessed?

A

Specificity (true positive / (true + false neg)

Sensitivity (true neg / (true + false pos)

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4
Q

What are the constituent components involved in 1st trim screening for down syndrome?

A

bhCG + PAPP-A
NT
Maternal age (>40)

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5
Q

What is nuchal translucency?

A

Measure of thickness behind frontal neck - fluid

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6
Q

From what gestation is NT valid?

A

11- 13 + 6 weeks

1st trim

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7
Q

What is considered a normal NT?

A

<3.5mm

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8
Q

Reasons for increased NT?

A

Chromosomal abnormalities; T 18, 21
Cardiac abnormalities
Turner’s syndrome

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9
Q

What is MSAFP?

A

Maternal serum AFP -

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10
Q

In what conditions is an increased MSAFP seen?

A 
Multiple pregnancies
Placental abruption 
Anencephaly 
Spina bifida 
Gastroschisis
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11
Q

What is pre-eclampsia?

A

Pregnancy-induced hypertension (>20 wks) in association with proteinuria (>0.3 g in 24 hours) with or without oedema

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12
Q

What is the pathogenesis of pre-eclampsia?

A

Suboptimal uteroplacental perfusion associated with a maternal inflammatory response and maternal vascular endothelial dysfunction. This in turn leads to vascular hyperpermeability, thrombophilia and hypertension, which may compensate for the reduced flow in the uterine arteries

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13
Q

What are the parameters for hypertension in pregnancy?

A

Systolic BP >140 mm Hg or diastolic BP >90 mm Hg

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14
Q

What is HELLP syndrome?

A

Haemolysis
Elevated liver enzymes
Low Platelets

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15
Q

Mode of action of labetalol?

A

Alpha and beta blocker

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16
Q

Mode of action of betamethasone in neonate?

A

Increase lung maturity (surfactant production)
Decreased NEC
Decreased intraventricular haemorrhage

17
Q

Mode of action of hydralazine?

A

Peripheral vasodilatory via direction relaxation of vascular smooth muscle

18
Q

Mode of action of magnesium sulfate?

A

Peripheral and cerebral vasodilator
Anticonvulsant
Membrane stabiliser

19
Q

What is meant by rhesus neg?

A

No D antigens on the RBC of mother

20
Q

What is the mode of action of anti-D?

A

Neutralises foetal antigens in maternal blood to prevent mother isoimmunization resulting in the production anti-D antibodies which can have catastrophic effects on future pregnancies and on neonate

21
Q

What is seen in the blood of a sensitized mother?

A

Positive antibodies to D antigen

22
Q

In an affected rhesus positive baby, what would happen to the following cord blood parameters:
Hb
Bilirubin
Coombs test

A

Hb; decreased
Bilirubin; increased
Coombs test; positive (detects Abs that act against the surface of RBC)

23
Q

When should anti-D be given to prevent rhesus isoimmunisation following a sensitizing event?

A

Ideally within 72 hours

But up to 10 days

24
Q

What route is anti-D given?

A

IM

25
Q

How does the dose of anti-D differ based on gestational age?

A

<20 wks; 250 IU

>20 wks; 500 IU

26
Q

List some sensitizing events that warrant anti-D?

A 
Post-partum; within 24 hours of a birth of Rh +ve baby
Miscarriage >12 weeks
ToP at any gestation 
Amniocentesis 
Trauma to abdomen
27
Q

When is routine prophylaxis given to Rh -ve women?

A

28 weeks; dose of 500 IU IM

28
Q 
Would you administer anti-D in this case:
Rh -ve mother 
ABO compatible 
Rh +ve baby 
Coombs test -ve 
Infant bilirubin level normal
A

Yes; give postpartum to prevent isoimmunisation

29
Q 
Would you administer anti-D in this case:
Rh -ve mother 
ABO incompatible 
Rh -ve baby 
Coombs test -ve
Infant bilirubin level normal
A

No

30
Q 
Would you administer anti-D in this case:
Rh -ve mother 
ABO compatible 
Rh + baby 
Coombs test +ve 
Infant bilirubin level increased
A

Yes and no
Mother already sensitized so anti-d antibodies already formed
Need to monitor future pregnancies very carefully to assess foetus for anaemia and hydrops

31
Q 
Would you administer anti-D in this case:
Rh +ve mother 
ABO incompatible 
Rh -ve baby 
Coombs test +ve 
Infant bilirubin level increased
A

No; infant increased bilirubin due to ABO incompatibility not rhesus
Monitor baby; keep hydrated
Can offer phototherapy for jaundice

32
Q

What are routine components of antenatal care routine?

A 
Weeks pregnant
Height of uterus/ fundal height 
BP 
Urinalysis 
Oedema
Fifths palpase
Foetal lie and presentation 
FHR 
Foetal movements 
FBC
33
Q

What changes occur normally in the maternal CV system?

A

Increased CO
Increased HR
Decreased BP in 2nd trim

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