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WH- Normal antenatal progress > Preparing for pregnancy and antenatal care > Flashcards

Preparing for pregnancy and antenatal care Flashcards

1
Q

What should a doctor ask a patient looking to get pregnant?

A
  • Age, PMHx, PSHx, any medications or allergies.
  • Smoking and alcohol status
  • Any previous pregnancies
  • Does she have regular periods or any problems having sexual intercourse?
  • Weight and BMI
  • Any FHx of any conditions, or any problems in pregnancy
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2
Q

What changes are needed to optimise chances of a healthy pregnancy?

A

Moderate exercise
Relaxation and avoiding stressful situations
Stopping contraception
Folic acid (400 mcg/day)
Supplements such as iron, calcium, iodine and zinc if medically indicated
Avoid smoking and alcohol during pregnancy
Seek pre-pregnancy counselling in regards to previous medical problems
Supplementation with vitamin D is recommended for Asian women.

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3
Q

Advice relating to stopping contraception

A

There is no delay in return to fertility after stopping the pill or having the coil removed.
There is a delay of several months after stopping contraceptive injection.
It is suggested to wait for 3 months after stopping the coil before trying for pregnancy

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4
Q

Advice relating to folic acid

A

Recommended for use before pregnancy and up to 12 weeks gestation.
Recommended to reduce NTDs
For women at higher risks (previous affected child, FHx of NTDs, Women with NTDs, epilepsy, diabetes and obesity) should take a 5mg/day.

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5
Q

Which vitamin supplement might be teratogenic?

A

Vitamin A so this should be avoided and food products such as liver and pate high in vit.A should be avoided.

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6
Q

Which medical problems need pre-pregnancy counselling?

A 
DM
Epilepsy 
Cardiac disease 
Respiratory disease
GI disease such as Crohn's or coeliac disease 
Psychiatric disorder
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7
Q

What should a general health check include?

A

General examination including BP, heart and lungs.
FHx of inherited disorders or congenital abnormalities.
Urine dipstick
Blood tests such as thalassaemia and sickle cell disease may be offered if at risk
Rubella and hepatitis status should be checked and vaccines given if not immune
Dental examination
HIV screening if at risk

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8
Q

What is the effect of pregnancy of pre-existing medical conditions?

A
  • Effect may be transient (DM) or persistent leading to maternal morbidity (severe renal impairment).
  • If risk of death is very high, pregnancy may be discouraged altogether
  • Optimal control of certain diseases before conception may be important to avoid the risk of fatal malformation or adverse outcome (DM)
  • Some medications may be changed before conception to reduce the risk of teratogenic (anti epileptics)
  • Both prescription and OTC drugs should be used as little as possible during pregnancy.
  • Most drugs carry warnings about use during pregnancy
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9
Q

How many appointments are required for a nulliparous woman?

A

10

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10
Q

How many apartments are required for a parous woman?

A

7

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11
Q

What is the schedule of appointments in nulliparous women?

A

Booking appointment (8 weeks)
16 weeks (Review screening results)
18-20 weeks (USS for structural abnormalities)
25 weeks (symphysis-fundal-height) (nulliparous only)
28 weeks (screening for anaemia and atypical red cell autoantibodies)- offer anti-D prophylaxis to rhesus-negative women.
31 weeks- measure symphysis-fundal-height
34 weeks- 2nd dose of anti-D to rhesus-negative women
36 weeks- check position of baby (offer ECV for baby in breech position
38 weeks
40 weeks (nulliparous)
41 weeks- membrane sweep and induction of labour

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12
Q

What does the booking visit entail?

A

Comprehensive hx should be elicited and a full physical examination.
RF should be highlighted.
Hx of inheritable diseases in close relatives should be sought.
Hx of travel (HIV, hepatitis, haemoglobinopathies)
Hx of alcohol abuse, smoking and addictive drug use are useful behavioural markers of potential risks (foetal abnormalities, impaired foetal growth, preterm labour and neonatal drug withdrawal problems)
Hx of psychiatric illnesses
Ethnic background, partner’s details or other next of kin
FHx of any illnesses or any problems in pregnancy
Previous obstetric and gynaecological hx including smears.
Last menstrual period (LMP)

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13
Q

What should a doctor do at a booking visit?

A
  • Identify who may need additional care and plan pattern of care for the pregnancy.
  • Check blood group and rhesus D status
  • Offer screening for haemoglobinopathies, anaemia, red cell autoantibodies, HBV, HIV and syphillis
  • Offer screening for asymptomatic bacteriuria
  • Offer screening for DS
  • Early USS for gestational age assessment
  • USS for structural anomalies
  • Calculate BMI
  • Measure BP and test urine for proteinuria
  • Offer screening for gestational diabetes and pre-eclampsia using RF
  • Identify women who have had genital mutilation
  • Ask about mood to identify possible depression
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14
Q

What should routine blood tests include?

A 
FBC- anaemia 
Blood group- rhesus negative and abnormal antibodies (kell and Duff) 
Rubella screen 
Syphillis screen 
HBV screen 
HIV screen 
Sickle cell disease (black women at increased risk) 
Gestational diabetes
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15
Q

Risk factors for gestational diabetes

A 
Previous GDM 
FHx of DM 
Previous macrosomic baby 
Previous unexplained stillbirth 
Obesity 
Glycosuria on more than one occasion 
Polyhydramnios 
Large for gestational age foetus in current pregnancy
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16
Q

What should screening tests include?

A

Anaemia and blood group
Haemoglobinopathies such as sickle cell disease and thalassaemia
Down’s syndrome- combined test or quadruple test.
Infection- MSU- reduces the risk of pyelonephritis
Pre-eclampsia- BP measurement and urinalysis for protein
Placenta praevia - 32 week screening for low-lying placenta
Structural foetal anomalies- USS routinely between 18-20 weeks

17
Q

Risk factors for pre-eclampsia

A 
Age 40 or older 
Nulliparity 
Pregnancy interval of more than 10 years 
FHx of pre-eclampsia
Previous hx of pre-eclampsia 
BMI of 30 
HTN 
Pre-existing renal disease 
Multiple pregnancy
18
Q

Approxment measurement of symphysis-fundal height with progression of pregnancy

A

12 weeks- pubic symphysis
20 weeks- umbilicus
36 weeks- xiphoid process

19
Q

Which factors makes a woman high risk during pregnancy?

A

Women at extreme of age (less than 18 or more than 40) are at higher risk of complications.
—Women older than 40 are more likely to have other health problems such as HTN or diabetes.
- Asian and black women are at higher risk of developing diabetes.
- Women from certain countries are at higher risk of FGM.
- premature labour
- FGR
- Antepartum haemorrhage
-Gestational HTN/ pre-eclampsia
- DM/ thrombocytopenia
- Type of delivery i.e. CS or instrumental delivery
- PPH
- 3rd or 4th degree tear
- previous stillbirth, miscarriage or neonatal death.
- identify women who are at risk of domestic abuse and addiction
- Hx of mental health problems conveys a risk of postpartum depression or psychosis.

20
Q

What are the aims of physiological changes in pregnancy?

A

Maintenance of pregnancy
Preparation for delivery
Preparation for breastfeeding

21
Q

What are the main hormones produced in pregnancy?

A

B-HCG
oestrogen
Progesterone
Human placental lactogen

22
Q

Role of b-HcG in pregnancy

A

Useful for detection of pregnancy
Produced by the placenta
Peaks at 3 months the goes down at a constant rate

23
Q

Role of oestrogen in pregnancy

A

Continuously rises in pregnancy.
Increased breast and nipple growth and pigmentation of the areola.
Promotes uterine bloods flow, myometrial growth and cervical softening.
Increased sensitivity and expression of myometrial oxytocin receptors.

24
Q

Role of progesterone in pregnancy

A

Continuously rises in pregnancy
Promotes smooth muscle relaxation (gut, ureters, uterus) and raises body temperature.
It prevents preterm labour and is now increasingly administered to prevent preterm labour

25
Q

Role of human placental lactogen in pregnancy

A

Function similar to GH
Modifies maternal metabolism to increase the energy supply to the foetus.
Increased insulin secretion but reduced insulin peripheral effects (liberating maternal fatty acids and sparing glucose enabling it to be diverted to the foetus)

26
Q

What happens to the pituitary gland during pregnancy?

A

Increased anterior hormone production
Increased prolactin levels due to oestrogen stimulation.
Gonadotropin secretion is inhibited but increased ACTH levels.
Maternal cortisol is increased.
Oxytocin release during first stage of labour and during suckling.

27
Q

Haematological changes in pregnancy

A

Increased plasma volume- acute excessive weight gain is due to oedema.
Increased red cell volume- there’s a higher plasma volume increase compared to RBC volume leading to oedema.
Increased neutrophils but reduced lymphocyte function giving rise to lowered resistance to viral infections.
Increased clotting factors therefore increased risk of DVT

28
Q

Cardio-respiratory changes in pregnancy

A

Increased CO due to increased HR and SV
Cardiac hypertrophy and increase in volume by 70-80 ml.
Decreased peripheral resistance by nearly 50% so increased stroke volume.
Decreased blood pressure
Level of diaphragm rises in pregnancy- breathing more diaphragmatic than costal.
Increased tidal volume due to progesterone
Hyperventilation

29
Q

Genital tract and breast changes in pregnancy

A

Uterus hypertrophy and muscle fibres stretching.
Cervical gland hypertrophy- formation of thick mucus plug or operculum (barrier to infection)
Increased vaginal discharge due to cervical ectopy and cell desquamation
-Increased vaginal lactobacilli proliferation which results in increased lactic acid which lowers vaginal pH and keep the vagina free from any bacterial pathogen.
- Increased lactiferous ducts and alveoli under stimulus of oestrogen, progesterone and prolactin.
- Oxytocin causes contraction of myoepithelial cells to cause ejection of milk.
- Prolactin stimulates the cells of the alveoli to secrete milk.

30
Q

GI and GU changes in pregnancy

A

Increased renal blood flow
Ureteric dilatation due to progesterone
Increased GFR so urinary frequency increased
Relaxation of bladder muscle
Reduced tone of oesophageal sphincter due to increased abdominal pressure causes reflux oesophagitis.
Reduced gastric mobility so reduced gastric emptying (constipation)
Haemorrhoids due to increased abdominal pressure

31
Q

Dermatological changes in pregnancy

A

Increased skin pigmentation- linear nigra, nipple and areola
Distension and proliferation of blood vessels- spider angiomata, facial flushing, stria gravilarium and palmar erythema

32
Q

Musculoskeletal changes in pregnancy

A 
Increased BMI 
Lower back pain 
Stretch mark 
Sciatica
Lordosis 
Carpal tunnel syndrome 
Calf cramp

WH- Normal antenatal progress (1 decks)

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