Reproductive 1 Flashcards
What is the difference between GRAVIDA and PARITY?
Gravida = the number of times a woman has been pregnanat Parity = The number of children a woman has given birth to
What is the purpose of a booking visit in antenatal care and who is it carried out by and when?
8-12 weeks
Carried out by the midwife
Build up a picture of any ‘risks’ of the pregnancy
Take a sample of blood to do screening tests on
When does a dating scan take place, what information is given here, what else happens?
8-14 weeks
Estimated due date given
Screened for abnormalities and take specific blood tests
When does an anatomy scan take place and what is its purpose?
18-20 (+6) weeks
Check physical development, check there are no physical abnormalities, and find out the sex of the baby
When can the parents find out the sex of the baby?
At the anatomy scan at 18-20 weeks
How many antenatal appointments with the midwife are offered to first time parents?
Up to 10
At what point in the pregnancy do antenatal appointments become more frequent and what happens here?
24 weeks Check urine and BP Palpate to check foetal position Check foetal growth Listen to foetal heart beat
How is babies growth measured (not using ultrasound)?
From the top of the womb to the pubic bone (symphasis-fundal height)
What is average gestation?
40 weeks
When do post natal checks happen, with which professional, what is the purpose?
6 weeks after birth
GP
Ensure women are well and recovering
A good time to discuss contraception which can be started at this time
In the booking visit when assessing risks to the pregnancy what 4 things may you want to find out?
1) Had complications in a previous pregnancy (Eg. pre-eclampsia or premature birth)
2) Mother is currently being treated for a chronic disease such as diabetes or hypertension
3) Has she or anyone in the family previously had a baby with an abnormality eg. spina bifida
4) Has a family history of inherited disease eg CF, sickle cell
If a pregnancy is deemed high risk what extra antenatal care may this mean? 4
1) Hospital appointments and addition ultrasound scans
2) Consultant-obstetrician led care
3) Hospital as a place of birth
4) May be delivered before 40 weeks by induction or C section
What continent has the highest maternal mortality?
Sub saharan africa
What is the difference between a still birth and a miscarriage?
Baby born before 24 weeks = miscarriage
Baby born after 24 weeks = still birth
How many pregnancies in the UK result in a stillbirth?
> 3600 a year
1 in every 200
Eleven babies everyday
What ethical criteria must screening tests meet?
Wilson’s criteria
What 4 infectious diseases and 3 other things are currently offered screening for in the antenatal period?
Infectious disease = 1) HIV 2) Hepatitis B 3) Syphilis 4) Rubella Other things 1) Rhesus negative 2) Haemaglobinopathies (sickle cell and thalassemia) 3) Fetal anomalies
What a Rhesus negative women offered, when and what does it do?
Offered anti D at 28-30 weeks
Neutralises fetal Rh D+ antigens which would have entered maternal blood and prevents the formation of Ab
Another anti D after delivery if baby is Rh+ (cord blood tests at birth)
What 2 screening programmes happen for screening fetal anomalies?
1) Down syndrome screening
2) Anomaly scan
What does down syndrome screening consist of and when is it carried out?
Done in first trimester at dating scan Nuchal translucency scan Do a blood test for: 1) hCG (Human chorionic gonadotrophin) 2) PAPP-A (pregnancy associated plasam protein A)
How are downs syndrome results given, what is considered high risk and what is offered if women are deemed high risk?
Given as a risk factor
High risk is 1 in 150
Offered a definitive pre natal diagnosis
CVS from 11 weeks with a risk of miscarriage of 1%
Amniocentesis from 15 weeks with a miscarriage risk of 0.8%
What infectious disease is not normally screened for but is in a history of drug abuse or obstetric cholestacis?
Hepatitis C
What disease isnt routinely screened for but is encouraged to undertake optional screening in under 25s?
Chlamydia
How many couples in the UK have difficulty conceiving>?
1 in 7
What percentage of couples conceive within 1, 2 or 3 years?
1 year = 84%
Within 2 years = 92%
Within 3 years = 93%
If couples haven’t conceived within 3 years what are there chances of conceiving in subsequent years?
25% or less
What is the difference between primary and secondary infertility?
Primary = Has never conceived Secondary = Has had one or more pregnancies in the past but is having difficulty conceiving
What percentage of infertility has female and male cause?
Female = 45% Male = 30%
What are the 3 type of female causes of infertility?
1) Ovulation disorders (some dont produce eggs at all)
2) Problems with the uterus and fallopian tubes (sacrring from surgery, fibroids, endometriosis)
3) Age (biggest decrease in fertility occurs in mid thirties)
What are the 3 male causes of infertility?
1) Semen (decreased number of sperm, none at all, motility problems, abnormal morphology)
2) Ejaculation disorders
3) Alcohol
When does a couple get referral for treatment for infertility?
After trying to conceive naturally unsuccessfully for a year, in the absence of any known cause of infertility
What 7 lifestyle changes involved in pre treatment before treatment for infertility?
1) Alcohol intake cut
2) Stop smoking
3) Stop caffeinated beverages
4) Obesity - BMI reduced to under 30
5) Low body weight - brought up to above a BMI of 19
6) Tight underwear stopped
7) Folic acid supplementation given - 0.4 mg a day
In investigations before fertility treatment what 4 investigations are carried out?
1) Semen analysis
2) Assessment of ovulation
3) Tubal damage and uterine abnormalities
4) Screening tests for abnormalities such as chlamydia
In treatment for female infertility what 3 infertility treatments may be carried out?
1) The use of drugs for ovulation induction
2) Laparoscopy for ablation of endometriosis/ unblock tubes
3) Assisted reproduction techniques (ART)
eg, IVF/ ICSI
In treatment for male infertility what 3 treatments may be carried out?
1) Medical treatment for erectile dysfunction
2) Surgical correction of tube blockage/sperm retrieval
3) IVF/ICSI
What are the 6 stages of IVF treatment?
1) Pre treatment eg. lifestyle changes
2) Down regulation of womens hormones
3) Ovarian stimulation - to encourage eggs
4) Egg and sperm retrieval -USS guided
5) Embryo transfer 1 embryo
6) Early pregnancy support (progesterone for 8/40)
What are the 5 risks of IVF?
1) Multiple pregnancy
2) Complications of procedure/medications
3) Psychological impact
4) Social impact
5) Ethics
In pharmacology what is fetal dose and what is it affected by?
Amount of drug that reaches the foetal circulation
Affected by the drug concentration in the mother and the amount that crosses the placenta
If a pregnant woman is given warfarin what percentage of feotuses are affected and what are the 4 possible effects?
10-20% of babies exposed are affected
1) Facial and bony deformities
2) Foetal haemorrhage
3) Blindness
4) Stillbirth
What is sodium valporate used to treat?
Anti epileptic medication
If sodium valporate is given to a pregnant woman what 4 possible defects can it cause in the foetus?
1) Neural tube defects
2) Skeletal defects
3) Hypospadias
4) Heart defects
What are the 3 stages of labour and how long is each stage expected to be?
1) First stage Cervical dilation from 4cm to 10cm (fully dilated) 0.5cm per hour 2) Second stage Fully dilated until delivery of baby Expected within 2-3 hours 3) Third stage From delivery of baby until delivery of placenta Expected within 1 hour
What are the 3Ps of labour?
Power - contractions
Passenger - Fetus
Passage - pelvis
What are the primary and secondary forces of the 1st P ‘Power’?
Primary - uterine contractions
Secondary - maternal effort
In cardinal movements, how should the babies head appear?
Oxiput-anterior (oxiput = back of head)
Once the head has been delivered, what happens to allow the body to be born?
Head rotates 90 degrees to be born with body facing laterally
What are the 8 cardinal movements?
1) Head floating before engagement
2) Engagement, descent, flexion (of the head)
3) Further descent (internal rotation of the head to be oxiput anterior)
4) Complete rotation beginning extension
5) Complete extension (of neck)
6) Restitution (external rotation of head to allow body to be delivered)
7) Delivery of anterior shoulder
8) Delivery of posterior shoulder
