Terms and physiology + checks Flashcards
How long is a pregnancy?
What are the 1st, 2nd and 3rd trimesters?
40 weeks
1st: 0-12 weeks
2nd:13-27 weeks
3rd: 28-40 weeks
What is Naegele’s Rule for?
To estimate the baby’s due date
1st day of last menstrual period, add 7 days, add 9 months
What is gravidity?
Number of pregnancies regardless of outcome
What is parity?
Number of deliveries beyond 24 weeks not including current
what is primigravida?
first time pregnancy regardless of outcome
what is Primiparous?
First time delivery >24 weeks
What is Multiparous?
2+ births >24 weeks
What is nulliparous?
Never birthed >24 weeks
How many weeks are full term?
37-42 weeks
How many weeks are premature?
mild?
early?
severe?
<37 weeks
mild: 32-27
early: 28-32
severe: <28
What is the gravidity and parity of twins?
1 pregnancy and 1 birth
G1P1
What routine vaccines are offered to pregnant women and when?
16+ weeks
Pertussis (whooping cough)
Flu
What is the ideal presentation of a foetus in a womb?
Head
lie
placenta
attitude
Head first
Longitudinal
upper segment
flexed vertex
How big should the cervix diameter be for delivery?
10cm
What 5 things is the placenta responsible for/transport?
NICHE
Nutrition
Immunity
Circulation
Hormonal
Excretion
What type of blood does the baby have?
What hormones are exchanged?
HbF - high O2 affinity
Progesterone, oestrogen, bhCG, hPL (human placental lactogen)
How do we monitor the foetus?
With ultrasound
What does CRL stand for?
what does it mean?
Crown rump length
The length of the fetus from the top of its head to bottom of torso.
How many weeks is it classified as an embryo?
What should the CRL be at 8-12 weeks and 21 weeks?
1-8 weeks
50mm
210mm
When is surfactant produced?
at 35 weeks
What is surfactant used for?
Reduce surface tension and prevent alveolar collapse after expiration
What do we give if the baby is premature? ie. reduced surfactant prod
prenatal?
postnatal?
Prenatal - maternal prenatal corticosteroid
Baby surfactant after birth
What are the maternal changes in pregnancy?
Cardio?
Haem?
GI?
Immunity?
Low BP (high CO but low TPR)
Anemia (high CO + same RBCs)
Dysmotility therefore constipation and GORD
Low immune response
What are the maternal changes in pregnancy?
Endo?
GU?
Hormones?
poor glycemic control = lots of hypos in DM
High renal excretion and High UTI risk + Asymptomatic bacteriuria (ASB)
High Oestrogen, progesterone, prolactin, T3+T4, bhCG, ESR + CRP, ALP
what 3 visual changes can we have and what are they?
linea nigra - dark line from umbilicus to pic area
striae gravidarum - stretch marks
Polymorphic eruption of pregnancy - itchy bumpy rash within stretch marks
What is the main things midwifes check every appointment?
symphysis fundal height (SFH)
What is SFH and what is it used for?
what is the normal height?
Distance from the pubis symphysis to the top of the uterine fundus
Monitors fetal growth
+/- 2cm for gestational age
What is the first check that is done and its name?
How many weeks?
What is tested/checked?
8-12 weeks
Booking
Screen mum for Hep B, HIV, Syphilis, sickle cell and thalessemia (HHSST)
BMI, BP, FBC
What is after the booking scan?
How many weeks?
What is tested for in that?
Dating scan
11-13+6 weeks
USS to check Nuchal translucency
Check the bhCG, PAPP-A
What does nuchal translucency check?
What is PAPP-A? What does it check for?
thickness of tissue round baby’s neck
Pregnancy associated plasma protein - protein made by placenta
checks for trisomy 13 (Palau’s syndrome), 18 (Edwards syndrome) and 21 (Downs syndrome)
What do we look for specifically in the bhCG, PAPP-A and nuchal translucency for Downs?
High bhCG
Low PAPP-A
>/ 6mm nuchal translucency
What do we check for at 18 - 20+6 weeks? what is that appt called?
Anomaly/anatomy USS
Congenital heart defects (CHD), Neural tube defects (NTD), Gastroschisis + omphalocele, placenta previa
What is checked at 28 weeks?
OGTT + Rhesus if Rhesus Negative
Midwife - BP Checks, SFH, Urine dip
What checks are done and 34, 38 and 41 weeks?
34 weeks - USS + 2nd RhoGAM dose, 2nd placenta previa scan
38 weeks - Discuss long PREG
41 weeks - Discuss inducing labour
what is the technique to induce labour called and what happens in it?
Membrane sweep
Finger around cervix to induce labour
What are all mums advised to take/stop?
Vit D suppose 10mcg/day
folate for first trimester
smoking cessation
no alcohol
Healthy eating
What are 3 other tests that are done?
CVS (Chorionic villi sample)
Amniocentesis
NIPT (Non invasive prenatal testing)
When is CVS done?
what is it done for?
11-14 weeks
cells from the placenta
checks for chromosomal conditions
Amniocentesis
when is it done? what is it to check for?
What are the risks and %?
15 weeks
sample amniotic fluid to check for trisomy 13, 18 and 21
Risk 0.5-1% miscarriage, precipitation of RHD, clubfoot and infection
NIPT (Non invasive prenatal testing)
when is it done?
what do we do/look for?
how sensitive for which disease?
screening test done between 15-20 weeks
sample mums blood for cffDNA (Cell free foetal)
99% sensitive for Downs
What is the quad test?
when is it done?
Tests for?
what is shown on the test?
15 weeks
tests for downs
High bhCG
Low AFP
Low E3
High Inhibin A
What is a hyperechogenic bowel?
what is it associated with?
When is it seen?
18-20 weeks
downs, CF, CMV+B19
non specific marker - brighter appearing bowel
