Uncomplicated pregnancy

Question 1

What are the trimesters and when would you start feeling FM?

Answer 1

• 1st trimester = start of pregnancy to 12w
• 2nd trimester = 13w - 26w
• 3rd trimester = 27w - birth
• Fetal movements start from ~20w and continue until birth.

Question 2

When is the first booking clinic?

What does it involve?

Answer 2

This is the initial appt with midwife arranged before 10w, to discuss pregnancy and plans. It will involve:

(1. ) bloods: FBC, thalassaemia, sickle cell disease screen
(2. ) infectious screen for HIV, Hep B, Syphillis
(3. ) - wt, ht, bmi
- Urinedip for pre-eclampsia, asyx bacteruria
- BP for pre-eclampsia
- Discuss female genital mutilation, domestic violence

(4. ) Assess RF + put plans in place
- Rhesus negative (book anti-D prophylaxis at 28 + 34w)
- Gestational diabetes (book OGTT at 24-28w)
- Fetal growth restriction (book additional growth scans)
- VTE (provide prophylactic LMWH if hi risk)
- Pre-eclampsia (provide aspirin if high risk)

Question 3

Lifestyle advice of pregnant women? What should they take?

Answer 3

(1. ) 400mcg folic acid before pregnancy to 12w - reduces neural tube defects
(2. ) Vitamin D + avoid vitamin A/liver pate as it is teratogenic
(3. ) Don’t drink - Alcohol can lead to miscarriage, small for dates, preterm delivery, fetal alcohol syndrome
(4. ) Don’t smoke - Smoking can lead to miscarriage, still birth, preterm delivery, placental abruption, pre-eclampsia, cleft palate, SIDS
(5. ) Avoid unpasteurised diary or blue cheese, undercooked meat
(6. ) Continue exercise
(7. ) Be wary of flying as can increase risk for VTE

Question 4

What does down syndrome screening involve? When is it done?

Answer 4

Caused by trisomy 21 (x3 copies of chromosome 21). Older mothers have a higher risk of Down’s syndrome.

(1. ) Combined test (11-14w)
- combines results from USS + maternal blood tests
- USS measures nuchal translucency
- Blood tests: bHCG (high), PAPPA (low)

(2. ) Triple test (14-20w)
- Blood tests: bHCG (hi), AFP (lo), serum oestriol (lo)

(3. ) Quadruple test (14-20w)
- As triple test but with additional inhibin-A (hi).

(4.) If screening test has a high risk score, mother is offered amniocentesis or chorionic villus sampling, and sampled fetal cells are karyotyped.

Question 5

When are scans performed?

Answer 5

(1. ) 10-13w + 6 = dating scan
- gestational age is calculated from crown rump length (CRL)
- multiple pregnancies are identified

(2. ) 18-20w + 6 = anomaly scan
- identify finger, toes, limbs, genitalia, head, heart, placenta
- any anomalies, such as heart conditions
- if placenta praevia identified -> additional 32w scan

Question 6

What vaccines are available during pregnancy?

Answer 6

• 16w - whooping cough
• Flu available in winter or autumn
• note: MMR vaccine is avoided during pregnancy

Question 7

What are the stages of labour?

Answer 7

Normally occurs between 37-42w. There are three stages:

(1. ) First stage = onset of labour (true contractions) until 10cm cervical dilatation
- Latent phase = 0-3cm dilation involves irregular contractions
- Active phase = 3-7cm dilation, regular contractions
- Transition phase = 7-10cm dilation, strong regular contractions

(2. ) Second stage = from 10cm cervical dilatation until delivery of the baby
(3. ) Third stage = from delivery of the baby until delivery of the placenta

Question 8

What is Braxton-Hicks contractions

Answer 8

• Usually during 2nd + 3rd trimester.
• Women experience temporary and irregular tightening or mild cramping in the abdomen.
• These are not true contractions, and they do not indicate the onset of labour.
• They do not progress or become regular.
• Staying hydrated and relaxing can help reduce Braxton-Hicks contractions.

Question 9

When is induction of labour initiated?

Answer 9

IOL is performed when it thought that the baby will be safer delivered than remaining in utero

Use of medications to stimulate the onset of labour. Offered to:

• Post-dates: 41-42w
• PROM
• Pre-eclampsia
• Existing diabetes
• Fetal growth restriction
• Obstetric cholestasis
• Intrauterine fetal death

Question 10

WHat methods are used for induction of labour?

Answer 10

(1. ) Membrane sweep - finger in cervix making circular sweeping movement, if successful onset of labour within 48hrs.
(2. ) Vaginal prostaglandin pessary/tablet/gel
(3. ) Cervical ripening balloon - silicone balloon that is inserted into cervix and gently inflated to dilate the cervix
(4. ) Artificial rupture of membranes with an oxytocin infusion
(5. ) Oral mifepristone (anti-progesterone) plus misoprostol used to IOL where intrauterine fetal death has occurred

Question 11

What is Bishops’ Score?

Answer 11

The Bishop score used to asses cervix to help predict successful induction of labor

Five things are assessed (min score is 0, max is 13).
>8 = successful induction of labour, <8 = cervical ripening may be required.

• Fetal station (scored 0-3)
• Cervical position (scored 0-2)
• Cervical dilatation (scored 0-3)
• Cervical effacement (scored 0-3)
• Cervical consistency (scored 0-2)

Question 12

Complication of IOL + criteria, management

Answer 12

Uterine Hyperstimulation - this where contractions are prolonged and frequent. It can lead to: fetal compromise, with hypoxia and acidosis, emergency c-section, uterine rupture.

Criteria:

• Individual contractions lasting >2mins
• > 5 contractions every 10mins

Management

• Removing vaginal prostaglandins, or stopping the oxytocin infusion
• Tocolysis with terbutaline