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3a > WH: Pregnancy - Antenatal Care > Flashcards

WH: Pregnancy - Antenatal Care Flashcards

1
Q

What is Gravida (G) ?

A

it is the total number of pregnancies a woman has had

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2
Q

What is Primigravida ?

A

it refers to a patient that is pregnant for the first time?

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3
Q

What is multigravida ?

A

refers to a patient that is pregnant for at least the second time

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4
Q

What is Parity? be specific

A

the number of times the woman has given birth after 24 weeks gestation, regardless of whether the fetus was alive or stillborn

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5
Q

What is Nulliparous ?

A

a patient that has never given birth after 24 weeks gestation

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6
Q

What is primiparous?

A

a patient that given birth after 24 weeks gestation once before

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7
Q

what is multiparous ?

A

a woman that has given birth after 24 weeks gestation 2 or more times

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8
Q

write the G + P for: A pregnant woman with 3 previous deliveries at term?

A

G4 P3
(4 pregnancies + 3 deliveries)

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9
Q

write the G + P for: A non pregnant woman with a previous birth of healthy twins?

A

G1 P1

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10
Q

write the G + P for: A non-pregnant woman with a previous miscarriage (before 24 weeks)?

A

G1 P0 +1
(Para 1 as not given birth before 24 weeks gestation but +1 indicates early pregnancy loss)

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11
Q

write the G + P for: A non-pregnant woman with a previous stillbirth?

A

G1 P1

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12
Q

Describe the weeks for trimester 1, 2 + 3 ?

A
  • First trimester: start of pregnancy - 12 weeks
  • Second: 13 - 26 weeks
  • Third: 27 - birth
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13
Q

When do fetal movements start from?

A

start form around 20 weeks gestation and continue until birth
(concernif not felt by 24 weeks)

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14
Q

what 2 vaccines are offered to all pregnancy women ? when ?

A
  • Whooping cough (pertussis) from 16 weeks gestation
  • Influenza (flu) when available in autumn or winter
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15
Q

what supplements are recommended to be taken in pregnancy?

A
  • folic acid
  • Vitamin D
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16
Q

what should be avoided during pregnancy? diet/lifestyle

A
  • Alcohol
  • Smoking
  • Unpasturised diary
  • Undercooked or raw poultry
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17
Q

when are the effects of alcohol greatest in pregnancy?

A

in the first 3 months

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18
Q

what can alcohol in early pregnancy lead to?

A
  • Miscarriage
  • Small for dates
  • Preterm delivery
  • FAS
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19
Q

What are the characteristics of FAS? physical/mental

A
  • Microcephaly
  • Thin upper lip
  • Smooth flat philtre
  • Short palphral fissure
  • Learning disbailty
  • Behavioural difficulties
  • Hearing + vision problems
  • CP
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20
Q

What can smoking in pregnancy cause? (6)

A
  • Fetal growth restricion
  • misscariage/Stillbirth
  • Preterm labour
  • pre-eclampsia
  • Cleft lip or palate
  • SIDS
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21
Q

what are the rules for flying in pregnancy? twins?

A
  • 37 weeks in a single pregnancy
  • 32 weeks in a twin pregnancy
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22
Q

before how many weeks gestation (ideally) is the booking clinic?

A

before 10 weeks gestation

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23
Q

what is done at the booking clinic (3) ?

A
  • Education
  • Booking bloods
  • Other measurements
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24
Q

What do the booking bloods test for? (4)

A
  • Blood group, antibodies and rhesus D status
  • FBC for anaemia
  • Screening for thalassaemia and sickle cell disease
  • offered screening for infectious disease
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25
Q

which women offered thalassaemia screening? sickle cell disease?

A

thallassaemia (all women)
sickle cell disease (women at higher risk)

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26
Q

what infectious disease are women tested for antenatally ? how?

A

testing antibodies for
- HIV
- Syphillis
- Hepatitis B

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27
Q

which women are offered Down’s syndrome screening during pregnancy?

A

all women. the woman can decide whether they want to go ahead with it.

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28
Q

combined test: what does it screen for? how many weeks gestation? what test required? what are the results looking for?

A
  • Performed between 11-14 weeks to screen for Edwards, pataus + downs
  • involves US (CRL + nuchal translucency) and maternal blood tests (beta-HCG + PAPPA)
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29
Q

what happens if screening shows women to have greater risk of Down’s syndrome?

A

greater than 1 in 150 =>
- chorionic villus sampling (CVS)
- Amniocentesis
(take a sample of the fetal cells to perform karyotyping)

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30
Q

quadruple test: what does it screen for? how many weeks gestation? what test required? what are the results looking for?

A

screen for downs syndrome only from 14 - 20 weeks (not as accurate as combined)
- maternal blood test (beta-HCG, alpha-fetoprotein, serum estradiol , inhibit-A)

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31
Q

how does hypothyroidism treatment change during pregnancy ?

A

levothyroxine can cross placenta and provide thyroid hormone to developing fetus => levothyroxine dose needs to be increased during pregnancy

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32
Q

which antihypertensives need to be stopped during pregnancy? (3)

A
  • ACE inhibitors (ramipril)
  • Angiotensin receptor blockers
  • thiazide and thiazide-like diuretics
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33
Q

how does epilepsy management change in pregnancy ?

A

sodium valproate must be avoided
- lamotrigine and carbamazepine are the safer anti-epileptic medication in pregnancy

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34
Q

How does rheumatoid arthritis management change in pregnancy?

A

methotrexate is contraindicated (causes miscarriage + congenital abnormalities)
- Hydroxychloroquine is safe during pregnancy (first line choice)

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35
Q

Should NSAIDs be used in pregnancy? explain?

A

should be avoided
- they work by blocking prostaglandins => could causes closure of ductus arteriosus + delay labour

36
Q

How do ACE inhibitors and angiotensin II Receptor Blockers affect the fetus?

A

they affect the fetal kidneys
- Oligohydramnios
- Miscarriage
- Hypocalvaria (incomplete formation of the skull bones)

37
Q

what is neonatal abstinence syndrome (NAS) ? how does it present?

A

withdrawal symptoms due to maternal opiate usage
- Irritable
- Tachypnia
- High temp
- Poor feeding

38
Q

what does sodium valproate cause in pregnancy ?

A

neural tube defects and developmental delay

39
Q

do mum and baby have the same blood group ?

A

no - they have different blood groups
- ABO is co-dominant inheritance
- rhesus +ve is dominant

40
Q

where in normal circulation does maternal and fetal blood mix ?

A

it doesn’t (well it shouldn’t )

41
Q

with what maternal and fetal rhesus status is rhesus incompatibility relevant ?

A
  • Mum: -ve
  • Baby: +ve
42
Q

What is is called when rhesus -ve women developed rhesus-D antibody ?

A

sensitisation

43
Q

describe the process of rhesus sensitisation ?

A

rhesus -ve mother and rhesus +ve => if blood share => mothers immune system recognise foreign antigen => rhesus-antibody (sensitised)

44
Q

How would baby blood get to maternal circulation ? (7)

A

sensitising events (share of blood)
- Miscarriage
- Ectopic pregnancy
- TOP
- Abdo trauma
- At birth
- External cephalic version
- Amniocentesis

45
Q

why is rhesus sensitisation bad ? what can it lead to ?

A

sensitised rhesus -ve mother with rhesus D antibody and a second rhesus +ve baby => if blood share => antibodies attach to baby RBC = > haemolytic => haemolytic disease of the newborn

46
Q

how to manage rhesus incompatibility ?

A
  • check blood group and rhesus status of mother
  • prevention of desensitisation (IM anti-D to rhesus -ve women)
  • Chek fetal rhesus status from umbilical cord at birth
47
Q

how does anti-D prophylaxis work ?

A

anti-D attaches to rhesus D antigens on fetal RBC in mother circulation => destroyed => prevent sensitisation when is

48
Q

anti-d prophylaxis given ?

A
  • routine: 28 weeks, at birth (if fetal umbilical cord blood smpale shows baby rhesus +ve)
  • sensitisation event
49
Q

What counts as a baby that is small for gestational age ?

A
  • fetus that is measured below 10th centime for their gestational age
50
Q

What measurements is SGA based on ?

A

measurement on US
- estimated fetal weight (EFW)
- Fetal abdominal circumference (AC)

51
Q

what counts as low birth weight ?

A

birth weigh of less than 2.5kg

52
Q

what 2 categories can SGA generally be split into ? what do these mean ?

A
  • Constitutionally small (no pathology)
  • Fetal growth restriction (pathological process has restricted genetic growth potential)

SGA does not always mean FGR !

53
Q

what is FGR? what 2 categories are there. ?

A

Fetal growth restriction: not growing as expected due to pathology
- Placental mediated growth restriciton
- Non-placental mediated (pathology of fetus)

54
Q

give some examples of placental causes of FGR ? (6)

A
  • Idiopathic
  • Pre-ecclampsia
  • Maternal smoking/drinking
  • Anaemia
  • Malnutrition
  • Infection
55
Q

give some examples of non-placental causes of FGR ? (4)

A
  • Genetic abnormalities
  • Structural abnormality
  • Fetal infection
  • Errors of metabolism
56
Q

Name some other signs of FGR ?

A
  • low amniotic fluid vol
  • Reduced fetal movements
  • Abnormal CTG
57
Q

name some complications of FGR ? (5)

A

Short term
- fetal death, still birth, birth asphyxia, neonatal hypoglycaemia
- Long term: CVD, T2DM, obesity, mood + behaviour problems

58
Q

SGA RF ? (8)

A
  • Prev SGA baby
  • Obesity
  • Smoking
  • Diabetes
  • existing hypertension
  • Pre-ecclmapsia
  • Older mother (>35)
  • Multiple pregnancy
59
Q

SGA Investigations ?

A

investigations for underlying cause:
- BP
- Uterine artery doppler scan (check blood flow through uterine artery)
- Karyotyping for genetic abnormalities

60
Q

SGA management ?

A

depends on the cause
- aspirin if pre-ecclampsia (or at risk of - prophylaxis)
- Modifiable RF: stop smoking + alcohol
- Early delivery where growth is static (decrease risk of still birth)

61
Q

what is large for gestational age?

A

LGA: estimated fetal weight above 90th centile

62
Q

what is macrosomia ?

A

when weight of newborn is >4.5kg at birth

63
Q

(generally) what causes macrosomia (1) and what does increase risk of (1) ?

A

causes by GDM and increases risk of shoulder dystocia

64
Q

causes of macrosomia ? (6)

A
  • Constitutional
  • Maternal diabetes
  • Prev macrosomia
  • Maternal obesity
  • Overdue
  • Male
65
Q

What risk does LGA have on the mother ?

A

Maternal:
-shoulder dystocia
- failure to progress
- perineal tears
- instrumental delivery or CS
- PPH
- uterine rupture

66
Q

what risk does LGA have on the fetus + baby ?

A

Fetal:
- birth injury (clavicular fracture, herbs palsy)
- neonatal hypoglycaemia
- obesity in childhood
- T2DM

67
Q

LGA management ? (2)

A
  • US to exclude polyhydramnios + estimtate fetal weight
  • OGTT (GDM)
68
Q

What is multiple pregnancy ?

A

pregnancy with more than one fetus

69
Q

when is a multiple pregnancy usually diagnosed ?

A

at booking US
- Shows number of placentas (chorionicity) and number of amniotic sacs (amniocity)

70
Q

Complication of multiple pregnancy to mother ? (7)

A
  • Anaemia
  • Polyhydramnios
  • Hypertension
  • Malpresentation (fetus not suitable for vaginal birth)
  • preterm birth
  • Instrumental or CS
  • PPH
71
Q

Fetal + neonatal complications of multiple pregnancy ?

A
  • Miscarrige
  • Stillbirth
  • FGR
  • Prematurity
  • Twin-twin trasfusion
72
Q

describe what twin-twin transfusion syndrome is ?

A

where foetuses share a plecenta
- one fetus (recipient) will recieve majority of blood from placenta + the other fetus (donor) is stared of blood)

73
Q

twin-twin transfusion syndrome. how will the recipient and donor present ?

A
  • recipient: Fluid overload, HR, polyhydramnios)
  • Donor: growth restriction, anaemia, oligohydromanios
74
Q

What is oligohydramnios ? what value ?

A

low levels of amniotic fluid during pregnancy
- amniotic fluid index <5th centile for GA)

75
Q

describe he trends of amniotic fluid vol throughout pregnancy ? fluid vol at term ?

A

amniotic fluid vol increases until 33 weeks
- plateau 33-38
- then decline
- fluid cola t term is around 500ml

76
Q

what is amniotic fluid made of ?

A

predominantly fetal urine output
- plus small placental secretions

77
Q

where does amniotic fluid go ?

A

fetus breathes + swallows fluid, gets processed, fills bladder, voided

78
Q

oligohydramnios causes ? (4)

A
  • preterm pre labour ROM
  • placental insufficney
  • non-functioning fetal kidneys
  • obstructive uropathy
79
Q

oligohydramnios Dx ? Ix ?

A

US (amniotic fluid index <5th centile for GA)
- Ix amniotic ludi protein test if ROM suspected

80
Q

oligohydramnios Mx ?

A

P-PROM: consider induction around 34-36 weeks

81
Q

oligohydramnios complicaitons ? (2)

A
  • preterm birth
  • Stillbirth
  • muscle contractures
82
Q

what Ployhydramnios ?

A

high level amniotic fluid during pregnancy (amniotic fluid index >95th centile for GA)

83
Q

causes of Ployhydramnios ? (6)

A
  • idiopathic (50-60%)
  • condition affecting fetal swallowing (oesophageal atresia)
  • duodenal atresia
  • Maternal DM
  • macrosomia
  • Twin-twin transfusion
84
Q

Ployhydramnios Dx ? Ix ?

A

US (amniotic fluid index ?95th centile for GA)
- consider OGTT

85
Q

Ployhydramnios prognosis ? (4)

A
  • increase prenatal moraitliy
  • malpresentation
  • increase risk cord prolapse
  • PPH (as uterus must contract further to achieve haeostasis)

3a (43 decks)

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