WH: Pregnancy - Antenatal Care Flashcards
What is Gravida (G) ?
it is the total number of pregnancies a woman has had
What is Primigravida ?
it refers to a patient that is pregnant for the first time?
What is multigravida ?
refers to a patient that is pregnant for at least the second time
What is Parity? be specific
the number of times the woman has given birth after 24 weeks gestation, regardless of whether the fetus was alive or stillborn
What is Nulliparous ?
a patient that has never given birth after 24 weeks gestation
What is primiparous?
a patient that given birth after 24 weeks gestation once before
what is multiparous ?
a woman that has given birth after 24 weeks gestation 2 or more times
write the G + P for: A pregnant woman with 3 previous deliveries at term?
G4 P3
(4 pregnancies + 3 deliveries)
write the G + P for: A non pregnant woman with a previous birth of healthy twins?
G1 P1
write the G + P for: A non-pregnant woman with a previous miscarriage (before 24 weeks)?
G1 P0 +1
(Para 1 as not given birth before 24 weeks gestation but +1 indicates early pregnancy loss)
write the G + P for: A non-pregnant woman with a previous stillbirth?
G1 P1
Describe the weeks for trimester 1, 2 + 3 ?
- First trimester: start of pregnancy - 12 weeks
- Second: 13 - 26 weeks
- Third: 27 - birth
When do fetal movements start from?
start form around 20 weeks gestation and continue until birth
(concernif not felt by 24 weeks)
what 2 vaccines are offered to all pregnancy women ? when ?
- Whooping cough (pertussis) from 16 weeks gestation
- Influenza (flu) when available in autumn or winter
what supplements are recommended to be taken in pregnancy?
- folic acid
- Vitamin D
what should be avoided during pregnancy? diet/lifestyle
- Alcohol
- Smoking
- Unpasturised diary
- Undercooked or raw poultry
when are the effects of alcohol greatest in pregnancy?
in the first 3 months
what can alcohol in early pregnancy lead to?
- Miscarriage
- Small for dates
- Preterm delivery
- FAS
What are the characteristics of FAS? physical/mental
- Microcephaly
- Thin upper lip
- Smooth flat philtre
- Short palphral fissure
- Learning disbailty
- Behavioural difficulties
- Hearing + vision problems
- CP
What can smoking in pregnancy cause? (6)
- Fetal growth restricion
- misscariage/Stillbirth
- Preterm labour
- pre-eclampsia
- Cleft lip or palate
- SIDS
what are the rules for flying in pregnancy? twins?
- 37 weeks in a single pregnancy
- 32 weeks in a twin pregnancy
before how many weeks gestation (ideally) is the booking clinic?
before 10 weeks gestation
what is done at the booking clinic (3) ?
- Education
- Booking bloods
- Other measurements
What do the booking bloods test for? (4)
- Blood group, antibodies and rhesus D status
- FBC for anaemia
- Screening for thalassaemia and sickle cell disease
- offered screening for infectious disease
which women offered thalassaemia screening? sickle cell disease?
thallassaemia (all women)
sickle cell disease (women at higher risk)
what infectious disease are women tested for antenatally ? how?
testing antibodies for
- HIV
- Syphillis
- Hepatitis B
which women are offered Down’s syndrome screening during pregnancy?
all women. the woman can decide whether they want to go ahead with it.
combined test: what does it screen for? how many weeks gestation? what test required? what are the results looking for?
- Performed between 11-14 weeks to screen for Edwards, pataus + downs
- involves US (CRL + nuchal translucency) and maternal blood tests (beta-HCG + PAPPA)
what happens if screening shows women to have greater risk of Down’s syndrome?
greater than 1 in 150 =>
- chorionic villus sampling (CVS)
- Amniocentesis
(take a sample of the fetal cells to perform karyotyping)
quadruple test: what does it screen for? how many weeks gestation? what test required? what are the results looking for?
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)
how does hypothyroidism treatment change during pregnancy ?
levothyroxine can cross placenta and provide thyroid hormone to developing fetus => levothyroxine dose needs to be increased during pregnancy
which antihypertensives need to be stopped during pregnancy? (3)
- ACE inhibitors (ramipril)
- Angiotensin receptor blockers
- thiazide and thiazide-like diuretics
how does epilepsy management change in pregnancy ?
sodium valproate must be avoided
- lamotrigine and carbamazepine are the safer anti-epileptic medication in pregnancy
How does rheumatoid arthritis management change in pregnancy?
methotrexate is contraindicated (causes miscarriage + congenital abnormalities)
- Hydroxychloroquine is safe during pregnancy (first line choice)
Should NSAIDs be used in pregnancy? explain?
should be avoided
- they work by blocking prostaglandins => could causes closure of ductus arteriosus + delay labour
How do ACE inhibitors and angiotensin II Receptor Blockers affect the fetus?
they affect the fetal kidneys
- Oligohydramnios
- Miscarriage
- Hypocalvaria (incomplete formation of the skull bones)
what is neonatal abstinence syndrome (NAS) ? how does it present?
withdrawal symptoms due to maternal opiate usage
- Irritable
- Tachypnia
- High temp
- Poor feeding
what does sodium valproate cause in pregnancy ?
neural tube defects and developmental delay
do mum and baby have the same blood group ?
no - they have different blood groups
- ABO is co-dominant inheritance
- rhesus +ve is dominant
where in normal circulation does maternal and fetal blood mix ?
it doesn’t (well it shouldn’t )
with what maternal and fetal rhesus status is rhesus incompatibility relevant ?
- Mum: -ve
- Baby: +ve
What is is called when rhesus -ve women developed rhesus-D antibody ?
sensitisation
describe the process of rhesus sensitisation ?
rhesus -ve mother and rhesus +ve => if blood share => mothers immune system recognise foreign antigen => rhesus-antibody (sensitised)
How would baby blood get to maternal circulation ? (7)
sensitising events (share of blood)
- Miscarriage
- Ectopic pregnancy
- TOP
- Abdo trauma
- At birth
- External cephalic version
- Amniocentesis
why is rhesus sensitisation bad ? what can it lead to ?
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
how to manage rhesus incompatibility ?
- 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
how does anti-D prophylaxis work ?
anti-D attaches to rhesus D antigens on fetal RBC in mother circulation => destroyed => prevent sensitisation when is
anti-d prophylaxis given ?
- routine: 28 weeks, at birth (if fetal umbilical cord blood smpale shows baby rhesus +ve)
- sensitisation event
What counts as a baby that is small for gestational age ?
- fetus that is measured below 10th centime for their gestational age
What measurements is SGA based on ?
measurement on US
- estimated fetal weight (EFW)
- Fetal abdominal circumference (AC)
what counts as low birth weight ?
birth weigh of less than 2.5kg
what 2 categories can SGA generally be split into ? what do these mean ?
- Constitutionally small (no pathology)
- Fetal growth restriction (pathological process has restricted genetic growth potential)
SGA does not always mean FGR !
what is FGR? what 2 categories are there. ?
Fetal growth restriction: not growing as expected due to pathology
- Placental mediated growth restriciton
- Non-placental mediated (pathology of fetus)
give some examples of placental causes of FGR ? (6)
- Idiopathic
- Pre-ecclampsia
- Maternal smoking/drinking
- Anaemia
- Malnutrition
- Infection
give some examples of non-placental causes of FGR ? (4)
- Genetic abnormalities
- Structural abnormality
- Fetal infection
- Errors of metabolism
Name some other signs of FGR ?
- low amniotic fluid vol
- Reduced fetal movements
- Abnormal CTG
name some complications of FGR ? (5)
Short term
- fetal death, still birth, birth asphyxia, neonatal hypoglycaemia
- Long term: CVD, T2DM, obesity, mood + behaviour problems
SGA RF ? (8)
- Prev SGA baby
- Obesity
- Smoking
- Diabetes
- existing hypertension
- Pre-ecclmapsia
- Older mother (>35)
- Multiple pregnancy
SGA Investigations ?
investigations for underlying cause:
- BP
- Uterine artery doppler scan (check blood flow through uterine artery)
- Karyotyping for genetic abnormalities
SGA management ?
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)
what is large for gestational age?
LGA: estimated fetal weight above 90th centile
what is macrosomia ?
when weight of newborn is >4.5kg at birth
(generally) what causes macrosomia (1) and what does increase risk of (1) ?
causes by GDM and increases risk of shoulder dystocia
causes of macrosomia ? (6)
- Constitutional
- Maternal diabetes
- Prev macrosomia
- Maternal obesity
- Overdue
- Male
What risk does LGA have on the mother ?
Maternal:
-shoulder dystocia
- failure to progress
- perineal tears
- instrumental delivery or CS
- PPH
- uterine rupture
what risk does LGA have on the fetus + baby ?
Fetal:
- birth injury (clavicular fracture, herbs palsy)
- neonatal hypoglycaemia
- obesity in childhood
- T2DM
LGA management ? (2)
- US to exclude polyhydramnios + estimtate fetal weight
- OGTT (GDM)
What is multiple pregnancy ?
pregnancy with more than one fetus
when is a multiple pregnancy usually diagnosed ?
at booking US
- Shows number of placentas (chorionicity) and number of amniotic sacs (amniocity)
Complication of multiple pregnancy to mother ? (7)
- Anaemia
- Polyhydramnios
- Hypertension
- Malpresentation (fetus not suitable for vaginal birth)
- preterm birth
- Instrumental or CS
- PPH
Fetal + neonatal complications of multiple pregnancy ?
- Miscarrige
- Stillbirth
- FGR
- Prematurity
- Twin-twin trasfusion
describe what twin-twin transfusion syndrome is ?
where foetuses share a plecenta
- one fetus (recipient) will recieve majority of blood from placenta + the other fetus (donor) is stared of blood)
twin-twin transfusion syndrome. how will the recipient and donor present ?
- recipient: Fluid overload, HR, polyhydramnios)
- Donor: growth restriction, anaemia, oligohydromanios
What is oligohydramnios ? what value ?
low levels of amniotic fluid during pregnancy
- amniotic fluid index <5th centile for GA)
describe he trends of amniotic fluid vol throughout pregnancy ? fluid vol at term ?
amniotic fluid vol increases until 33 weeks
- plateau 33-38
- then decline
- fluid cola t term is around 500ml
what is amniotic fluid made of ?
predominantly fetal urine output
- plus small placental secretions
where does amniotic fluid go ?
fetus breathes + swallows fluid, gets processed, fills bladder, voided
oligohydramnios causes ? (4)
- preterm pre labour ROM
- placental insufficney
- non-functioning fetal kidneys
- obstructive uropathy
oligohydramnios Dx ? Ix ?
US (amniotic fluid index <5th centile for GA)
- Ix amniotic ludi protein test if ROM suspected
oligohydramnios Mx ?
P-PROM: consider induction around 34-36 weeks
oligohydramnios complicaitons ? (2)
- preterm birth
- Stillbirth
- muscle contractures
what Ployhydramnios ?
high level amniotic fluid during pregnancy (amniotic fluid index >95th centile for GA)
causes of Ployhydramnios ? (6)
- idiopathic (50-60%)
- condition affecting fetal swallowing (oesophageal atresia)
- duodenal atresia
- Maternal DM
- macrosomia
- Twin-twin transfusion
Ployhydramnios Dx ? Ix ?
US (amniotic fluid index ?95th centile for GA)
- consider OGTT
Ployhydramnios prognosis ? (4)
- increase prenatal moraitliy
- malpresentation
- increase risk cord prolapse
- PPH (as uterus must contract further to achieve haeostasis)
