1. Antenatal Care Flashcards
(25 cards)
Outline the timing of the trimesters?
First trimester < 14wks
Second trimester = 14-28wks
Third trimester > 28wks
When is the best time to start antenatal care?
Before Pregnancy
What measure taken pre-pregnancy can improve antenatal care?
Folic Acid Supplementation 3months prior (Spina bifida)
Stop Smoking + Recreational Drugs
Optimise weight (weight at conception = key factor)
Healthy Eating
Ovulation Predictors (no evidence base, stressful)
Rubella Screening (esp emigrants, small % no immune).
What are the aims of antenatal care?
- Prevent death
- Minimise morbidity
- Support women and family (father and extended included)
- Optimise intergenerational health (e.g. obesity begets obesity)
What are the components of the antenatal assessment?
- History
- Examination
- Investigations
The first antenatal visit may take place in…
- GP or hospital
- Early pregnancy assessment?
- Midwife/home births?
- Combined antenatal care
Outline the antenatal visit schedule?
- 8-14 weeks
- 20-24 weeks
- Every 2 weeks after 26 weeks
- Every week after 36 weeks
Early scans associated with healthy safe deliveries.
Scans for abnormalities.
What are the elements of the antenatal Hx?
- Present pregnancy e.g. dates
- Past obstetric and gynecological
- Medical and surgical
- Family History
- Drug History
- Social History
What assessments should be carried out as part of the antenatal examination?
- Blood pressure e.g. need to use right cuff
- Measure maternal height, weight
- Urinalysis
- Cardiorespiratory assessment
- Abdominal assessment (Paticularly in 2nd and 3rd trimeester, Check engagement, lie, liqiour etc)
- Pelvic assessment
Why is the (correct) measurement of blood pressure particularly important?
Hypertension increases risk of GDM.
Wrong cuff = risk of over diagnosis of Hypertension and overuse of interventions.
Why is (correct) measurement of weight important?
Used to weight for tracking of pregnancy. Weighing ceased.
Reintroduction of weighing for GDM risk, drug dosing.
Cannot relay on self-reporting.
Patient ends up in wrong BMI category 22% of time. Under diagnosis of morbid obesity 5%.
What investigations should be carried out as part of antenatal assessment?
- Full blood count (Hb, MCV to check for anaemia)
- Blood group e.g. ABO, Rh (Tranfusion during birth, Rh prophylaxis with anti-D)
- Rubella, chickenpox titres (Adult immigrants, no vaccineation Hx)
- HIV, Hepatitis B
- Screen for thalassemia etc
- Ultrasound
Why is screening for chicken pox particularly important?
Exposure to chickenpox during pregnancy gives higher risk of pneumonia than normal.
What genetic tests may be carried out as part of antenatal assessment?
- Triple testing
- Chorionic villus sample (CVS)
- Amniocentesis (sample of the amniotic fluid)
- Scan for anomaly
Whom may provide care in the antenatal period?
- Social worker
- Dietician
- Physiotherapist
- Parentcraft
- Psychiatrist
- Physician etc
Outline how one screens for Gestational Diabetes Mellitus?
- 1st degree family history
- BMI > 29.9 kg/m2
- Hx of macrosomia (>4.5 kgs)
- Ethnicity e.g. Asians
- Persistent glycosuria
- Hx of unexplained stillbirth
- Hx of LFD/polyhydramnious
You can base it on 1 high glucose testing..
What are some symptoms to note?
Nausea, vomiting? (In 1st trimeester reassuring, but in 2nd or 3rd tri more worrying, 2 reasons)
- Dehyrdation and micronutrients vernecaes encephalopathy,
- Other conditions such as a tumour.
Vaginal bleeding?
Fetal movements?
Minor ailments? (Don’t dismiss)
- Itch?E.g. an itch could be cholestasis of pregnancy which is associated with higher rate of stillbirth
What is involved in an antenatal assessment of the foetus?
• Cardiotocography • Fetal biophysical score • Fetal body composition • Umbilical artery doppler Selected Blood Tests
What is cardiotography?
Cardiotography
• Acceleration = Reassuring
• Deceleration = Worrying
In medicine (obstetrics), cardiotocography (CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester. The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor (EFM).
What blood tests may be performed as part of a antenatal foetal assessment?
Repeat Rh, antiobodies (At 32wks) Renal function tests FBC, including platelets Uric Acid Liver function tests Microbiological cultures
What decision can be made does the antenatal assessment aim to inform?
- Timing of delivery?
- Need for admission? (Lying in hospitals, but try to avoid. Outpatients preferable but not always possible e.g. pre-eclampsia risk, high temperature etc)
- Mode of delivery? (Elective C-section, If she has two or more previous C-sections contraindicates a vaginal birth, Preuria (a condition that I/s C-section. (I think)
- Type of induction? (Amniotomy? Vaginal Protosglandins?)
What drugs may be employed during the antenatal period? Special Considerations?
- General caution e.g. Teratogenicity
- Adjust exisiting medications?
- Corticosteroids? (To treat respiratory distress, a common feature in the 2nd trimester)
- Antihypertensives?
- Insulin? (If dietary interventions insufficient)
- Antibiotics? (Note that GFR increases during pregnancy and therefore higher doses, eg of gentamicin need to be used)
What special preparations may need to be put in place during the antenatal period?
Psychological
Paediatric consultation? (Involvment of neonatologists may be warrented at this stage)
Anaesthetic Clinic? (If patient morbidly obese a care plan may need to be developed with heavy Anaesthesiological involvement)
Blood for transfusion?
What are the central principles of Antenatal Care?
- Active listening
(Do not dismiss. Dx is in the story. Especially if mother >1 child, percieved differences between pregnancies can be significant diagnositically.) - Psychological support
- Continuity of care
(In pregnancies, as in all their relationships, women want stability!) - Consistent, high-quality information.
(Common complaint from women is conflicting information, e.g. surrounding breast feeding). Based on science, not opinion or conjecture (problem in Ireland, around intergenerational myths/home remedies) - Reassurance
(Media scare mongering, based on clinical outcomes IRL one of safest places to have baby, despite less investment through private care or from central government. Maternal mortality 1/10,000 which includes trauma/accidents, this is largely ignored in the media debate)
