Unit 7: pregnancy

Question 1

What is the purpose of a booking appointment?

Answer 1

Done between 8 to 12 weeks
Recieve information from the midwife/doctor on screening tests, maintaining a healthy pregnancy, lifestyle changes and supplements if needed.
May recieve information on breastfeeding, pelvic floor exercises.
Start making maternity notes
Assess if additional care is needed
Tests: blood test, sickle cell and thalessmia training if before 10 weeks, urine test, ultrasound to estimate the due date.
Gynecological history

Question 2

What is the role of a community midwife?

Answer 2

Work in GP clinics, fertility clinics and visit patient homes
Often first point of contact
Work in preconception advice, antenatal care and postnatal care, particularly when there are not problems with the pregnancy.

Question 3

What are the complications of sickle cell anemia?

Answer 3

Sickle cell crisis - a painful episode, often when rbcs build up in the liver or spleen, rapidy fall in Hb leads to ischemic damage
Increased risk of ischemic stroke
Increased risk of a serious infection, interferes with the filtering of blood in the spleen.
Acute stress syndrome - when rbcs block the small arteries surrounding the alveoli in the lungs, decreases oxygen perfusion.

Question 4

What causes mood swings during pregnancy?

Answer 4

Oestrogen and progesterone

Question 5

What causes nausea and morning sickness during pregnancy?

Answer 5

hCG detected by the chemical trigger zone
Changes in the digestive system - decreased speed of digestion, increased intraabdominal pressure
Nausea in 80%
Vomiting in 40%

Question 6

What is the dating scan?

Answer 6

Occurs between 8 to 14 weeks
Ultrasound scan
Estimates the babies due date, check the physical development of the baby and screen for possible conditions including down syndrome.

Question 7

What is the nuchal transluceny test?

Answer 7

Measures the thickness of fluid at the back of the babies neck
Increased thickness indicates a risk of down syndrome
Done between 11 and 14 weeks
A normal measurement is less than 3.5 mm

Question 8

What are the potential complications of rhesus factor during pregnancy?

Answer 8

When a mother is rhesus negative and sensitised to rhesus and a baby is rhesus positive.
Mothers immune system produces antibodies against the babies blood cells.
Can lead to still birth, vision loss, hearing loss or severe learning difficulties.

Question 9

What are the treatments for rhesus factor during pregnancy?

Answer 9

For born baby - phototherapy to break up bilirubin and fluids to compromise for increased urine volume
For unborn baby - intruterine blood transfusions - very rare and very risky, may also recieve immunoglubulins against the maternal antibodies.
Mam - anti-D medication prevents sensitisation, early c-section or induced labour

Question 10

What is the anomaly scan?

Answer 10

Performed at around 20 weeks gestation
Sonographer
Sagittal section of the baby on ultrasound
Tests for 11 rare conditions by looking at the appearance of the baby.
Includes T13 T18, cleft lip, spina bifida etc

Question 11

What factors may influence a patients decision in screening?

Answer 11

If the condition is treatable
How the screening test is done/ what are the risks of the test?
How specific are the results/ degree of certainty?
Social/cultural and personal beliefs

Question 12

What is meant by a sickle cell disease?

Answer 12

A disease effecting the red blood cells, they are typically an abnormal shape and lower in number.
Hinders the ability to transport oxygen.

Question 13

What is the management of sickle cell disease?

Answer 13

Blood transfusion
Bone marrow transplant
Self manage to avoid a crisis - by drinking lots of fluids, paracetamol to manage pain
Hydroxycarbamide - prevent sticking of rbcs, decrease proliferation of rbcs, more effective transfusion
Cranzilizumab - intravenously, inhibits binding to p selectin to decrease stickiness

Question 14

What are the key hormonal changes during pregnancy?

Answer 14

hCG levels double in the first 24 hours
progesterone and oestrogen increase
ACTH levels increase - this increases water absorption, leads to a higher blood pressure and an impaired glucose tolerance
Prolactine - produced by pituitary gland decrease FSH and LH

Question 15

What are the key changes in the genital tract during pregnancy?

Answer 15

Increased muscle mass and shortening of muscles in the uterus
Dilation of the vagina, more discharge
Vulva -increased blood flow, appears darker and reder,
Cervix - operculum forms, towards end of pregnancy collagenases, relaxin and prostaglandins thin and stretch the cervix

Question 16

What are the key changes in the renal system during pregnancy?

Answer 16

The smooth muscle of the bladder, ureter etc relaxes increases urinary stasis.
Increases risk of urinary tract infections
Relaxation of the internal urethra sphincter and the pressure of the foetus on the bladder can cause incontinence

Question 17

What are common symptoms of early pregnancy?

Answer 17

Missed period
Breast tenderness
Increased basal body temperature
Fatigue
Frequent urination
Morning sickness

Question 18

What is the main function of the thyroid?

Answer 18

Regulated by secretion of TSH from the pituitary gland
Secretes T3 and T4, regulates metabolic rate, also influences heart rate, ventilation and menstrual cycle.

Question 19

How does hyperthyroidism occur in pregnancy and how does this present?

Answer 19

TSH and hCG are similar in structure
Graves disease - autoimmune condition that produces TSI antibodies to stimulate the thyroid gland. Prevents as anxiety, weight loss.
Increased risk of pre-eclampsia, miscarriage, still birth, overdevelops foetus thyroid and congestive heart failure

Question 20

How does hypothyroidism occur in pregnancy and how does this present?

Answer 20

Hypothyroidism is caused by Haishimoto disease
Autoimmune - antibodies attack the thyroid
Risk of congestive heart failure, miscarriage, still birth, pre-eclampsia and low birth weight

Question 21

What happens if the placenta is in the wrong location?

Answer 21

placenta previa or a low lying placenta is normally identified between 18 and 21 weeks
Often require a c-section and are at a higher risk of hemorrhage
A retained placenta - must be removed surgically or by hand to prevent a post partum hemorrhage.

Question 22

How does a sonographer estimate the size of the baby hence the baby delivery date?

Answer 22

Corwn rump length - from top of the head to the bottom of the torso
Use this to estimate the stage of gestation hence the delivery date.

Question 23

What vaccinations/medications should a pregnant woman be given?

Answer 23

Recommended to have the flu vaccine and the whooping cough vaccine (Tba vaccine)
Should avoid live vaccinations
Any repeat prescriptions should be reviewed by a pharmacist

Question 24

How is age a maternal risk factor in pregnancy?

Answer 24

Above 35yrs old are considered a geriatric mother
Increased risk of gestational diabetes, pre-eclampsia, miscarriage and chromosome abnormalities

Question 25

How is being diabetic a maternal risk factor?

Answer 25

Baby is more likley to be big, increased risk of peritoneal tear or require a c-section.
Higher risk of miscarriage
Baby more likley to be obese or diabetic eraly in life
May restrict foetal glucose levels hence growth,

Question 26

How is being obese a maternal risk factor?

Answer 26

Doubles to risk of still birth
Increased maternal risk of thrombosis, gestational diabetes and pre-eclampsia
Doubles risk of neural tube birth defects

Question 27

What is gestational diabetes, what causes it?

Answer 27

Gestational diabetes in an increased level of blood glucose during pregnancy due to insulin resistance
Originally adaptive to supply the foetus with more blood

Question 28

What are the risk factors for gestational diabetes?

Answer 28

Age over 40yrs
Obese
Immediate family member who is diabetic
Gestational diabetes on a previous pregnancy
Previous gastric bypass
If of asian or black descent

Question 29

What are the symptoms and complications of gestational diabetes?

Answer 29

Symptoms: increased thirst, increased urination, tiredness, blurred vision
Complications: premature birth, increased levels of amniotic fluid, larger baby, jaundice in the baby

Question 30

What is the test for gestational diabetes?

Answer 30

An oral glucose tolerance test
Done after fasting overnight
Given a glucose solution of known concentration and measure blood glucose levels two hours later.

Question 31

What is the treatment for gestational diabetes?

Answer 31

Blood sugar testing kits - to monitor the levels of blood sugar
Encourage gentle exercise
In early stage may be given glucose injections

Question 32

What is and what causes pre-eclampsia?

Answer 32

Pre-eclampsia is an increased blood pressure during pregnancy.
Caused be increased cardiac output, also placenta problems, blood supply to the placenta is not sufficient to supply the foetus

Question 33

What are some of the complications of pre-eclampsia?

Answer 33

Very rare: the mother develops seizure resulting in a coma or unconsciousness
Swelling of extremeties
Protein in urine = diagnostic tool
Intrauterine feotal growth restriction

Question 34

What are the risk factors for pre-eclampsia?

Answer 34

High blood pressure
Family history
Diabetic
Autoimmune disease
Kidney disease
Multiple pregnancy
Obesity

Question 35

What are some of the treatments for pre-eclampsia?

Answer 35

Daily aspirin
Induced early labour or c-section
May be given beta-blockers - debate over if this will harm the developing foetus.

Question 36

Why are pelvic floor exercises beneficial for pregnant women?

Answer 36

Strengthen pelvic floor
Decrease risk of prolapse
Decrease risk of urinary incontinence after labour
Aid maternal effort during labour.

Question 37

What additional care is given to a diabetic mother?

Answer 37

Pre conceptual care - regular blood tests, monitor blood glucose levels to recommend when it is safe to have a baby.
Recommend more frequent monitoring of blood glucose levels and changing to insulin injections rather than tablets due to morning sickness
Routine - eye tests
Early induced labour or c-section due to increased size of foetus
Give birth under consultant led care, with frequent monitoring of glucose and insulin levels, often connected to an IV drip