ANC p2 Flashcards
1
Q
What % pop are Rhesus -ve
A
15%
2
Q
What is the sensitising event in Rhesus
A
When foetal cells enter the maternal circulation during 1st pregnancy
3
Q
Causes of sensitising events (6)
A
Ectopic TOP Foetal-maternal haemorrhage Maternal trauma Miscarriage Amniocentesis
4
Q
How does antiD immunoglobulin work?
A
Binds to RhD+ cells in maternal circulation so no response is stimulated
5
Q
Indications Anti-D Ig (8)
A
Invasive obstetric testing APH Ectopic Fall/abdo trauma IU death Misscarriage Termination Delivery
6
Q
How do you work out how much Anti-D Ig a patient needs?
A
Kleihauer test
7
Q
When should AntiD Ig be given to Rhesus -ve mothers? (weeks)
A
28
36
8
Q
How much AntiD Ig should be given to Rh -ve mothers after delivery
A
500IU AntiD
9
Q
How can Dr’s now ID if a baby is Rh +ve or -ve
A
NIPT
at booking
Looking at cells in maternal blood from foetus
10
Q
Def gestational diabetes
A
Any degree of glucose intolerance w/ onset/recognition during pregnancy
11
Q
What % rise in insulin req occurs on average in pregnancy?
A
30%
12
Q
RF poor pancreatic reserve (6)
A
BMI >30 Asian Ethnicity Prev gestational DM 1st degree relative DM PCOS Prev macrosomic baby
13
Q
CF gestational DM (5P
A
Classic DM Sx
Plus infection risk incr- UTI
Worsening pre-existing Heart disease
Diabetic retinopathy worsens
14
Q
Why does the foetus suffer from hyperinsulinaemia if mum has GDM?
A
Because glucose is transported through placenta
but insulin isnt
–> fetal hyperglycaemia
hence foetus prod lots of insulin –> hyperinsulinaemia
15
Q
Effects on foetus of hyperinsulinaemia (5)
A
Macrosomia Organomegaly Erythropoeisis Polyhydramnios Incr rates pre-term delivery
16
Q
What happens after delivery to foetus if has hyperinsulinaemia
A
High I but now no glucose from mum
–> hypoglycaemia
High I –> Decr fetal surfactant prod –> TTN
17
Q
Indications GGT to be done
A
Prev pregnancy w/ GDM 1st degree relative w/ DM FHx Prev macrosomic baby Prev unexplained stillbirth Prev baby w/ neonatal hypogylcaemia BMI >30 PCOS Glycosuria on 2 occ within 7 days Polyhydramnios Foetal growth >4.5kg
18
Q
Ix GDM
A
OGTT = mainstay
19
Q
When is OGTT offered?
A
Booking in prev GFM
24-8w if RF present
Any point if 2+ glycoosuria
20
Q
Diagnosis of GDM is made if:
A
Fasting glucose >5.6
2h >7.8
21
Q
Mx GDM
A
Lifestyle advice BG measure q.d.s Fortnightly visits <34w Weekly visits >34w Med - insulin
22
Q
What extra USS do GDM pt needs?
A
For foetal growth/liquour volume @32/6w
23
Q
When should you aim to deliver GDM
A
37-9 w/ if on Tx
Or
elective CSC when >4kg
24
Q
How to maintain glucose levels during labour
A
Insulin/dextrose infusion
25
Post natal care GDM
Check fetal levels glucose within 4hrs
Stop anti-DM Dx after delivery
6-13w - fasting gluc test
26
How many scans does a nulliparous low risk female have?
10
27
How many scans does a multiparous low risk female have
7
28
AN schedule - 10 weeks (2)
Booking visit
| Blood test
29
AN schedule - 11-13+6 (2)
Dating scan/excl multip
| Downs screening + NT
30
AN schedule - 16 w (2)
Results of screening tests
| Bloods + USS
31
AN schedule - 18-21w
Anomaly scan
32
AN schedule - 25w (4)
For Nulliparous ONLY
Excl pre-eclampsia
Routine care - BP/Urinalysis/SFH
Perform GGT if indicated
33
AN schedule - 28w (4)
Routine SFH/BP/Urinlaysis
FBC,antibodies
GTT
NIPT + anti-D if Rhe -ve
34
AN schedule - 31w (3)
Nulliparous only
Routine - BP/SFH/Urinalysis
Review bloods/anaemia
35
AN schedule - 34w (3)
Routine SFH/BP/urinalysis
Repeat bloods - Hb/2nd AntiD
Inform about delivers
36
AN schedule - 36,38,40,41
```
Routine - SFH/BP/Urinalysis
Check presentation (if not cephalic --> ECV) `
```
37
AN schedule - 42w (2)
Sweep membranes
| Offer IOL
38
Minor conditions in pregnancy - itching Mx (3)
Monitor:
Jaundice
LFTs
Bile acids
39
Minor conditions in pregnancy - pelvic girdle pain Mx (4)
Physio
Analgesia
Crutches
Corsets
40
What % of pregnancy women experience heart burn?
70%
41
Mx heart burn in pregnancy (3)
More pillows
Antacids
Ranitidine
42
What serious condition can heartburn indicate in pregnancy?
Pre-eclampsia
43
What can ankle oedema signify in pregnancy?
Pre-eclampsia
44
What mustn't you give to Mx ankle oedema in pregnancy?
Diuretics
45
Which 3 chromosomal abnormalities can an increased NT indicate?
Trisomy 21,13,18
46
What NT is significant?
>3.5
47
Which blood markers are used as a combined screening tool for trisomies?
E3
hCG
PAPPA
aFP
48
When can amniocentesis be performed?
>16w
49
What can amniocentesis be used for diagnosing? (3)
Chromosomal abnormalties
Infections
Inherited disorders
50
What week is the cut off for CVS?
14w
51
When is CVS safest?
11w
52
What is CVS diagnostic for? (3)
Chromosomal abnrom
AD disorder
AR disorders
53
Risks of miscarriage for amniocentesis
2-3%
54
Risk of miscarriage for CVS?
4%
55
What is now used instead of CVS/amnio
NIPT (99.5% specificity)
56
Which conditions are picked up at the 20w scan? (10)
```
Clefts
Anencephaly
Open spina bifida
Gastroschisis
Exomphalos
Bilateral renal agenesis
Lethal skeletal dysplasia
Edwards/Pataus
X-linked conditions
```
57
Downs - screening (3)
PAPPA - decreased
bHCG - increased
NT - increases
58
47XXY
Kleinfelters
59
Features of Kleinfelters (3)
Normal intellect
Small testes
Infertile
60
Screening anencephaly/SB (2)
Increased AFP
| USS at 20w
61
Tx of fetal cardiac abnormalities (2)
Digoxin for arrhythmias
| Valvuloplasty for critical aortic stenosis or hypoplastic L heart
62
What is Exophalmos
Extrusion of bowel contents in the perineal sac
63
What is gastrochisis
Free bowel loop in amniotic cavity
64
Who is more at risk of abdominal wall defects?
Young mothers
65
Def fetal hydrops
Accumulation of fluid in 2+ fetal compartments
66
causes of fetal hydrops (6)
```
Barts hydrops
Chromosomal defects
Structural defects
Cardiac defects
Twin-twin transfusion syndrome
Rhesus
```
67
Ix fetal hydrops (4)
USS
ECG
Maternal blood
Amniocentesis
68
Average increase in W in pregnancy
10-15kg
69
CHanges to the genital tract during pregnancy (3)
Increase uterus W by up to1kg
Mm hypertrophy
Cervix softens
70
What % increase in blood volume do you get during pregnancy
50%
71
What components of FBC increase during pregnancy
RBC
| WCC
72
What component of FBC decreases during prepgnancy
Hb
73
Cardiac output change pregnancy
40%
74
Change to tidal volume during pregnancy
40% increase
75
Change to U+E in pregnancy
40% increase GFR
| Decr Cr + urea
76
Prevalence twins
1/80
77
prevalence triplets
1/1000
78
What % of twins are dizygotic
2/3
79
What are dizygotic twins
Different sperm fertilise different oocytes
| Non identical
80
What % of monozygotic twins are DCDA (dichorionic, dizygotic)
30%
81
DCDA division day
Before day 3
82
What 'sign' can be seen in DCDA
Lambda sign
83
WHat 5 of monozygotic twins are MCDA (monochorionic, diamniotic)
70%
84
MCDA division say
Day 4-8
85
What 'sign' can be seen in MCDA
T sign
86
MCMA - division day
9-13
87
What is the risk w/ MCMA
Cord entanglement
| Hence sudden death
88
What are MC twins
Incomplete division --> conjoined twins
89
Causes of twins (2)
Assisted conception
| ? Maternal age/parity
90
Diagnosis of twins is made by: (5)
```
Vomiting in early pregnancy
Incr uterus size for dates
Palpation before 12 w
3+ foetal poles felt
USS
```
91
Complications of twins - maternal (5)
```
Exaggeration all obstetric risks
Gestatioinal DM + PE >
Incr risk pre-eclampsia
Anaemia
Haemorrhage
```
92
Complications of twins - foetal (5)
```
mortality/
LT handicap
Miscarriage
Pre-term labour
IUGR
Abnormalities
```
93
What incr mortality is there for twins
6x
94
What is the main cause of mortality - twins
Pre-term labour
95
Specific complications for monochorionic twins (6)
```
TTTS
TAPS (Swin anaemia polycythaemia sequence)
Twin reversal arterial perfusion
IUGR
Co-twin death
Cord entanglement
```
96
What is TTTS
Twin-twin transfusion syndrome
| Unequal blood distribution
97
TTTS - donor twin
VOlume depleted
Anaemia
IUGR
Oligohydramnios
98
TTTS - recipient twin
Volume overload
Polycythaemia
Heart failure
99
Tx of TTTS
Laser ablation
100
What is TAPS
Twin anaemia polycythaemia sequence
| = differences in Hb
101
What is twin reversal aa perfusion
One twin is pump and supplies blood to other due to cardiac defect
102
What is co-twin death
Death of 1 twin --> hypovolaemia in the other --> death/neurodisability
103
Why is there an increased chance of death for the 2nd twin after the 1st is delivered? (5)
```
Hypoxia
Cord prolapse
Placental abruption
Tetanic uterine contraction
Breech
```
104
Antepartum Mx of twins (6)
```
Consultant lead
Fe, folic acid, aspirin (prevent pre-eclampsia)
USS every 4w from w24 if DC
ID risk of pre-term delivery
ID IGUR
Early delivery
```
105
When is delivery advised for DC twins?
37w
106
When is delivery advised for MC twins
36w
107
How often is USS for DC twins
Ev 4 w from w24
108
How often is USS or MC twins
ev 2 w from week 12
109
Between what weeks is TTTS usually diagnosed
16-24w
110
What cardiac abnormalitiy can be ID'd in TTTS
Triscuspid regurg
111
Foetal termination due to abnormality - DC
Kcl intracardiac before 14w
| Or TOP from 32w to allow other twin to survive
112
Foetal termination due to abnormality - MC
Bi-polar diathermy
113
What helps prevent PPH in twin pregnancies
Prophylactic oxytocin infusion post-delivery
