Antenatal care Flashcards Preview

Obstetrics and Gynaecology > Antenatal care > Flashcards

Flashcards in Antenatal care Deck (55):
1

Important antenatal discussions

US
Exercise, diet, smoking, alcohol
Pelvic floor exercises
Optimal fetal positioning
Perineal massage
Signs of labour
When to come in
Hospital access
Pain management
3rd stage labour management
Vitamin K and Hepatitis B
Length of stay
EMS
Breastfeeding

2

Investigations required antenatal

Booking
24-28 weeks
34-36 weeks
40 weeks

3

Investigations at booking visit

Blood group
pap smear
Hb
Antibodies
RPR
Hep B.Hep C
Rubella
HIV
Syphillis
MSU, GBS
Gonorrhea, chlamydia
Iron

4

Investigations at 24-28 weeks

Hb
Antibodies
OGTT
Urine

5

Investigations at 34-36 weeks

Hb
Antibodies
RPR

6

Investigations at 40 weeks

Hb
Antibodies

7

Examination requirements at each antenatal visit

BP
Edema, reflexes, clonus
Abdominal->gestation calculation and size
Presentation
1/5 palpable
Liquor
FHS
Fetal movement

8

Antenatal visit schedule

4/52 to 28
2/52 to 36
1/52 to delivery

9

Common complaints in pregnancy, cause and treatment

Morning sickness
Carpal tunnel syndrome
Vaginal discharge
Pelvic pain
Heartburn
Varicose veins
Hemorrhoids

10

History for each subsequent visit

General health
Fetal well being
Leakage of fluid
Vaginal bleeding
Contractions/abdominal pain
Preeclampsia-->headache, visual disturbance, RUQ pain

11

What is biophysical profile

Combination of non-stress test and US

12

Components of BPP

1. NST-->variation of fetal heart
2. Breathing: >1 episode of rhythmic breathing movement of 30sec or more in 30 min
3. Movement >3 discrete body/limb within 30 minutes
4. Muscle tone: >1 episode of extension with return to flexion or opening/closing of hand
5. Determination of amniotic fluid index

13

Normal amniotic fluid volume

800-1000ml at 36-37 weeks

14

In T2 what does the AFI represent

Fetal urine output

15

If AFI low in T2 what does it indicate

Uteroplacental dysfunction-> -ve oxygenation, fetus preferentially shunts blood to brain and heart->kidney underperfused= -ve urine output= -ve amniotic fluid

16

What value of AFI is adequate, oliohydramnios and polyhydramnios

Adequate= 5cm
Oliohydramnios= 25 cm

17

Most common cause of oligohydramnios

Ruptured membranes
IUGR in 60%

18

Causes of polyhydramnios

Fetal malformation (anencephaly, esophageal atresia), genetic
Maternal diabetes
Multiple gestation
Fetal anemia
Viruses

19

What are complications of polyhydramnios

Uterine overdistension->preterm, PROM, fetal malposition, uterine atony

20

Caffeine

In coffee, tea, chocolate, soft drink
>300mg may +risk of abortion
Insomnia, regurgitation, reflux, urine frequence

21

Exercise and CI

No evidence to decrease activity
If regular before should continue
Relieves stress, anxiety, +self esteem and shortens labor
If +time in supine, should avoid in T2/3
Should stop if experience oxygen deprivation-->extreme fatigue, dizzy, SOB

CI to exercise:
IUGR
Persistent vaginal bleeding
Incompetent cervix
Risks for preterm
ROM
HTN, pre/eclampsia

22

Nausea and vomiting

Common, 50% in T1
If severe- dehydration, electrolyte imbalan
Mild->avoid spicy/fatty foods. Small frequent meals. Inhale peppermint. Drink ginger teas.
Severe->IVF (with glucose, to reduce the ketosis which can exacerbate the nausea), supplements, antihistaine, metoclopramide.

23

Heartburn

30%
Relaxation of LES
Eliminate spicy/acidic
Small, frequent
Sit up
Reduce liquid with meal
Sleep with head elevated
Liquid antacids, H2 inhibitors
Reduce amount of food before bed

24

Constipation

Common
+fiber, +liquids, Metamucil
Avoid enemas, strong cathartics and laxatives.

25

Varicosities

Common in lower extremeties and vulva
Chronic pain, thrombophlebitis
Avoid garments that restrict in the knee/upper leg
Support stocking
+periods of rest with elevation of lower extremities

26

Hemorrhoids

Cool sitz baths
Stool softners
+fluid and fiber
Hemorrhoidal ointment
Topical anaesthetic spray/steroid cream
Most improve after delivery
Hemorrhoidectomy can be performed safely in pregnancy if required

27

Leg cramps

50%
Massage and stretching

28

Back pain

Progressive
Minimise time standing
Wear support belt
Paracetamol
Exercises to strengthen back
Supportive shoes
Gentle back massage

29

Round ligament pain

Sharp, bilateral, unilateral groin pain
+In T2
Get on hands and knees with head on floor and buttocks in the air

30

Sexual intercourse and contraindications

No restrictions in a normal pregnancy
Nipple stimulation, penetration and orgasm can +oxytocin and prostaglandin= uterine contractions

CI: ruptured membrane, placenta previa, preterm labor

31

Employment

Should avoid activities which+ risk of falls/trauma

32

Travel

Best time is T2->past risk of miscarriage in T1, and not yet preterm labor of T3
Stretch out for 10 minutes every 2 hours
Bring copy of medical record
Wear seat belt in car
No additional risk with air travel
Usual travel precautions depending on destination

33

When should a pregnant woman contact her obstetrician

Vaginal bleeding
Leakage
Rhythmic abdominal cramping/back pain >6hr does not improve with hydration/lying supine/changing postition
Progressive and prolonged abdominal pain
Progressive vomiting, can't hold down any food/water for 24 hours
Seizure
Progressive severe headache, visual chages, generalised edema
Pronounced decrease in frequency/intensity of fetal movements

34

Goals of first antenatal visit

Health of mother and fetus
Identify conditions affected by pregnancy
Identify factors that affect pregnancy
Determine the model of care

35

History in first antenatal visit

Past obstetric history->pregnancies, delivery, ectopics, miscarriage, SVB, C section
Gynaecological history: LMP, pap smears, contraception
Calculate EDD
FHx->medical conditions, congenital, HTN, diabetes
MHx, medications, supplements
SHx, relations
Allergies
Investigations
Psychological

36

Booking examination

General inspection- demeanour, tatoos, scars, rashes, pallor, jaundice
Spine- scoliosis, kyphosis
Vitals- BP
Thyroid
CVS- heart murmus
Respiratory
Breast examination
Abdominal examination- inspect, palpate and auscultate
Bimanual not usually requires
Legs- varicose and edema

37

Where is fetal heart heard early and late in pregnancy

Early- midline of uterus
Late- position of anterior shoulder

38

Risk factors identifiable in pregnant woman

Age > 35
Evidence of post partum psychiatric
Previous pregnancy/birthing issues
Medical history->DM, HTN, renal/heart
Drug use
Obesity
Short
Parity when >3

39

Advice to pregnant women on onset of labour

Regular painful contractions from small of back to lower abdomen->come to hospital when contractions every 5-10 minutes
ROM + gush of fluid->come to the hospital
Bloody/mucus show may not be labour, if with contractions contact midwife, go to delivery unit.
Best to come in if think in labour

40

General advice for healthy pregnancy

Diet, exercise, weight gain
Smoking, alcohol, drugs
Iron and folate
Get someone else to change cat litter tray
Avoid soft cheeses, unpasteurised, pate

41

Up to 10, 10-14, 20 weeks gestation, how accurate is the CRL

+/- 5 days 20 weeks

42

Most accurate measure for gestation assessment in second trimester and third trimester

In second- BPD
In third- femur

43

What to arrange at first visit

Confirm pregnancy
Dating USS
Routine bloods
Shared care arrangements- refer to hospital
CFTS

44

When should urine be checked

When +BP

45

When can fetal parts be palpated

From 28 weeks

46

When does fetal head descent become relevant

When >36 weeks

47

When is Rh status rechecked

at 26-28 weeks

48

When is anti-D given

28 weeks and 34 weeks

49

When is Hb and syphillis repeated

36 weeks

50

When is IOL offered post dates

41-42 weeks

51

Woman presents pregnant, what do you tell them

Congratulate
Ask if well
Where she can book for the birth will be determined by health and progress, medical cover

52

History from woman presenting pregnanct

Full history->obstetric, gynae, medical/surgical, social, family
LMP, cycle, contraception
Calculate EDD: add 9 months and seven days to LMP if regular
Feelings about the pregnancy

53

Examination for woman presenting pregnant

General- BP
CV
Respiratory
Thyroid
Breast
Abdominal
Vaginal?

54

When to book into hospital

As soon as possible
Decision about care
Given hand held record
Over investigations, USS, first trimester screening

55

Arrangements following first visit

To return after investigations
Monitor general health