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Obstetrics and Gynaecology > Antenatal care > Flashcards

Antenatal care Flashcards

(55 cards)

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1
Q

Important antenatal discussions

A 
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
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2
Q

Investigations required antenatal

A

Booking
24-28 weeks
34-36 weeks
40 weeks

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3
Q

Investigations at booking visit

A 
Blood group
pap smear
Hb
Antibodies
RPR
Hep B.Hep C
Rubella
HIV
Syphillis
MSU, GBS
Gonorrhea, chlamydia
Iron
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4
Q

Investigations at 24-28 weeks

A

Hb
Antibodies
OGTT
Urine

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5
Q

Investigations at 34-36 weeks

A

Hb
Antibodies
RPR

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6
Q

Investigations at 40 weeks

A

Hb

Antibodies

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7
Q

Examination requirements at each antenatal visit

A 
BP
Edema, reflexes, clonus
Abdominal->gestation calculation and size
Presentation
1/5 palpable
Liquor
FHS
Fetal movement
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8
Q

Antenatal visit schedule

A

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

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9
Q

Common complaints in pregnancy, cause and treatment

A 
Morning sickness
Carpal tunnel syndrome
Vaginal discharge
Pelvic pain
Heartburn
Varicose veins
Hemorrhoids
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10
Q

History for each subsequent visit

A 
General health
Fetal well being
Leakage of fluid
Vaginal bleeding
Contractions/abdominal pain
Preeclampsia-->headache, visual disturbance, RUQ pain
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11
Q

What is biophysical profile

A

Combination of non-stress test and US

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12
Q

Components of BPP

A
  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
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13
Q

Normal amniotic fluid volume

A

800-1000ml at 36-37 weeks

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14
Q

In T2 what does the AFI represent

A

Fetal urine output

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15
Q

If AFI low in T2 what does it indicate

A

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

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16
Q

What value of AFI is adequate, oliohydramnios and polyhydramnios

A 
Adequate= 5cm
Oliohydramnios= 25 cm
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17
Q

Most common cause of oligohydramnios

A

Ruptured membranes

IUGR in 60%

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18
Q

Causes of polyhydramnios

A 
Fetal malformation (anencephaly, esophageal atresia), genetic
Maternal diabetes
Multiple gestation
Fetal anemia
Viruses
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19
Q

What are complications of polyhydramnios

A

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

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20
Q

Caffeine

A

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

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21
Q

Exercise and CI

A

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
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22
Q

Nausea and vomiting

A

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.

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23
Q

Heartburn

Study These Flashcards
A 
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
Q

Constipation

Study These Flashcards
A

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

Obstetrics and Gynaecology (45 decks)

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