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