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RB Y3 3 Reproduction & Sexual Health > Antenatal Care > Flashcards

Antenatal Care Flashcards

(89 cards)

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1
Q

what is the purpose of blood and serum screening test for Downs

A

incorporate results with maternal age and gestation to give a person a risk assessment for Downs, they can then go onto to have diagnostic testing

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2
Q

when can the blood test for Downs be performed

A

between 11 weeks and 13 weeks 6 days

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3
Q

what do you do if mother wants Downs screening, is 12 weeks, but cannot measure NT

A

perfrom serum screening

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4
Q

what is measured in blood test for Downs, and what results suggests a high risk result for DOwns

A

NT - inc

bHCG - inc

PAPP-A - dec

+ maternal age

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5
Q

what is nuchal thickness

A

measurement of the fluid behind the skin at the back of the foetal neck using US

normal <3.5mm

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6
Q

what conditions is nunchal thickness increased in

A

chromosomal abnormalities, CVS abnormalities and lots of genetic syndromes

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7
Q

when can serum screening be performed for Downs

A

between 15-20 weeks

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8
Q

what is measured in serum screening for Downs

A

bHCG (inc), AFP and UE3 (dec)

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9
Q

what are the diagnostic tests available for Downs

A

amniocentesis and CVS

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10
Q

what are the risks of CVS and amniocentesis

A

there is a risk of miscarriage, this would tend to occur within 72 hours of the procedure

1% in amniocentesis and 2% in CVS

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11
Q

what is non invasive prenatal testing

A

a prenatal test for Downs (and other chromosomal abnormalities) that is not invasive and does not have an accompanying risk of miscarriage

it can currently only be obtained privately

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12
Q

is non invasive prenatal testing diagnostic

A

no, but it is 99% accurate

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13
Q

when are women screened for anaemia

A

at booking and at 28 weeks

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14
Q

what is the expected fundal height growth

A

1cm week

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15
Q

how do you measure fundal height

A

from the pubic bon to the top of the uterus

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16
Q

what are the expected landmarks for fundal height at 12, 20 and 36 weeks

A

pubic symphysis

umbilicus

xiphoid process

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17
Q

when should mental heatlh screening occur during pregnancy

A

at every appointment!

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18
Q

which pregnant women are tested for anti D antibodies and when

A

all rhesus negative at booking and at 28 weeks

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19
Q

who receives anti D Ig as prophylaxis

A

all non sensitised Rh neg mothers at 28 and 34 weeks

after sensitising event

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20
Q

what is a Kleihauer test and when would you perform it

A

calculates how much anti D Ig is needed

done after a sensitising event

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21
Q

what happens if there is a sensitising event and the mother is Rh neg and has received no prophylaxis

A

can still give anti D Ig as prophylaxis up to 72 hours after event - there is some protection up to 10 days after

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22
Q

route and site of antiD injection

A

deep IM injection into deltoid muscle

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23
Q

if a Rh positive baby is attacked by Rh Ab from mother, how does it present

A

RBC haemolysis –> jaundice and haemolutic anaemia

decrease in Hb, increase in bilirubin, positie Coombs tset

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24
Q

what is Naegeles rule

A

predicts an estimated due date by adding 9 months and 7 days onto womans last menstrual period

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25
what causes hypermesis gravidarum
not entirely sure, thought to be due to raised beta hCG levels (extreme in molar pregnancy)
26
when does HG commonly occur
between 8 and 12 weeks, can occur up to 20 weeks
27
does obesity increase riks of HG?
yes
28
does a personal/family history of HG increase risk?
yes
29
does smoking increase risk of HG?
no, decreases it
30
what anti emetics are first line for HG
anti histamines, eg promethazine and cyclizine
31
which anti emtics are second line for HG
ondansetron and metaclopramide
32
outline the changes to BP during pregnancy
decrease in DBP during trimester 1 and 2 increase back to pre pregnancy levels by term drops straight after delivery and then rises an peaks 3-4 days post natally
33
if a mother is found to have borderline hypertension during pregnancy, what is the likely diagnosis
pre existing hypertension
34
what is high blood pressure defined as during pregnnacy
* **140/90mmHg on 2 occasions OR \>160/100mmHg once**
35
are antihypertensives containdicated in pregnancy
ACEi and ARBs are contraindicated
36
what are he antihypertensives of choice in pregnancy
1st labetalol methydopa and nifedipine
37
define pregnancy induced hypertension
New onset of hypertension without any features of pre-eclampsia after 20 weeks of pregnancy or within the first 25 hours postpartum.
38
when does PIH usually present and how long does it last
2nd half of pregnancy around 6 weeks after pregnancy
39
what does PIH cause a very high risk of
pre eclampsia
40
after how many weeks can pre eclampsia occur
20
41
what is HELLp syndrome
a severe manifestation of pre eclapsmia haemolysis, elevated liver enzymes,low platelets
42
what is usually the presenting sign of pre eclampsia
rise in blood pressure
43
outline the aetiology of PE
* failure of normal invasion of trophoblasts cells leads to maladaptation of spinal arterioles - dont dilate and form low resiistance high capacitance vessels. this causes reduced uteroplacenetal blood flow --\> oligohydramnios, placental abruption, IUGR, foetal death * ischaemic placenta inducecs maternal systemic inflammatory hresponse and widespread endothelial damage - vasocoonstriction - kidneys retain more salt --\> hypertension
44
what pharmacological management is given as prophylaxis for PE
75mg aspirin OD from 12 weeks until birth of baby
45
what is the most significant risk factor for PE
previous PE
46
is PE more common in primigravidas?
yes
47
what signs are seen on maternal uterine artery doppler in PE
high resistnace outflow and diastolic notch
48
what is the main cause of maternal mortlaity in PE
CV accidents and pulmonary oedema
49
management of PE
deliver if close to or at term stabilise mother control BP with drugs
50
labetalol mechanism of action
a and beta blocker
51
what is labetalol CI in
asthma - blocks beta receptors too
52
what can leabetalol cause in the neonate
transienet hypoglycaeia
53
what is an adverse effect of methyldopa
depression
54
define eclampsia
**Eclampsia is the development of convulsions secondary to pre-eclampsia.**
55
what type of seizures occur in eclampsia
tonic clonic
56
management of eclampsia
magnesium sulphate IM/IV
57
how does Mg sulphate treat eclampsia
it decreases the calcium uptake by smooth muscles to prevent fits and lower blood pressure
58
before which gestation is defined as PTD
37 weeks
59
is a previous PTL a risk factor for another one?
yes, 20% risk
60
define SGA
estimated foetal weight/abdominal circumference below 10th centile on population/customised centiles
61
what are the causes of PTD
* infection - UTI, BV * over distension, eg polyhydramnios, multiple pregnancy * vascular * intercurrent illness, eg pyelonephritis, UTI, pneumonia
62
what causes babies to be asymmetrically/symmetrically small
symmetrical - usually caused by genetic problems, eg downs asymmetrical - usually occurs in the 3rd trimester, growth of the body is sacrificed to maintain head growth
63
what drug is particularly assoicated with a risk of SGA baby
cocaine
64
define SGA
estimated foetal weight/anbdominal circumference \< 10th centile on population/customised centiels
65
how is SGA diagnosed
* measure foetal abdominal circumference and combined with head circumference and femur length gives estimated foetal weight * can be combined with liquor volume, amnitoic fluid index and Doppler scan
66
why are SGA babies particuarlly suceptible to hypothermia
* Increased heat loss due to decrease in subcutaneous fat * Decreased heat production due to intrauterine stress and depletion of nutrient stores * Increased surface to volume ratio due to small size
67
why is betamethasone given to preterm babies
it is a corticosteroid that crosses the placenta - heps foetal lung maturity so helps prevent neonatal complications of premature delivery
68
what birth weight is considered large for dates regardless of gestational age
\>4kg
69
what symphyseal fundal height is considered large
\>2cm more than gestational age
70
what is a maternal cause of polyhydramnios
diabetes
71
what are the risks of polyhydramnios
* preterm contractions * preterm delivery * premature rupture of membranes * foetal malposition/death
72
what is hydrops foetalis
severe odema in baby's tissues and organs - can be due to rhesus disease or other non immune causes
73
what happens in acute polyhydramnios
rare, uterus becomes acutely distended and often results in preterm labour painful for mother, experiences dyspnoea and vomiting
74
what causes chronic polyhydramnios
conditions where there is a large placenta - multiple pregnancies, chorioangioma of placenta, maternal diabetes
75
is polyhydramnios assoicated with underlying congenital abnormalities
in a lot of cases yes
76
how is polyhydramnios diagnosed
by US measurement of amniotic fluid index - add the vertical depth of fluid measured in each quadrant of the uterus together
77
what is the normal range for AFI
5-24 cm
78
certain viral infections can cause polyhydramnios - name 3
parvovirus B19, rubella, toxoplasmosis and CMV
79
is maternal age a risk factor for multiple pregnancy
yes more likely with inc age
80
what determines the chorionicity of twins
at what stage (how many days in) the egg cleaves
81
how many placentas do mono and di chorionic twins have
2 placenta in di chorionic and one in monochorionic
82
how can chorionicity of twins be determines
by US * membrane shape and thickness * lamda sign is indicative of dichorionic twins
83
84
what is twin-twin transfusion syndrome
when twins are sharing a placenta, one can receive too little blood supply and the other too much - low urine output, amnitoic fluid and growth in one and oligohydramnios - high blood pressure and polyhydramnios in the other. this can put strain on foetus and lead to heart failure
85
what problem with blood can TTTS lead to
one baby gets anaemia and the other polycythaemia
86
which type of twins are at the greatest risk
monochorionic monozygous twins, there is a risk of cord entanglement and a higher risk of foetal death
87
management of TTTS
* SFLA to laser shut abnormal blood vessles if before 25 weeks * if after, amnioreduction or septostomy
88
where in the world is the prevalence of natural twinning highest
central africa
89

RB Y3 3 Reproduction & Sexual Health (21 decks)

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