Antenatal care Flashcards by Jay Slater

what condition must you assess risk for at a booking appointment (2)

gestational diabetes

pre eclampsia

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what are the risk factors for gestational diabetes

BMI >30
previous baby >4.5kg
PMH
Fx

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gestational diabetes diagnosis

OGTT >5.1mmol fasting

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why must you check haemoglobin at booking appointment

to see if anaemia

pregnancy = high risk of bleeding

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as well as haemoglobin content, what other blood things do you want to check at booking screen

why

ABO - incase of blood transfusion

rhesus - if -ve give anti-D SC

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why is a mother being rhesus -ve a potential problem

if baby is rhesus +ve and their blood comes into contact (eg trauma, abdo bleeding), the mum will undergo a sensitizing event and gain some -ve antibodies

if mum is to have another baby that is -ve

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prevention of haemolytic disease of newborn

anti-D SC to any rhesus -ve mum at 12 weeks and 28 weeks

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what sexual history do you want to know about in the booking appointment

STIs - syphilis, HIV, hep B/C

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what 3 investigations do you want to do at booking appointment to screen for pre eclampsia

bp
urinalysis
maternal uterine artery doppler studies (MUAD)

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top differential for positive hCG but empty uterus on US

ectopic pregnancy

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when do people get a follow up antenatal appointment

20 weeks

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things to do at follow up appointment

screen for MENTAL HEALTH 
bp -pre eclampsia
urinalysis - pre eclampsia
symphysis fundal height 
fetal heart auscultation

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where should the fundus be at 20w (rough guide)

umbilicus

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where should the fundus be at 37w (rough guide) - full term

between costal margins of ribs

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what rule is used to calculate due date

naegles rule

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who delivers the baby if green pathway

midwives

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who delivers the baby if red pathway

obstetricians

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at how many weeks is US done

12 weeks

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what do you measure nuchal thickness on US for

down syndrome

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what is nuchal thickness on US

amount of skin/fat behind fetal neck

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normal nuchal thickness

<3.5mm

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if nuchal thickness >3.5mm, what are the potential causes

chromosome abnormality (eg downs) 
cardiac abnormality

ie increased nuchal thickness doesn’t mean down syndrome - just a screening tool

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screening test for downs syndrome

nuchal thickness

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diagnostic test for downs syndrome

amniocentesis (14-16 weeks)

CVB (<14 weeks)

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if nuchal thickness >3.5mm, what do you do next

amniocentesis (14-16 weeks) | CVB (<14 weeks)

what do you measure crown rump length (CRL) for on US

to date pregnancy, alongside date of last prior, up until 14 weeks

what 2 things do you look for on US at the 12 week scan

nuchal thickness | crown rump length (CRL)

what are you looking for on US at the 20 week scan (2)

``` feotal abnormalities placenta praevia (when placenta lies low in the womb) ```

apart from US what other test can be done at 12 weeks | why would you do them

serum scanning - amniocentesis or CVB done if NT>3.5mm or genetic testing required (eg family history)

where is needle inserted in chorionic villous biopsy (CVB) | what are you sampling

needle inserted through vagina | sampling placenta

why can CVB sometimes be inaccurate

confined placental mosaicism

when do you use CVB over amniocentesis

<14 weeks

where is the needle inserted in amniocentesis | what are you sampling

needle inserted through abdo wall | sampling amniotic fluid

which test is superior to CVB and amniocentesis but not currently provided on the NHS

NIPT (non invasive prenatal testing) - just requires a maternal blood test

which genetic test is used in amniocentesis/CVB to pick up downs syndrome

aCGH - picks up chromosome imbalances

why might you use chromosome analysis over aCGH

chromosome analysis picks up balanced translocation | aCGH only picks up unbalanced translocations

how many extra calories per day do you need when youre pregnant

250-300 not eating for 2!

supplementation requirements for pregnancy

5mg folic acid + 10mcg vit D

what does folic acid deficiency cause in babies

neural tube defects

what other supplementation could you recommend for during pregnancy (on top of folic acid and vit D)

iron supplements

which scheme provides those on benefits/<18yo with money for supplements during pregnancy

healthy start scheme

generally, should people continue taking drugs during pregnancy

if benefits outweigh risks (eg seizure risk) yes | persons choice

if on heparin and planning pregnancy, what should you do

switch to LMWH

which drug for connective tissue diseases is teratogenic and hence should be stopped during pregnancy

methotrexate

is there an increase in seizure frequently during pregnancy for epileptics if they take their medication

no - only increases if they stop medication!

which antiepileptic MUST you avoid in pregnancy

sodium valproate

what could happen if someone took sodium valproate during pregnancy

anencephaly | neural tube effects eg spina bifida

which diabetic drug is teratogenic

sulphonylureas

is insulin safe in pregnancy

yes

``` if obese what prophylaxis should you give for what (pregnancy specific condition) ```

75mg aspirin | for pre-eclampsia

what does obesity increase your risk of during pregnancy

miscarriage

what antihypertensives should you avoid in pregnancy first line medication

ACEinhibitors and ARBs labetalol

how do you assess growth on US after 14w (before 14w = CRL)

had circumference

what is the principle rule when prescribing something in pregnancy

weigh up pros and cons - ultimately patient decision

teratogenic epileptic drug

sodium valproate

teratogenic antidepressant

paroxetine - KNWO THIS!

what can sodium valproate cause in babies

neural tube defects eg spina bifida, anencephaly

teratogenic anticonvulsant

benzodiazepine

teratogenic antipsychotic (2)

clozapine | olanzapine

teratogenic rheumatology drug

methotrexate

teratogenic anti coagulant

warfarin

what can warfarin cause in babies

warfarin embryopathy - short limbs and phalanges, facial defects also bleeding risk in mums (bad during pregnancy)

which antibiotic stains childrens bone and teeth (hence should be avoided in pregnancy and childhood)

tetracycline

what can benzodiazepine cause in babies if given in third trimester

'floppy baby syndrome'

which antidepressant should be avoided in breastfeeding | what should be used instead

citalopram | use sertraline

what can alcohol during pregnancy cause how does this present

fetal alcohol syndrome thin upper lip, fat midface, smooth philtrum, microcephaly (small head)

why should opiates be stopped during pregnancy

neonatal opiate withdrawal after birth if not

at what stage (gestation) does the embryo gain rights

14 days - cant do embryo research after this

Antenatal care Flashcards

(68 cards)