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O&G > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

When are women screened for anaemia in pregnancy

A
  • booking visit 8-12w

- 28w

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2
Q

Why does anaemia occur during pregnancy

A

increased plasma volume diluting the Hb

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3
Q

What are the normal ranges of Hb during pregnancy

A
  • > 110 g/l at booking

- >105 g/l at 28 week

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4
Q

What is the management of anaemia in pregnancy

A
  • Iron if low Hb or ferritin
  • B12: test for pernicious anaemia, if not B12 injection or tablet if mild
  • Folate: should be taking 400mcg, if deficient, take 5mg
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5
Q

What is gestational diabetes

A

diabetes triggered by pregnancy, that usually resolves after they have given birth. It is a result of reduced insulin sensitivity.

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6
Q

What are the risk factors of gestational diabetes

A
  • Raised BMI (>30)
  • Previous gestational diabetes
  • Asian, black Caribbean, Middle Eastern
  • Previous macrocosmic baby (or large for dates baby on scans)
  • Family history of diabetes (first degree relative)
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7
Q

When is the oral glucose tolerance test done

A

Booking

26 weeks

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8
Q

How is the oral glucose tolerance test conducted

A
  • Performed in the morning after a fast (can drink water)
  • They drink a 75g glucose drink at the start of the test (usually lucozade)
  • Blood sugar is measured before the sugar drink (fasting) and then at 2 hours
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9
Q

What values on oral glucose tolerance test suggest gestation diabetes

A

At baseline > 5.6

At 2 hours >7.8

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10
Q

What is the management of gestational diabetes

A
  • Joint diabetes / antenatal clinics
  • Fasting glucose < 7 trial of diet and exercise
  • Fasting glucose > 7 start insulin
  • Fasting glucose > 6 and macrosomia (or other complications) start insulin
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11
Q

What is the management of pregnant women with pre-existing diabetes

A
  • Metformin is the only safe oral agent
  • Most women are switched to insulin only
  • Closer monitoring is required
  • Folic acid (5mg) should be taken pre-conception to 12 weeks gestation
  • Retinopathy screening should be performed during pregnancy as this can progress rapidly
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12
Q

What is small for gestational age

A

Defined as a fetus that has an estimated fetal weight (on ultrasound) or abdominal circumference below the 10th centile for their gestational age.

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13
Q

What are the causes for SGA

A
  • constitutionally small
  • Fetal Growth Restriction (FGR) AKA Intrauterine growth restriction (IUGR)
  • Abnormal SGA, the baby is small due to a genetic or structural abnormality.
  • Multiple pregnancy
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14
Q

What is fetal growth restriction

A

small fetus (or a fetus that is not growing as expected) due to a pathology reducing the amount of nutrients and oxygen being delivered to the fetus.

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15
Q

Other features suggested of SGA

A
  • reduced liquor volume
  • abnormal doppler studies
  • reduced fetal movements
  • abnormal CTGs.
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16
Q

Causes of FGR

A
  • Idiopathic
  • Pre-eclampsia
  • Maternal smoking
  • Maternal alcohol
  • Anaemia
  • Malnutrition
  • Infection
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17
Q

Children who are FGR are disposed to what conditions later in life

A

HTN

T2DM

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18
Q

Risk factors for FGR babies

A 
Previous SGA baby
Obesity
Smoking
Diabetes
Existing hypertension
Pre-eclampsia
Antiphospholipid syndrome
Older mother (>35)
Low levels of Pregnancy‑Associated Plasma Protein‑A (PAPPA)
Antepartum haemorrhage
Multiple pregnancy
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19
Q

What is the management of FGR

A
  • Treat underlying cause e.g. pre-eclampsia
  • Careful monitoring of growth and health antenatally
  • Get paediatricians involved at birth of baby
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20
Q

What investigations should be carried out if suspecting an FGR baby

A
  • ultrasound monitoring of growth and amniotic fluid volume
  • umbilical artery dopplers, ductus venous dopplers
  • CTGs
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21
Q

What is large for gestational age

A

Babies are defined as being large for gestational age (also known as macrosomia) when they are born at a weight more than 4kg.

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22
Q

What are the causes of large for gestational age

A 
Constitutional
Maternal diabetes
Previous macrosomia
Maternal obesity or rapid weight gain
Overdue
Male baby
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23
Q

What are the risks of LGA to the mother

A 
Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery / caesarean
Post partum haemorrhage
Uterine rupture (rare)
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24
Q

What are the risks of LGA to the baby

A

Birth Injury (Erbs palsy, clavicular fracture, fetal distress and hypoxia)
Neonatal hypoglycaemia
Obesity in childhood and later life

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25
Q

Why is chickenpox dangerous in pregnancy

A
  • varicella pneumonitis
  • fetal varicella syndrome
  • Severe neonatal varicella infection (if mum is infected around delivery)
26
Q

How do you establish immunity of mum regarding chickenpox

A
  • Mothers that have previously had chickenpox are immune and safe
  • If in doubt test IgG levels for immunity (positive = immune)
27
Q

What do you post-exposure to the chicken pox in pregnant woman - previously had chicken pox

A

Nothing, they’re safe

28
Q

What do you post-exposure to the chicken pox in pregnant woman - not immune

A
  • IV varicella immunoglobulins as prophylaxis against developing chickenpox. This should be given within 10 days.
  • 24 hours aciclovir if chicken pox rash has started
29
Q

What are the features of congenital rubella syndrome

A
  • Sensorineural deafness
  • Congenital heath disease
  • Cataracts
  • Several other features
30
Q

Should pregnant woman who are not immune recieve the rubella vaccine

A

No it’s a live virus, non immune woman should be given the vaccine after pregnancy

31
Q

What are the complications of twin pregnancies

A 
Anaemia
Polyhydramnios
Hypertension
IUGR
Prematurity
Increased perinatal mortality
Malpresentation
Postpartum haemorrhage
Twin-twin transfusion syndrome
32
Q

What is twin-twin transfusion syndrome

A
  • There is a connection between the blood supplies of the two babies
  • The recipient gets the majority of the blood, and can become fluid overloaded (with polyhydramnios)
  • The donor is starved of blood, and can become anaemia
    .
33
Q

What is the management of severe twin-twin transfusion syndrome

A

laser treatment to destroy the connection between the two blood supplies

34
Q

What are monozygotic twins

A

identical - come from single zygote

35
Q

What are dizygotic twins

A

non-identical (come from two different zygotes)

36
Q

What is mono-amniotic vs diamniotic twins

A

one vs two amniotic sac

37
Q

What is mono-chorionic vs dichorionic

A

one vs two placentas

38
Q

What is the delivery of mono-amniotic twins

A

elective caesarean section at around 32-34 weeks.

39
Q

What is the delivery options of diamniotic twins

A
  • aim delivery 37-38 weeks
  • Vaginal delivery is possible when the presenting twin is cephalic presentation. The second baby may require caesarean section after successful delivery of the first baby.
  • Elective caesarean is generally advised when presenting twin is not cephalic presentation.
40
Q

What antenatal care should be given during a twin pregnancy

A
  • 5mg of folic acid
  • Iron supplements
  • Vitamin D
  • Close monitoring
  • Induction / section between 37 and 38 weeks for diamniotic twins.
  • Steroids are given prior to delivery to mature the fetal lungs
41
Q

What is the increase scanning requirements of twin pregnancies

A

2 weekly scans from 16 weeks for monochorionic twins

4 weekly scans from 20 weeks for dichorionic twins

42
Q

What are you looking for on US during twin pregnancies

A
  • growth restriction

- twin-twin transfusion syndrome

43
Q

Why is delivery of twin before 38 weeks

A

associated with increased fetal death

44
Q

What is the combined test

A
  • Weeks 11-14
  • US: Nuchal translucency
  • beta-HCG)
    Pregnancy‑Associated Plasma Protein‑A (PAPPA)
45
Q

What is nuchal translucency

A

thickness of the back of the neck of the fetus – Downs Syndrome is a cause of thickness >6mm)

46
Q

wHat might you see in the combined test if child has down syndrome

A
  • Nuchal translucency >6mm
  • High bHCG
  • Low PAPPA
47
Q

What is the triple test

A
  • Weeks 15-20
  • Beta-HCG -a higher result indicates greater risk
  • Alpha-fetoprotein (AFP)
  • Serum oestriol (female sex hormone)
48
Q

wHat might you see in the triple/quadruple test if child has down syndrome

A
  • High bHCG
  • Low AFP
  • Low oestriol
  • High inhibin
49
Q

What is the quadruple test

A
  • Weeks 15-20
  • Inhibin-A
  • AFP
  • bHCG
  • Oestriol
50
Q

Who is offered amniocentesis/chorionic villous sampling

A

Risk above 1 in 150

51
Q

What is amniocentesis

A

ultrasound guided aspiration of some amniotic fluid using a needle and syringe. This is later in pregnancy once enough amniotic fluid makes it safer to take a sample.

52
Q

What is Chorionic villus sampling

A

ultrasound guided biopsy of placental tissue. This is used when testing is done earlier in pregnancy (before 15 weeks).

53
Q

What is placenta praevia

A

the placenta is lying in the lower portion of the uterus, at a lower point than th presenting part of the fetus. It can lie close to the opening to the cervix, or be covering it.

1-2% of pregnancies

54
Q

What is considered a major praevia

A

covers the internal cervical OS

55
Q

What is considered a minor praevia

A

doesn’t covers the internal cervical OS

56
Q

What are the risk factors for placenta praevia

A

Previous caesarean sections
Older maternal age
Structural uterine abnormalities (e.g. fibroids)

57
Q

If a placenta praevia is not diagnosed on an early pregnancy scan, what is the main presentation

A

painless vaginal bleeding - usually around 36 weeks

58
Q

What is the management of placenta praevia

A
  • Rest and avoid intercourse
  • Avoid vaginal examination / speculum unless by experienced obstetrician
  • Ultrasound at 34 weeks gestation (or earlier if bleeding) to assess the placental position.
59
Q

What happens if the placenta remains over the os at 34 weeks

A

repeat scan every 2 weeks

  • elective c section 37
  • EmCS/earlier if bleeding
60
Q

What are the complications of placenta praevia

A

Antepartum haemorrhage

Postpartum haemorrhage

O&G (13 decks)

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