Antenatal Care Flashcards
(30 cards)
What is involved in pre-pregnancy counselling?
Tailored to each patient, depending on their lifestyle habits and chronic conditions they may suffer from.
Topics discussed include:
- Timing of pregnancy- >35 y/o have increased risk, pregnancy interval (optimal = 18-59 months)
- Advice about conception - regular unprotected sex, family planning services
- Advice on folic acid - risk of NT defect
- Pregnancy testing - urinary B-hCG test
What are the risk factors for neural tube defects?
- Either partner has NT defect
- Family history of NT defect
- Previous pregnancy with NT defect
- Mother is taking AEDs
What dose of folic acid should women take when considering pregnancy?
- Normal risk of NT defect = 400mcg OD from preconception to 12 weeks post-partum
- High risk of NT defect = 5mg OD from preconception to 12 weeks post-partum
What lifestyle changes should be encouraged preconception?
- Healthy diet - low fat and sugar, high in fruit, veg, fibre - 2,500 calories per day
- Maintaining healthy BMI between 18-25 - women with BMI>30 should lose 5-10% of body weight before conception
- Smoking cessation - referral to cessation services
- Alcohol abstinence - referral to alcohol liaison service by midwife
- Stop illicit drug use - use contraception until drug use has stopped, test for Hep B,C and HIV
- Should not take OTC medications until doctor has been consulted first
Risks of obesity in pregnancy…
- Pre-term labour
- Pre-eclampsia
- GDM
- Miscarriage
- Macrosomia
- Shoulder dystocia
Risks of low BMI in pregnancy…
- Pre-term labour
- Low birth weight
- Gastrochisis
- First trimester miscarriage
Risks of smoking in pregnancy…
- Pre-term labour
- Low birth weight
- Birth defects of the mouth
- Sudden infant death syndrome
Risks of alcohol in pregnancy…
- First trimester miscarriage
- Structural abnormalities
- Preterm labour
- Low birth weight
After 3 months: learning difficulties, foetal alcohol syndrome
Risks of illicit drug use in pregnancy…
Opioids: structural abnormalities, foetal growth restriction, foetal distress, sudden infant death syndrome
Stimulants: first trimester miscarriage, structural abnormalities, preterm labour, placental abruption, sudden infant death syndrome
When is the first antenatal appointment, and what is its purpose?
Takes place at 10 weeks:
Main purpose is to take a detailed history and examination to determine if antenatal care needs to be hospital or community led.
Investigations:
- FBC (again at 28 weeks)
- Blood group and rhesus status (again at 28 weeks)
- Infection screen - syphillis, rubella, HIB, Hep B
- Urine culture
- Screening for GDM, sickle cell, thalassaemia
- Consent for chromosomal anomaly scan
How can gestational age be estimated?
40 weeks from last menstrual period
When do the two routine antenatal scans take place?
- Dating scan : 11-14 weeks - gestational age and EDD
- Anomaly scan: 18-20 weeks - most structural malformations can be assessed, amniotic fluid and foetal growth assessed
When are additional growth scans indicated?
- Previous SGA
- Pre-eclampsia
- GDM
- High BMI
How many antenatal visits are recommended during pregnancy?
- 10 visits for nulliparous women
- 7 visits for multiparous women
What will most antenatal visits include?
- BP and weight measurement
- Urine dip - MSU, GTT
- Foetal movements and maternal concerns
- SFH, position and presentation
What ‘minor’ maternal complications should be looked out for in antenatal care?
- Ankle oedema - raise legs when sat down
- Candidiasis - give imadazole pessary for active infection
- Pelvic girdle pain and backache - physiotherapy + analgesia
- Constipation - high fibre intake + stool softeners
- Abdominal pain - rule out pancreatitis/ appendicitis
- Heartburn - use extra pillows
- Carpal tunnel syndrome
- Itchiness - check for scleral jaundice
What happens in antenatal classes?
Education and training for both parents - intrapartum techniques for posture, breathing and pushing are taught.
What are the two types of twins?
Dizygotic = fertilisation of different oocytes from different sperm therefore they are non-identical
Monozygotic = result from mitotic division of a single zygote leading to identical twins
What does division at different stages mean?
- Division before day 3 = dichorionic, diamniotic twins (separate amniotic sacs and separate placentas)
- Division between day 4-7 = monochorionic, diamniotic (shared placenta and separate amniotic sacs)
- Divison between day 8-12 = monochorionic, monoamniotic (shared placenta and amniotic sac)
- Division after day 13 = conjoined twins
How do women with twins usually present?
- Significant vomiting occurs
- Uterus is much more palpable than the gestation
Comlplications from multiple pregnancies…
Maternal:
- GDM
- Pre-eclampsia
- Hyperemesis
- PPH
Foetal:
- Preterm delivery
- IUGR
- Miscarriage of one of the twins - twin-twin transfusion syndrome
- Monoamniotic = risk of cord entanglement
What is twin-twin transfusion syndrome?
Usually occurs in monochorionic twins where there is unequal blood distribution from the placenta leading to one donor twin (anaemic and depleted) and one recipient twin (polycyhthaemia and polyhydramnios)
Antenatal management of multiple pregnancies…
- More regular growth scans after 20 weeks: 28, 32 and 36 weeks - checking for IUGR
- If twin-twin transfusion syndrome is identified, babies to be delivered at 26 weeks
- Delivery = 37 weeks for dichorionic, and 36 weeks for monochorionic
Intrapartum management of multiple pregnancies…
- Mode of delivery = vaginal if first baby is cephalic presentation - otherwise C-section
- CTG monitor - risk of intrapartum hypoxia
- Foetal monitoring continuously
- If second twin is not cephalic, external cephalic version (ECV -manually turning the foetus around) can be attempted before mother starts pushing again
