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Y4 cOGText > Antenatal Care > Flashcards

Antenatal Care Flashcards

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1
Q

How much folic acid should be given before conception?

A

400mg folic acid

from before conception until 12 weeks gestation

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2
Q

What does folic acid reduce the risk of?

A

Neural tube defects

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3
Q

What pregnant women would have to continue taking 5mg folic acid after the 12 weeks?

A 
diabetes
on anti-epileptic medication
BMI>30
previous pregnancies with neural tube defects
FH
PMH
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4
Q

How much vitamin D should mothers be given?

A

10mg of Vitamin D supplements during pregnancy & breastfeeding

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5
Q

True or false: pregnant woman should eat for 2.

A

False.

Only an excess of 250-300 calories are needed (especially in last trimester)

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6
Q

List the side effects that alcohol in pregnancy can cause.

A 
Fetal alcohol syndrome 
IUGR & postnatal restricted growth
learning difficulties
risk of miscarriage
withdrawal
Wernicke's encephalopathy & Korsakoff's syndrome
microcephaly
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7
Q

Nicotine use in pregnancy increases the risks of…?

A

miscarriage

pre-term labour

IUGR

still-births

SIDS

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8
Q

when is the booking visit?

A

10-12 weeks (by a community midwife)

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9
Q

what is done in the booking visit?

A

history taken - medical, drug, social, FH, LMP, was pregnancy planned, ethnicity of parents,

obstetric history - previous pregnancy, mode of delivery, previous miscarriages/TOP

blood group & Hb checked - & screened for haemoglobinopathies

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10
Q

what haemoglobinopathies are screened for at the booking visit?

A

HIV/AIDS
Syphilis
Hep B & C

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11
Q

What conditions are screened for at 18-20 weeks?

A

Anencephaly

Spina Bifida

Cleft lip

diaphragmatic hernia

gastroschisis

exomphalos

bilateral renal agenesis

lethal skeletal dysplasia

cardiac anomalies (TGA, AVSD, TOF, HLHS)

Edward’s syndrome (Trisomy 18)

Patau’s syndrome (Trisomy 13)

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12
Q

What % of babies with downs syndrome will have a normal anomaly scan?

A

50%

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13
Q

what is the combined test?

A

screening test for down syndrome

blood test & USS at 11 & 13 weeks

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14
Q

what is nuchal translucency?

A

the amount of fluid collecting within the nape of the fetal neck

normal value is <3.5mm

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15
Q

what does the blood test for Down syndrome include?

A

Serum pregnancy-associated plasma protein A (PAPP-A)

alpha fetoprotein (aFP)

beta-HCG

aka the triple test

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16
Q

in a fetus with down syndrome what would the results of the combined test look like?

A

PAPP-A & aFP = LOW

beta-HCG & nuchal translucency = INCREASED

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17
Q

what is the second stage of testing for down syndrome?

A

done at 15-16 weeks

quadruple test

blood test - aFP, inhibin, oestriol & total hCG

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18
Q

when is anti-D given?

A

in mother’s who are rhesus negative

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19
Q

what are the two main fetal abnormality DIAGNOSTIC tests?

A

chorionic villus sampling (CVS)

Amniocentesis

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20
Q

when are each of the diagnostic tests carried out?

A

CVS between 11 & 13 weeks

amniocentesis from 15 weeks

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21
Q

what is Non-invasive prenatal test (NIPT)?

A

a new screening test

analyses the cell-free DNA in the mother’s blood from the fetus

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22
Q

define monozygotic & dizygotic…

A

monozygotic - splitting of a single fertilised egg

dizygotic - fertilisation of 2 ova by 2 sperm

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23
Q

what is chorionicity?

A

Number of placentas

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24
Q

What is dichorionic?

A

2 placentas

always dichorionic diamniotic (DCDA)

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25
What is monochorionic?
1 shared placenta monochorionic monoamniotic monochorionic diamniotic conjoined twins
26
when & how is chorionicity determined?
by USS using the shape & thickness of the membrane more reliably done at the booking scan (11-13 weeks)
27
what are some signs/symptoms of multiple pregnancy?
exaggerated pregnancy symptoms e.g. excessive sickness / hyperemesis gravidarum high AFP large dates for uterus multiple fetal poles
28
What is twin-twin transfusion syndrome (TTTS) ?
a condition where there is disproportionate blood supply to fetuses in monochorionic pregnancies
29
what is a breech presentation?
longitudinal lie but presenting part is fetal buttocks (buttocks come out first) complete, footling or frank
30
what is external cephalic version (ECV)?
Attempting to manually turn the fetus into a cephalic presentation 50% successful
31
what is a term pregnancy?
37 - 42 weeks
32
how many USS does an uncomplicated pregnancy get?
2 a booking scan & an anomaly scan
33
what is the leading cause of maternal death in the first year post-delivery?
suicide
34
what are the hypertensive disorders of pregnancy?
pre-existing hypertension gestational hypertension pre-eclampsia
35
what is hypertension in pregnancy defined as?
systolic > 140mmHg or diastolic >90mmHg
36
describe gestational hypertension?
a.k.a idiopathic hypertension develops after 20 weeks no proteinuria or oedema
37
what are the characteristics of PRE-ECLAMPSIA?
``` pregnancy induced hypertension with proteinuria (>0/3g/24hrs) ```
38
what are features of SEVERE pre-eclampsia?
``` >170/110mmHg & proteinuria headache visual disturbances papilloedema right upper quadrant/epigastric pain sudden onset oedema hyperreflexia, clonus platelets/abnormal liver enzymes/HELLP syndrome ```
39
what is eclampsia characterised by?
grand mal seizures
40
how would pre-existing hypertension be managed in pregnancy?
switch from teratogenic ACEIs to either: labetalol nifedipine methyldopa
41
how would pregnancy induced hypertension be managed? (if below 20 weeks)
``` antihypertensives: labetalol nifedipine methyldopa hydralazine ```
42
how would pre-eclampsia be managed?
``` antihypertensives: labetalol nifedipine methyldopa hydralazine ``` IV magnesium sulphate - if severe
43
why are mothers with pre-eclampsia sometimes given IM steroids?
to encourage fetal lung maturation if gestation is <34 weeks | aim is to speed up the production of surfactant within the fetus' lungs & avoid acute respiratory distress syndrome
44
what IM steroids are given in pre-eclampsia?
betamethasone or dexamethasone
45
what is the treatment of eclampsia?
``` IV magnesium sulphate urgent delivery (usually by caesarean section) ```
46
what secondary prevention is there for women with a history of pre-eclampsia or have risk factors?
low dose aspirin started at 12 weeks | increased surveillance
47
what is gestational diabetes mellitus (GDM)?
Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
48
what are risk factors for GDM?
``` Previous GDM obesity (BMI>30) FH ethnicity previous big baby ```
49
what are signs of GDM?
Polyhydramnios | glycosuria
50
at what HBA1C should pregnancy be avoided?
above 86mmol/mol aim for 48mmol/mol
51
discuss the screening & diagnosis of GDM?
assess RF at booking visit previous GDM - recurrence risk >50% blood glucose monitoring oral glucose tolerance test at 24-28weeks
52
what are the diagnostic values for GDM?
Fasting glucose >= 5.1mmol/l | 2 hour >= 8.5mmol/l
53
how are GDM mothers monitored postnatally?
fasting blood glucose monitored 6-8 weeks postnatally | annual screening
54
what is PPROM?
Pre-term pre-labour rupture of membranes (PPROM) = breakage of the amniotic sac before the onset of labour
55
what are causes of PPROM?
Infection - may weaken tensile strength of the fetal membranes cervical incompetence over-distension of uterus vascular causes - placental abruption
56
what are the different stages of preterm birth?
extremely preterm - before 28 weeks very preterm - 28 to 32 weeks moderate/late preterm - 32 to 37 weeks
57
What are the survival rates of preterm infants?
``` less than 22 - close to 0 22 weeks - 10% 24 weeks - 60% 27 weeks - 89% 31 weeks - 95% 34 weeks - equivalent to baby born at full term ```
58
how do you diagnose PPROM?
Speculum examination - pooling of blood in the posterior vaginal fornix USS - may show oligohydramnios
59
how do you manage PPROM?
Monitor for signs of clinical chorioamnionitis antibiotics - to prevent ascending infections tocolytics maternal steroids magnesium sulphate
60
when does rhesus isoimmunisation occur?
occurs in rhesus D negative mothers who have a rhesus positive fetus
61
what is antepartum haemorrhage?
bleeding from the genital tract after 24 weeks gestation & before the second stage of labour during birth
62
what are causes of antepartum haemorrhage?
``` placenta praevia placenta abruption local causes - cervical ectropion, polyps, infection, cervical cancer vasa praevia uterine rupture indeterminate can be a sign of preterm labour ```
63
what is placenta praevia?
a placenta that is either covering the internal cervical os or one that is within 2cm of the cervical os
64
how does placenta praevia typically present?
bright red painless vaginal bleeding
65
what is placental abruption?
the separation of a normally implanted placenta either partially or totally before birth
66
how does placental abruption present?
painful vaginal bleeding (can be painless or concealed) | results in a tender, tense uterus (woody hard uterus)
67
what are some potential consequences of placental abruption?
intrauterine death & fetal hypoxia PPH DIC
68
How do you manage placental abruption?
resuscitate mother urgent C-section & replace blood products fetal resus if needed
69
what is vasa praevia?
occurs when there are fetal blood vessels in the membranes overlying close to the internal cervical os
70
how does vasa praevia present?
membranes are ruptured followed by small amount of dark vaginal bleeding & is accompanied by an acute fetal bradycardia & decelerations becoming a significant fetal mortality risk
71
how can uterine rupture present?
acute constant abdo pain may refer to shoulder tip sudden collapse on abdo palpation, fetal parts will be easily felt as fetus may be in intra-abdominal cavity (out of womb) acute fetal distress on CTG & sudden maternal collapse
72
what is placenta accreta?
when the placenta grows too deeply into the uterine wall
73
what is chicken pox?
a systemic disease characterised by a prodrome of fever and malaise, followed by the appearance of itchy vesicular skin rash which affects the whole body including palms, soles & mucous membranes
74
what are the complications of chicken pox on mother & fetus?
mother - increased risk of pneumonia, encephalitis, hepatitis fetus (before 28 weeks) - fetal varicella syndrome neonatal - 30% will die
75
what test can check if mother has immunity to virus?
blood test to check IgG antibodies to varicella zoster virus
76
how is chicken pox in pregnancy treated?
varicella-zoster immunoglobulins (VZIG) - effective within 10days of exposure aciclovir symptomatic relief
77
can a woman with HIV have a vaginal birth?
yes - if viral load is <50copies/ml if not then Caesarean is protective for baby
78
how are women with HIV treated during pregnancy?
combined antiretroviral therapy in 2nd trimester by the 24th week
79
what is Virchow's triad?
hypercoagulability venous stasis vascular damage
80
why are babies born pre-term?
25% planned caesarean section - severe pre-eclampsia, kidney disease & poor fetal development 20% premature rupture of membranes 25% emergency - placental abruption, infection, eclampsia 30% unknown

Y4 cOGText (9 decks)

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