Antenatal care pt 3 Flashcards
(36 cards)
How to you calculate EDD?
Naegele’s rule - LMP + 1 year - 3months and 7 days.
What is polymorphic eruption of pregnancy and its management?
Itchy rash which starts in 3rd tirmester. Usually begins on abdomen. Characterised with urticarial papules, wheals and plaques.
Managed: topical emollients, topical steroids, oral antihistamines and maybe oral steroids
What is atopic eruption of pregnancy?
Presents in the 1st and 2nd trimester.
E-type/eczema type: Red, itchy skin affects elbows, knees, neck, and chest.
P-type/puringo-type: itchy papules affecting abdo, back and limbs
What is Melasma?
Patches of increased pigmentation on the face. Usually symmetrical.
No active treatment - avoid sun, use make up, lightening creams etc.
Describe features of pyogenic granuloma?
Lobular capillary haemangiomas - rapidly growing lump that develops over days to 1-2cm in size. Often on fingers and may ulcerate or bleed.
More common in pregnancy. Need to rule out nodular melanoma
Describe features of pemphioid gestationis
Autoimmune skin disease which occurs in pregnancy. Antibodies created which damage connection between epidermis and the dermis. This causes bulae. Typical in 2nd or 3rd trimester and initially presents with a itchy red papular rash around umbilicus.
Typically resolves after delivery but can use topical emolients/steroids, oral steroids or immunosuppressants.
Describe features of obstetric cholestasis
It is stasis of bile flow due to increased oestrogen and progesterone levels.
Results in pruritis, jaundice and raised bilirubin. Associated with increased risk of premature birth and stillbirth.
What are the investigations and management of obstetric cholestasis
Ix - LFTs (deranged with high bilirubin)
Rx - Ursodeoxycholic acid, emollients, antihistamines, soluble vitamin K and planned delivery at 37 weeks.
What are the investigations of gestational diabetes
OGTT. Positive if:
Fasting glucose =/> 5.6
2 hours glucose =/> 7.8
What is the management of gestational diabetes?
If fasting glucose < 7mmol/l then trial diet and exercise change. If no improvement add metformin, if still no improvement then ADD insulin.
If fasting glucose > 7mmol/l then start insulin.
If fasting glucose is 6-6.9 and evidence of complications (macrosomia) then offer insulin
What is the management of pre-existing diabetes in pregnancy
If BMI > 27 then weight loss.
Stop oral hypoglycaemics (except metformin) and start insulin.
Folic acid from preconception to 12 weeks.
Retinopathy screening preformed after booking and 28 weeks gestation.
What are the fetal risks of gestation diabetes?
Neonatal hypoglycaemia (baby is accustomed to large supple of glucose during pregnancy).
Polycythaemia,
Jaundice,
Congenital heart disease,
Cardiomyopathy
What is the postnatal care for diabetes
If gestational then can stop diabetes meds immediately after birth but need follow up to test fast glucose after 6 weeks.
Women with existing diabetes should lower insulin dose and be wary of hypoglycaemia.
Describe features of neonatal hypoglycaemia
Needs monitored with regular glucose checks and frequent feeds. Maintain blood sugars above 2mmol/l and if it falls then give IV dextrose or NG feeding.
What is the normal fetal movements
Onset (quickening) occurs between 18-20 weeks and increases until 32 weeks where it then plateaus.
Fetal movement should be established by 24 weeks.
What are the risk factors for reduced fetal movements
Postural changes - more movement when lying down and less sitting up.
Woman being distracted.
Placental position - may have less movement with anterior placentas.
Medications - Alcohol, opiates or benzodiazepines.
Fetal position - anterior fetal position means movement less noticble.
Body habitus - obese patients.
Amniotic fluid volume - both oligo and polyhydramnios
Fetal size - SGA fetus
What are the investigations for reduced fetal movements
> 28 weeks then do handheld doppler to confirm fetal heartbeat. If no detectible heartbeat then do immediate ultrasound. If heartbeat is present then do CTG.
If between 24-28 weeks then do handheld doppler used to confirm doppler.
If < 24 weeks then use handheld doppler if previously had movements. If movements have never been felt then refer to maternity unit.
What is foetal lie and the three types?
Fetal lie is the long axis of the foetus relative to the longitudinal axis of the uterus.
Longitudinal lie,
Transverse lie,
Oblique lie
What are the risk factors for a transverse lie?
Previous pregnancies,
Fibroids and other pelvic tumours,
Multiple pregnancies,
Prematurity,
Polyhydramnios,
Foetal abnormalities
How do you diagnose transverse lie?
Abdominal examination and ultrasound scan
What is fetal presentation?
The first part of the baby which enters the maternal pelvis.
What is fetal position?
The position of the fetal head as it exits the birth canal
What are the complications and management of transverse lie?
Complications: PROM, cord prolapse or compound presentation.
Before 36 weeks no management required as likely to resolve.
After 36 weeks can do external cephalic version or elective C-section
What is preterm labour with intact membranes and how is it diagnosed??
Regular painful contractions and cervical dilation.
If less than 30 weeks then clinical assessment is sufficient.
If over 30 weeks then transvaginal ultrasound is used to assess cervical length. If less than 15mm then offer treatment
