Flashcards in Antepartum care Deck (21)
Name 3 investigations to do in prepregnancy counselling
Rubella and varicella serology, Pap smear
Name 3 common medications that are C/I in pregnancy and what alternative management you can use for a woman on these medications
Sulfonylureas - switch to metformin or insulin
Warfarin - switch to enoxaparin
Sodium valproate - can cease Rx if no seizure for > 2 years
Name 2 comorbid medical conditions where pregnancy is C/I (as prognosis for mother is terrible)
Severe renal failure (creatinine > 0.3)
Name 2 pieces of pharmacological and behavioural advice to give women in prepregnancy counselling
Pharmacological - folate supplements (500mg for 3 months before pregnancy), avoid teratogenic drugs
Behavioural - how to get pregnant (frequent intercourse up to ovulation), cease alcohol/smoking etc
What are the 6 main steps in the first antenatal visit?
Confirm gestational age
Screen for problems
Give general advice
Name 4 things on Hx suggestive that a woman is pregnant
Increased urinary frequency
At what gestational ages should you be able to tell that the woman is pregnant on abdominal vs vaginal exam?
Abdominally - 12 weeks
Vaginally - 8 weeks
Name 1 Ix to do in a first antenatal visit
Why is serum beta-HCG more accurate than urine beta-HCG?
Urine beta-HCG crossreacts with LH = greater false positives (also is only a qualitative, not quantitative reading)
What are two ways of determining the gestational age of a foetus? Which is more accurate?
Menstrual dating (Naegele's rule) - 9 months + 1 week from last normal menstrual period (to estimate delivery date)
U/S scan - more accurate, menstrual dating affected by irregular cycles or if woman is on hormonal contraception
What is Naegele's rule?
A way of estimating the gestational age of a foetus from menstrual dates - add 9 months + 1 week from last normal menstrual period to estimate delivery date
What U/S parameter is most accurate at determining the gestational age of a foetus between 6-12 weeks, and between 12-20 weeks? Why the difference?
6-12 weeks - crown rump length
12-20 weeks - biparietal diameter. CRL not as accurate as foetus starts to flex and extend head
Is U/S as accurate at determining gestational age of a foetus above 20 weeks as it is when foetus is
No - foetuses will all grow the same rate up to 20 weeks, but not beyond (depending on size of mum)
What are the 6 main types of investigations you should order for a woman in her first antenatal Hx/during the first 20 weeks of pregnancy? Give examples of each type
Blood tests (haematological) - Hb, platelets, MCV (look for thallassaemia)
Blood bank - blood grouping, screen for ITP antibodies
Microbiology/serology - rubella, varicella, syphilis, HBV, HCV, HIV, MSU MCS (asymptomatic bacteriuria)
Cytology - pap smear
Biochemistry - tests for Down Syndrome (PAPP-A and beta-HCG, or NIPT)
Imaging (U/S) - 12 week nuchal translucency and 19 week morphology
Name 7 pieces of general/lifestyle advice you can give a woman in her first antenatal visit
Diet - avoid raw poultry, mayonnaise, soft serve icecream, unpasteurised milk (risk of listeria)
Mineral/Vit supplementation - potential need for Fe, Calcium, Vit D, Folate, iodine, multivitamin supplements
Exercise - moderate exercise good, strenuous can = foetus SGA
Smoking and alcohol - no no
Sex - OK!
Work - most usually work until 34 weeks unless complication
Medications - paracetamol, metoclopromide (Maxalon), penicillins OK
What are the 3 main types of models of care in pregnancy (in public hospital)?
Normal risk - resident/midwife led care in public hospital
Shared care - between GP obstetrician and specialist
High risk - obstetrician-led care (inc. subspecialist in MFM)
Why do we have subsequent antenatal visits?
For surveillance of complications of pregnancy (pre-eclampsia, placental insufficiency, infection, foetal compromise, psychological state of mother and father etc)
What is the usual visit frequencies in antenatal care?
4 weekly until 28 weeks
2 weekly until 36 weeks
Weekly until delivery
Name 3 questions to ask on Hx in subsequent antenatal visits
Foetal movements (after 20 weeks)
Oedema (especially fingers)
Name 5 examinations to do on subsequent antenatal visits
Abdominal exam (lie, presentation, auscultation)
Urinanalysis (proteinuria, infection)