Normal pregnancy care Flashcards
(23 cards)
key points preconceptual counselling (9)
- previous pregs and implications
- assess CV health
- smear abnormalities (do smear 3m postnatally)
- Rubella status
- chronic condition check and control
- med check eg AED
- folic acid supplementation
- lifestyle
- education on diet eg 2500 cals, listeriosis
indications for 5mg folic acid (not 0.4) (4)
> 30 BMI
Sickle cell
malabsorption
AEDs
indications for 25ug Vit d (not 10ug) (4)
> 30 BMI
PreE risk
afrocaribbean or S. Asian
mx if risk of PreE
75mg aspirin and increase BP monitoring
VTE risk mx
LMWH
booking history key points
age <17, >35
hx preg
past ob hx: IUGR, SGA, prem, APH, PPH, Rh, PreE, GDM, congenital ab
past Gynae: surgery eg loop diathermy
PMHx incl psych
drugs
Fix: GDM increase if first degree released DM. also HTN, TE, preE and autoimmune
booking visit examination
BMI
baseline BP
From 12 weeks can auscultate FH
booking visit investigations
USS booked for 11-13+6 when also do combined test
Bloods: FBC, Anti-D antibodies (Rh), GTT if risk, stphillis, rubella immunity (vac offered postnatally), HIV and HepB screening offered
screen for chlamydia and BV
Urine MCandS, Urinalysis
what is screened for at 20 week scan?
anomaly scan, most structural defects
USS cervical length measured (give PG if short)
USS of uterine artery can be used as screening for IUGR or PreE
what is done at 28 weeks?
FBC and antibody assessment. repeat if tx for anaemia
GTT if RF
?NIPT for Rh
what is measured at dating scan
crown-rump length dates preg (b4 14 weeks); site preg, multiple preg; combined or triple/quadruple if later
how many appointments does NICE recommend for uncomplex nulliparous and multiparous?
10 and 7
schedule of antenatal visits
- 10 weeks booking
- 11-13+6 dating scan and Chr testing
- 16 weeks: discuss results of booking bloods, Chu ab. triple test if missed combined
- 18-21 weeks: anomaly scan. if placenta low scan 32 weeks
- 25: nulliparous only. exclude PreE and do GTT if need
- 28: fundal height measured. FBC and antibodies checked. anti-D given to Rh neg women
- 31: fundal height in nulliparous
- 34: fundal height. FBC if Hb was low
- 36,38,40: fundal height, lie, presentation. refer for ECV if breech.
- 41: check above and offer sweep and IOL by 42 weeks
when is it done and what is miscarriage risk
- amniocentesis
- CVS
Amniocentesis: 1%, 15 weeks
CVS: 1-2%, from 11 weeks
what can amniocentesis pick up?
infection (too, CMV), Chr. ab, inherited disorders eg CF, sickle cell, thalassaemia
what methods are used in amniocentesis and CVS?
karyotyping, FISH, microarray-CGH for Chr. abs
how many live births are affected by Chr. abs?
6/1000
what is included in
1) combined test
2) triple test
3) quadruple test
1) maternal age, nuchal translucency, PAPP-A, B-hCG
2) AFP, B-hCG, oestriol
3) bloods, age, AFP, total hCG, inhibin, oestriol
diagnosis of labour
and how initiation labour starts, ss
painful regular contractions leading to cervical dilatation and effacement.
Braxton hicks in T3 + production PGs, decrease cervical R, release oxytocin, further stimulates contractions from pacemakers in Cornu uterus. often Get show. +/- ROM
what is first stage of labour and how long should the active phase take.
from dx labour til full dilation. <16 hrs active (after 4cm). 8 null, 5 multi. average rate 1cm/hr null, 2cm/hr multi.
what happens in active 2nd stage and how long
uncontrollable urge to push with contractions as head descends. <1hr. 40mins null, 20 multi.
normal blood loss in 3rd stage
what happens in 3rd stage
from deliver fetus to placenta. <500ml, normally around 15 mins. active with IM syntocin/syntometrine.
perineal trauma classification 1st degree: 2nd degree: 3rd degree: 4th degree:
1st: minor damage to fourchette
2nd and episiotomies: perineal muscle
3rd: anal spinchter (1%)
4th: anal mucosa
