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Obstetrics and Gynaecology > Obstetric Monitoring > Flashcards

Obstetric Monitoring Flashcards

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1
Q

How many antenatal appointments should a nulliparous woman have?

A

10

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2
Q

How many antenatal appointments should a multiparous woman have?

A

7

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3
Q

What is routinely done at all appointments?

A

Plot symphysis fundal height
Measure BP
Urine dip - proteinuria

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4
Q

What should pregnant women be informed about at first contact with a healthcare professional?

A

Folic acid supplementation
Food and nutrition
Lifestyle advice
Antenatal screening information

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5
Q

What folic acid supplementation should pregnant women take?

A

400 micrograms per day before pregnancy and for first 12 weeks

5mg if BMI >30

Folic acid reduce neural tube defects

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6
Q

What food and nutrition advice should pregnant women be given?

A

How to avoid food poisoning:
Listeria - only pasteurised or UHT milk, avoid soft cheese
Salmonella - avoid raw/partially cooked eggs and meat

Avoid vit A - found in eating liver products
Supplement vit D

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7
Q

What lifestyle advice are pregnant women given?

A

Risks of smoking, alcohol and recreational drugs
Avoid long haul flights
Seatbelt above and below bump when in car

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8
Q

When should booking for pregnancy be done?

A

Within first 10 weeks

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9
Q

What happens at the booking appointment?

A

Inform about baby development
Reiterate diet, lifestyle, nutrition etc.
Exercise - pelvic floor
Reiterate screening and book these
Discuss place of birth
Pregnancy care pathway
Breastfeeding workshops and information
Antenatal classes
Discuss mental health
Measure BMI, BP, urine dip, urine culture
Bloods - infection screen, Hb, blood group, haemoglobinopathies

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10
Q

What appointments do all women have?

A 
16 weeks
18-20 weeks
28 weeks
34 weeks
36 weeks
38 weeks
41 weeks
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11
Q

What happens are the 16 week appointment?

A

Review and discuss screening

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12
Q

What happens are the 18-20 week appointment?

A

Fetal anomaly scan - if woman chooses

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13
Q

What happens are the 28 week appointment?

A

Second haematological condition screening

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14
Q

What happens are the 34 week appointment?

A

Prepare for labour

Help recognise active labour

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15
Q

What happens are the 36 week appointment?

A 
Check presentation and offer ECV (external cephalic version) if necessary
Information about:
Breastfeeding
Labour
Vit K prophylaxis
Baby blues
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16
Q

What happens are the 38 week appointment?

A

Options for managing prolonged pregnancy

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17
Q

What happens are the 41 week appointment?

A

Membrane sweep and induction of labour

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18
Q

What additional appointments do nulliparous women have?

A

25, 31 and 40 week routine care appointments

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19
Q

When is a gestational age assessment made?

A

USS between 10+0 and 13+6 weeks

Measure crown rump length - if >84cm then use head circumference

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20
Q

What are the benefits of antenatal screening?

A

Choice of termination
Time to prepare for disabilities - costs and treatments
Birth in specialist setting
Intra-uterine therapy

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21
Q

What are the limitations of antenatal screening?

A

Detection rates vary - anomaly, fetal position, woman BMI
May lead to tough decisions - further tests and termination
Emotional turmoil - false negative/positive

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22
Q

What diagnostic tests are done in antenatal screening?

A

Chorionic villus sampling

Amniocentesis

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23
Q

What happens in chorionic villus sampling and when?

A

Fine needle take sample of tissue from placenta - tested

11-14 weeks

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24
Q

What risks are associated with chorionic villus sampling?

Study These Flashcards
A

Miscarriage
Rhesus sensitisation
Uterine infection

25
What happens in amniocentesis and when?
Fine needle passed through mothers abdomen into uterus to collect sample of amniotic fluid Fluid contain baby's cells which can be tested Done after 15 weeks
26
What risks are associated with amniocentesis?
Miscarriage Rhesus sensitisation Uterine infection Club foot if done <15 weeks
27
What haematological conditions are screened for antenatally?
Anaemia Blood group and rhesus D status Atypical red-cell alloantibodies
28
When are haematological conditions screened for antenatally?
Booking and 28 weeks
29
What is the risks and outcomes of finding anaemia on antenatal screening?
Trial oral iron supplements Risk - low birth weight, preterm
30
What is the risks and outcomes of finding blood group and rhesus D status on antenatal screening?
Anti-D prophylaxis to all rhesus -ve women who aren't sensitised at 28-34 weeks Risk of haemolytic disease of newborn
31
What is the risks and outcomes of finding atypical red cell alloantibodies on antenatal screening?
Refer to specialist care Risk of haemolytic disease of newborn
32
What fetal abnormalities are screened antenatally?
Haemoglobinopathies Fetal anomaly Down's, Edward's and Patau's syndrome
33
When and how are haemoglobinopathies screened?
By 10 weeks Blood test if area of high prevalence, questionnaire if low prevalence Dad need blood test if mum carrier, if both carriers then diagnostic testing req.
34
When and how are fetal anomalies screened?
Between 18+0 and 20+6 weeks Scan with echo - 4 chamber view, open spina bifida, diaphragmatic hernia, cleft lip, gastroschisis, bilateral renal agenesis, cardiac abnormalities
35
When and how are down's, patau's and Edward's syndrome screened?
By 13+6 weeks Combined test - Nuchal translucency, B-HCG and plasma protein A Serum screening used if large BMI stop nuchal translucency or booking late If chance <1/150 then low risk and no further tests, if >1/150 then further testing
36
How are infections screened antenatally?
Blood test at booking
37
What infections are screened for antenatally?
HIV Hep B Syphilis
38
What is the outcome of finding an infection on screening?
HIV - specialist care and treatment, birth plan to avoid transmission, avoid breast feeding Hep B - B vaccinations given to baby between birth and 1 year Syphilis - Specialist team - Abx, Baby need blood test and poss Abx at birth
39
What is Naegele's rule?
Rule to calculate delivery day Date of first day of LMP + 7 days - 3 months + 1 year
40
Where can women give birth?
Midwifery led unit Home Obstetric unit
41
When is giving birth in a midwifery led unit particularly suitable?
Low risk pregnancy as rate of interventions lower and outcome is same as obstetric unit
42
What is the outcome for the baby if a woman chooses to give birth at home?
Small increase risk of adverse outcome
43
When should birth be planned in an obstetric unit?
Higher rate of interventions | Conditions that place pregnancy as high risk
44
What interventions can be done in birth?
Instrumental vaginal birth C section Episiotomy
45
What conditions can place a pregnancy as high risk?
``` Cardiac disease Hypertension Haemoglobinopathies VTE Hyperthyroidism Diabetes Infections - Hep, HIV Abnormal renal function Epilepsy Previous/current pregnancy complication ```
46
What observations of the woman are done on initial assessment of labour?
Review antenatal notes Ask about contractions - length, frequency, strength Ask about pain relief Review obs - pulse, BP, temperature, urinalysis Record vaginal loss (if any)
47
What observations of the unborn baby are done on initial assessment of labour?
Ask about baby movements in last 24hr Palpate woman's abdomen - fundal height, baby lie, presentation, position, engagement Auscultate fetal heart rate
48
When can you offer vaginal examination in assessment of labour?
Uncertainty about whether woman is in established labour Woman appear in established labour
49
What maternal red flags in labour would require transfer to an obstetric unit?
``` Pulse >120 on 2 occasions, 30 mins apart BP >160/110 OR >140/90 on 2 occasions 30 mins apart 2+ protein on urinalysis and BP >140/90 Temp >38 or >37.5 on 2 occasions 1hr apart Vaginal blood loss Presence of significant meconium Pain different from normal contraction Delay in 1st or 2nd stage labour Request of regional anaesthesia ```
50
What fetal red flags in labour would require transfer to an obstetric unit?
Abnormal presentation - inc. cord presentation Transverse or oblique lie High or free floating head in nulliparous woman Suspected fetal growth restriction or macrosomia Suspected anyhydramnios or polyhydramnios Fetal HR <110 or >160 Deceleration in fetal heart rate heard
51
What non pharmacological pain relief is considered in labour?
Breathing exercises Immersion in water Massage
52
What pharmacological pain relief options are there for labour?
Entonox IV/IM opioids Regional anaesthesia
53
What is entonox? What are its advantages and disadvantages?
Mix of O2 and NO Under patient control, act quickly and wear off quickly Can cause nausea and light-headedness
54
What opioids are used in labour?
Pethidine Diamorphine Others
55
What are the ads and disads of opioid pain relief in labour?
Effective within 15 mins Debate of effectiveness SE for mum and resp depression and drowsiness in fetus Cant use birthing pool for 2 hrs after administration
56
What regional anaesthesia can be used in labour?
Bupivicaine and fentanyl given either epidural or combined spinal epidural
57
What are the ads and disads of regional anaesthesia?
Most effective pain relief for labour, can avoid greater analgesia or GA if instrumental or C section needed Dizziness, shivering, hypotension Increased rate of operative vaginal delivery Have to be in obstetric unit with CTG monitoring Associated with longer 2nd stage of labour
58
What happens following full cervical dilatation in a woman with an epidural?
Delay pushing for 1 hour

Obstetrics and Gynaecology (21 decks)

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