Pregnancy Risk Factors and Care

Question 1

Common Pregnancy risk factors

Answer 1

• BMI >30
• Gestational weight gain
• Smoking

Question 2

Why is BMI>30 a pregnancy risk factor

Answer 2

Obesity puts the body in a pro-inflammatory state with endothelial cell dysfunction and vasoconstriction

Question 3

Impact of BMI>30 on mother

Answer 3

• HTN and endothelial dysfunction → GHTN and Pre-eclampsia
• Antenatal → Miscarriage, GDM, VTE, OSA
• Intrapartum → C-section, anaesthetic risk, PPH, difficulty monitoring fetal HR

Question 4

Impact of BMI>30 on baby

Answer 4

• LGA
• Preterm birth
• Sill birth/neonatal death
• Shoulder dystocia
• Long-term neonatal consequences (congenital abnormalities, neonatal body compositions, infant weight gain, obesity)

Question 5

What is the role of the first Trimester scan?

Answer 5

4-13 week ultrasound can be used for
- Confirm viable pregnancy
- Confirm location (exclude ectopic)
- Dating using crown-rump length (If don’t know LMP)
- Gross fetal anatomy
- Detecting multiple pregnancies
- Nauchel translucency if doing screening for aneuploidy (chromosome abnormalities)

Question 6

What screening is offered to all women in NZ?

Answer 6

• 1st antenatal blood tests
• Prenatal screening for aneuploidy
• Anatomy scan at 18-20 weeks
• 24-28 week blood tests (anaemia, iron, blood group, antibody screen, diabetes)

Question 7

Prenatal screening for aneuploidy

Answer 7

• Offered to ALL women but up to individual
• Screening for abnormality of chromosomes (Trisomy 21 DS, Trisomy 18 and Trisomy 13)
• 3 options available (2 funded and one not)
• Funded = blood tests (9-13 weeks 6 days) and nuchal translucency scan at 11-13 weeks
• Not funded = Non-invasive prenatal testing (6-7 weeks)
• If +ve screening → Amniocentesis or CVS

Question 8

What is the role of the 20-week anatomy scan?

Answer 8

• Good at detecting defects in certain areas (Neural tube, urinary system, anterior abdominal wall)
• More difficult to detect cardiac, facial, intestinal and minor skeletal abnormalities
• However, some abnormalities are not present at this time of gestational not all structures are full developed

Question 9

Why is this gestational age (20 weeks) chosen for the anatomy scan?

Answer 9

• Developed such that we can see and check certain parts of anatomy and are growing as expected

Question 10

What lab tests are recommended at the ‘booking’ appointment

Answer 10

• Bloods (Hb, MCV, Platelet count, Blood group + antibodies, Rubella antibodies, Hep B+C, Syphilis, HIV, HbA1c)
• Midstream Urine
• STI swab
• Cervical smear if due
• USS to confirm date or if any sx

Question 11

Why is regular antenatal care an important predictor of pregnancy outcome?

Answer 11

• Monitors the progress of the pregnancy
• able to identify any problems/new risks
• revise the care plan
• aim is to identify risk factors early and prevent/reduce the adverse effects of pregnancy complications

Question 12

What does the antenatal care look like after the booking appointment?

Answer 12

Until 28 weeks = monthly visits with LMC
28-36 weeks = visits every 2 weeks
From 36 weeks = visits every week