Pregnancy Risk Factors and Care Flashcards
Common Pregnancy risk factors
- BMI >30
- Gestational weight gain
- Smoking
Why is BMI>30 a pregnancy risk factor
Obesity puts the body in a pro-inflammatory state with endothelial cell dysfunction and vasoconstriction
Impact of BMI>30 on mother
- HTN and endothelial dysfunction → GHTN and Pre-eclampsia
- Antenatal → Miscarriage, GDM, VTE, OSA
- Intrapartum → C-section, anaesthetic risk, PPH, difficulty monitoring fetal HR
Impact of BMI>30 on baby
- LGA
- Preterm birth
- Sill birth/neonatal death
- Shoulder dystocia
- Long-term neonatal consequences (congenital abnormalities, neonatal body compositions, infant weight gain, obesity)
What is the role of the first Trimester scan?
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)
What screening is offered to all women in NZ?
- 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)
Prenatal screening for aneuploidy
- 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
What is the role of the 20-week anatomy scan?
- 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
Why is this gestational age (20 weeks) chosen for the anatomy scan?
- Developed such that we can see and check certain parts of anatomy and are growing as expected
What lab tests are recommended at the ‘booking’ appointment
- 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
Why is regular antenatal care an important predictor of pregnancy outcome?
- 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
What does the antenatal care look like after the booking appointment?
Until 28 weeks = monthly visits with LMC
28-36 weeks = visits every 2 weeks
From 36 weeks = visits every week