Preparing for pregnancy and antenatal care Flashcards
(32 cards)
What should a doctor ask a patient looking to get pregnant?
- Age, PMHx, PSHx, any medications or allergies.
- Smoking and alcohol status
- Any previous pregnancies
- Does she have regular periods or any problems having sexual intercourse?
- Weight and BMI
- Any FHx of any conditions, or any problems in pregnancy
What changes are needed to optimise chances of a healthy pregnancy?
Moderate exercise
Relaxation and avoiding stressful situations
Stopping contraception
Folic acid (400 mcg/day)
Supplements such as iron, calcium, iodine and zinc if medically indicated
Avoid smoking and alcohol during pregnancy
Seek pre-pregnancy counselling in regards to previous medical problems
Supplementation with vitamin D is recommended for Asian women.
Advice relating to stopping contraception
There is no delay in return to fertility after stopping the pill or having the coil removed.
There is a delay of several months after stopping contraceptive injection.
It is suggested to wait for 3 months after stopping the coil before trying for pregnancy
Advice relating to folic acid
Recommended for use before pregnancy and up to 12 weeks gestation.
Recommended to reduce NTDs
For women at higher risks (previous affected child, FHx of NTDs, Women with NTDs, epilepsy, diabetes and obesity) should take a 5mg/day.
Which vitamin supplement might be teratogenic?
Vitamin A so this should be avoided and food products such as liver and pate high in vit.A should be avoided.
Which medical problems need pre-pregnancy counselling?
DM Epilepsy Cardiac disease Respiratory disease GI disease such as Crohn's or coeliac disease Psychiatric disorder
What should a general health check include?
General examination including BP, heart and lungs.
FHx of inherited disorders or congenital abnormalities.
Urine dipstick
Blood tests such as thalassaemia and sickle cell disease may be offered if at risk
Rubella and hepatitis status should be checked and vaccines given if not immune
Dental examination
HIV screening if at risk
What is the effect of pregnancy of pre-existing medical conditions?
- Effect may be transient (DM) or persistent leading to maternal morbidity (severe renal impairment).
- If risk of death is very high, pregnancy may be discouraged altogether
- Optimal control of certain diseases before conception may be important to avoid the risk of fatal malformation or adverse outcome (DM)
- Some medications may be changed before conception to reduce the risk of teratogenic (anti epileptics)
- Both prescription and OTC drugs should be used as little as possible during pregnancy.
- Most drugs carry warnings about use during pregnancy
How many appointments are required for a nulliparous woman?
10
How many apartments are required for a parous woman?
7
What is the schedule of appointments in nulliparous women?
Booking appointment (8 weeks)
16 weeks (Review screening results)
18-20 weeks (USS for structural abnormalities)
25 weeks (symphysis-fundal-height) (nulliparous only)
28 weeks (screening for anaemia and atypical red cell autoantibodies)- offer anti-D prophylaxis to rhesus-negative women.
31 weeks- measure symphysis-fundal-height
34 weeks- 2nd dose of anti-D to rhesus-negative women
36 weeks- check position of baby (offer ECV for baby in breech position
38 weeks
40 weeks (nulliparous)
41 weeks- membrane sweep and induction of labour
What does the booking visit entail?
Comprehensive hx should be elicited and a full physical examination.
RF should be highlighted.
Hx of inheritable diseases in close relatives should be sought.
Hx of travel (HIV, hepatitis, haemoglobinopathies)
Hx of alcohol abuse, smoking and addictive drug use are useful behavioural markers of potential risks (foetal abnormalities, impaired foetal growth, preterm labour and neonatal drug withdrawal problems)
Hx of psychiatric illnesses
Ethnic background, partner’s details or other next of kin
FHx of any illnesses or any problems in pregnancy
Previous obstetric and gynaecological hx including smears.
Last menstrual period (LMP)
What should a doctor do at a booking visit?
- Identify who may need additional care and plan pattern of care for the pregnancy.
- Check blood group and rhesus D status
- Offer screening for haemoglobinopathies, anaemia, red cell autoantibodies, HBV, HIV and syphillis
- Offer screening for asymptomatic bacteriuria
- Offer screening for DS
- Early USS for gestational age assessment
- USS for structural anomalies
- Calculate BMI
- Measure BP and test urine for proteinuria
- Offer screening for gestational diabetes and pre-eclampsia using RF
- Identify women who have had genital mutilation
- Ask about mood to identify possible depression
What should routine blood tests include?
FBC- anaemia Blood group- rhesus negative and abnormal antibodies (kell and Duff) Rubella screen Syphillis screen HBV screen HIV screen Sickle cell disease (black women at increased risk) Gestational diabetes
Risk factors for gestational diabetes
Previous GDM FHx of DM Previous macrosomic baby Previous unexplained stillbirth Obesity Glycosuria on more than one occasion Polyhydramnios Large for gestational age foetus in current pregnancy
What should screening tests include?
Anaemia and blood group
Haemoglobinopathies such as sickle cell disease and thalassaemia
Down’s syndrome- combined test or quadruple test.
Infection- MSU- reduces the risk of pyelonephritis
Pre-eclampsia- BP measurement and urinalysis for protein
Placenta praevia - 32 week screening for low-lying placenta
Structural foetal anomalies- USS routinely between 18-20 weeks
Risk factors for pre-eclampsia
Age 40 or older Nulliparity Pregnancy interval of more than 10 years FHx of pre-eclampsia Previous hx of pre-eclampsia BMI of 30 HTN Pre-existing renal disease Multiple pregnancy
Approxment measurement of symphysis-fundal height with progression of pregnancy
12 weeks- pubic symphysis
20 weeks- umbilicus
36 weeks- xiphoid process
Which factors makes a woman high risk during pregnancy?
Women at extreme of age (less than 18 or more than 40) are at higher risk of complications.
—Women older than 40 are more likely to have other health problems such as HTN or diabetes.
- Asian and black women are at higher risk of developing diabetes.
- Women from certain countries are at higher risk of FGM.
- premature labour
- FGR
- Antepartum haemorrhage
-Gestational HTN/ pre-eclampsia
- DM/ thrombocytopenia
- Type of delivery i.e. CS or instrumental delivery
- PPH
- 3rd or 4th degree tear
- previous stillbirth, miscarriage or neonatal death.
- identify women who are at risk of domestic abuse and addiction
- Hx of mental health problems conveys a risk of postpartum depression or psychosis.
What are the aims of physiological changes in pregnancy?
Maintenance of pregnancy
Preparation for delivery
Preparation for breastfeeding
What are the main hormones produced in pregnancy?
B-HCG
oestrogen
Progesterone
Human placental lactogen
Role of b-HcG in pregnancy
Useful for detection of pregnancy
Produced by the placenta
Peaks at 3 months the goes down at a constant rate
Role of oestrogen in pregnancy
Continuously rises in pregnancy.
Increased breast and nipple growth and pigmentation of the areola.
Promotes uterine bloods flow, myometrial growth and cervical softening.
Increased sensitivity and expression of myometrial oxytocin receptors.
Role of progesterone in pregnancy
Continuously rises in pregnancy
Promotes smooth muscle relaxation (gut, ureters, uterus) and raises body temperature.
It prevents preterm labour and is now increasingly administered to prevent preterm labour
