Prgenancy

Question 1

What vitamins should pregnant women take?

Answer 1

Folic acid 400micrograms (deficiencies cause neural tube defects)
Vitamin D 10 micrograms a days
AVOID vitamin A

Question 2

When is the first appointment?

Answer 2

8-12 weeks (ideally before 10 weeks)

Question 3

What 6 things are done at every appointment?

Answer 3

Blood pressure
Urine dip
Identify women with risk factors for pre-eclampsia (to start ibuprofen)
Offer influenza vaccination between oct and jan
Give info and support
Symphysis fundal height (every appointment after and including 25 weeks)

Question 4

What is screened for?(Bloods)

Answer 4

Blood group/Rhesus D status
Haemoglobinopathies, anaemia, red-cell antibodies
Hep B, HIV, syphillis

Question 5

Why is blood group/ rhesus status checked?

Answer 5

Because if mother rhesus -ve and baby rhesus +ve mother might initiate immune response (usually not first but subsequent pregnancies if mother becomes sensitised)

Question 6

Why is blood screened for HIV, Hep B, syphillis?

Answer 6

Prophylaxis treatment and effects delivery methods

Question 7

When is Down’s screened?

Answer 7

Combined test 11wks -13(+6days) weeks - bloods and ultrasound looking at nuchal thickness
Quadruple test (15wks - 20wks) - bloods only
Bloods - beta‑human chorionic gonadotrophin, pregnancy‑associated plasma protein‑A
Diagnostic testing - chorionic sampling or amniocentesis if screening indicates higher risk

Question 8

When are ultrasound scans performed?

Answer 8

11weeks-13(+6days) - gestational age assessment

19-20(+6days) weeks -USS for structural abnormalities (i.e. heart, limb, cranial)

Question 9

When are the 10 appointments in a nulliparous pregnancy? (Asterix shows nulliparous only)

Answer 9

1. 8-12 weeks
2. 16 weeks
3. 25 weeks*
4. 28 weeks
5. 31 weeks*
6. 34 weeks
7. 36 weeks
8. 38 weeks
9. 40 weeks*
10. 41 weeks

Question 10

When is pertussis vaccine offered and what is it for?

Answer 10

16 week appointment - whooping cough

Question 11

When is Symphysis fundal height measured?

Answer 11

25 week appointment and every subsequent apptmt

Question 12

What is treatment for rhesus -ve mother?

Answer 12

Anti-D prophylaxis (offer at 28 weeks and then second dose at 34 weeks)and injection of rhesus positive antibodies (to mop up small amounts of fetal blood)

Question 13

What vitamin is often given at 36 week appointment?

Answer 13

Vit K because newborns are often deficient

Question 14

2 ways to induce labour

Answer 14

Membrane sweep or vaginal prostaglandins

Question 15

Why does membrane sweep induce labour?

Answer 15

Separates amniotic sac from cervix to induce prostaglandin release

Question 16

Define neonate

Answer 16

An infant less than 28 days old

Question 17

Define extreme pre-term

Answer 17

Less than 26 weeks of pregnancy

Question 18

Define pre-term

Answer 18

Less than 37 weeks of pregnancy

Question 19

Define term

Answer 19

37-42 weeks of pregnancy

Question 20

Describe post-term

Answer 20

Greater than 42 weeks of pregnancy

Question 21

Describe an episiotomy

Answer 21

Widening of the vaginal opening before delivery by making an incision in the perineum

Question 22

What are 4 complications of an episiotomy?

Answer 22

1. Bleeding
2. Infection
3. Tearing into rectal tissue and anal sphincter (potentially leads to incontinence)
4. Dyspareunia (pain in genital area during sex)

Question 23

Why does prematurity cause lung problems?

Answer 23

There is not enough surfactant to reduce surface tension so the lungs aren’t spongey and elastic
Surfactant is produced from 32 weeks

Question 24

Which cells produce surfactant?

Answer 24

Type 2 alveolar epithelial cells

Question 25

When does surfactant start being produced?

Answer 25

Approx 32 weeks

Question 26

How is surfactant production induced?

Answer 26

Steroids (given to either the mother or fetus)

Question 27

3 Ps for the reasons for delayed labour

Answer 27

1. Power (of uterine contractions) 2. Passenger (is the fetus too big/ in the right position/breech) 3. Pelvis (is it big enough for delivery)

Question 28

What can be done in the first stage of labour if the uterine contractions aren't powerful enough?

Answer 28

Perform an amniotomy (break the waters) or give oxytocin

Question 29

What can be done in the second stage of labour if the uterine contractions aren't powerful enough?

Answer 29

``` Give encouragement Give syntocinon (synthetic oxytocin) Instrumental delivery using forceps ```

Question 30

How long should be allowed for third stage of pregnancy?

Answer 30

30 mins should be allowed for delivery of placenta and membranes

Question 31

What can be done if third stage is delayed?

Answer 31

Give oxytocin Controlled cord traction (pull the placenta gently) Surgery to manually remove placenta from the myometrium

Question 32

Describe the process of pathologically fetal hypoxia

Answer 32

1. Poor gas exchange between fetus and mother causes an increase in fetal CO2 (hypercapnia) which causes decrease in pH (acidaemia) 2. Low fetal O2 leads to hyperaemia which causes low fetal O2 in tissues leading to hypoxia which changes respiration from aerobic to anaerobic which increase lactate, which decreases pH which causes acidaemia. Can lead to tissue death (necrosis)

Question 33

What can cause acute hypoxia?

Answer 33

During contractions gas exchange doesn't occur so prolonged contractions can cause acute hypoxia.