Uncomplicated Pregnancies Flashcards
(29 cards)
Define terminology
- primip
- multip
- intrapartum
- postpartum
Primip - first pregnancy
Multip - 2nd or higher pregnancy
Intrapartum - during labour
Postpartum - after delivery
Pre natal and pre conception advice
FOLIC ACID - 400 micrograms a day until 12/40 (5mg instead if epilepsy/diabetes/obesity)
Stop smoking
No alcohol
Healthy weight
Vaccinations (MMR)
Switch contraindicating drugs for any conditions
What foods need to be avoided during pre conception and pregnancy and why
Unpasteurised (soft/blue) cheeses or milk - may have listeria which causes miscarriage
Raw eggs - has salmonella
Raw meat and cold cured meat (salami) due to risk of toxoplasmosis (miscarriage/congenital abnormalities)
Why is folic acid given until 12/40 gestation
Reduce risk of spinal bifida
Why is it important to stop smoking pre conception
Linked to miscarriage, premature birth, low birth weight and SIDs
Why is being at a healthy weight advised for pre conception
Increased risk of difficulties conceiving, PIH, GDM, thrombosis and delivery complications
BMI 30 = obese = cut off for IVF
Why is MMR vaccine important to have before pregnancy
Rubella infection can lead to foetal abnormalities and can’t have live vaccinations during pregnancy so must get pre-conception
Who gives antenatal care?
Midwifery and GP if patient is low risk with no past medical history of previous obstetric complications
Consultant Obstetrician is high risk patient with known medical condition e.g. diabetes, epilepsy or previous obstetric complications
Most often it’s both together
What are the general investigations in a routine antenatal appointment
BP
Height and weight
Urine for proteinuria and glucose from gestational DM and UTIs due to increased risk
Folic acid if not already on it
Educate on antenatal screening, diet and lifestyle
Fundal height
Book blood (blood group and rhesus, infectious disease like HIV, syphilis, hepatitis)
Ultrasound
How many routine antenatal appointments should there be
10 for nulliparous (1st pregnancy)women
7 visits for parous (had uncomplicated pregnancy before) women
What is fundal height and what level should it be at throughout pregnancy
Level of fungus (top of uterus) on abdominal palpating measured from pubic symphysis
12/40 - level of pubic symphysis
20/40 - level of umbilicus
When are ultrasound scans done during pregnancy and what is checked during each one
11-13 / 40 (dating scan)
Estimated time of delivery based on foetal movements
Screen for chromosomal abnormalities (Down’s, Edward’s and Patau syndrome)
18-21 / 40 (morphology scan)
gross abnormalities with foetus or placenta or risk of other complications
Where does HCG come from during pregnancy and when + where can it be detected
From placenta
In blood 11 days after conception
In urine 12-14 days after conception
How does HCG levels change during pregnancy
Double every 48 hrs
Peaks at 8-11 weeks then decline
What mechanical effect does progesterone have on the body during pregnancy
Increased laxity in ligaments and relaxes muscles leading to greater joint instability
How much does body weight go up by during pregnancy
Increase 2kg in first 20 weeks then 0.5 kg per week (mostly due to amniotic fluid) until 40 weeks full term = totals to 9-12 during pregnancy
What cardiovascular changes happen during pregnancy
Cardiac output increases due to increase in resting heart rate and increase in stroke volume
Blood volume goes up due to increase in plasma volume and no. Of red blood cells (if more plasma increase than red blood cell it’s physiological anaemia)
Decrease in blood pressure during first 20 weeks of pregnancy
What changes happen during pregnancy regarding - resp, gastrointestinal, urinary, skin and breasts
Resp - increase tidal volume and ventilation
Gastrointestinal - progesterone causes muscle relaxation so slower emptying of stomach and oesophageal sphincter relax causing indigestion and vomitting
Peristalsis slows for same reason
Give Gaviscon for gastro issues
Urinary - increased due to pressure from uterus (also may cause increased risk of UTIs)
Skin - linea nigra, stretch marks and increased perspiration (from increased temp from increased cardiac output)
Breast - enlargement, heavy and sore
What is labour and its 3 stages
Presence of regular uterine contractions with progressive cervical dilation and effacement
Stage 1 - cervix dilated to 4cm and regular contractions
2nd - fully dilated and pushing for delivery
3rd - delivery of baby and placenta
What is monitored during 2nd stage of labour
Fetal heart rate using CTG CardioTocoGram (may slow down if stressed)
What is instrumental / assisted delivery and what is used for it
Assist delivery when there is slow progress in delivering fetal head / evidence of fetal distress in second stage
Head must be low enough to attempt this
Ventous (Kiwi) - suction cup
Forceps
When is caesarean section given
Breech, previous CS or maternal request
Foetal distress, failure to progress (+ baby head to far up to use instrument), cord prolapse, footling breech
Where is suction cup placed during assisted delivery and why
Not on fontanel- below posterior fontanel to avoid herniating since skull is not fused yet
What are the risks of assisted delivery
Tear on mum
Subgamia haematoma risk, retinal haemorrhage, brain injury, or skull fracture for baby
