Uncomplicated Pregnancies

Question 1

Define terminology
- primip
- multip
- intrapartum
- postpartum

Answer 1

Primip - first pregnancy
Multip - 2nd or higher pregnancy
Intrapartum - during labour
Postpartum - after delivery

Question 2

Pre natal and pre conception advice

Answer 2

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

Question 3

What foods need to be avoided during pre conception and pregnancy and why

Answer 3

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)

Question 4

Why is folic acid given until 12/40 gestation

Answer 4

Reduce risk of spinal bifida

Question 5

Why is it important to stop smoking pre conception

Answer 5

Linked to miscarriage, premature birth, low birth weight and SIDs

Question 6

Why is being at a healthy weight advised for pre conception

Answer 6

Increased risk of difficulties conceiving, PIH, GDM, thrombosis and delivery complications
BMI 30 = obese = cut off for IVF

Question 7

Why is MMR vaccine important to have before pregnancy

Answer 7

Rubella infection can lead to foetal abnormalities and can’t have live vaccinations during pregnancy so must get pre-conception

Question 8

Who gives antenatal care?

Answer 8

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

Question 9

What are the general investigations in a routine antenatal appointment

Answer 9

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

Question 10

How many routine antenatal appointments should there be

Answer 10

10 for nulliparous (1st pregnancy)women
7 visits for parous (had uncomplicated pregnancy before) women

Question 11

What is fundal height and what level should it be at throughout pregnancy

Answer 11

Level of fungus (top of uterus) on abdominal palpating measured from pubic symphysis

12/40 - level of pubic symphysis
20/40 - level of umbilicus

Question 12

When are ultrasound scans done during pregnancy and what is checked during each one

Answer 12

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

Question 13

Where does HCG come from during pregnancy and when + where can it be detected

Answer 13

From placenta

In blood 11 days after conception
In urine 12-14 days after conception

Question 14

How does HCG levels change during pregnancy

Answer 14

Double every 48 hrs
Peaks at 8-11 weeks then decline

Question 15

What mechanical effect does progesterone have on the body during pregnancy

Answer 15

Increased laxity in ligaments and relaxes muscles leading to greater joint instability

Question 16

How much does body weight go up by during pregnancy

Answer 16

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

Question 17

What cardiovascular changes happen during pregnancy

Answer 17

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

Question 18

What changes happen during pregnancy regarding - resp, gastrointestinal, urinary, skin and breasts

Answer 18

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

Question 19

What is labour and its 3 stages

Answer 19

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

Question 20

What is monitored during 2nd stage of labour

Answer 20

Fetal heart rate using CTG CardioTocoGram (may slow down if stressed)

Question 21

What is instrumental / assisted delivery and what is used for it

Answer 21

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

Question 22

When is caesarean section given

Answer 22

Breech, previous CS or maternal request

Foetal distress, failure to progress (+ baby head to far up to use instrument), cord prolapse, footling breech

Question 23

Where is suction cup placed during assisted delivery and why

Answer 23

Not on fontanel- below posterior fontanel to avoid herniating since skull is not fused yet

Question 24

What are the risks of assisted delivery

Answer 24

Tear on mum
Subgamia haematoma risk, retinal haemorrhage, brain injury, or skull fracture for baby

Question 25

What is an episiotomy and when is it done

Answer 25

Cut made to perineum to facilitate delivery of head
Prevent perineal tear’s extending down to anal sphincter

Always done in instrumental deliveries

Question 26

What is perineal trauma, it’s complication and treatment

Answer 26

Tear of vaginal tissue, muscle and skin during delivery

May have faecal incontinence if tear extends through anal sphincter

Repaired with sutures

Question 27

Postnatal care

Answer 27

Pelvic floor exercises
Breast / bottle feeding
Midwife visits every day for first 5 days after discharge
GP review 6 weeks postpartum and discuss contraception too

Question 28

What are the advantages of breast feeding

Answer 28

Health benefits for baby - transfer of immunoglobulins (IgA) which helps baby immune system

Health benefits for mum - reduced risk of breast and ovarian cancers

Strengthens mother child bond

Question 29

What rhesus status consideration if there for future pregnancies after 1st pregnancy

Answer 29

Rhesus sensitisation
- if first baby had opposite rhesus status to mum and blood mixes, mums immune system develops antibodies against apposite rhesus status red blood cells which may attack next baby if that baby also has opposite rhesus status leading to HAEMOLYTIC DISEASE OF NEW BORN IN FUTURE PREGNANCIES

So prophylactically take anti D at 28 and 34/40 to prevent development of those antibodies