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RB Y3 3 Reproduction & Sexual Health > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

what is the purpose of blood and serum screening test for Downs

A

incorporate results with maternal age and gestation to give a person a risk assessment for Downs, they can then go onto to have diagnostic testing

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2
Q

when can the blood test for Downs be performed

A

between 11 weeks and 13 weeks 6 days

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3
Q

what do you do if mother wants Downs screening, is 12 weeks, but cannot measure NT

A

perfrom serum screening

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4
Q

what is measured in blood test for Downs, and what results suggests a high risk result for DOwns

A

NT - inc

bHCG - inc

PAPP-A - dec

+ maternal age

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5
Q

what is nuchal thickness

A

measurement of the fluid behind the skin at the back of the foetal neck using US

normal <3.5mm

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6
Q

what conditions is nunchal thickness increased in

A

chromosomal abnormalities, CVS abnormalities and lots of genetic syndromes

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7
Q

when can serum screening be performed for Downs

A

between 15-20 weeks

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8
Q

what is measured in serum screening for Downs

A

bHCG (inc), AFP and UE3 (dec)

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9
Q

what are the diagnostic tests available for Downs

A

amniocentesis and CVS

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10
Q

what are the risks of CVS and amniocentesis

A

there is a risk of miscarriage, this would tend to occur within 72 hours of the procedure

1% in amniocentesis and 2% in CVS

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11
Q

what is non invasive prenatal testing

A

a prenatal test for Downs (and other chromosomal abnormalities) that is not invasive and does not have an accompanying risk of miscarriage

it can currently only be obtained privately

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12
Q

is non invasive prenatal testing diagnostic

A

no, but it is 99% accurate

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13
Q

when are women screened for anaemia

A

at booking and at 28 weeks

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14
Q

what is the expected fundal height growth

A

1cm week

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15
Q

how do you measure fundal height

A

from the pubic bon to the top of the uterus

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16
Q

what are the expected landmarks for fundal height at 12, 20 and 36 weeks

A

pubic symphysis

umbilicus

xiphoid process

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17
Q

when should mental heatlh screening occur during pregnancy

A

at every appointment!

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18
Q

which pregnant women are tested for anti D antibodies and when

A

all rhesus negative at booking and at 28 weeks

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19
Q

who receives anti D Ig as prophylaxis

A

all non sensitised Rh neg mothers at 28 and 34 weeks

after sensitising event

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20
Q

what is a Kleihauer test and when would you perform it

A

calculates how much anti D Ig is needed

done after a sensitising event

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21
Q

what happens if there is a sensitising event and the mother is Rh neg and has received no prophylaxis

A

can still give anti D Ig as prophylaxis up to 72 hours after event - there is some protection up to 10 days after

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22
Q

route and site of antiD injection

A

deep IM injection into deltoid muscle

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23
Q

if a Rh positive baby is attacked by Rh Ab from mother, how does it present

A

RBC haemolysis –> jaundice and haemolutic anaemia

decrease in Hb, increase in bilirubin, positie Coombs tset

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24
Q

what is Naegeles rule

A

predicts an estimated due date by adding 9 months and 7 days onto womans last menstrual period

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25
Q

what causes hypermesis gravidarum

A

not entirely sure, thought to be due to raised beta hCG levels (extreme in molar pregnancy)

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26
Q

when does HG commonly occur

A

between 8 and 12 weeks, can occur up to 20 weeks

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27
Q

does obesity increase riks of HG?

A

yes

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28
Q

does a personal/family history of HG increase risk?

A

yes

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29
Q

does smoking increase risk of HG?

A

no, decreases it

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30
Q

what anti emetics are first line for HG

A

anti histamines, eg promethazine and cyclizine

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31
Q

which anti emtics are second line for HG

A

ondansetron and metaclopramide

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32
Q

outline the changes to BP during pregnancy

A

decrease in DBP during trimester 1 and 2

increase back to pre pregnancy levels by term

drops straight after delivery and then rises an peaks 3-4 days post natally

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33
Q

if a mother is found to have borderline hypertension during pregnancy, what is the likely diagnosis

A

pre existing hypertension

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34
Q

what is high blood pressure defined as during pregnnacy

A
  • 140/90mmHg on 2 occasions OR >160/100mmHg once
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35
Q

are antihypertensives containdicated in pregnancy

A

ACEi and ARBs are contraindicated

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36
Q

what are he antihypertensives of choice in pregnancy

A

1st labetalol

methydopa and nifedipine

37
Q

define pregnancy induced hypertension

A

New onset of hypertension without any features of pre-eclampsia after 20 weeks of pregnancy or within the first 25 hours postpartum.

38
Q

when does PIH usually present and how long does it last

A

2nd half of pregnancy

around 6 weeks after pregnancy

39
Q

what does PIH cause a very high risk of

A

pre eclampsia

40
Q

after how many weeks can pre eclampsia occur

A

20

41
Q

what is HELLp syndrome

A

a severe manifestation of pre eclapsmia

haemolysis, elevated liver enzymes,low platelets

42
Q

what is usually the presenting sign of pre eclampsia

A

rise in blood pressure

43
Q

outline the aetiology of PE

A
  • failure of normal invasion of trophoblasts cells leads to maladaptation of spinal arterioles - dont dilate and form low resiistance high capacitance vessels. this causes reduced uteroplacenetal blood flow –> oligohydramnios, placental abruption, IUGR, foetal death
  • ischaemic placenta inducecs maternal systemic inflammatory hresponse and widespread endothelial damage - vasocoonstriction - kidneys retain more salt –> hypertension
44
Q

what pharmacological management is given as prophylaxis for PE

A

75mg aspirin OD from 12 weeks until birth of baby

45
Q

what is the most significant risk factor for PE

A

previous PE

46
Q

is PE more common in primigravidas?

A

yes

47
Q

what signs are seen on maternal uterine artery doppler in PE

A

high resistnace outflow and diastolic notch

48
Q

what is the main cause of maternal mortlaity in PE

A

CV accidents and pulmonary oedema

49
Q

management of PE

A

deliver if close to or at term

stabilise mother

control BP with drugs

50
Q

labetalol mechanism of action

A

a and beta blocker

51
Q

what is labetalol CI in

A

asthma - blocks beta receptors too

52
Q

what can leabetalol cause in the neonate

A

transienet hypoglycaeia

53
Q

what is an adverse effect of methyldopa

A

depression

54
Q

define eclampsia

A

Eclampsia is the development of convulsions secondary to pre-eclampsia.

55
Q

what type of seizures occur in eclampsia

A

tonic clonic

56
Q

management of eclampsia

A

magnesium sulphate IM/IV

57
Q

how does Mg sulphate treat eclampsia

A

it decreases the calcium uptake by smooth muscles to prevent fits and lower blood pressure

58
Q

before which gestation is defined as PTD

A

37 weeks

59
Q

is a previous PTL a risk factor for another one?

A

yes, 20% risk

60
Q

define SGA

A

estimated foetal weight/abdominal circumference below 10th centile on population/customised centiles

61
Q

what are the causes of PTD

A
  • infection - UTI, BV
  • over distension, eg polyhydramnios, multiple pregnancy
  • vascular
  • intercurrent illness, eg pyelonephritis, UTI, pneumonia
62
Q

what causes babies to be asymmetrically/symmetrically small

A

symmetrical - usually caused by genetic problems, eg downs

asymmetrical - usually occurs in the 3rd trimester, growth of the body is sacrificed to maintain head growth

63
Q

what drug is particularly assoicated with a risk of SGA baby

A

cocaine

64
Q

define SGA

A

estimated foetal weight/anbdominal circumference < 10th centile on population/customised centiels

65
Q

how is SGA diagnosed

A
  • measure foetal abdominal circumference and combined with head circumference and femur length gives estimated foetal weight
  • can be combined with liquor volume, amnitoic fluid index and Doppler scan
66
Q

why are SGA babies particuarlly suceptible to hypothermia

A
  • Increased heat loss due to decrease in subcutaneous fat
  • Decreased heat production due to intrauterine stress and depletion of nutrient stores
  • Increased surface to volume ratio due to small size
67
Q

why is betamethasone given to preterm babies

A

it is a corticosteroid that crosses the placenta - heps foetal lung maturity so helps prevent neonatal complications of premature delivery

68
Q

what birth weight is considered large for dates regardless of gestational age

A

>4kg

69
Q

what symphyseal fundal height is considered large

A

>2cm more than gestational age

70
Q

what is a maternal cause of polyhydramnios

A

diabetes

71
Q

what are the risks of polyhydramnios

A
  • preterm contractions
  • preterm delivery
  • premature rupture of membranes
  • foetal malposition/death
72
Q

what is hydrops foetalis

A

severe odema in baby’s tissues and organs - can be due to rhesus disease or other non immune causes

73
Q

what happens in acute polyhydramnios

A

rare, uterus becomes acutely distended and often results in preterm labour

painful for mother, experiences dyspnoea and vomiting

74
Q

what causes chronic polyhydramnios

A

conditions where there is a large placenta - multiple pregnancies, chorioangioma of placenta, maternal diabetes

75
Q

is polyhydramnios assoicated with underlying congenital abnormalities

A

in a lot of cases yes

76
Q

how is polyhydramnios diagnosed

A

by US measurement of amniotic fluid index - add the vertical depth of fluid measured in each quadrant of the uterus together

77
Q

what is the normal range for AFI

A

5-24 cm

78
Q

certain viral infections can cause polyhydramnios - name 3

A

parvovirus B19, rubella, toxoplasmosis and CMV

79
Q

is maternal age a risk factor for multiple pregnancy

A

yes more likely with inc age

80
Q

what determines the chorionicity of twins

A

at what stage (how many days in) the egg cleaves

81
Q

how many placentas do mono and di chorionic twins have

A

2 placenta in di chorionic and one in monochorionic

82
Q

how can chorionicity of twins be determines

A

by US

  • membrane shape and thickness
  • lamda sign is indicative of dichorionic twins
83
Q
A
84
Q

what is twin-twin transfusion syndrome

A

when twins are sharing a placenta, one can receive too little blood supply and the other too much

  • low urine output, amnitoic fluid and growth in one and oligohydramnios
  • high blood pressure and polyhydramnios in the other. this can put strain on foetus and lead to heart failure
85
Q

what problem with blood can TTTS lead to

A

one baby gets anaemia and the other polycythaemia

86
Q

which type of twins are at the greatest risk

A

monochorionic monozygous twins, there is a risk of cord entanglement and a higher risk of foetal death

87
Q

management of TTTS

A
  • SFLA to laser shut abnormal blood vessles if before 25 weeks
  • if after, amnioreduction or septostomy
88
Q

where in the world is the prevalence of natural twinning highest

A

central africa

89
Q
A

RB Y3 3 Reproduction & Sexual Health (21 decks)

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