care of the pregnant woman year 2 lent term. the case 38 year old booked at 12 weeks gestation in...
TRANSCRIPT
The Case• 38 year old booked at 12 weeks gestation in
the antenatal clinic
• Expecting her third baby
• 1st baby 2.8kg (6lb 3oz) at term
• 2nd baby 2.4 kg (5lb 6oz) at term
• Smokes 20/day
• BMI 25
Investigations: blood
• Standard at booking: Hb, Blood group, antibodies, rubella antibodies, serum test for syphilis.
• Optional at booking: triple test, tests for hepatitis B, HIV
• Varies with units: random blood sugar
Investigations: ultrasound
• Dating scan
• ?nuchal scan (under development nationally)
• Anomaly scan
Maternal age >35y increased risk for:
• Chromosomal abnormality
• Miscarriage
• Twin pregnancy
• Stillbirth
• Maternal morbidity: thrombosis; hypertension; gestational diabetes; placental abruption
Risks of smoking in pregnancy• Reduced fertility, ectopic pregnancy,
miscarriage
• Preterm labour
• Placental abruption
• Stillbirth
• Intrauterine restriction: dose related
• Cot death, infant respiratory infection, lower IQ
Management of case
• Delivery in hospital unit with fetal monitoring and paediatric facilities
• Consider induction of labour with close fetal monitoring – timing may be decided from other parameters
Treatment plan• Refer (if willing) to smoking-cessation
programme
• Monitor fetal growth in third trimester using ultrasound- measure head circumference and abdominal circumference
• Biometric tests for fetal well-being: liqour volume, Doppler, cardiotocography
Syntometrine
• 5U syntocinon 0.5mg ergometrine
• Given at delivery of anterior shoulder to constrict the uterus
• Helps prevent post-partum bleeding
Vitamin K
• Given to the baby (usually IM)
• Helps prevent haemorrhagic disease of newborn from deficiency of clotting factors (immature liver)