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Obs and Gynae Y4 > 2. Principles of antenatal care > Flashcards

2. Principles of antenatal care Flashcards

1
Q

What medications to avoid in pregnancy?

A

Retinoid acid – teratogenic
Statins – oligohydramnios
Sodium valproate – neurodevelopmental delay

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2
Q

When is the dating scan?

A

11-13+6

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3
Q

What happens at the dating scan?

A

Downs syndrome screening, Nuchal translucency measurement

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4
Q

Risks due to High BMI in pregnancy

A

Miscarriage, GDM, HTN

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5
Q

Risks due to smoking in pregnancy

A

IUGR, stillbirth

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6
Q

Daily dose of folic acid?

A

400 mcg (higher in obesity and epilepsy)

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7
Q

How long to take daily dose of folic acid?

A

12/40

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8
Q

Risks due to alcohol use in pregnancy?

A

FAS, learning difficulties, growth restriction

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9
Q

Care in Low Risk pregnancy

A

Midwife care throughout

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10
Q

Care in High Risk pregnancy

A

Combined care, monitoring foetal growth (Eg in epilepsy)

OR consultant/hospital only (severe maternal medical disease)

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11
Q

Routine tests in pregnancy

A

1) Infection: Hep B, HIV, Syphilis (TPHA)
2) Electrophoresis: HbSc Thalassemia
3) FBC: Blood group, screen for red cell antibody
4) Optional: screening for aneuploidy
5) Rubella – eliminated in the UK, not tested for

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12
Q

Down syndrome screening

A

1st trimester (>90% trisomies detected):
(used in a formula to calculate the risk)
- 1 in 150 risk of aneuploidy prompts an invasive test

2nd trimester (65-70%)

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13
Q

1st trimester Down Syndrome screening

A

B-HCG, PAPP-A (pregnancy associated plasma protein), nuchal translucency, maternal age

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14
Q

2nd trimester Down Syndrome

A

B-HCG, Alpha feto-protein, Estriol + inhibin-A

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15
Q

Further invasive testing for Downs Syndrome

A
  • Chorionic Villous Sample
  • Amniocentesis
  • Maternal serum non-invasive prenatal testing (free foetal DNA)
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16
Q

Chorionic Villous Sample

A

10-14 weeks

  • 100% accurate
  • 1% loss rate
  • on NHS
17
Q

Amniocentesis

A

16-20 weeks

  • 100% accurate
  • 1% loss rate
  • on NHS
18
Q

Maternal serum non-invasive prenatal testing (free foetal DNA)

A
  • No procedure-related loss
  • 99% accurate
  • Cost £350
19
Q

Time of routine anomaly scan

A

All pregnant women,

18-21 weeks

20
Q

What happens during the routine anomaly scan?

A

(18-21 weeks)

  • Organs examined: brain, heart, lungs, kidneys, spine, limbs, face
  • Placental site is identified
21
Q

Lethal abnormalities

A
  • Congenital renal agenesis
  • Trisomy 18 and 14
  • Anencephaly
  • Congenital diaphragmatic hernia
  • Hypoplastic left heart
22
Q

Significant abnormalities

A
  • Trisomy 21
  • Cleft/lip palate
  • Club foot
  • Gastroschisis
  • Gut atresia
  • Cardiac abnormalities
23
Q

Smoking management in pregnancy

A
  • Nicotine replacement therapy

- Varenicline and Bupropion not licensed for use

24
Q

When is routine Anti-D prophylaxis given

A

28 weeks

25
Q

What are the sensitising events in Rhesus iso-immunization?

A

Delivery, ante-partum haemorrhage, placental abruption, amniocentesis

26
Q

Define Rhesus iso-immunization

A

Mixing of maternal and foetal circulations, mother forms antibodies to foetal RBCs, antibodies can be triggered to attack in the next pregnancy.

27
Q

When is Breech more common?

A

In premature deliveries

28
Q

How to treat breech presentation?

A

External Cephalic Version - physical manipulation of the baby in the abdomen

29
Q

Rate of twin pregnancy

A

1 in 80

30
Q

Dating scan in Twins

A

Establish chorionicity (monitor twin to twin transfusion syndrome if monochorionic)

31
Q

When is routine iron supplementation required?

A

Twin pregnancies

32
Q

Rate of stillbirth

A

1 in 250

33
Q

Causes of stillbirth

A

IUGR, placental insufficiency, prematurity, congenital disorders, infection, multiple pregnancy

34
Q

What is a treatment for Thrush (candida) in pregnancy?

A

Clotrimazole

35
Q

Treatment for heartburn in pregnancy

A

Antacid (gaviscon or magnesium trisilicate)

36
Q

Treatment for anaemia in pregnancy

A

Ferrous sulphate

Obs and Gynae Y4 (22 decks)

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