Antenatal Care and Screening Flashcards
What is the ‘booking visit’?
This is the first visit to the clinic where the inital tests are carried out (8-12 weeks)
What is done at the booking visit?
History - menstrual, obstertric, gynae, family, PMHx
Examination - weight, height, CVS and abdominal
Investigations - Hb, ABO, rhesus (anti-D), STI check (syphilis, HIV, Hep), Urinalysis (MSSU C&S)
USS - confirm viability, gestational age, singleton/multiple, detect major abnormalities, offer down syndrome screening
On other visits to the midwife what is looked for?
Physical and mental health checks Normal foetal movements symphysis-fundal height lie and presentation BP and urinalysis foetal heart auscultation
When should appointment for USS for major abnormalities occur?
18-21 weeks
What is placenta praevia?
This is when the placenta grows to partly or fully obstruct the cervix (and is low-lying in the uterus).
Normally the placenta should move with the uterus as it grows and expands upwards
What should happen if placenta praevia is found on 18-21 week USS scan?
Be offered another scan at 32 weeks. If there is uncertainty of continued placenta praevia then a TV-USS should be offered
What should be done before any screening test is offered?
Pre-screening counselling - this is to provide each couple/mother with the information to make a decision about whether screening is the best idea for them. If it will not change their management of the pregnancy then do they need to have it?
How is Down’s syndrome risk assessed in first trimester?
Nuchal thickness - the thickness of the space behind the neck (if greater than 3.5mm then could be indicative of a chromosomal abnormality - also need to take into account the CRL)
HCG (increased levels associated with DS)
PAPP-A (low levels associated with DS)
Also thick of maternal age - risk increases with age (esp >40)
When is down syndrome risk assessed by USS/bloods?
11-14 weeks
How is down syndrome risk assessed in the second trimester?
A blood sample is taken from the mother to assess for AFP, b-HCG, unconjugated estradiol 3, inhibin A
If the blood sample in second trimester is abnormal what can be offered?
Amniocentesis
What are more invasive tests offered?
Amniocentesis (performed after 15 weeks - miscarriage rate of 1%)
Chorionic Villous sampling (performed after 12 weeks - miscarriage rate of 2%)
How does haemolytic disease develop?
RhD negative mother has a RhD positive foetus. on delivery there is slight mixing of the maternal and foetal blood - this results in antibodies forming against RhD. if mother gets pregnant again with a RhD positive foetus the antibodies in the blood will attack the blood cells in the foetus and cause haemolysis.
What do you need to screen for in terms of mental health in pregnancy/motherhood?
New feelings/thoughts which make you feel disturbed or anxious?
Suicide or self-harm?
Feeling incompetent as a mother, distanced or estranged from child? persistent?
are things getting worse?
What is the test used for diagnosis of gestational diabetes?
OGTT - 75g of glucose and measured after 2 hours
