Ante-natal care of normal pregnancy

Question 1

What is trisomy

Answer 1

Extra copy of a chromosome

Question 2

What is antenatal care for

Answer 2

Used to detect early signs of complications

Educating pregnant women

Question 3

What does adding folic acid supplementation do during pregnancy

Answer 3

Neural tube is the embryonic precursor to the CNS. Closes by day 28. Folic acid supplemnetation reduces the risk of neural tube defects

Question 4

How much folic acid is given to pregnant women

Answer 4

400mcg daily

High risk groups are given 5mg daily

Question 5

What are high risk groups in pregnant women

Answer 5

Diabetes

BMI>30

Sickle cell

History of child with NTD (neural tube defect) or family with NTD

Anti-epileptic medications

Methotrexate

Question 6

What does a vitamin D deficiency result in

Answer 6

Rickets in children
Osteomalacia in adults
Neonatal tetany in babies

Question 7

How much vitamin D should be given to pregnant women

Answer 7

10mcg daily high risk groups

Question 8

What screening tests are done before 10 weeks pregnancy

Answer 8

Sickle cell

Thalassaemia (not enough haemoglobin production)

Question 9

What screening tests are done weeks 8-10 in pregnancy

Answer 9

HIV
Hepatitis B
Syphilis
Blood group and rhesus status

Question 10

What screening tests are done in weeks 11-14 in pregnancy

Answer 10

Down’s (trisomy 21)

Edward’s (trisomy 18). Most babies with this will not live

Patau’s (trisomy 13)

Question 11

How are trisomies screened for and what are they

Answer 11

Combined test

• 10-14 weeks
• Blood test and ultrasound to measure nuchal translucency (size of the normal fluid filled space at back of fetal neck)

Diagnostic test

• Amniocentesis (from 15 weeks)
• CVS (from 11-14 weeks)

Question 12

What is the downside of combined test used to screen for trisomies

Answer 12

Has a poor detection rate. Lots of false negatives, high false positive rates

Question 13

What is non-invasive prenatal testing used for and how

When is it able to be done

Answer 13

screening for trisomies

Works by analysing the DNA fragments present in the maternal blood during pregnancy

Most comes from the mother, but around 10-20% of it comes from the placenta, which is representative of the unborn baby

Can be measured at 7 weeks gestation

Question 14

How can you prevent rhesus disease

Answer 14

Give mother Anti Rh immunoglobulin

This mops up any fetal rhesus D antigens and prevents sensitisation

Question 15

When is Anti D prophylaxis given

Answer 15

ONCE at 28 weeks
TWICE at 28 weeks and 34 weeks

PLUS

With any potentially sensitising event

After delivery

Question 16

How is congenital syphiis preventable

Answer 16

Single dose of IM penicillin

Question 17

When is risk of vertical transmission of Hep B high

Answer 17

If HBeAf positive

Question 18

How to manage infants born to HepB infectious mothers

Answer 18

Vaccinated, often in combination with HBV specific immunoglobulin. This reduces vertical transmission

Question 19

Consequences of smoking during pregnancy

Answer 19

Premature births 
Miscarriages 
300 perinatal deaths 
Low birth weight 
Respiratory conditions 
Diabetes 
Obesity 
Problems of ear, nose and throat

Question 20

How to manage smoking in pregnancy

Answer 20

Behavioural interventions; nicotine replacement therapy

Electronic cigarettes

Question 21

What is pre-ecmalpsia

Answer 21

Condition arising only after 20 weeks

It is combination of hypertension and proteinuria

Question 22

Complications of pre-eclampsia in mother and fetus

Answer 22

Maternal; fits; HEELP syndroms; stroke; liver failure; renal failure; pulmonary oedema

Fetal; growth restriction; stillbirth; prematurity

Question 23

Prevention of pre-eclampsia

Answer 23

Low dose aspirin 75mg daily

Question 24

High risk factors for pre-eclampsia

Answer 24

Hypertension in previous pregnancy 
CKD
Autoimmune disease 
Type 1 or 2 diabetes 
Chronic hypertension

Question 25

Moderate risk factors for pre-eclampsia

Answer 25

First pregnancy 
Age 40 or older 
Pregnancy interval> 10 years 
BMI> 35 
Family history of pre-eclampsia 
Multiple pregnancy

Question 26

How to screen for gestational diabetes

Treatment?

Answer 26

Screen high risk groups with oral glucose tolerance test

-Most women treated with dietary changes. Some require metformin and/or insulin

Question 27

Complications of gestational diabetes in mother

Answer 27

Pre-ecmaplsia

Polyhydramnios (excess of amniotic fluid which can cause fetal malposition and maternal respiratory compromise)

Prolonged labour

Obstructed labour

Caesarean section

Uterine atony (uterus fails to contract after childbirth which can cause postpartum haemorrhage)

Postpartum haemorrhage

Question 28

Complications of gestational diabetes in fetus

Answer 28

Congenital abnormalities

FETAL MACROSOMIA (a baby over 8lb)

Stillbirth

Birth injuries

Neonatal hypoglycaemia

Question 29

What is fetal growth restriction majority due to

Answer 29

Placental dysfunction

Question 30

How to surveil a pregnancy

Answer 30

Measure size of uterus with a tape measure

Measure BP and test urine for proteinuria and glycosuria

Listen to baby’s heartbeat if mum wants to