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Obstetrics > Antenatal > Flashcards

Antenatal Flashcards

0
Q

What are the routine visits for low risk women?

A

Booking visit
Dating scan 12 weeks
Feral anomaly scan 20 weeks
36 weeks??

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1
Q

What time period can chorionic cilia sampling take place?

A

11-14 weeks

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2
Q

How much frolic acid should a woman take and how long for?

A

400 micrograms a day

For the first 12 weeks (and preconception)

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3
Q

What is the purpose of taking folic acid?

A

Prevent neural tube defects eg anencephaly and spinabifida

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4
Q

In a low risk pregnancy what dates are USS performed?

What is done in each scan?

A

12 week - early gestational age

20 week - structural fetal abrnomalities

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5
Q

What infections are screened for at booking?

A

TORCH

Bacteruria

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6
Q

What does TORCH stand for?

Why are they screened for?

A

Toxoplasmosis
Rubella
Cytomegalovirus
Herpes/HIV

Can cause congenital abnormalities

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7
Q

How many times should a woman’s height and weight be measured during preganancy?

A

Just once at booking unless there is concern about weight

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8
Q

What are the symptoms of preeclampsia?

A 
Headaches (usually frontal) 
Visual disturbances
RUQ pain
Vomiting 
Breathless
Sudden onset oedema
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9
Q

What is the purpose of a dating scan?

A

Determine gestational age
Diagnose multiple pregnancies
Confirm viability
Downs screening

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10
Q

The combined test for Down’s syndrome can be done in which dates?

A

11 weeks to 13 weeks 6 days

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11
Q

The combined test for Down’s syndrome involves which tests?

A

Nuchal translucency
bHCG
PAPPA - pregancy associated plasma protein a

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12
Q

What does the triple/ quadruple test measure?

A

bHCG
Unconjugated estriol
Alpha feroprotein

+inhibin A for quad

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13
Q

What age the triple or quadruple test offered?

A

15 weeks -20 weeks

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14
Q

What would make a woman high risk for neural tube defect?

How much folic acid should she take?

A 
Previous neural tube defect 
Coeliac
Diabetes 
Sickle cell
Antiepileptics
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15
Q

How much vitamin D should women take and how long for?

A

10 micrograms OD

During pregnancy and breast feeding

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16
Q

What foods should be avoided in pregnancy?

A 
Blue cheese/ Brie - listeria
Pate -listeria
Liver - too much vitamin a
Raw shellfish - salmonella
Caffeine - low birth weight
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17
Q

Where should you refer women to get more info on pregnancy?

A

NHS website

The pregancy book by DOH

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18
Q

What foods should be avoided in pregnancy?

A

Soft cheeses
Undercooked meat
Vitamin A
Lots of fish

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19
Q

Why is vitamins A supplementation not recommended in pregnancy?

A

It can impair folic acid absorption

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20
Q

What has too much vitamin A in?

A

Fish liver oil

Eating liver

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21
Q

In a woman with previous baby with neural tube defects or a woman who hasn’t taken foic acid 3 months prior to pregnancy
How much do they take?

A

5mg

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22
Q

How common is Down’s syndrome?

A

1:650-1000

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23
Q

What is the chance of miscarriage with
CVS
Amniocentesis?

A

2% cvs

1% amniocentesis

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24
Q

What is the difference between a threatened miscarriage and an antepartum haemorrhage?

A

Threatened is before 24 weeks and haemorrhage is after

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25
Q

Name some causes of antepartum haemorrhage? A

A 
Placenta praevi
Placental abruption
Local bleeding from vagina/vulva
Ectropion
Cervical polyps
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26
Q

How common is placenta praevia?

A

1:200

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27
Q

If someone has a low lying placenta at 24 weeks, is this worrying?

A

Not really, the placenta may migrate up, only about 5% will end up with placenta praevia

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28
Q

What can cause placental abruption?

A

The cause is unknown but it is associated with
Trauma
SROM in polyhydramnios (sudden reduced pressure)

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29
Q

What are the risk factors for placental abruption?

A

Low socioeconomic class
Hypertension
Preeclampsia
Smoking

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30
Q

At what week gestation is the uterus normally palpable?

A

12-14 weeks

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31
Q

How many weeks is the uterus at the level of the umbilicus?

A

20 weeks

32
Q

What signs of the abdomen do you look for in an obstetric examination?

A 
Abdominal distension 
Scars 
Linea nigra
Stiae
Fetal movements
33
Q

When palpating in an obstetrics examination what 3 things do you feel for?

A

Lie - ?longitudinal
Presentation -?cephalic/ breech
Engagement - 5ths palpable

34
Q

What percentage of babies are breech at
28 weeks?
37 weeks?

A

30%

3%

35
Q

How might antiphospholipid syndrome effect pregnanacy?

A

Recurrent miscarriage
IUGR
Preeclampsia

36
Q

What can antiphospholipid syndrome be treated with?

A

Aspirin
And
Low molecular weight heparin

37
Q

What antibodies are present in

Antiphospholipid syndrome?

A

Lupus anticoagulant

Anticardiolipin antibodies

38
Q

How much is the risk of VTE in preganacy increased by?

A

x6

39
Q

How common is a
PE
DVT
In preganacy?

A

0.3%

1%

40
Q

What is used to treat VTE?

A

Low molecular weight heparin

41
Q

What are the risk factors for VTE?

A 
High parity 
Obesity 
Varicose veins 
Age over 35 
Infection 
Preeclampsia 
Immobility (ie after c section)
42
Q

Who are given anti D prophylaxis Rh -be or +be women?

A

Rh negative

43
Q

What categories are there on the thesis system? Which predominates?

A

C D and E

D predominates

44
Q

At what weeks gestation is anti D routinely given?

A

28 weeks
And
34 weeks

45
Q

How quickly after a sensitising event should anti D be given?

A

Within 72 hours although could still have benefit 9 days later

46
Q

What dose of anti d should be given after 20 weeks?

A

500 IU

47
Q

What is the name of the test performed after birth to assess the levels of anti D antibodies in the mothers blood?

A

Kleihaur

48
Q

What can transfer of the anti D antibodies do to the baby?

A

Neonatal jaundice
Neonatal anaemia - haemolytic disease of the newborn
Anaemia in utero if severe

49
Q

What is the name of the test which looks for antibodies against red blood cells in the baby’s blood?

A

Coombs test (direct)

50
Q

What does HELLP stand for?

A

Haemolysis
Elevated liver enzymes
Low platelet count

51
Q

What may also occur in HELLP?

A

DIC

Liver failure

52
Q

What are normal protein levels excreted in the urine did a pregnant lady?

A

0.3g in 24 hours

53
Q

What is the triad of preeclampsia?

A

Hypertension
Proteinuria
Oedema

54
Q

What trimester is blood pressure lowest?

A

Second trimester

55
Q

How common is pre- eclampsia?

Severe preeclampsia?

A

6% of nulips

5:1000

56
Q

What symptoms might be present in pre eclampsia?

A

Head ache
Drowsiness
Visual disturbances
Nausea / vomiting

57
Q

How do you treat HELLP ?

A

Supportive treatment

Mg sulphate to prevent seizures

58
Q

What is the main complication of pre eclampsia in relation to the fetus?

A

IUGR
Premature labour
Mortality

59
Q

What is considered high blood pressure?

What blood pressure dictates immediate admission to hospital?

A

140/90

160/110

60
Q

What is the first line anti hypertensive in pregnanacy?

A

Labetalol

61
Q

What drug may also be prescribed in a wan with hypertension

A

Asprin if she has risk factors for pre eclampsia

62
Q

What are the risks of mg sulphate?

A

Loss of patellar reflexes
Respiratory depression
Hypotension

63
Q

Define ‘pre existing hypertension in preganancy’

A

BP above 140/90 before 20 weeks gestation

64
Q

Where does fertilisation usually take place?

A

Ampulla of Fallopian tube as the egg normally waits there for up to 38 hours

65
Q

Is the infundibulum lateral or medial to the ampulla of Fallopian tube?

A

Lateral

66
Q

Is the isthmus lateral or medial to the ampulla?!

A

Medial

67
Q

What feature on USS is used to estimate gestational age
At 10-14 weeks?

Over 14 weeks

A

Crown rump length

Bi parietal diameter

68
Q

When is the estimated due date after LMP if regular 28 day cycle?

A

40 weeks after the first day of LMP

69
Q

What is the risk of passing maternal rubella to the fetus in the first trimester?

In the second trimester?

A

80%

25%

70
Q

What is the success rate of extra cephalic version?

A

50%

71
Q

When should extra cephalic version be performed?

A

36 weeks for nullip

37 weeks for multip

72
Q

What are the risks of extra cephalic version?

A

Placental abruption
Uterine rupture
Feto maternal haemorrhage

Increased risk of needing intervention when cephalic after ECV

73
Q

Can extra cephalic version be performed at home?

A

No needs to be in hospital where there is monitoring and facilities available to deliver baby if any thing goes wrong

74
Q

What are the absolute contra indications for extra cephalic version?

A 
Antepartum haemorrhage in the last 7 days 
Abnormal CTG
Major uterine abnormality 
Ruptured membranes
Multiple preganacy
75
Q

What are the relative contraindications for extra cephalic version?

A 
SGA
Preeclampsia
Oligohydromnios
Scarred uterus 
Unstable lie
Major fetal abnormalities
76
Q

Women who are at risk of pre eclampsia are advised to take aspirin, what are the tisk factors?

A

Previous pregnancy hypertension
Chronic kidney disease
Autoimmune disorders - SLE
Diabetes

77
Q

In these women at risk of pre eclampsia when should they take aspirin?

A

OD

From 12 weeks till birth

Obstetrics (7 decks)

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