Antenatal Appointments

Question 1

what is done at first contact with preg women (4)

Answer 1

identify high risk pt - BMI, PMH, smoker
review meds for preg safety
check VTE risk
advise folic acid & vit D

Question 2

folic acid dose

Answer 2

400ug OD low risk or 5mg OD high risk

Question 3

when is booking visit

Answer 3

8 to 12 weeks

Question 4

what is done at booking visit (6)

Answer 4

RFs for pre-eclampsia
USS
Bloods - foetal screen for Downs, group, anaemia, RC ABs, HB-opathies, hep B, HIV, syphillis
Height / weight / BP / proteinuria
given hand held notes

Question 5

what is given to prevent pre eclampsia

Answer 5

aspirin

Question 6

when is OGTT done and what is it

Answer 6

75g 2hr OGTT at 24-28wks

Question 7

cut offs for GDM tests

Answer 7

fasting 5.6
2hr 7.8

Question 8

if OGTT is positive, what is the follow up and when is it

Answer 8

1 week joint diabetes and obs clinic

Question 9

contrast LGA and macrosomia

Answer 9

LGA is proportional
macrosomia has large abdo circumference

Question 10

what is done at 16wk visit

Answer 10

review all screening tests
pertussis / influenza vaccines
BP & proteinuria
discuss scan

Question 11

who gets a 25wk scan and what does it sho

Answer 11

Primip
SFH - USS if <10 or >90 centile

Question 12

28wk visit

Answer 12

2nd screening for anaemia and red cell alloantibodies
offer first anti D if neg
measure SFH
BP & proteinuria

Question 13

who gets a 31wk visit and what happens

Answer 13

Primip
measure SFH
BP & proteinuria

Question 14

34wk visit

Answer 14

offer 2nd anti D if neg
BP & proteinuria
SFH
birth plan preparation

Question 15

36wk visit

Answer 15

BP & proteinuria
SFH
check presentation - offer ECV if breech
give info on breastfeeding, newborn care, Vit K etc

Question 16

38wk visit

Answer 16

BP & proteinuria
SFH
give info on risks of prolonged preg after 42wks & Mx

Question 17

who gets 40wk visit and what happens

Answer 17

Primip
BP & proteinuria
SFH
offer membrane sweep

Question 18

41wk visit

Answer 18

BP & proteinuria
SFH
offer membrane sweep & induction

Question 19

at which appts are blood tests done

Answer 19

8-12 wks
28 wks

Question 20

when is anti D given

Answer 20

28 and 34 wks

Question 21

when is BP and proteinuria checked

Answer 21

EVERY appt

Question 22

when are the scans done

Answer 22

12wk
20 wk

Question 23

how many appts do multips vs primips get

Answer 23

multips 7, primips 10

Question 24

when is the dating scan

Answer 24

10 to 13 weeks

Question 25

what is the dating scan for

Answer 25

gestational age and EDD viability & location detect multiple pregs detect gross foetal abnormalities NUCAL TRANSULENCY for downs

Question 26

what is nuchal translucency

Answer 26

lymph fluid accumulates behind neck

Question 27

radiological signs of multiple pregs & meaning

Answer 27

lamba sign = DC twins T sign = MC twins

Question 28

when is anomaly scan

Answer 28

18 to 20 weeks

Question 29

what is the purpose of anomaly scan

Answer 29

locate placenta CRL, BPD, femur length, AC detect major abnormalities - if present, allow for TOP, preparation, Mx in birth centre

Question 30

best and worst type of twins & what they mean

Answer 30

best = dichorionic / diamniotic - 2 bags, 2 placentas worst = monochorionic / monoamniotic - one bag, one placenta

Question 31

why is MCMA twins the worst

Answer 31

risk of twin to twin transfusion syndrome - necrosis of one twin, increased inflammation, early labour

Question 32

how is twin twin transfusion syndrom treated

Answer 32

intrauterine laser therapy

Question 33

when is the combined downs screening done

Answer 33

11 to 13+6 weeks

Question 34

what is the combined downs screening

Answer 34

nuchal translucency on USS high serum hCG low PAPPA

Question 35

if the booking is later in preg, when is downs screening done

Answer 35

15 to 20wks

Question 36

what is in the triple test

Answer 36

plasma bHCG unconjugated estriol AFP

Question 37

what is in the quad test

Answer 37

plasma bHCG unconjugated estriol AFP inhibin A

Question 38

results of Downs screen for Downs / Turners

Answer 38

high HCG high inhibin (HIgh)

Question 39

results of downs screen for edwards

Answer 39

low HCG low estriol (HE is low)

Question 40

results of downs screen for patau

Answer 40

high AFP (P in patau and AFP)