Antenatal Care 1

Question 1

What is autosomal dominant inheritance?

Answer 1

Only mutated copy of the gene is needed for person to be affected by disorder
e.g. Marfans

Question 2

What is autosomal recessive inheritance?

Answer 2

Both copies of gene must have mutations
parents each carry one copy of mutated gene
e.g. CF

Question 3

What is X-linked dominant?

Answer 3

mutation in genes on the X chromosome
males most severely affected as only one X
no male to male transmission

Question 4

What is X-linked recessive?

Answer 4

Both X in females must be mutated to be affected, but will affect males if mutated in the single X chromosome

Question 5

What is Y-linked recessive?

Answer 5

mutated gene on Y chromosome

only passes from father to son

Question 6

What are the common congenital abnormalities?

Answer 6

neural tube defects - spina bifida and anencephaly
folic acid supplementations reduces incidence

cardiac defects can be diagnosed with US and can be corrected after birth with surgery

defects in the abdominal wall - exomphalos and gastroschisis

chest defects - diaphragmatic hernias, pleural effusions

GI defects - oesophageal atresia and trachea-oesophageal fistulae, duodenal atresia

GU - hydronephrosis, posterior urethral valves

Skeletal - skeletal dysplasia, limb abnormalities

Fetal hydrops - extra fluid in 2+ areas of the fetus

Question 7

What is important to consider when prescribing in women of child bearing age?

Answer 7

drugs have harmful effects on the fetus at any time during pregnancy so bear in mind when prescribing

Question 8

Why is safe prescribing important in the 1st trimester?

Answer 8

drugs produce congenital malformations (teratogenesis), period of
greatest risk from 3 rd -11 th week of pregnancy

Question 9

Why is safe prescribing important in the 2nd and 3rd trimester?

Answer 9

drugs affect growth or functional development of fetus, or toxic effects on fetal tissues

Question 10

Why is safe prescribing important shortly before term and during labour?

Answer 10

adverse effects on labour or on neonate after

delivery

Question 11

What are the main principles of safe prescribing in pregnancy?

Answer 11

only prescribe if benefit to mother is thought to be greater than risk to fetus

all drugs should be avoided in the first trimester

smallest effective dose

use usually safe drugs rather than new/untried drugs

Question 12

What are the aims of antenatal care?

Answer 12

1. Detect + manage pre-existing maternal disorders that may affect pregnancy
   outcome
2. Prevent/detect + manage maternal complications of pregnancy
3. Prevent/detect + manage fetal complications of pregnancy
4. Detect congenital fetal problems if requested by patient
5. Plan with mother the circumstances of delivery to ensure maximum safety for
   mother + baby, and max maternal satisfaction
6. Provide education + advice regarding lifestyle + ‘minor’ conditions of pregnancy

Question 13

What screening is done during booking (before 10 weeks)?

Answer 13

• check rubella immunity and need for postnatal immunisation
• check for hep B to allow immunoglobulin administration to neonate
• check for syphilis infection and HIV status
• arrange for genetic counselling/later CVS if at risk of inherited disorder

Question 14

What screening is done between 9-12 weeks?

Answer 14

USS to date pregnancy and identify twins
advise regarding chromosomal trisomies
counsel and offer CVS is high risk

Question 15

What screening is done between 18-21 weeks?

Answer 15

routine anomaly US to detect structural abnormalities

counsel and offer CVS if high risk

Question 16

What screening is done later in pregnancy?

Answer 16

some abnormalities only visible in later pregnancy

US if polyhydramnios, breech, suspected IUGR

Question 17

What are the risk factors for complicated pregnancies that occur pre-pregnancy?

Answer 17

poor past obstetric history or a very small baby 
maternal disease 
assisted conception 
extremes of reproductive age 
heavy smoking/drug abuse

Question 18

What are the risk factors for complicated pregnancies that occur during pregnancy?

Answer 18

hypertension/proteinuria 
vaginal bleeding 
small for dates baby 
prolonged pregnancy 
multiple pregnancy

Question 19

What some available investigations for complicated pregnancies?

Answer 19

cervical scan at 23 weeks
Uterine artery Doppler
Maternal blood tests

Question 20

What are the different methods of monitoring fetal well being?

Answer 20

US - used to measure fetal size after 1st trimester

Doppler umbilical artery waveforms - helps identify which small foetuses are growth restricted

Doppler waveforms of fetal circulation - used in high risk pregnancies

US assessment of amniotic fluid volume - useful in high risk pregnancy

CTG/non-stress test - fetal heart recorded electronically

Kick chart - compromised foetuses have reduced movements

Question 21

What social problems affect pregnancy outcomes?

Answer 21

• problem drug use - vascular damage, vascular damage, thromboembolic disease, blood-borne virus infection
• difficulties accessing care
• recent migrants, refuges, poor English
• young women under 20
• domestic abuse
• learning difficulties
• unemployment, imprisonment and poverty

Question 22

What are some important measures to be taken preconceptually?

Answer 22

• Discuss previous pregnancies
• Health check before conception e.g. treat cervical smear abnormalities
• Rubella status in case of need of immunisation
• Optimise health in chronic disease e.g. glucose control in diabetes
• Optimise medication e.g. antiepileptic medication
• Preconceptual folic acid of 0.4mg/day

Question 23

What lifestyle advice should be given in pregnancy?

Answer 23

Well balanced diet (2500 calories)
Alcohol - best avoided esp in first trimester
Dental check up advised
Coitus not contraindicated except in placenta praevia/ruptured membranes
Avoid infection - drunk only pasturized milk, avoid soft/blue cheese, pate, cooking eggs/poultery well
Exercise - swimming is ideal, avoid contact sports
Vaccinations
Insurance issues
Driving - seatbelt above and below bump

Question 24

When should 400 micrograms be given and when should 5mg of folic acid be given in pregnancy?

Answer 24

400 micrograms of folic acid should be taken at least one month prior to conception and in the first 3 months of pregnancy to reduce NTDs

High dose (5mg) should be given

• in women on anti-epileptic agents,
• obese women,
• diabetic women,
• women with a history of NTDs

Question 25

What past obstetric history should be obtained?

Answer 25

``` all previous pregnancies recorded including miscarriages and terminations gestation of each pregnancy antenatal complications details of induction of labour duration of labour presentation of baby method of delivery (spontaneous, assisted or C-section) birth weight and gender of baby previous operations condition of each infant at birth and need for special care baby unit complications of pueriperium = PPH, extensive perineal trauma, wound breakdown, infections, DVT difficulties with breastfeeding ```

Question 26

What FH should be obtained?

Answer 26

``` Twins Diabetes HTN Pre-eclampsia Autoimmune disease Venous thromboembolic disease Thrombophilia Other inherited disorders ```

Question 27

When is vitamin D given in pregnancy?

Answer 27

10ug/day in women with a high BMI >30, South Asian/Afro-Caribbean origin or with low sunlight exposure

Question 28

What other supplementation is common in pregnancy?

Answer 28

Iron

Question 29

What are the risks of substance abuse in pregnancy?

Answer 29

can have severe and damaging impact on pregnancy and health of baby pregnancy can be an incentive to make positive change in lifestyle drug/alcohol/tobacco use before and during pregnancy are major risk factors for: - complications in pregnancy and labour - withdrawal in infants - physical and neurological damage to baby - foetal alcohol spectrum disorder