Antenatal Care

Question 1

How do you calculate EDD?

Answer 1

LMP + 1 year and 7 days minus 3 months

Question 2

Name four signs you might see on inspection in an Obstetric Exam

Answer 2

Linea Nigra (Pigmented from Xiphisternum to Suprapubic)
Striae Gravidarum (new, purple)
Striae Albicans (old, white)
Flattening/Eversion of the Umbilicus

Question 3

State five features of palpation in antenatal care

Answer 3

Symphysis Fundal Height (able to estimate from 20 weeks)
Estimation of foetal number 
Foetal Lie
Presentation 
Amniotic Fluid Volume

Question 4

How would you listen to foetal heart in an obstetric examination?

Answer 4

From 16 weeks - Doppler USS/Sonicaid

From 28 weeks - Foetal Stethoscope

Question 5

State 6 symptoms of Pregnancy

Answer 5

Amenorrhoea
Morning Sickness
Increased Micturition Frequency
Excess Fatigue
Breast Tenderness
Pica

Question 6

Describe the pattern of hCG in pregnancy

Answer 6

Increases exponentially from day 8

Peaks at 8-12 weeks

Home Pregnancy Tests are sensitive to levels >50IU/L

Question 7

How is a Pregnancy Dated?

Answer 7

Via the dating scan between 10 and 13+6 weeks

Using CRL

Question 8

What else should be offered at the dating scan if not already?

Answer 8

Urine Screen for Pre- Eclampsia
Haemaglobinopathy screen
Rhesus Screen
Downs Syndrome Screen

Question 9

When should you carry out the structural anomaly scan?

Answer 9

Between 18-20 weeks

Question 10

What is the combined test for Downs Syndrome?

Answer 10

Nuchal Translucency
Free bHCG
PAPP- A
Woman’s Age

Between 10+3 weeks and 13+6 weeks

Question 11

What is the Quadruple Test for Downs Syndrome?

Answer 11

15 to 17 weeks gestation

aFP (low)
Unconjugated Estradiol (low)
bHCG (high)
Inhibin A (high)

If chance is >1/150, invasive testing is offered

Question 12

What should be done at the 28 week scan?

Answer 12

Another opportunity for anaemia/atypical antibody screening

Anti D Prophylaxis if Rhesus Negative

Measure BP/Proteinuria/SFH

Question 13

When should you offer a second dose of Anti D

Answer 13

34 weeks

Question 14

What supplements does a Pregnant woman require?

Answer 14

Folic Acid - 400mcg/d for the first 12 weeks to reduce risk of neural tube defects

Iron/Iodine - only if deficient area

Zinc and Calcium - if dairy free

Vitamin A (note can be teratogenic if >700mcg/d)

She requires an extra 350kcal a day

Question 15

Who requires a higher dose of Folic Acid?

Answer 15

Those on Antiepileptic Drugs

Obese

History of NTD

Question 16

Name four foods a pregnant woman should avoid

Answer 16

Pâté
Soft cheeses
Raw fish
Unpasteurised Milk

Question 17

Other than CRL, name four other USS measurements

Answer 17

Biparietal Diameter
Head Circumference
Abdominal Circumference
Femur Length