Antenatal Care Flashcards
what dose of folic acid should be given pre-conception?
400mg
folic acid 400mg should be given from before conception until __ weeks
12
which patients should receive a higher dose of folic acid from 12 weeks gestation?
- BMI >30
- individuals with diabetes
- individuals on antiepileptics
- individuals with a previous pregnancy affected by a neural tube defect
the booking visit should be done between _ and _ weeks
week 10-12
a fetal anomaly scan is done between _ and _ weeks
18-20+6
the first stage of trisomy screening is done between _ and _ weeks
11-13+6 weeks
what does the ultrasound scan look for when we screen for down’s syndrome?
nuchal translucency
a normal value for nuchal translucency is
<3.5mm
the second stage of trisomy screening (quadruple blood test) is done at _ to _ weeks
15-16 weeks
what 4 pregnancy hormones are measured in the quadruple test?
AFP
hCG
unconjugated estriol
inhibin A
the first stage of trisomy screening involves…
a blood test
an USS
what hormones are checked in the combined test for downs syndrome?
PAPP-A
AFP
bHCG
PAPP-A and AFP levels will be ___ if the fetus has downs syndrome
low
when do women get their first USS in pregnancy
10-13+6 weeks at the booking visit
what does the booking USS look for?
- viability
- determines gestation
- confirms intrauterine pregnancy
- number of pregnancies
when is symphyseal fundal height first measured?
24 weeks
when is an OGTT offered to check for gestational diabetes
28 weeks
women with preexisting diabetes or women with new gestational diabetes are offered extra scans between _ and _ weeks
28-36 weeks
when mothers are first exposed to the rhesus antigen they form Ig__ antibodies which are too big to cross the placenta and harm the fetus
IgM
when mothers are exposed to the rhesus antigen for a second time the body forms Ig_ antibodies which are smaller and can cross the placenta and harm the fetus
IgG
how does anti-D work?
removes Rh positive blood cells from the mother’s circulation before antibodies are formed
when is anti-D given
to rhesus NEGATIVE mothers who have been exposed to a sensitising event
name a sensitising event that would require use of anti-D in a Rh -ve mother
- vaginal bleeding from 12 weeks
- TOP
- amniocentesis/CVS
- surgical management of miscarriage
- molar pregnancy
- ectopic pregnancy
- delivery if baby is Rh +ve
- fetal death
how long does a dose of anti-D last?
6 weeks
will cover further sensitising events in this period
when is prophylactic anti-D given to Rh -ve mothers and why?
28 weeks
to cover silent sensitising events
when is diagnostic testing such as CVS and amniocentesis offered to women?
if they are:
A. found to be at high risk of downs syndrome at trisomy screening
B. fetal anomaly seen at 20 week scan
which can be done before 15 weeks: CVS or amniocentesis?
CVS
can be done from 11-13+6 weeks
if twins are referred to as monochorionic diamniotic this means…
they share a placenta but not an amniotic sac
AFP is ___ in multiple pregnancy
high
how regularly are women seen who have confirmed monochorionic twins on scan?
every 2 weeks by a consultant
how regularly are women seen who have confirmed dichorionic twins on scan?
every 4 weeks
what supplementation are women with multiple pregnancy given?
iron
folic acid
low dose aspirin
when should DCDA twins be delivered?
37-38 weeks
when should MCDA twins be delivered? what precautionary management should be given?
36+0 weeks with steroids
when should MCMA twins be delivered?
32-34+0 weeks with steroids
should be delivered by LSCS due to risk of cord entanglement
how should a breech fetus be managed prior to delivery?
USS to confirm presentation then external cephalic version
NB mums have the option to choose LSCS over vaginal birth for breech presentations
non-cephalic presentation is normal up to __ weeks
36
____ breech is the most risky form of breech presentation
footling
risk of cord prolapse
term pregnancy is considered to be between __ and __ weeks gestation
37-42 weeks
women with prolonged pregnancy are monitored every _ weeks to assess fetal wellbeing and are offered induction of labour at ___ to ___ weeks
2 weekly
41-42
the umbilical artery _____ its resistance in fetal hypoxia and the middle cerebral artery ___ its resistance in fetal hypoxia
UA increases
MCA decreases
a stillbirth is defined as death of the fetus at or after ___ weeks gestation
28
why are women induced who are post-dates?
they are at increased risk of a stillbirth
how is gestational hypertension different to pre-eclampsia?
no proteinuria or oedema
hypertension in pregnancy is defined as having a systolic BP > ___mmHg and a diastolic BP of >___mmHg
> 140 systolic
>90 diastolic
an increase in systolic BP >__mmHg or a diastolic BP >__mmHg since booking would also qualify a patient as having gestational hypertension
30mmHg systolic
15mmHg diastolic
preeclampsia (PET) is defined as hypertension after __ weeks gestation with proteinuria >___g in 24hrs
20 weeks
0.3g
what does HELLP syndrome stand for? what is it a complication of?
haemolysis, elevated liver enzymes, low platelets
pre-eclampsia
what investigations should be done to check for PET
BP
urinalysis
bloods: Hb, platelets, U+Es, LFTs, coag screen, urate
some risk factors for PET include ___parity, BMI >__, age __ or over
nulliparity (1st baby)
BMI >35
age >40
name a severe symptom of pre-eclampsia
- visual disturbance
- headache
- RUQ/epigastric pain
- papilloedema
- hyperreflexia/clonus
- HELLP syndrome
which drugs are first line for hypertension in pregnancy
labetalol
nifedipine
NOT ACEi!!
IM steroids are given
34
which hypertensive drug should not be given to asthmatics in pregnancy
labetalol
eclampsia is managed with what IV drug?
magnesium sulfate
how is pre eclampsia managed with medication in the antenatal period?
antihypertensives
low dose aspirin from 12 weeks
what are some signs of gestational diabetes (GDM)?
polyhydramnios
glycosuria
HbA1c should be ___mmol in women with GDM
48
what supplementation should women with GDM be given?
- high dose folic acid (5mg)
- low dose aspirin from 12 weeks
- metformin if diet and exercise do not improve HbA1c
LSCS should be offered to women with diabetes/GDM if the EFW is >___kg
4.5
there is a recurrence risk of ___% in women who have previously had GDM
50
describe how an OGTT is done to investigate for diabetes
a fasting venous blood sample is taken, the woman is then given a 75g sachet of glucose, a venous blood sample is taken 2hr after ingestion
how is preterm premature rupture of membranes (PPROM) diagnosed?
sterile speculum examination
what would speculum examination show in PPROM?
pooling of blood in the posterior vaginal fornix
how is PPROM managed?
- monitor for infection
- erythromycin for 10 days
- nifedipine if between 26 and 33+6 weeks
- steroids
- MgSO4 IV until the birth of the baby
- fetal monitoring using CTG
if fetal anaemia is not detected soon, the baby can develop a condition called..
hydrops fetalis
name a cause of antepartum haemorrhage
placenta praevia placental abruption vasa praevia uterine rupture ectropion cervical cancer
massive haemorrhage is defined as blood loss >___ml and/or signs of…
1000
clinical shock
bright painless vaginal bleeding in 3rd trimester…
placenta praevia
“hard woody uterus”
placental abruption
“painful vaginal bleeding in the 3rd trimester”
placental abruption
“clinical shock that is out of proportion to the amount of visible blood in a woman in her 3rd trimester”
placental abruption
name a risk factor for placental abruption
pre-eclampsia hypertension trauma smoking/drugs polyhydramnios previous abruption PPROM multiple pregnancy
how is a placental abruption managed?
resuscitate mother
urgent c section
replace blood products
anti-D if necessary
mum comes before baby
define vasa praevia
fetal blood vessels overlying close to the internal cervical os
“small amount of dark vaginal bleeding accompanied by acute fetal bradycardia and decelerations on CTG”
vasa praevia
how is vasa praevia managed?
steroids at 32 weeks
ELCS at 34-36 weeks
if emergency, emergency LSCS and maternal/neonatal resus
the biggest risk factor for uterine rupture is..
previous uterine surgery eg previous LSCS or myomectomy
maternal collapse in the third trimester preceded by severe abdominal pain…
uterine rupture
if maternal infection with chicken pox occurs in the last __ weeks of pregnancy there is a significant risk of varicella of the newborn
4
a woman is not immune to varicella zoster virus and is pregnant, she has been exposed to the virus in her pregnancy. she is not symptomatic. what should you do?
give varicella zoster immunoglobulins
a woman is not immune to varicella zoster virus and is pregnant, she has been exposed to the virus in her pregnancy. she has a mild rash. what should you do?
give oral aciclovir within 24h
paracetamol and fluids
NB should only be given to women over 20 weeks gestation
what abnormalities would be seen in a fetus with cytomegalovirus infection?
cerebral abnormalities eg microcephaly, ventriculomegaly, white matter abnormalities, intracerebral haemorrhage
a baby is born with jaundice, a petechial rash, hepatosplenomegaly and microcephaly. what infection are they likely to have contracted?
congenital cytomegalovirus (CMV) infection
a baby is born with severe anaemia, heart failure and hydrops fetalis. what infection are they likely to have contracted?
parvovirus B19
women with parvovirus B19 infection are infections until __day(s) after the rash develops
1
parvovirus B19 infection presents very similarly to what other infection?
rubella
serology should be done to distinguish between the two
