antenatal care

Question 1

what supplement is advised for all women trying to get pregnant

Answer 1

folic acid 400mg from before conception to 12 weeks

Question 2

which vitamin supplements may be advised and which should be avoided

Answer 2

10mg vit D is good // not Vit A

Question 3

foods to avoid in pregnancy

Answer 3

listeria: unpasturised milk, ripened soft cheese, pate or undercooked meat // salmonella: avoid raw eggs, meat (esp chicken)

Question 4

when should flying be avoided in pregnancy

Answer 4

single pregnancy >37 weeks // multiple pregnancies > 32 weeks

Question 5

natural remedies for N+V in pregnancy

Answer 5

ginger or p6 acupuncture

Question 6

medications for N+V in pregnancy

Answer 6

antihistamines (eg promethazine)

Question 7

function folic acid

Answer 7

helps synthesise DNA

Question 8

what can cause folic acid deficiency

Answer 8

phenytoin // methotrexate // pregnancy // alcohol

Question 9

high risk neural tube defects

Answer 9

previous defect in parents or pregnancy // AED, coeliac, diabetes, thalassaemia // obese >30 BMI

Question 10

risks with smoking and pregnancy + canabis

Answer 10

low birthweight // preterm // IUGR // stillbirth

Question 11

risks of alcohol in pregnancy

Answer 11

fetal alcohol syndrome (smooth philtrum, thin lips, microcephaly) // IUGR

Question 12

risks of cocaine in pregnancy

Answer 12

maternal HTN or placental abruption // foetal prematurity or abstinence

Question 13

heroin risks pregnancy

Answer 13

abstinence syndrome

Question 14

how many antenatal checks are recommended in first pregnancy (uncomplicated)

Answer 14

10

Question 15

how many antenatal checks are recommended in subsequent pregnancy (uncomplicated)

Answer 15

7

Question 16

which conditions are generally screened for in pregnancy (maternal)

Answer 16

anaemia // UTI // bloods group + rhesus // pre-eclampsia // hep B, HIV, syphilis

Question 17

which conditions are generally screened for in pregnancy (foetal)

Answer 17

downs // abnormalities // neural tube

Question 18

when is the booking visit in pregnancy

Answer 18

8-12 weeks (ideally <12)

Question 19

invx booking visit

Answer 19

BP, urine, BMI // FBC, glucose, rhesus // Hep B, syphilis, HIV // urine culture

Question 20

when are scans to confirm dates

Answer 20

10-13+6

Question 21

what can increased nuchal translucency on USS indicate

Answer 21

downs // congenital heart defect // abdo wall defect

Question 22

what can cause hyperechogenic bowel on USS indicate

Answer 22

CF // downs // CMV

Question 23

when is the combined testing for downs syndrome offered

Answer 23

11-13.6

Question 24

when is the quadruple testing for downs syndrome offered

Answer 24

those who missed combined testing - 14-20 weeks

Question 25

when is the anomaly scan performed

Answer 25

18-20+6

Question 26

when does second screen for anaemia and blood antibodies occur

Answer 26

28 weeks

Question 27

when would first + second dose of anti-D be given to negative mothers

Answer 27

28 weeks // 34 weeks

Question 28

when is cephalic version indicated

Answer 28

36 weeks

Question 29

when is placental site identified

Answer 29

week 20

Question 30

how is SFH measured

Answer 30

top of pubic bone to top of uterus (centimetres)

Question 31

when should SFH be used

Answer 31

from 20 weeks // pregnancy should be within 2cm of gestation

Question 32

what can increase FSH

Answer 32

fibroids, BMI, polyhydramnios

Question 33

what tests are done in combined test for downs

Answer 33

nuchal transluceny + serum bHCG + pregnancy assoc plasma protein A (PAPPA)

Question 34

what results from combined test indicate downs

Answer 34

thick nuchal translucency + raised hCG + low PAPPA

Question 35

what results from combined test indicate edwards or patus

Answer 35

similar to downs but LOWER hCG

Question 36

what is performed in quadruple test for downs + what indicates it

Answer 36

low AFP + low oestrogen + raised hCG + raised inhibin

Question 37

how can trisomy results be interpreted

Answer 37

lower chance (less than 1 in 150) or high chance (more than 1 in 150)

Question 38

what further screening is offered if high chance trisomy + what is involved

Answer 38

non-invasive prenatal test –> ccfDNA (detection 99%)

Question 39

what diagnostic testing for downs is done in 1st trimester and what is the risk

Answer 39

chorionic villus sampling –> 2% risk miscarriage, adequate sample

Question 40

what diagnostic testing for downs is done in 2nd trimester and what is the risk

Answer 40

amniocentesis –> 1% risk, sample may not be big enough

Question 41

what does it mean to be rhesus negative

Answer 41

no D antigen on red blood cell

Question 42

what type of pregnancy is at risk from rhesus incompatibility

Answer 42

rhesus -ive mum and rhesus +ive baby

Question 43

what causes rhesus reaction in pregnancy

Answer 43

maternal blood forms antibody against rhesus antigen in baby –> IgG produced –> attacks baby and causes haemolysis

Question 44

consequences of rhesus haemolysis on baby

Answer 44

hydrops fetalis // jaundice, anaemia, hepatosplenomegaly // heart failure

Question 45

when should antiD be given

Answer 45

28 and 34 weeks (or after sensitising events + klehaur test))

Question 46

sensitising events in pregnancy

Answer 46

delivery // TOP // miscarriage >12 weeks // ectopic // external cephalic version //APH // amniocentesis, CVS // trauma

Question 47

what tests are done to babies with rhesus -ive mother

Answer 47

FBC, blood group, coombes test (for antiglobin)