Antenatal care

Question 1

Antenatal screening: Key milestones

Answer 1

1. < 10 weeks : Booking scan
2. 10 - 14 weeks : Dating scan
   -Down’s syndrome screening : Nuchal scan
3. 18-21 weeks : Anomaly scan
4. 28 weeks : Anaemia and Anti-rhesus antibody prophylaxis if RH-
5. 34 weeks : 2nd Rhesus prophylaxis dose
6. 36 weeks : Check presentation : External cephalic conv if indicated

Question 2

Antenatal screening : Booking scan

Answer 2

1. FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
2. hepatitis B, syphilis , HIV test is offered to all women
3. urine culture to detect asymptomatic bacteriuria
4. OGTT for high risk of gestational diabetes

Question 3

Antenatal screening: Down’s syndrome screening

Answer 3

10-14 weeks : Combined test
1. US of Nuchal translucency
2. Maternal blood test
-Beta HCG } high is high risk
-Pregnancy associated plasma protein PAPPA } if low is high risk

14-20 weeks : Triple test
1. Beta HCG } high is high risk
2. AFP } if low is high risk
3. Serum oestriol } if low is high risk

15 - 20 weeks
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A

Question 4

Antenatal screening: Down’s syndrome : Karyotyping

Answer 4

If risk in screening is >5%

1. Second screening NIPT - non invasive

or

2. < 16 weeks : Chorionic villous sampling
   >16 weeks : Amniocentesis

Question 5

Antenatal care : Healthy women

Answer 5

1. N+V
   * Antihistamin : Promethazine
2. Vitamin D
   * 10mcg
3. Folic acid 400mcg until 12 weeks

Question 6

Antenatal care : Folic acid

Answer 6

1. Healthy women : 400mcg till 12 weeks
2. High risk : 5mg till 12 weeks

Question 7

Antenatal care : High risk of NTD

Answer 7

1. Either partner or FH of NTD
2. Anti-epileptic medication
3. Diabetes
4. Coeliac’s disease
5. Obesity >30kg

Question 8

Rubella : Risk in pregnancy

Answer 8

8-10 weeks - highest risk, risk of damage is as high as 90%

Question 9

Congential Rubella syndrome : Clinical features

Answer 9

• sensorineural deafness
• congenital cataracts
• congenital heart disease

Question 10

Rubella : Management

Answer 10

MMR vaccination - Post natal period

Question 11

Cytomegalovirus infection : Clinical features

Answer 11

cerebral calcification, microcephaly and sensorineural deafness

Question 12

Varicella zoster : Risk to foetus

Answer 12

< 20 weeks

Question 13

Varicella zoster : Clinical features

Answer 13

Risk to mother : Pneumonitis
Risks to foetus :
* Scarring of the skin, limb hypoplasia, microcephaly
* Eye deflects, hypoplasia, microcephaly

Question 14

Varicella zoster : Management

Answer 14

1. Check varicella antibodies - admister Varicella IG
2. Post exposure : Acyclovir 7-14 days post exposure

Question 15

HIV : Management

Answer 15

1. HIV screening - all pregnant women
2. Anti-retroviral therapy
3. Delivery
   * <50copies : Vaginal delivery
   * >50 : Caesarian section - IV Zidovudine infusion 4 hours prior

Question 16

HIV : Breastfeeding

Answer 16

No women with HIV should breastfeed.

Question 17

GBS : Risk factors

Answer 17

Assoc with increased risk of chorioamniotis and neonatal septum

Risk factors for Group BStreptococcus(GBS) infection:
* prematurity
* prolonged rupture of the membranes
* previous sibling GBS infection
* maternal pyrexia e.g. secondary to chorioamnionitis

Question 18

GBS : Management

Answer 18

1. Isolated on vaginal swab
2. Previous baby with GBS disease
   * Intrapartum antibiotic prophylaxis : Benzylpencillin