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Reproduction & Sexual Health > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Describe the timeline of a low risk pregnancy appointments

A

Booking appointment - 8-12 weeks
Review 16 weeks
Anomaly Scan 20 weeks
Midwife review - 25,28,31,34,36 weeks

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2
Q

What is classed as ‘term’?

A

37-42 weeks

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3
Q

What is included in the booking appointment history?

A 
Obstetric 
Medical 
Surgical 
Allergies
Mental Health 
Family 
Social - domestic abuse and FGM
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4
Q

What examination is done at booking visit?

A

Height
Weight
BP

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5
Q

What blood tests are done at booking?

A

Hb
ABO - rhesus/antibody
Syphilis, HIV, HBV and HCV
Urinalysis

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6
Q

What will a booking ultrasound determine?

A 
Confirms viability 
Most accurate time to determine chronicity 
Shared sac/placental site 
Estimated Delivery Date 
Major structural abnormalities 
Offer trisomy screening
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7
Q

How do you calculate the estimated due date?

A

Add 280 days to the woman’s last menstrual period using gestational calculator

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8
Q

What is done on examination at the review appointments?

A 
BP 
Urinalysis 
Symphysis-fundal height 
Lie and presentation 
Engagement of presenting part 
Foetal heart auscultation
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9
Q

State the 11 diseases an anomaly scan screens for

A 
Anencephaly 
Bilateral renal agenesis 
Cleft Lip 
Diaphragmatic Hernia 
Exomphalos 
Gastroschisis 
Spina Bifida 
Serious cardiac abnormality 
Lethal skeletal dysplasia 
Edward's syndrome 
Patau's Syndrome
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10
Q

When is the anomaly scan?

A

18-20 weeks

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11
Q

Describe the variations in placental site

A

Does not cover cervix - no further scans needed
Covers cervix - scan at 32 weeks to ensure it has moved
Transvaginal ultrasound may be required

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12
Q

What is placental praevia and how is it managed?

A

Placenta covers lower uterus and part of cervix
C-section at 37-38 weeks
Antepartum haemorrhage - immediate section

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13
Q

Name three types of trisomy

A

21 - Down’s
18 - Edward’s
13 - Patau’s

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14
Q

Describe trisomy 21

A

50% have a normal anomaly scan, cannot predict severity

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15
Q

Describe trisomy 18/13

A

Edwards - lethal if complete - stillbirth or neonatal death

Partial - significant disability can be identified on anomaly

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16
Q

What is the rate of recurrence of anomalies?

A

1%

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17
Q

How are trisomy screened for in the first trimester?

A

Nuchal Thickness

Blood tests - hCG and PAPP-A

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18
Q

Describe nuchal thickness

A

Fluid behind the foetal neck, measured at 11-13+6 weeks

<3.5 normal when CRL 45-84mm

19
Q

What two substances are measured in the trisomy blood test?

A

HCG

PAPP-A

20
Q

What does an increased NT indicate?

A

Chromosomal abnormality
Cardiovascular abnormality
Higher risk of foetal death

21
Q

When and why is trisomy screened in the second trimester?

A

15-20+6 weeks

Women who book late or have unsuccessful first trimester screening

22
Q

How is down’s screening carried out in the second trimester?

A

Includes maternal age and biochemical markers

23
Q

Which biochemical markers are included in a second trimester test?

A

Alpha-fetoprotein
hCG
Unconjugated oestradiol
Inhibin A

24
Q

Describe an NIPT test

A

Cell free foetal DNA - detects foetal DNA in blood sample from mother. Detectable from 10 weeks and continues to rise - screening tool

25
Q

Name the two diagnostic tests for trisomy and when are they performed

A

Amniocentesis - after 15 weeks

Chorionic villus sampling - after 12 weeks

26
Q

What are the two main haematological conditions screened for in pregnancy?

A

Sickle cell and thalassemia

27
Q

Why does alpha fetoprotein increase in certain abnormalities?

A

Spina bifida
Gastroschisis
Twins
Internal organs are closer to the amniotic fluid causing increased circulating alpha fetoprotein

28
Q

Name the four findings on urinalysis in pregnant women

A
  • UTI
  • Asymptomatic bacteriuria
  • Proteinuria (pre-eclampsia)
  • Glucose (diabetes)
29
Q

Name three types of anaemia in pregnancy

A

Iron deficiency
Folate deficiency
B12 deficiency

30
Q

When is anaemia screened for?

A

Screening at booking and 28 weeks

31
Q

When is the blood group/antibodies determined?

A

Booking and 28 weeks

32
Q

What is meant by rhesus negative?

A

You do not have the D antigen on blood cell surface

33
Q

What happens if a rhesus negative mother is exposed to rhesus antigen?

A

Sensitising event - mother will produce antibodies and attack the baby’s blood cells

34
Q

What can sensitising events lead to in terms of the baby?

A

Foetal anaemia, hydrops and intrauterine death

35
Q

How is haemolytic disease of the newborn investigated?

A

Ultrasound - foetal middle cerebral artery

36
Q

How is haemolytic disease of the newborn treated?

A

Deliver with blood transfusion

In-utero transfusion

37
Q

What test can check for antibodies?

A

Coombs test

38
Q

Where is anti-D immunisation given?

A

Deltoid - IM or SC

39
Q

What doses of anti-D immunisation?

A

<20 weeks 250 units
>20 weeks 500 units
Prophylaxis 1500 units

40
Q

What would be classed as a sensitising event?

A 
TOP 
Abdominal trauma 
Invasive investigation 
Haemorrhage 
External cephalic version 
Miscarriage 
Ectopic pregnancy
41
Q

How is a baby born with haemolytic disease of the newborn treated?

A

Phototherapy

Exchange transfusion

42
Q

State the risks of gestational diabetes

A 
BMI >30 
Previous macrocosmic baby weight
Previous gestational diabetes 
Family history of diabetes 
Ethnic minority 
All women who have gone through stillbirth should be tested
43
Q

Describe the difference between high risk and low risk pre-eclampsia treatment

A

High Risk - 150mg aspirin daily 12-36weeks

Low Risk - 75mg aspirin daily 12 weeks - birth

Reproduction & Sexual Health (36 decks)

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