Antenatal care Flashcards
who is screening offered to
all eligible pregnant women england
what options are given
no screening
T21 and T18/13
T21 only
T18/13 only
when does the first scan take place
10-14 weeks - blood samples for downs syndrome and / or edwards syndrome
when does the second scan take place
18-20 weeks
fetal anomalies
- conditions that may benefit from treatment before or after birth
apporpriate hospital centre for birth
baby may die shortly after birth
what biochemical marker is used to calculate likelyhood of pregnancy being affected
hCg
down syndrome
extra chromosome 21
edwards syndrome
extra chromosome 18
pataus syndrome
extra chromosome 13
first trimerster combined test
NT, free beta Hcg and PAPPA and crown rump legnth
11 - 14 weeks
if US shows CRL less than 45 women should have further scan to measure NT
If CRL greater than 84 the second trimester quaruple test should be offered
second trimester quadruple test
14-20 weeks biomarkers
screening in twin pregnancies
eligble for both combine dscreening and quadruple screening
fetal cardiac protocol
What fraction of pregnancies are unplanned?
1/3
What is the incidence of maternal mortality?
9/100000
what are the most common causes of maternal death?
Heart disease
Blood clots
Epilepsy and stroke
What is covered in pre-pregnancy counselling?
General health measures
Improve diet
Optimise BMI
Reduce alcohol consumption
Smoking cessation
Folic acid
Up to date cervical smear
Medical history
Optimise known medical problems
Stop/change unsuitable drugs
Occasionally advice against pregnancy
Significant cardiac disease
Previous pregnancy problems
Maternal
Pre-eclampsia – aspirin 150mg during pregnancy and regular BP monitoring
Gestational diabetes – HbA1C booking and OGTT at 28 weeks
Previous caesarean section – consider elective caesarean section
DVT or PE – consider antenatal thromboprophylaxis and 6 weeks postnatal treatment
Foetal
Intrauterine growth restriction – aspirin 150mg during pregnancy and serial USS
Preterm birth – transvaginal cervical length scans or cervical suture
What are some previous medical problems that need discussed at pre-pregnancy counselling?
Maternal
Pre-eclampsia – aspirin 150mg during pregnancy and regular BP monitoring
Gestational diabetes – HbA1C booking and OGTT at 28 weeks
Previous caesarean section – consider elective caesarean section
DVT or PE – consider antenatal thromboprophylaxis and 6 weeks postnatal treatment
Foetal
Intrauterine growth restriction – aspirin 150mg during pregnancy and serial USS
Preterm birth – transvaginal cervical length scans or cervical suture
What does antenatal examination involve?
Abdominal palpation
Assess symphyseal fundal height (SFH)
Estimate size of baby
Estimate liquor volume
Determine foetal presentation
Listen to foetal heart
What does abdominal palpating when pregnant allow?
Assess symphyseal fundal height (SFH)
Estimate size of baby
Estimate liquor volume
Determine foetal presentation
What does SFH stand for?
Symphyseal fundal height
What are examples of antenatal screening offered to woman?
Screening for infection (carried out in 1st trimester)
Hep B
Syphilis
HIV
Maternal treatment and planning reduces vertical transmission
MSSU
UTI
Anaemia and isoimmunisation (1st trimester and at 28 weeks)
Isoimmunisation is high levels of certain red cell antibodies that can cause anaemia in the foetus
Anomalies by USS
Ensure pregnancy is viable and identify abnormalities incompatible with life
First scan carried out between 11 and 14 weeks
Second scan in 2nd trimester
Chromosomal abnormalities
1st trimester screening
Carried out at 10-14 weeks
Uses maternal factors, serum B-human chorionic gonadotrophin (B-hCG) and pregnancy associated plasma protein A (PAPP-A) and foetal nuchal translucency (NT) measurement
2nd trimester screening
Sometimes NT measurement not possible due to foetal position or maternal BMI
Checks for down syndrome (trisomy 21), Edward’s syndrome (trisomy 18) and Patau’s syndrome (trisomy 13)
Screening for what infections is carried out?
Hep B
Syphilis
HIV
Maternal treatment and planning reduces vertical transmission
MSSU
UTI
Why are anomilies checked for with USS?
When do these scans occur?
Ensure pregnancy is viable and identify abnormalities incompatible with life
First scan carried out between 11 and 14 weeks
Second scan in 2nd trimester
What chromosomal abnormalities are checked for?
Checks for down syndrome (trisomy 21), Edward’s syndrome (trisomy 18) and Patau’s syndrome (trisomy 13)
How are chromosomal abnormalities checked for during screening?
Uses maternal factors, serum B-human chorionic gonadotrophin (B-hCG) and pregnancy associated plasma protein A (PAPP-A) and foetal nuchal translucency (NT) measurement
When would NT measurements not be possible?
Due to foetal position or maternal BMI
What does NT measurement stand up for?
Nuchal translucency measurement
When is 1st trimester screening for chromosomal abnormalities carried out?
Between 10-14 weeks
When do US anomaly scans take place?
First scan carried out between 11 and 14 weeks
Second scan in 2nd trimester
When does screening for anaemia and isoimmunisation take place?
1st trimester and at 28 weeks
f chromosomal screening reveals high risk, what can then be done?
What is considered to be high risk?
High risk is >1/150 chance
More testing is offered
What additional testing is offered if chromosomal screening reveals high risk?
CVS
Between 10-14 weeks
1-2% of miscarriage
Amniocentesis
15 weeks onwards
1% risk of miscarriage
Non-invasive prenatal testing
Maternal blood taken to detect foetal cell free DNA and look for chromosomal trisomy
What is the incidence of twin pregnancy?
2-3% of all births, increasing due to assisted conception
Describe non-invasive prenatal testing as an additional form of testing after high risk chromosomal abnormality is identified?
Non-invasive prenatal testing
Maternal blood taken to detect foetal cell free DNA and look for chromosomal trisomy
Not offered on NHS
When does CVS take place?
Between 10-14 weeks
When can amniocentesis take place?
Beyond 15 weeks
before 10 weeks
sickle cell anaemia and thalassaemia
8-12 weeks
blood tests for full blood count and rhesus status
11-14 weeks
early blood test for down syndrome
NT scan for down syndrome
between 14-20 weeks
later blood test down syndrome
18-211 weeks
mid pregnancy US scan
Early pregnancy screening scan
checks your baby’s heartbeat, growth and
development
* estimates the stage of pregnancy
* confirms whether you’re having one baby or more
* gives the nuchal-translucency measurement
Mid-pregnancy screening scan
This scan is offered between 18 and 21 weeks. It is
sometimes known as a fetal anomaly scan. It’ll look for
lots of things about your baby’s health. Most women find
their baby is healthy and developing well. But sometimes
the sonographer finds an issue – usually these are minor,
but some are serious.
amniocentesisi
Amniocentesis (you might hear it shortened to ‘amnio’) can be
carried out after 15 weeks of pregnancy. It usually takes about
10 minutes.
An ultrasound scan will check your baby’s position in the womb.
The specialist doctor (obstetrician) will guide a fine
needle through your abdomen (tummy)
into your womb. The doctor can then
take a sample of the fluid surrounding
your baby (called amniotic fluid).
Your baby’s chromosomes can be
counted from the sample. Amniocentesis
does not produce a clear result in around
one in every 100 samples. If this happens,
you may be offered a repeat test.
Why are blood groups and red cell antibodies
important when I’m pregnant?
- If you need a blood transfusion.
If you need a blood transfusion the blood selected for you must be the
correct blood group. It must also be the correct match for any antibodies
you have. - To ensure you and your baby get the right treatment.
If tests show that you have made antibodies to your baby’s blood you may
need extra treatment.
How could red cell antibodies affect my baby?
Antibodies are generally harmless, but they can move from your blood
stream into your baby’s blood. Your baby’s red cells could be damaged if
they have the blood group which matches these antibodies. The illustrations
on the previous page show how this can happen.
In most cases the baby is not harmed. However, certain antibodies,
particularly if they are strong, could destroy the baby’s red cells. This
condition is called haemolytic disease of the fetus and newborn (HDFN)
previously called Rhesus disease. HDFN can cause anaemia, jaundice
and in severe cases brain damage or death, either while the baby
is in the womb or after delivery.
The antibody called anti-D causes the most common form of HDFN.
The antibodies remain in the mother’s blood and they could also damage
the red cells of a subsequent baby, if he or she has the same blood group
as the first.
Is there a test to see if my baby would be affected by the antibodies
I have
fetal Blood Group Genotyping
What are anti-D injections and what are its associated risks?
which transports blood cells around the body. The plasma used in anti-D
injections is collected from specially selected blood donors. It is also known
as ‘prophylactic anti-D’ or ‘anti-D immunoglobulin’. It has been used
successfully for over 30 years.
Can anti-D injection cause any adverse effects?
Common side effects: Soreness at the injection site is common. The soreness
lasts for a few hours to a day or two.
Uncommon side effects: a mild fever, headache or rash. Very occasionally
women can experience an allergic reaction to anti-D injections. If you have
any concerns, please speak to your midwife or obstetrician.
Transmission of infection from anti-D injections has never occurred in the UK
despite thousands of doses having been administered to pregnant women
every year since the late 1960s. A very small risk of infection from the
plasma donors cannot however be completely ruled out.
Anti-D injections are only needed if a D negative woman is pregnant
with a D positive baby. In about one in three pregnancies, the baby will
be D negative, and the anti-D injection would be unnecessary
dichorlonic diamniotic twins
each baby has a seperate placenta and amniotic sac
monocholoronic diamniotic twins
share a placenya and sepearate amniotic sacs
monochorlonic diamnotic twins
share a placenta and amniotic sac
trichorionic triamniotic triplets
one baby has a seperate placenta and amniotic sac
