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Obs & Gynae > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

What occurs at the booking visit?

A 
Risk assessment
BMI
Blood pressure
USS between 11 and 13+6
Blood tests
Vaginal infections
Urine M+C
Urinalysis - glucose, protein, nitrites
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2
Q

What is the combined test?

A

12 week USS
Blood beta hCG
Pregnancy associated plasma protein A (PAPPA)

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3
Q

What does the week 12 USS do?

A
  • crown-rump length for dating
  • multiple pregnancies
  • nuchal translucency
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4
Q

What do the booking visit bloods test for?

A 
FBC - anaemia
Serum antibodies - syphilis
GTT
Rubella immunity
HIV and hep B
Hb electrophoresis
Screening for chromosomal abnormalities
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5
Q

What lifestyle changes are advised in pregnancy?

A

2500 calories/day
Coitus fine unless placenta praevia
Avoid soft and blue cheese, pate, uncooked foods
Do exercise
Vit D for South Asian, Afro-Caribbean or BMI>30

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6
Q

What does the 20 week USS screen for?

A

Anomaly scan

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7
Q

What can be done at 23 weeks?

A

Doppler of uterine arteries
If OK then SGA
If reduced then IUGR or pre-eclampsia

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8
Q

How many appointments does a woman need?

A

10 for nulliparous

7 for multiparous

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9
Q

What investigations are done every appointment?

A

Ask about physical and mental state
Weighed
BP
Urine - protein, glucose, leucocyte, nitrites

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10
Q

What is done at 16 weeks?

A

Results of screening tests and booking bloods

Offer triple test

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11
Q

What is done at 18-21 weeks?

A

Anomaly scan

Repeat at 32 weeks if placenta is low

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12
Q

What is done at 25 weeks?

A

For PRIMIPS

Exclude early onset pre-eclampsia

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13
Q

What is done at 28 weeks?

A

fundal height measured
FBC and antibodies checked
GTT if indicated
Anti-D given to rhesus-negative women

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14
Q

What is done at 31 weeks?

A

For PRIMIPS
Fundal height measured
28 week blood tests are reviewed

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15
Q

What is done at 34 weeks?

A

Fundal height measured

FBC rechecked

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16
Q

What is done at 36, 38 and 40 weeks?

A

Fundal height, fetal lie and presentation is checked

Referred for ECV if breech

17
Q

What is done at 41 weeks?

A

Membrane sweeping offered

Induction at 42 weeks

18
Q

What minor conditions occur in pregnancy?

A

Itching- assess LFTs
Pelvic girdle pain - physiotherapy, corsets, analgesics, crutches
Abdo pain - rule out non-pregnant causes
Heartburn - antacids or ranitidine
Backache - sciatica
Constipation - exacerbated by iron
Ankle oedema - worsens at end, sudden increase is worrying
Leg cramps
Carpal tunnel syndrome - fluid retention compresses median nerve
Vaginitis - due to candidiasis, difficult to treat

19
Q

What are physiological changes in pregnancy?

A 
Weight gain 10-15 kg
Uterus gets heavier 1kg
Cervix softens
Blood volume increases
Haemoglobin decreases
WBC increases
CO increases
Peripheral resistance decreases
Blood pressure falls
Thyroid enlarges
20
Q

What causes congenital abnormalities?

A 
Structural deformities
Chromosomal abnormalities
Inherited diseases
Intrauterine infections
Drug exposure
21
Q

What is the difference between screening and diagnostic tests?

A

Screening - available for all women and gives a risk of being affected
Needs to be cheap, high sensitivity, specificity, safe

Diagnostic tests - performed on women with high risk to confirm

22
Q

How are neural tube defects screened for?

A

AFP is produced in fetal liver and measured in maternal blood

  • open neural tube defects
  • gastrochisis
23
Q

How is maternal blood tested for chromosomal abnormalities?

A

Blood markers are altered when fetus has chromosomal abnormality

  • beta hCG
  • PAPPA
  • AFP
  • Oestriol
  • Inhibin A
24
Q

How is USS used as a screening and diagnostic test?

A

Nuchal translucency measured between 11-14 weeks
Linked to cardiac abnormalities

20 week anomaly scan diagnoses most cardiac abnormalities

25
Q

How else can fetal abnormalities be tested?

A

MRI scan in utero - better for intracranial lesions
3D USS

Chorionic villus sampling - biopsy of trophoblast after 11 weeks

Amniocentesis - removal of amniotic fluid from 15 weeks

26
Q

What investigation results are seen in Down’s syndrome?

A

USS - thickened NT
- absent/shortened nasal bone

Blood - low PAPPA

  • high beta hCG
  • low AFP
  • low oestriol
  • high inhibin
27
Q

What screening tests are done for Down’s?

A

Booking bloods + maternal age + NT = combined test

If screening is done after 14 weeks or baby was being awkward
Quadruple test = AFP, hCG, oestriol, inhibin

28
Q

What are neural tube defects?

A

Result of failure of neural tube closure - neural tissue degenerates
Spina bifida, anecephaly

Give folic acid 3 months preconception

Increased AFP but anomaly scan has 95% sensitivity

29
Q

What are cardiac defects?

A

More common in women with congenital heart disease and diabetes

Increased NT at 12 weeks and most picked up at 20 weeks

30
Q

What abdominal wall defects exist?

A

Exomphalos - partial extrusion of abdo contents into peritoneal sac
50% have chromosomal problems

Gastroschisis - free loops of bowel in amniotic cavity
Common in young mothers

31
Q

What chest defects exist?

A

Diaphragmatic hernia -> pulmonary hypoplasia

60% survive

32
Q

What gastrointestinal defects exist?

A

Oesophageal atresia and TOF
Duodenal atresia
Lower gut atresia

33
Q

What urogenital defects exist?

A

Hydronephrosis - prone to infection and renal damage

Posterior urethral valves - obstruct male urethra -> oligohydramnios, bladder, renal dilation
Ranges from lethal to renal failure in adulthood

34
Q

What skeletal defects exist?

A

Skeletal dysplasia

Isolated limb abnormalities

35
Q

What is fetal hydrops?

A

Extra fluid accumulates in 2+ areas of the fetus
Occurs in early pregnancy
Chromosomal abnormalities
Structural abnormalities - pleural effusion
Cardiac abnormalities
Anaemia -> cardiac failure
TTTS

36
Q

What is polyhydramnios?

A

Increased liquor volume

Occurs in 1% of pregnancies

37
Q

What causes polyhydramnios?

A

Idiopathic
Maternal disorders: diabetes, renal failure
TTTS
Fetal abnormalities (particularly upper GI obstructions or inability to swallow, chest abnormalities, myotonic dystrophy)

38
Q

How does polyhydramnios present?

A

Maternal discomfort
Large for dates
Taut uterus
Difficult palpation

39
Q

What are complications of polyhydramnios?

A

Preterm labour
Maternal discomfort
Abnormal lie

Obs & Gynae (20 decks)

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