antenatal care

Question 1

whah health checks should be made pre-conceptually?

Answer 1

• smoking
• drugs
• rubella vaccine (/ rubella immunoglobulin G)
• glucose control in diabetics
• prescribe 0.4mg of folic acid OD
• record date of menstruation
• smoking cessation advice
• reduce alcohol intake to one glass a day

Question 2

when is the antenatal booking visit?

Answer 2

12 weeks

Question 3

at what age groups are the maternal risks the biggest?

Answer 3

<17 yrs

>35 yrs

Question 4

which familial diseases need to be asked about?

Answer 4

diabetes (esp if 1st degree relative)
hypertension
thromboembolic disease
autoimmune disease
pre-eclampsia

Question 5

gestational diabetes is more common in women weighing ?
>70kg
>80kg
>100kg
>110kg

Answer 5

> 100kg

Question 6

dystocia in labour is more common in women who are?

Answer 6

< 150 cm

as they may have narrow hips?

Question 7

when can ultrasound be used to screen for chromosomal abnormalities?
after 10 weeks\
after 11
after 12
after 14

Answer 7

after 11 weeks

Question 8

the ultrasound is used in conjunction with pappa and bcg

true or false

Answer 8

true

Question 9

which blood tests are done ?

Answer 9

fbc
serum antibodies (anti-D)- identify those at risk of intrauterine isoimmunization
blood glucose levels
blood tests for syphillis
rubella immunity
HIV and HEP B screening
haemoglobulin electrophoresis is offered in women at risk of sickle cell anaemias or thalassaemias.

other tests:
check for infections that can cause pre-term labour [chlamydia, bacterial vaginosis]

do urine microscopy and culture- as asymptomatic bacteria can lead to pyelonephritis

urinalysis- for glucose, protein, and nitrites screen. for underlying diabetes, renal disease and infection

Question 10

health promotion and advice given to pregnant women:

Answer 10

balanced diet
eat 0.4mg folic acid every day
vitamin d if less exposure
contra-indicate sex if placenta praevia
dental check advised
exercise is advised
travel ( airlines mainly say if  less than 34-36 weeks)
risk of vte is reduced with adequate hydration, but if there is additional risk maybe give aspirin or lmwh.

Question 11

alcohol in pregnancy?

Answer 11

max-one drink a day

more than 20 units can restrict the child’s intelligence and may cause foetal alcohol syndrome.

Question 12

the rest of the booking visit talks about?

Answer 12

smoking, drugs (any ocp, or otc ?, drug abuse?) educating the woman about labour. intrapartum techniques about posture, breathing, and pushing are taught.
at the end the doctor/midwife can also advise the woman on the most appropriate type of antenatal care and a plan for visit frequency- do they want consultant led or community lead? ( oneis usually high risk one lower)

Question 13

abnormality scan is done at which number of weeks?

Answer 13

20

Question 14

what happens here?

Answer 14

it detects most structural fetal abnormalities.

Question 15

what is used for iugr and pre-eclampsia risk assessment?

Answer 15

doppler of the uterine arteries.

Question 16

when is the doppler performed?

Answer 16

23 weeks

Question 17

how much vitamin D should women be advised to take?

Answer 17

10mcg of Vit D OD

Question 18

what are the risk factors for gestational diabetes?

Answer 18

body mass index above 30 kg/m2

previous macrosomic baby weighing 4.5 kg or above

previous gestational diabetes

family history of diabetes (first‑degree relative with diabetes)

family origin with a high prevalence of diabetes:

South Asian,black Caribbean, Middle Eastern

Question 19

what percentage of live births are affected by chromosomal abnormalities?

Answer 19

0.6% /

6/1000

Question 20

what is the most affected trio of tests for screening for abnormalities?

Answer 20

-maternal age
-blood tests
-nuchal translucency scan (11-14 weeks)
these will detect 90% of the babies with down’s with 5 % false positive

Question 21

structural abnormalities question:
what are the two main examples of failure of neural tube to join?

what is the screening for these defects?

Answer 21

spina bifida

anencephaly (not compatible with life)
alpha fetoprotein is elevated in pregnancies affected by NTD; has been used as a screening test, but now almost never done as 20 week abnormality scan has rendered the screening almost redundant.

Question 22

what is fetal hydrops?
signs?
rf?
ix?
mx?

Answer 22

what is it?
when fluid accumulates in more than 2 places in the fetus.can be immune or non immune.

anaemia and haemolysis are the immune causes,
non-immune (secondary to another cause); structural, chromosomal, cardiac abnormalities, anaemia, twin-twin transfusion syndrome

ix:ultrasound, echo, assessment of the middle cerebral artery, maternal blood is taken for kleihauer, parvovirus, cmv and toxoplasmosis igm testing.

can do fetal blood sampling if suspect anaemia

can only cure if the hydrops is caused by anaemia ( or vessel compression.

Question 23

polyhydramnios: 
what is it?
causes:
clin ft:
complications:
management:

Answer 23

liquid volume increased; deepest liquor volume is . >10m is generally abnormal

caused; idiopathic; maternal factors; fetal anomoly

mother will b - large for date, taut uterus and difficult to palpate
complications: abnormal lie, maternal discomfort, malpresentation
management:
can use amnio-reduction, NSAIDS to reduce fetal urine production. consider steroids, if < 34 weeks pregnant\

deliver vaginally unless persistently unstable lie or other obstetric indication.