Antenatal Care

Question 1

When should the booking visit have occurred by?

Answer 1

10 Weeks

Question 2

List factors to be considered in preconceptual care

Answer 2

Up to date cervical smear
Rubella status
Chronic disease optimised e.g. diabetes
Medication optimised
Routine folic acid 0.4mg daily
Alcohol, smoking and drug cessation

Question 3

Which maternal age groups are considered high risk?

Answer 3

<17
>35
Increasing maternal age associated with increased risk of trisomy

Question 4

Which medical conditions in pregnancy confer an increased risk of recurrence in subsequent pregnancies?

Answer 4

PET
PLT
GDM
Rh Disease
Postpartum and Antepartum haemorrhage 
Stillbirth
Growth restriction
Small for dates
Some congenital abnormalities

Question 5

What is the purpose of the 12 Week USS?

Answer 5

Gestational Age
11-13+6 weeks –> crown rump length

Detection of multiple pregnancies

Nuchal translucency for screening

Question 6

Investigations to be carried out at booking visit

Answer 6

History and Examination

USS (date, screening)

Blood level of B-hCG and PAPPA (pregnancy-associated protein A)

Bloods
FBC --> Anaemia
Serum antibodies: anti-D --> risk of intrauterine isoimmunisation 
GTT in at-risk mother
Blood test for syphilis (serology)
Rubella status (immunoglobulin G) --> vaccination offered postnatal if not 
HIV and Hep B
Sickle cell anaemia
Thalassaemia

Other Tests
Screening for infections (chlamydia and BV associated with PTL)
Urine MC&S (asymptomatic bacteruria –> pyelonephritis in 20%)
Urinalysis Glucose Nitrates Protein

Question 7

Health promotion advice for pregnant women

Answer 7

Drugs
Avoid in first trimester
Folate supplementation until 12 weeks
Vitamin D for >30 BMI, South Asian, Afro-Caribbean
Iron supplements 

Lifestyle
2500 calories a day
Avoid alcohol in particular for first 12 weeks
Sex not contraindicated unless placenta praevia or ruptured membranes
Avoiding unpasteurized cheese (listeria), and under cooked meats/eggs (salmonella)

Smoking
Nicotine replacement
Dental check up

Prep for Birth
Antenatal clinics
Intrapartum techniques

Question 8

What are the Birth planning pathways?

Answer 8

Community-based: core team of midwives –> referred to hospital if complications occur

Consultant-led: visits shared by consultant obstetrician-led team with community-led midwives + GP

Question 9

What is the purpose of the 20 week USS?

Answer 9

Enables detection of most structural abnormalities

Repeat scan at 32 weeks if low-lying placenta

Question 10

Additional USS are a sign of?

Answer 10

Dopplers of uterine arteries at 23 weeks –> IUGR or PET

Not routine

Question 11

What are the constituents of the Combined Test?

Answer 11

1) Maternal Age

2) Nuchal translucency (thickened) by USS 11-1
3+6 weeks
Space between skin and soft tissue overlying cervical spine
Indicates risk of structural (cardiac) abnormalities

3) Beta hCG (high)
4) PAPPA (low)

Question 12

Management of heartburn in pregnancy

Answer 12

Antacids and ranitidine

*PET can present with epigastric pain

Question 13

Management of vaginitis during pregnancy

Answer 13

Commonly due to candidiasis

Imidazole vaginal pessaries are used for symptomatic infection

Question 14

Causes of a raised maternal plasma AFP

Answer 14

Alpha fetoprotein is produced by fetal liver

Open neural tube defects
Gastrochisis

Also indicator of risk in third trimester but seldom used as USS more accurate

Question 15

List all risk factors for Down Syndrome

Answer 15

History
Increased maternal age
Previous affected baby (1% increase)
Balanced parental translocation (rare)

USS
Thickened nuchal translucency 
Structural abnormality 
Absent/short nasal bone
Tricuspid regurgitation

Bloods
Low PAPA (1st tri)
High B-hCG (1st & 2nd tri)
Low AFP (1st & 2nd tri)
Low oestriol (2nd tri)
High inhibin (2nd tri)

Question 16

Amniocentesis

Answer 16

Removal of amniotic fluid by passing fine-gauge needle through abdominal wall
Safest after 15 weeks (1% miscarriage rate after amniocentesis)
Prenatal diagnosis of chromosomal abnormalities, infections (CMV, toxoplasmosis) and inherited disorders e.g. sickle cell, thalassaemia and CF

use FISH/PCR –> results within 48 hours

Question 17

Chorionic Villus Sampling

Answer 17

Biopsy of trophoblast by passing fine-gauge needle through abdominal wall/cervix
Allows earlier testing from 11 weeks (allows abortion to be performed under GA)
Slightly higher rate of miscarriage than amniocentesis but could be attributed to early testing when spontaneous miscarriage is more prevalent
Used to diagnose chromosomal problems with autosomal dominant/recessive conditions

Use FISH/PCR –> results within 48 hours

Question 18

List 3 Trisomy Chromosomal Abnormalities

Answer 18

Trisomy 18 Edward’s Syndrome

Trisomy 13 Patau’s Syndrome

Trisomy 21 Down Syndrome

Question 19

Sex Chromosome Abnormalities

Answer 19

Klinefelter's
47 XXY
Normal intelligence
Small testes
Infertile

Turner's 
45 XO
Female
Infertile
Normal intellect

Question 20

What are the constituents of the Triple Test?

Answer 20

NOTE: this is later than the combined test, triple test used if missed combined test (at 11 - 13+6 weeks)

Triple test at 16 weeks
Less accurate

1) AFP
2) Oestriol
3) hCG