Antenatal Care

Question 1

When is the dating scan?

Answer 1

Between 11 + 13+6 weeks

Question 2

When is blood sugar tested and why?

Answer 2

Tested in at risk women at 26w

Question 3

Which infectious diseases are tested for?

Answer 3

HIV, Hep B, syphillis

Question 4

When is anti-D given if needed?

Answer 4

From 28w onwards

Question 5

What does a Rh affected baby look like/what are the Sx?

Answer 5

Oedematous, jaundiced, anaemic, HF, kernicterus

Question 6

What measurement is considered increased nuchal translucency?

Answer 6

> 3.5mm

Question 7

When is the combined test performed? What does it test for?

Answer 7

Between 11-14w.

Down’s, Edward’s, Patau’s

Question 8

What classifies high risk based upon combined test results? What can you offer to women with a high risk result?

Answer 8

1/150 or higher
From 11w - CVS
From 15w - amniocentesis

Question 9

What is NIPT?

Answer 9

Non-invasive pre-natal testing
Available in private sector
placental DNA extracted from maternal blood –> screen for various conditions

Question 10

How is a positive Hep B test managed in pregnancy?

Answer 10

Baby is given a hep B vaccine at birth and then 4 subsequent ones (5 in total).
Women with high viral load –> offered antiretrovirals in pregnancy and shortly after delivery to decrease risk further transmission

Question 11

How many antenatal appointments are arranged?

Answer 11

10 if nulliparous, 7 if multiparous

Question 12

How is syphilis in pregnancy Mx?

Answer 12

Abx in GUM clinic

Question 13

How can you tell if twins are dichorionic or monochorionic?

Answer 13

Di = lambda sign
Mono = T sign

Question 14

What are some of the maternal risks of multiple pregnancy?

Answer 14

Higher risk pre-eclampsia, GDM, anaemia

APH, PPH, hyperemesis gravidum

Question 15

How is multiple pregnancy managed? (not during labour)

Answer 15

• Folic acid 5mg, Fe supplements, aspirin
• DCDA 4 weekly scans from 24w
• MCDA 2 weekly scans from 16w
• regularly check BP & urine

Question 16

When is labour suggested in twins?

Answer 16

DCDA –> 37-38w
MCDA –> 34-37w
MCMA –> 34w by C-sec

Question 17

What are some foetal risks with multiples?

Answer 17

Miscarriage (vanishing twin)
Congenital abnormalities
Prematurity
IUGR
Monochorionic --> risk TTTS

Question 18

When is HTN defined as pre-existing and when is it pre-eclampsia?

Answer 18

If onset <20w = pre-existing

BP >140/90

Question 19

What can you give to women at increased risk of pre-eclampsia? Which women might you give this to?

Answer 19

Low dose aspirin from 12w gestation

Give in:
multiple preg, HTN in prev preg, CKD, SLE or antiphospholipid syndrome, DM, chronic HTN

Question 20

What are the types of HTN in pregnancy?

Answer 20

Pre-existing/chronic: presenting <20w
Gestational HTN: >20w, resolves within 2w delivery
Pre-eclampsia: HTN >20w –> later develop proteinuria

Question 21

How is eclampsia managed?

Answer 21

ABCDE
Mg sulphate & anti-HTN e.g. labetolol or nifedipine
DELIVER BABY!!

Question 22

What are the red flag Sx & signs of pre-eclampsia?

Answer 22

Headache
Visual disturbance
Epigastric/RUQ pain - hepatic capsule distension
SOB - pul oedema due to ARDS

Signs: periorbital oedema, hyper-reflexia, clonus, fits

Question 23

What are the Dx criteria for proteinuria in pre-eclampsia?

Answer 23

2+ on urine disptick
30mg/mmol PCR
300mg/24h urine collection

Question 24

Mx of eclampsia?

Answer 24

ABC - recovery position, poss O2

IV MgSO4, IV labetolol

Question 25

What is the most appropriate medical Tx for morning sickness?

Answer 25

Cyclizine (if needed)