Antenatal Care Flashcards
What is sensitivity?
true positive/ (positive + false negative)
What is specificity?
true negative/ (negative + false positive)
What is done at the booking visit?
full history; exam- BMI; CVS; abdomen; Ix
What is Naegele’s Rule?
estimated due date based on LMP
When is the booking visit?
around 12 weeks
What investigations are done at the booking visit?
Hb; ABO; Rhesus; syphilis; HIV; hep B and C; UA; US
What is looked at on US at the booking visit?
confirm viability; singleton/mulitple pregnancy; estimate gestational age; major structural abnormalities; offer Down’s screening
What is the purpose of UA?
look for asymptomatic bacteruria; gestational DM; pre-eclampsia
How many pregnancies at the booking viist US won’t be viable?
1 in 5
What is the function of the yolk sac?
supports pregnnacy until placenta
What is done at follow up visits?
history- physical and mental health; fetal movements; BP and UA; symphysis-fundal height; lie and presentation; fetal heart auscultation
When is a transverse lie a problem in pregnnacy?
36/37 weeks
What are the problems with transverse lie?
cord prolapse; malposition eg breech
What is the still birth rate in pregnnacy?
1 in 200
What is done in an anomaly risk assessment in the first trimester?
increased nuchal thickenss
What blood test is done for fetal anomlaies in the 2nd trimester?
hCG and AFP
What is considered high risk for Down’s?
more than 1 in 250
What is placental praevia?
placenta is low lying in the womb and covers all or part of hte cervix
What is done is placental praevia is seen at a scan between 18-20+6 weeks?
offered abdo scan at 32 weeks
When is nuchal thickness measured on USS?
11-13+6 weeks
What is nuchal thickness?
<3.5mm
What tests is nuchal thickness combined with in the first trimester for Downs screening?
HCG and PAPP-A
What is used to estimate gestation before 13 weeks?
crown-rump length
What should be used to estimate gestation after 13 weeks?
head circumference
What is second trimester screening for Down’s?
maternal age+ biochemical markers- AFP; hCG; uncojugated oestradiol and inhibin A
When is the second trimester screening for Down’s?
between 14-20 weeks
Who gets the second trimester screening for Down’s?
those who missed the first trimester offer
What is the miscarriage rate with amniocentesis?
1%
When is amniocentesis performed?
after 15 weeks
When is chorionic villous sampling carried out?
after 12 weeks
What is them iscarriage rate with chorionic villous sampling?
2%`
When is maternal anaemia screened for?
booking and 28 weeks
What questions are used to screen mental health in pregnnacy?
new feelings or thoughts which make you disturbed or anxious?
thoughts of suicide or self-harm?
feeling incompetent as a mother, feeling distnaced or estranged; feel getting worse?
What are the risk factors for gestational DM?
BMI >30; previous macrosomic baby (>4.5kg); Fhx; minority ethnic family origin
Who should be offered testing for gestational DM?
woman with any one risk factor for GDM
What is the fasting plasma glucose for GDM?
> 5.6mmol
What is the 2hour plasma glucpse level for GDM?
> 7.8mmol
Who should be sent for ultrasound measuremtn of fetal size?
women with single SFH below 10th centile or slowing or static growth
What could make SFH inaccurate?
BMI >35; large fibroids; hydramnios
What is the treatment for women at high risk of pre-eclampsia?
75mg of aspiring from 12 weeks to birth
What are the high risk factors for pre-eclampsia?
HT disease in prev pregnnacy; CKD; AI disease eg SLE or EPS; T1 or T2DM; chronic HT
What are the moderate risk factors for pre-eclampsia?
first pregnancy; age 40 or more; pregnnacy interval of >10 years; BMI >35; Fhx; multiple pregnnacy
When should a booking appt in pregnnacy be carried out?
ideally by 10 weeks
What should be done at 16 weeks?
review screening tests etc; BP and UA
What should be carried out at 18-20 weeks?
USS anomaly scan
Who should get an appt at 25 weeks?
nulliparous women
When is the second appt for all pregnant women?
28 weeks
What is done at the 28 week appt?
second screening for anaemia and blood group abs; offer anti-D; BP and UA; SFH;
Who should get an appt at 31 weeks?
nulliparous women
