Antenatal Care Flashcards
What general topics must you discuss at the booking visit?
- Smoking
- Diet
- Alcohol
- Folic acid
- Vitamin D
- Antenatal classes
What investigations are important at the booking visit?
- BMI
- Blood pressure
- Urine dipstick
- FBC - blood group
- Infection screen
- Urine culture
What infections do you test for at the booking visit?
- HIV
- Hep B
- Syphilis
- Rubella
- Asymptomatic bacteriruria
When is the dating scan?
10 - 13 +6 weeks
What is the purpose of the dating scan?
- Exclude multiple pregnancy
- Crown-rump measurements
When is the CRL less accurate for dating?
> 20wks
If CRL >84mm
When is the 1st T21 screening?
11-13+6weeks + nucal scan
- combined test
- Detect cardo-abnormalities
When is the anomaly scan?
- 18-20+6 weeks
At the anomaly scan, If a woman’s placenta is found to extend across the os, when should another scan be offered?
32 weeks
At 25 weeks what appointment is made for primips?
- General check-up
- BP, urine, symphysis-fundal height
- More information
When is the first dose of Anti-D offered to Rhesus negative women?
28 weeks
What Hb level may lead you to consider prescribing iron tablets?
<10.5
When is the second dose of Anti-D given?
34 weeks
What is discussed at 34 weeks?
Birth plan
Labour information
Pain relief
When is presentation checked with the offer of an ECV?
36 weeks
How do you calculate the date for expected delivery from the LMP?
- 1st day of LMP + 7 days
- + 9 months
If a woman has a routine cervical smear appointment during pregnancy, when should it be rearranged for?
12 weeks post partum
What may severe itching in pregnancy be indicative of?
Obstetric Cholestasis
When is the quadruple test offered?
14-20weeks
When is the OGTT offered if indicated?
24-28wks
How is the risk of T21 calculated?
Maternal age x risk ratio from combined screening
What risk level determines if the quadruple test is offered or not?
> 1 in 150
What is the likelihood of T21 if there is a positive combined screening test?
1 in 9
Which 3 chromosomal abnormalities are detected during pregnancy?
- T13 - Patau’s
- T18 - Edward’s
- T21
What is the detection rate of the combined screening test?
85%
What size nuchal translucency is indicative of disease?
3.5mm
What forms the combined screening test?
- Nuchal Translucency USS
- Maternal blood test for B-hCG and PAPP-A
What levels of b-hCG indicate disease?
Raised - T21
Low - T13, T18
What is PAPP-A?
- Pregnancy associated plasma protein A
- Produced by placenta during pregnancy
- Low levels indicate T13,18,21
What is the quadruple test for?
T21
Who is the quadruple test offered to?
- If missed combined screening after 1st trimester
- Blood test
What is a positive quadruple test?
- Alphafetoprotein - LOW
- Unconjugated oestriol (uE3) - LOW
- hCG - HIGH
- Inhibin A - HIGGH
What is the minimum detection rate of the quadruple test?
80%
What is the false positive rate of the quadruple test?
4.1%
What is the risk of miscarriage with chorionic Villous sampling?
1%
When are the results for CVS given?
48hrs
When are the results for Amniocentesis given
3 weeks
When are CVS and amniocentesis performed?
CVS - >11wks
Amniocentesis >15wks
What is the risk of miscarriage in amniocentesis?
1 in 120/0.8%
When can structural abnormalities be detected?
18-20+6 wks
What structural abnormalities can be detected?
- Ancephaly
- Gastroschisis
- Heart defects
- T13/T18
Which haemoglobinopathies can you detect during the booking bloods?
- Sickle Cell
- Thalassaemia
If the umbilical artery waveform demonstrates reverse-end diastolic flow or absent end diastolic flow, what does this indicate?
- Placental resistance
- Consider early delivery +30wks
