Antenatal care

Question 1

When is first clinic appointment

Answer 1

<10 weeks

Question 2

What is done in the first clinic appointment

Answer 2

Folic acid supplement 400mcg
Advice on food hygiene (avoid uncooked meat and seafood, soft cheese and unpasteurised milk) and lifestyle (smoking, alcohol, recreational drugs)
Risk assessment
‘Birth plan’
Advice on pelvic floor exercises
Refer to antenatal classes and breastfeeding workshops

Question 3

Tests offered at first clinic appointment

Answer 3

FBC - anaemia and platelets
Blood group (ABO, rhesus and autoantibodies)
Infection screen - syphilis, hep B/C, HIV
Urine dipstick
BP
BMI
Cervical smear
Electrophoresis for high risk - haemoglobinopathies
Arrange 12 week dating scan
Arrange Down syndrome screening - combined and quadruple
Arrange 20 week anomaly scan

Question 4

What are the fetal anomaly scans and when are they done

Answer 4

Nuchal translucency scan at ~12 weeks

Detailed ultrasound at ~20 weeks

Question 5

Next step if fetal anomaly scan or serum screening positive

Answer 5

Confirm diagnosis by amniocentesis (>16 weeks) or chorionic villus sampling (9-12 weeks)

Question 6

What is the cutoff for further investigation after fetal anomaly scan positive

Answer 6

If chance is higher than 1/150 of anomaly

Question 7

What prompts screening for gestational diabetes

Answer 7

BMI above 30
Previous gestational diabetes
Previous macrosomic baby
FH diabetes (first degree relative)

Question 8

Risk factors for pre-eclampsia

Answer 8

40+
Nulliparous
>10 years since last pregnancy
FH or previous history
BMI >30
IVF
Preexisting hypertension or renal disease 
Multiple pregnancy

Question 9

Criteria for increased surveillance for hypertension in pregnancy

Answer 9

Diastolic BP 110 or greater
OR
140/90 or greater on 2 occasions over 4 hours apart

Question 10

Criteria for treatment for hypertension in pregnancy

Answer 10

Systolic BP >160 on 2 consecutive occasions >4 hours apart

Question 11

What checks are done in every antenatal clinic

Answer 11

BP
Unite dipstick
Symphysis fundal height (from week 24)
Fetal presentation (from week 36)
Ask about fetal movements - mothers perception is adequate, don't need a formal count

Question 12

When is anti-D prophylaxis given

Answer 12

28
34
And within 72 hours of any sensitising event e.g APH, abdo trauma, CVS/amniocentesis, labour

Question 13

When should induction of labour be offered

Answer 13

After week 41

Question 14

When should external cephalic version be offered

Answer 14

If breech presentation after 36 weeks

Question 15

Risks of pregnancy in high BMI

Answer 15

VTE
Gestational diabetes
Preeclampsia
Inaccurate fundal symphysis measurements therefore need serial growth scans

Question 16

1st trimester Down syndrome screening and what are the positive results

Answer 16

NT scan - nuchal fold >3mm thickness

Blood test - high beta HCG, low PAPP-A

Question 16

2nd trimester Down syndrome screening

Answer 16

US

Blood test before 20 weeks - beta HCG, inhibin, oestriol, alpha fetoprotein

Question 17

Risk of miscarriage in amniocentesis or CVS

Answer 17

0.5-1%

Question 18

Management of type 1 diabetes in pregnancy

Answer 18

Preconception counselling
Monitor blood glucose and HbA1c closely
Check renal function (irreversibly declines in pregnancy) and retinopathy

Question 19

Management of asthma in pregnancy

Answer 19

Continue inhalers - all safe
If poorly controlled, risk of IUGR
If have high risk of preeclampsia, weigh up risk of using NSAIDs with asthma exacerbation

Question 20

Naegele EDD calculation

Answer 20

+1 year
-3 months
+7 days

Question 21

Results of quadruple testing suggestive of trisomy 21

Answer 21

Low alpha fetoprotein
Low oestriol
High inhibin
High beta HCG

Question 22

Results of quadruple testing suggestive of trisomy 18

Answer 22

All low

Question 23

Results of quadruple testing suggestive of NTD

Answer 23

Very high alpha fetoprotein

Everything else normal range

Question 24

Describe CVS

Answer 24

Ideally performed at 9-12 weeks gestation
Ultrasound guided sampling of placental tissue for DNA and cytogenetic analysis
Transcervical or transabdominal

Question 25

Risks of CVS

Answer 25

1% miscarriage
Contamination with maternal cells leading to false negative
Risk of limb defects higher if performed <9 weeks gestation
Infection

Question 26

Describe amniocentesis

Answer 26

Ideally done at 16-18 weeks gestation
Ultrasounds guided sample of amniotic fluid for karyotyping
Transabdominal

Question 27

Risks of amniocentesis

Answer 27

0.25% miscarriage. Much higher if <15 weeks gestation

Infection

Question 28

Indications for further fetal anomaly screening

Answer 28

Maternal age >35
Previous child with chromosomal abnormality or NTD
FH of chromosomal abnormality 
Abnormal screening scans or blood tests 
Teratogen exposure 
Maternal antiepileptic medication

Question 29

Calculation for gestational age using CRL

Answer 29

CRL(mm) + 6.5 = gestational age (weeks)

Question 30

When is screening for gestational diabetes done

Answer 30

24-28 weeks if no risk factors

16-18 weeks if high risk

Question 31

Diagnosis of gestational diabetes

Answer 31

After 20 weeks:
2hr post OGTT glucose levels of >7.8mmol/l
Or
Fasting glucose >5.6mmol/l

Didn’t exist preconception and resolves after delivery

Question 32

Vaccinations recommendations for pregnant woman and what gestation are they given?

Answer 32

Pertussis and Influenza between weeks 20-32
Varicella zoster Ig following exposure if never been exposed before
No live vaccines

Question 33

What test are done on amniotic fluid

Answer 33

Karyotyping

Viral serology

Question 34

Advice given for mothers if feel reduced fetal movements

Answer 34

Have cold drink
Lie left lateral
Count movements for 2 hours
<10 movements immediately go to maternal assessment unit

Question 35

Who gets high dose folic acid and what is the dose

Answer 35

5mg
Anti epileptic drugs
Previous baby with NTD
BMI >30
SCD
Diabetes 
Multiple pregnancy