Antenatal care

Question 1

If there is a problem during pregnancy, who takes priority: mum or foetus?

Answer 1

Mum

Question 2

In a normal pregnancy, how many US scans are carried out?

Answer 2

2

Question 3

Which scan takes place around 20 weeks gestation?

Answer 3

Detailed anomaly scan

Question 4

How long does pregnancy last (normal range)?

Answer 4

40 weeks

anytime between 37 and 42 weeks is considered normal

Question 5

How can you determine normal gestational age to give an estimated date of delivery?

Answer 5

Crown Rump Length (CRL)

Head circumference (HC)

Question 6

Until which gestation is CRL used to determine estimated date of delivery?

Answer 6

Up to 13 weeks gestation

Question 7

When is HC used to determine estimated date of delivery?

Answer 7

After 13 weeks gestation

Question 8

What is CRL and what are the normal measurements?

Answer 8

Midline sagittal section of the whole foetus where you measure from the top of the head to the bottom of the buttocks.
It is determined from US imaging.
The best of 3 measurements should be taken
45-84mm is normal

Question 9

Why is symphysis final height (SFH) measured?

Answer 9

To give an estimate of how well baby is growing

Question 10

When should symphysis fundal height be measured?

Answer 10

At each antenatal appointment from 24 weeks of pregnancy

Question 11

SFH should be plotted on which type of chart?

Answer 11

Customised chart

Question 12

If a SFH measurement plots below the 10th centile on the customised chart, what action should be taken?

Answer 12

Refer woman for US to assess foetal size

Question 13

If the SFH measurements on the customised chart are crossing centiles, what action should be taken?

Answer 13

Refer woman for US to assess foetal size

Question 14

Green pathway is _____ led care

Answer 14

Midwife

Question 15

Red pathway is _____ led care

Answer 15

Consultant

Question 16

If there are any complications with pregnancy, the patient will be on GREEN/RED pathway?

Answer 16

Red

Question 17

Booking visit - around which week is this?

Answer 17

week 8 - 12 gestation

Question 18

What happens at booking visit?

Answer 18

Detailed history
Examination
Investigations

Question 19

Booking visit - examinations

Answer 19

Mothers height, weight, BP
CVS examination
Abdominal examination

Question 20

Booking visit - investigations

Answer 20

Haemoglobin 
Check Rhesus status 
Infectious diseases 
Urinalysis: MSSU, C+S 
US

Question 21

Booking visit - investigations - why check rhesus status?

Answer 21

If woman is rhesus -ve then there is a risk of rhesus disease to the foetus

Question 22

What is rhesus disease?

Answer 22

Antibodies in a pregnant womans blood destroy her baby’s blood cells

Question 23

What are signs that a baby has developed rhesus disease?

Answer 23

Anaemia

Jaundice

Question 24

What causes rhesus disease?

Answer 24

When mother has rhesus -ve blood and baby in the womb has rhesus +ve blood.

Question 25

Rhesus -ve mother can give her first born rhesus +ve child rhesus disease. True or false?

Answer 25

False - mother must have been previously sensitised to rhesus +ve blood. - therefore, the baby can only get rhesus disease if the mother had a previous pregnancy with a rhesus +ve baby.

Question 26

Booking visit - investigations - what do you do if the mother is rhesus -ve ?

Answer 26

Give mother injections of anti-D antibodies which helps remove the RhD foetal blood cells before they can causes sensitisation.

Question 27

Booking visit - investigations - which infectious diseases do you test for?

Answer 27

HIV Syphilis Hep B

Question 28

Booking visit - investigations US

Answer 28

Confirm viability Assess whether single/multiple pregnancy Estimate gestational age Detect major structural anomalies

Question 29

Booking visit - investigations US - we don't know if its a continuing pregnancy until...

Answer 29

We see the foetal heart

Question 30

Booking visit - investigations US - what do we think if US of uterus is empty?

Answer 30

Ectopic pregnancy until proven otherwise

Question 31

Follow up visits - examination

Answer 31

``` BP Urinalysis Symphysis fundal height (SFH) Baby's lie and presentation Foetal heart auscultation ```

Question 32

Which 2 things assess the robustness of a screening test?

Answer 32

Sensitivity | Specificity

Question 33

Screening tests - everyone must have them True or false?

Answer 33

False | - women can choose not to have them

Question 34

Screening test - when should sickle cell and thalassaemia be screened for?

Answer 34

As early as possible, before 10 weeks

Question 35

Screening test when should downs, edwards and platau's syndromes be screened for?

Answer 35

Around booking appointment time (11 to 14 weeks)

Question 36

If screening test detects there is a higher chance of having downs / edwards / platau's syndrome, what is the next step?

Answer 36

Woman will be offered a diagnostic test | - that gives a more definite answer

Question 37

Screening test for sickle cell and thalassaemia will tell you whether or not your baby has the condition. True or false?

Answer 37

False | - Will tell you whether YOU are a carrier or not

Question 38

If you / baby's father are a carrier for sickle cell or thalassaemia, what is offered?

Answer 38

Diagnostic test to find out if baby is affected

Question 39

When is screening for abnormalities carried out?

Answer 39

Detailed anomaly scan at 20 weeks

Question 40

Name some abnormalities that may be detected on detailed anomaly scan?

Answer 40

Anencephaly | Spina bifida

Question 41

What does screening for downs / edwards / platau's syndrome involve?

Answer 41

Combined test | - US and blood test

Question 42

Trisomy 21

Answer 42

Downs Syndrome

Question 43

Trisomy 13

Answer 43

Platau's syndrome

Question 44

Trisomy 18

Answer 44

Edwards syndrome

Question 45

Downs syndrome increases/decreases with maternal age.

Answer 45

Increases

Question 46

The US component of downs / edwards / platau's syndrome screening measures what?

Answer 46

Nuchal Translucency | - measure of fluid at the back of the baby's neck

Question 47

If the patient misses first trimester screening for downs / edwards / platau's syndrome, what can they be offered during 2nd semester?

Answer 47

Maternal blood tests | - Assay of HCG and AFP

Question 48

Which diagnostic testing is offered? (2)

Answer 48

Amniocentesis | Chorionic villus sampling

Question 49

What is the risk with diagnostic testing?

Answer 49

Miscarriage

Question 50

When is Chorionic villus sampling offered?

Answer 50

Around 11-14 weeks gestation

Question 51

When is Amniocentesis offered?

Answer 51

Around 15 weeks gestation

Question 52

Why does rhesus disease not affect the first born Rh-positive child from a Rh-positive mother?

Answer 52

IgM Antibodies are produced which are too big to cross the placenta and affect the baby

Question 53

Why can rhesus disease affect any baby after the Rh-negative mother has been sensitised by Rh-positive antibodies from a previous pregnancy?

Answer 53

Rh +ve antibodies (from previous pregnancy) remain in the mothers immune system. When she encounters Rh +ve baby again in the womb, the Rh +ve antibodies are now IgG and they can immediately pass through the placenta to attack the baby blood cells causing rhesus disease

Question 54

Which gestation do you do symphysis fundal height measurement from?

Answer 54

24 weeks

Question 55

Name 3 ways to assess foetal wellbeing

Answer 55

Assess growth - customised charts - serial growth charts CTG Umbilical arterial doppler US

Question 56

What are the 3 features that make up a customised chart?

Answer 56

BMI Ethnicity Parity

Question 57

When is first dose of anti-D given to an Rh -ve mother during pregnancy?

Answer 57

Week 28

Question 58

The position of a baby in utero should be determined at how many weeks gestation?

Answer 58

36 weeks

Question 59

What is the purpose of measuring symphyseal fundal height?

Answer 59

To check for SGA baby

Question 60

At which week gestation should symphyseaal fundal height be measured from weekly?

Answer 60

24 weeks

Question 61

Folic acid should be given to ALL women before conception up to 12 weeks. True or false?

Answer 61

True - 400mg - to prevent neural tube defects

Question 62

How many extra calories should a woman consume during pregnancy to support growth of foetus?

Answer 62

250-300

Question 63

20 week anomaly scan can detect cleft palate. True or false?

Answer 63

True

Question 64

What is A normal value for nuchal translucency

Answer 64

less than 3.5mm

Question 65

Which 3 blod tests are carried out for down syndrome screening and are they high/low in downs syndrome

Answer 65

HCG - high AFP - low PAPP-A - low

Question 66

If woman declines IOL by 42 weeks, what do you do?

Answer 66

Offer increased monitoring of baby and US scan

Question 67

What is haemolytic disease of the newborn caused by?

Answer 67

Rhesus negative women and IgG crossing placenta to baby

Question 68

How does anti-D work

Answer 68

Removes rhesus +ve blood cells from maternal circulation before antibodies form

Question 69

What is the window for doing chorionic villous sampling

Answer 69

11 weeks - 13+6 weeks

Question 70

Which carries the highest misscarriage risk - chorionic villous sampling - amniocentesis

Answer 70

Chorionic villous sampling