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Reproduction SOH > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

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

A

Mum

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2
Q

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

A

2

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3
Q

Which scan takes place around 20 weeks gestation?

A

Detailed anomaly scan

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4
Q

How long does pregnancy last (normal range)?

A

40 weeks

anytime between 37 and 42 weeks is considered normal

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5
Q

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

A

Crown Rump Length (CRL)

Head circumference (HC)

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6
Q

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

A

Up to 13 weeks gestation

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7
Q

When is HC used to determine estimated date of delivery?

A

After 13 weeks gestation

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8
Q

What is CRL and what are the normal measurements?

A

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

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9
Q

Why is symphysis final height (SFH) measured?

A

To give an estimate of how well baby is growing

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10
Q

When should symphysis fundal height be measured?

A

At each antenatal appointment from 24 weeks of pregnancy

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11
Q

SFH should be plotted on which type of chart?

A

Customised chart

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12
Q

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

A

Refer woman for US to assess foetal size

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13
Q

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

A

Refer woman for US to assess foetal size

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14
Q

Green pathway is _____ led care

A

Midwife

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15
Q

Red pathway is _____ led care

A

Consultant

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16
Q

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

A

Red

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17
Q

Booking visit - around which week is this?

A

week 8 - 12 gestation

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18
Q

What happens at booking visit?

A

Detailed history
Examination
Investigations

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19
Q

Booking visit - examinations

A

Mothers height, weight, BP
CVS examination
Abdominal examination

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20
Q

Booking visit - investigations

A 
Haemoglobin 
Check Rhesus status 
Infectious diseases 
Urinalysis: MSSU, C+S 
US
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21
Q

Booking visit - investigations - why check rhesus status?

A

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

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22
Q

What is rhesus disease?

A

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

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23
Q

What are signs that a baby has developed rhesus disease?

A

Anaemia

Jaundice

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24
Q

What causes rhesus disease?

A

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

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25
Q

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

A

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.
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26
Q

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

A

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

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27
Q

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

A

HIV
Syphilis
Hep B

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28
Q

Booking visit - investigations US

A

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

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29
Q

Booking visit - investigations US - we don’t know if its a continuing pregnancy until…

A

We see the foetal heart

30
Q

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

A

Ectopic pregnancy until proven otherwise

31
Q

Follow up visits - examination

A 
BP 
Urinalysis 
Symphysis fundal height (SFH) 
Baby's lie and presentation
Foetal heart auscultation
32
Q

Which 2 things assess the robustness of a screening test?

A

Sensitivity

Specificity

33
Q

Screening tests - everyone must have them True or false?

A

False

- women can choose not to have them

34
Q

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

A

As early as possible, before 10 weeks

35
Q

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

A

Around booking appointment time (11 to 14 weeks)

36
Q

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

A

Woman will be offered a diagnostic test

- that gives a more definite answer

37
Q

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

A

False

- Will tell you whether YOU are a carrier or not

38
Q

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

A

Diagnostic test to find out if baby is affected

39
Q

When is screening for abnormalities carried out?

A

Detailed anomaly scan at 20 weeks

40
Q

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

A

Anencephaly

Spina bifida

41
Q

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

A

Combined test

- US and blood test

42
Q

Trisomy 21

A

Downs Syndrome

43
Q

Trisomy 13

A

Platau’s syndrome

44
Q

Trisomy 18

A

Edwards syndrome

45
Q

Downs syndrome increases/decreases with maternal age.

A

Increases

46
Q

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

A

Nuchal Translucency

- measure of fluid at the back of the baby’s neck

47
Q

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

A

Maternal blood tests

- Assay of HCG and AFP

48
Q

Which diagnostic testing is offered? (2)

A

Amniocentesis

Chorionic villus sampling

49
Q

What is the risk with diagnostic testing?

A

Miscarriage

50
Q

When is Chorionic villus sampling offered?

A

Around 11-14 weeks gestation

51
Q

When is Amniocentesis offered?

A

Around 15 weeks gestation

52
Q

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

A

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

53
Q

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

A

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

54
Q

Which gestation do you do symphysis fundal height measurement from?

A

24 weeks

55
Q

Name 3 ways to assess foetal wellbeing

A

Assess growth

  • customised charts
  • serial growth charts

CTG

Umbilical arterial doppler US

56
Q

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

A

BMI
Ethnicity
Parity

57
Q

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

A

Week 28

58
Q

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

A

36 weeks

59
Q

What is the purpose of measuring symphyseal fundal height?

A

To check for SGA baby

60
Q

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

A

24 weeks

61
Q

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

A

True

  • 400mg
  • to prevent neural tube defects
62
Q

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

A

250-300

63
Q

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

A

True

64
Q

What is A normal value for nuchal translucency

A

less than 3.5mm

65
Q

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

A

HCG - high
AFP - low
PAPP-A - low

66
Q

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

A

Offer increased monitoring of baby and US scan

67
Q

What is haemolytic disease of the newborn caused by?

A

Rhesus negative women and IgG crossing placenta to baby

68
Q

How does anti-D work

A

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

69
Q

What is the window for doing chorionic villous sampling

A

11 weeks - 13+6 weeks

70
Q

Which carries the highest misscarriage risk

  • chorionic villous sampling
  • amniocentesis
A

Chorionic villous sampling

Reproduction SOH (50 decks)

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