ANTENATAL CARE

Question 1

What is the standard dose of folic acid that all women looking to become pregnant should be on?

Answer 1

400 micrograms

Question 2

What are the indications for giving women who are looking to become pregnant a higher dose of folic acid than the normal 400 micrograms?

Answer 2

Women who are obese

Women with diabetes

Women with epilepsy

Women with a previous child who has been affected by a neural tube defect

Question 3

What is the increased dose of folic acid that should be given to women looking to become pregnant who have risk factors such as obesity, epilepsy, diabetes or those who have had a previous pregnancy affected by a neural tube defect?

Answer 3

5 mg

Question 4

Why do we recommend vitamin D supplementation in pregnant women?

Answer 4

Maternal vitamin D is important for fetal bone development, fetal lung development and reduction in neonatal immune conditions.

Low vitamin D levels are associated with impaired glucose tolerance and diabetes in the general population.

Question 5

What is the standard dose of vitamin D that all pregnant women should be on?

Answer 5

10 micrograms (400 units) of vitamin D per day

Question 6

What are the indications for giving pregnant women a higher dose of vitamin D than the normal 10 micrograms per day?

Answer 6

Obese (hence why Ruhmana needs to take it)

Increased skin pigmentation

Reduced exposure to sunlight

Socially excluded

Question 7

What is the increased dose of vitamin D that should be given to pregnant women who have risk factors for low levels of vitamin D?

Answer 7

High risk women are advised to take at least 1000 units per day.

Question 8

What vitamin supplements should avoided in early pregnancy?

Answer 8

Vitamin A supplementation is teratogenic

Question 9

What blood tests should be taken at booking appointment?

Answer 9

Full Blood Count

Haemoglobinopathy screen

Group and Save - rhesus status

HIV

Rubella Immunity

Syphilis screen

Hepatitis B

Combined screening test for trisomy 13, 18 and 21 - beta-HCG and PAPP-A

Question 10

What are the combined parts of the combined screening test for trisomy 13, 18 and 21?

Answer 10

Blood test - beta-HCG (high) and PAPP-A (low)

USS - Nuchal translucency

Question 11

What is the window for performing the combined screening test for trisomy 13, 18 and 21?

Answer 11

10th to 14th week gestation

Question 12

If a patient misses the window for the combined screening test for trisomy 13, 18 and 21, what test will she be offered?

Answer 12

The quadruple test, a blood test that measures:

AFP - Low

beta-HCG - High

Inhibin-A -

Oestriol - Low

It is less accurate than the combined screening test

Question 13

What is considered a high risk result from the combined screening test?

Answer 13

A high risk result for both the combined and quad test is considered as >1:150 (i.e. between 1 in 2 and 1 in 150 risk).

Question 14

If the combined screening test for trisomy 13, 18 and 21 yields a high risk result what diagnostic tests may be offered?

Answer 14

Non-invasive prenatal test (NIPT)

Amniocentesis

Chorionic villus sampling (CVS)

Question 15

What is the non-invasive prenatal test (NIPT) for the diagnosis of trisomy 13, 18 and 21?

Answer 15

This is a maternal blood test, hence non-invasive. It allows testing of the fetal genome via cell-free feral DNA that is found in the maternal blood stream. It is not completely diagnostic but in the context of a high risk screening test, NIPT might be recommended.

Question 16

What is amniocentesis in the context of trisomy 13, 18 or 21 diagnosis?

Answer 16

This is an invasive test that takes a small sample of amniotic fluid from around the baby under ultrasound guidance. It is done from 15 weeks gestation and women need to be aware that it carries a 1% risk of miscarriage.

Question 17

What is chorionic villus sampling (CVS) in the context of trisomy 13, 18 or 21 diagnosis?

Answer 17

This too is an invasive test where a tiny piece of the developing placenta is taken through the abdomen (or via the cervix) under ultrasound guidance. This test is normally done earlier that amniocentesis, at 11-14 weeks gestation. Again, women need to be aware that this test carriers a 1-2% risk of miscarriage.

Question 18

What risk factors would prompt you to screen a woman for gestational diabetes?

Answer 18

BMI above 30kg/m2

Previous pregnancy affected by gestational diabetes.

First-degree relative with diabetes

Previous macrosomic baby weighing more than 4.5kg

Family originates from South Asia, the Caribbean or the Middle East

Previous diagnosis of polycystic ovarian syndrome

Question 19

How often should women with gestational diabetes be checking their blood sugars?

Answer 19

Daily fasting (best in the morning)

2 hours after every meal

Question 20

What should the target blood glucose levels be for women diagnosed with gestational diabetes according to NICE?

Answer 20

Fasting: less than 5.6mmol/L

1 hour after meals: less than 7.8mmol/L or

2 hours after meals: less than 6.4mmol/L

Question 21

Who should be involved in the management of a woman with gestational diabetes?

Answer 21

The MDT includes:

Specialist midwives

Dieticians

Specialist obstetricians

Endocrinologists

Question 22

Due to her age, a 42-year-old pregnant woman is screened for chromosomal abnormalities. If her baby has trisomy 21 (Down’s syndrome), which of the following results would be expected?

High alpha fetoprotein (AFP)

High oestriol

Low human chorionic gonadotrophin beta-subunit (-HCG)

Low pregnancy-associated plasma protein A (PAPP-A)

Reduced nuchal translucency

Answer 22

Low pregnancy-associated plasma protein A (PAPP-A)

The following results would be expected in a trisomy 21 (Down’s syndrome) pregnancy:

• Low alpha fetoprotein (AFP)
• Low oestriol
• High human chorionic gonadotrophin beta-subunit (-HCG)
• Low pregnancy-associated plasma protein A (PAPP-A)
• Thickened nuchal translucency