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Y4 Obstetrics and Gynaecology > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

How many antenatal visits should someone with an uncomplicated pregnancy have ?

A
  • 10 antenatal visits in the first pregnancy if uncomplicated
  • 7 antenatal visits in subsequent pregnancies if uncomplicated

Note: women do not need to be seen by a consultant if the pregnancy is uncomplicated

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2
Q

Following confirmation of pregnancy what does the first antenatal appointment consist of and when should it occur ?

A

The booking visit should occur between weeks 8-12 but ideally before week 10

  • History - menstural, medical, obstetric, social, family
  • Examination -BP, BMI, CVS, Abdomen
  • During it offer general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
  • Screening: urine dipstick (for asymptomatic bacteruria and proteinuria) and blood tests for checking blood group and rhesus D status and screening for haemoglobinopathies, anaemia, red-cell alloantibodies, hepatitis B virus, HIV and syphilis
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3
Q

After the initial booking visit and screening what is the next antenatal visit

A

Early date US scan - occurs between 10 - 13+6 weeks

  • To determine gestational age and exclude multiple pregnancies, determine viability

Note this may be done with the booking visit

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4
Q

What is the next antenatal visit after the early date US scan ?

A

The downs syndrome combined screening test between weeks 11 - 13+6

  • Combined test consists of: nuchal translucency measurement + serum B-HCG + pregnancy associated plasma protein A (PAPP - A)

NT thickness = Measure of skin thickness behind fetal neck using U/S

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5
Q

For what reasons would a women undergo the triple or quadruple downs syndrome screening tests and when ?

A

If women book later in pregnancy or when it is not possible to measure nuchal translucency, owing to fetal position or raised BMI

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6
Q

What is measured in the triple or quadruple downs syndrome screening tests ?

A
  • *alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin
  • **alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A
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7
Q

> 1 in 250 pregnancies will be deemed as high risk for downs syndrome, what further investigations can be done to definitely diagnose or rule out downs syndrome ?

A

Amniocentesis:

  • –Usually performed after 15 weeks
  • –Carries a miscarriage rate of 1%

Chorionic villus sampling:

  • –Usually performed after 11.5-12 until 14 weeks
  • –Carries a miscarriage rate of 2%

Note the choice is up to the parents which test they choose

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8
Q

What percentage of downs syndrome babies will not be detected by downs syndrome screening ?

A

10% ==> 1 in 10 chance even if low risk that baby will have downs syndrome

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9
Q

Following downs syndrome screening what is the next antenatal appointment ?

A

16 week appointmeant consisting of:

  • Review, discuss and record the results of all screening tests undertaken
  • Investigate a haemoglobin < 11 g/100 ml and consider iron supplementation if indicated
  • Routine BP and urine dipstick
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10
Q

Following the 16 week appointment what is the next antenatal appointment ?

A
  • 18 - 20+6 weeks appointment
  • If the woman chooses, an ultrasound scan should be performed for the detection of structural anomalies.

Note: For a woman whose placenta is found to extend across the internal cervical os at this time, another scan at 32 weeks should be offered.

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11
Q

Following the 18 - 20+6 week structural abnormality scan what is the next antenatal appointment and who is this only offered for ?

A

Only for nulliparous women consisting of:

  1. Measure and plot symphysis‒fundal height
  2. Measure BP and test urine for proteinuria
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12
Q

What is the next appointment for ALL pregnant women after the 18 - 20+6 week appointment ?

A

The 28 week appointment consisting of:

  1. Routine - BP, urine dipstick, SFH
  2. Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
  3. First dose of anti-D prophylaxis to rhesus negative women
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13
Q

Followinf the 28 week appointment what is the next aneonatal appointment and who is this only for ?

A

Only for nulliparous women it is simply a routine check up:

  • BP, urine dipstick, SFH
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14
Q

Following the 28 week appointment what is the next antenatal appointment for ALL women ?

A

34 week appointment consisting of:

  • Routine care - BP, urine dipstick and SFH
  • Second dose of anti-D prophylaxis to rhesus negative women
  • review, discuss and record the results of screening tests undertaken at 28 weeks
  • Information on labour and birth plan
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15
Q

Following the 34 week antenatal appointment what is the next appointment ?

A

36 week appointment consisting of:

  • Routine care - BP, urine dipstick and SFH
  • Check presentation - offer external cephalic version (ECV) if baby is in the breech presentation
  • Provide info on breast feeding, vitamin K, ‘baby-blues
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16
Q

Following the 38 week antenatal appointment what is the next appointment and who is this only for ?

A

40 week appointment only for nulliparous women consisting of:

  • Routine care - BP, urine dipstick and SFH
  • Discussion about options for prolonged pregnancy
17
Q

Following the 38 week appointment what is the next antenatal appointment for ALL women ?

A

41 week appointment consisting of:

  • Routine care - BP, urine dipstick and SFH
  • Discuss labour plans - membrane sweep and induction of labour should be offered
18
Q

What conditions should all pregnant women be screened for ?

A
  • Anaemia
  • Bacteriuria
  • Blood group, Rhesus status and anti-red cell antibodies
  • Down’s syndrome
  • Fetal anomalies
  • Hepatitis B
  • HIV
  • Neural tube defects
  • Risk factors for pre-eclampsia
  • Rubella immunity
  • Syphilis
19
Q

What conditions may a pregnant women be screened for ?

A
  • Placenta praevia
  • Psychiatric illness
  • Sickle cell disease
  • Tay-Sachs disease
  • Thalassaemia
20
Q

What conditions should a pregnant women not be screened for ?

A
  • Bacterial vaginosis
  • Chlamydia
  • Cytomegalovirus
  • Fragile X
  • Hepatitis C
  • Group B Streptococcus
  • Toxoplasmosis
21
Q

What supplements are pregnant women recommended to take ?

A
  • Folic acid 400mcg should be given from before conception until 12 weeks into pregnancy
  • 10 micrograms of vitamin D per day
22
Q

Are iron supplements routinley recommended in pregnancy ?

A

No

23
Q

Taking supplements of what vitamin can be tetragenic during pregnancy ?

A

Vit A - intake above 700 micrograms might be tetragenic. Liver is high in vitamin A so consumption should be avoided.

24
Q

What is the recommendations for alcohol intake in pregnant women ?

A

To take none

25
Q

What are the risks of smoking during pregnancy

A

Low birth weight and preterm birth

26
Q

What are the 2 main food acquired infection pregnant women are informed about and how do they avoid them?

A
  1. listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
  2. salmonella: avoid raw or partially cooked eggs and meat, especially poultry
27
Q

what are the recommendations for air travel for pregnant women ?

A
  • women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
  • women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
28
Q

What is air travel in pregnant women associated with a risk of and what is done to reduce this risk?

A
  • Associated with an increased risk of VTE
  • Compression stocking are used to reduce the risk
29
Q

What are the recommendations for exercise during pregnancy ?

A
  • Beginning or continuing moderate exercise is not associated with adverse outcomes
  • Although certain activities should be avoided e.g. high-impact sports where there is a risk of abdominal trauma and scuba diving
30
Q

What are the recommendations on sexual intercose during pregnancy ?

A

It is not known to be associated with adverse outcomes

31
Q

How is the due date of a baby calculated ?

A

You simply add 9 months and 7 days onto when they last had there period

32
Q

What happens to the risk of downs sydrome in a pregnancy with increasing maternal age ?

A
33
Q

List 3 good questions to ask mothers when assessing their mental health during antenatal visits ?

A
  • Do you have new feelings and thoughs which you have never had before, which make you disturbed or anxious ?
  • Are you experiencing thoughts of suicide or harming yourself in violent ways ?
  • Are you feeling competent as a mother as though you cant cope or feeling distant or estranged
34
Q

SFH is measured at each antenatal appointment after 24 weeks onwards and each result is plotted on a growth chart, if a single SFH is plotted below the 10th centile or serial measurements demonstrate slow or static growth by crossing a centile then what should be done ?

A

U/S assessment of fetal size

35
Q

In what women is measurement of SFH inaccurate and therefore what is done instead to monitor their babies growth after 24 weeks onwards ?

A
  • In women it is inaccurate - BMI > 35, large fibroids, hydraminos
  • Fetal size should be assessed on U/S.

Y4 Obstetrics and Gynaecology (63 decks)

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