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Obstetrics > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Purpose of Antenatal Care

A

aims to provide Evidence-based Information and Support to make informed
decisions, Advise on Minor problems and symptoms, Assess Maternal and Foetal Risk, Monitor Wellbeing throughout pregnancy
• BP and Urine check at every visit to detect signs of Pre-eclampsia and Diabetes

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2
Q

What is shared obstetric care

A

GP and Community Midwife undertake most Obstetric care, with limited number of visits to Hospital
o Routine Involvement of Obstetrician in care of Uncomplicated Pregnancy does not improve Perinatal Outcomes
o Information given regarding giving birth at home, at Midwife-led unit, or Hospital

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3
Q

What happens at first contact?

A

Folic acid and Lifestyle advice, Antenatal Screening and Booking Appointment

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4
Q

When should booking happen?

A

Booking should happen ideally early in pregnancy (<12/40); Very late bookers, or unbooked pregnancies have higher risk of Perinatal and Maternal Morbidity and Mortality

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5
Q

What happens at booking?

A

should comprise Comprehensive History and Full Physical Examination
o BMI, BP, Dipstick, Ultrasound for Gestational age
o Information on Antenatal Classes, Pregnancy Care Pathway, Nutrition, Diet, Vitamins, Maternity Benefits and information on Foetal development

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6
Q

Blood Tests at Pregnancy: FBC

A

Lower limit of normal Hb at 10.5; Commonest cause of Anaemia is IDA
o Investigate Haematinics (Ferritin, TIBC, Red Cell Folate, Serum B12)

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7
Q

Blood Tests at Pregnancy: Blood group and abnormal antibodies

A

If Rh negative with Rh positive father – Commence Anti D Prophylaxis

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8
Q

Blood Tests at Pregnancy: Syphilis

A

Uncommon but important cause of Neonatal Disease

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9
Q

Blood Tests at Pregnancy: Rubella

A

2% of Nulliparous and 1% of multiparous are non-immune to Rubella; Should
receive Post-Partum Rubella vaccination

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10
Q

Blood Tests at Pregnancy: Hep B

A

Neonates infected are at higher risk of becoming Chronic Carriers
(90%), and higher risk of developing Cirrhosis and HCC
o Neonates given Hep B Vaccination at birth if mother HBsAg positive but e negative; If e positive, +Passive Immunisation (HBIg)

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11
Q

Blood Tests at Pregnancy: HIV

A

Vertical Transmission can be reduced by two thirds if treatment of mother
with Antiretrovirals, and Neonate for 6/52 post; Risk of transmission reduced with C-section and avoidance of Breastfeeding

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12
Q

Blood Tests at Pregnancy: Haemoglobinopathies

A

Hb Electrophoresis – Minor Ethnic or Racial origins with high risk of Haemoglobinopathies
(Mediterranean, Middle Eastern, Indian, SEA for Thalassaemia, African/Afro-Caribbean for
Sickle Cell disease); Also, if Persistent Maternal Anaemia

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13
Q

Blood Tests at Pregnancy: Others

A

Thyroid, HbA1c, Baseline Urea and Creatinine

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14
Q

16 week appointment

A

(Discuss Screening, investigate if Hb<11g/dL, Arrange Anomaly scan at 18-20 weeks)

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15
Q

25 weeks

A

if Primiparous – BP, Urine Drip, SFH plot (The works)

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16
Q

28 weeks

A

Screen Anaemia and Atypical RBC allo-ab, Anti D Prophylaxis, BP, The works

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17
Q

31 weeks

A

The works

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18
Q

34 weeks

A

Discuss Labour and Birth, Anti D Prophylaxis, The works

19
Q

36 weeks

A

Discuss Breastfeeding, Vit K Prophylaxis, Post-natal care, Mental Health awareness, The works

20
Q

Other antenatal appointments in third trimester

A

38, 40, 41 weeks: membrane sweep, 42 weeks: induction

21
Q

Prenatal Screening Tests

A

Prenatal Diagnosis helps in Planning Timing, Mode and Place of Delivery, Preparation for Parents, Planning Specialist Neonatal Services, Foetal Surveillance, In-Utero Treatment and
option of Termination of Pregnancy

22
Q

Screening for chromosomal abnormalities

A

Negative result doesn’t guarantee no abnormality

Offered to all women at booking

23
Q

Combined Test

A 
For Down Syndrome 
Offered at 11-13 weeks 
Nuchal scan: Increased translucency marker for structural defects
PAPP-A
B-HCG
24
Q

How is Down Syndrome risk calculated?

A

Down syndrome risk = Maternal Age Risk × Gestation-related risk (NT + Blood tests)
o Foetuses with Downs more likely to have absent/hypoplasia Nasal bone, Significant
Tricuspid Regurgitation

25
Q

Alternative screening for Down’s Syndrome

A

Dating scan plus Triple/Quad Tests at 16/52
– Oestriol, hCG, AFP, and inhibin A
o Oestriol reduced in Trisomy 21 and 18; hCG reduced in T18 and raised in T21
o Recommended if NT scan was not possible, or
missed window for Combined test

26
Q

Other trisomy screening

A

Integrated Test (NT and PAPP-A at 10 – 13 weeks, Quad serum at 15 weeks) and
Serum Integrated Test (Dating Scan, PAPP-A at 10 weeks, Quad serum at 15 weeks)
• AFP – If above 2.2 multiples of median, screening for Open NTDs and other structural defects
e.g. Abdominal Wall, Nephrosis, Bowel Obstruction, Teratomas etc
o Marker of Adverse Perinatal Outcomes – Foetal death, IUGR, Late Bleeding and Prem

27
Q

Screening for structural abnormalities

A

Occurs at 18 – 21 weeks Gestation; High pickup rate of CNS but lower of Cardiac defects
• Covers Skull Shape and Internal Structures, Spine, Abdominal Shape and Contents, Arms,
Legs, Heart, Face and Lips

28
Q

Neural Tube Defects

A

Occur early in development due to failure of closure; Believed to be reduced due to Folate supplementation; Spinal Bifida and Anencephaly make up 95% of defects
o Anencephaly – Absence of Skull vault and Cortex; Incompatible with life
o Spinal Bifida – Occulta, Meningocoele, Myelomeningocoele

29
Q

Cardiac Defects

A

Most common major malformations; May be associated with Chromosomal
abnormalities (Commonly T21 and 18); Most common is VSD
o Risk Factors – FH, Maternal Rx (Li, AEDs), Maternal DM, Other congenital
abnormalities, Increased NT

30
Q

Renal Agenesis

A

Lethal due to Anhydramnios causing Lung Hypoplasia; May not be evident
before 16/40 as Amniotic fluid not fully urinary before then

31
Q

Posterior Urethral Valve Syndrome

A

(Males, Outflow Obstruction), Hydronephrosis (75% of

Renal Abnormalities; May be PUJ obstruction, VUR, Ureterocoele, PUV)

32
Q

Lung Hypoplasia

A

Often Oligohydroamnios; Also, Compression; Severity associated with PPROM<25/40, Severe Oligohydramnios, Early delivery; High Mortality

33
Q

Diaphragmatic Hernia

A

30% incidence of Aneuploidy; 40% Postnatal death from Lung
Hypoplasia; Others might require Postnatal Surgery; Foetal surgical techniques in
development e.g. Foetoscopic Tracheal Occlusion

34
Q

Congenital Cystic Adenomatoid Malformation

A

Rare; Normal lung replaced by Proliferation of

Cysts resembling Bronchioles

35
Q

Exomphalos (Omphacocele)

A

Failure of gut to return to Abdominal Cavity after normal Extrusion and Rotation; Viscera contained within sac, and Umbilical cord arises from apex
o 1/3 occur with Chromosomal abnormalities; another 1/3 have other malformations
o Prognosis depends on Karyotype, Concurrent malformations, Ischaemia; 40% Mort

36
Q

Gastroschisis

A

Protrusion of gut through Anterior Abdominal wall defect (usually Right of Umbilicus);
Not covered by sac
o Usually occurs in very young mothers (<25yrs); No increased risk of
Chromosomal Abnormalities; 5 – 10% may die In-Utero or post-natal, but prognosis is
good in the remainder of infants

37
Q

Gastrointestinal Obstruction

A

Duodenal Atresia

(30% T21), Oesophageal Atresia (15% have Aneuploidy), Other Atresias may occur with Syndromes or Gastroschisis

38
Q

Chorionic Villus Sampling

A

Performed 10-13/40; Aspiration of some Trophoblastic cells
Small amount of tissue taken Transabdominally (sometimes Transcervical) under USS
guidance for Karyotyping; Rapid analysis is possible with FISH and PCR

39
Q

Chorionic Villus Sampling: Indication

A

Indications include Karyotyping in first trimester if screening indicates high risk for Aneuploidy, and DNA analysis of parents of carriers of identifiable gene mutation

40
Q

Chorionic Villus Sampling: Risk

A

Allows for first trimester TOP
risk of Miscarriage 1%; Increased risk of
Vertical transmission of Blood-borne Viruses

41
Q

Chorionic Villus Sampling: Accuracy

A

Placental Mosaicism and Maternal contamination can cause misleading results

42
Q

Amniocentesis

A

Performed >15/40; Aspiration of Amniotic fluid, which contains shed Foetal
cells from skin and GI tract; Transabdominal under USS guidance

43
Q

Amniocentesis: Indications

A

Same indications as CVS, plus allow for Enzyme assay for IEMs; Can also be used to
diagnose Foetal Infections e.g. CMV, Toxoplasmosis

44
Q

Amniocentesis: Risk

A

Lower procedure-attributed risk vs. CVS; Lower risk of Maternal contamination, or
Placental Mosaicism

Obstetrics (18 decks)

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