Antenatal Care and screening

Question 1

How much does the cardiac output and heart rate increase in pregnancy?

Answer 1

CO - 30-50%

HR - from 70 to 90bpm

Question 2

What does the blood flow to the uterus have to be?

Answer 2

over 1L per minute at term

Question 3

What happens to blood pressure in pregnancy?

Answer 3

the uteroplacental circulation expands, so blood pressure DROPS in SECOND trimester, it usually returns to NORMAL in THIRD trimester.

Question 4

What happens to blood viscosity during pregnancy?

Answer 4

Blood viscosity reduces

Question 5

What happens to urine output in pregnancy?

Answer 5

Renal plasma flow increases by 25-50%
GFR increases by 50%
serum urea and creatinine decrease (increased plasma volume dilutes it)
3rd trimester - bladder capacity decreases (pressure from uterus)

Question 6

What happens with UTI’s in pregnancy?

Answer 6

urinary stasis increases

3rd trimester - hydronephrosis occurs and makes pyelonephritis more common

Question 7

What is a side effect of pyelonephritis in pregnancy?

Answer 7

Associated with preterm labour.

Question 8

What happens to levels of haemoglobin, platelets and WBC’s in pregnancy?

Answer 8

Plasma volume increases 25-50%
RBC only increases 25%

^This causes a drop in haemoglobin and platelets in blood by dilution.

WBCs increase slightly.

Question 9

When should iron supplements be given?

Answer 9

If haemoglobin is:
<110 at booking
<100 at 28 weeks

(Normal is 121-151)g/L

Question 10

What respiratory changes happen in pregnancy?

Answer 10

• 02 consumption increases by 20% (plasma PO2 is unchanged)

- Progesterone causes increased rate and depth of breathing (this leads to decreased PCO2 and increase in pH).

Question 11

What GI changes happen in pregnancy?

Answer 11

• Oesophageal peristalsis is reduced
• GI emptying slows
• Cardiac sphincter relates

Caused by increased progesterone and decreased motion

Question 12

How many Scottish pregnancies are unplanned?

Answer 12

1/3

Question 13

How many women die in Scotland during pregnancy or up to 6 weeks after?

Answer 13

9.2 women per 100,000.

Question 14

What sound be prescribed to women with risk factors for pre-eclampsia?

Answer 14

Aspirin from 12 weeks or pregnancy.

Question 15

How much folic acid is prescribed during pregnancy?

Answer 15

400mcg is standard dose.

5mg for BMI>30, taking sodium valproate, previous babies.

Question 16

How much vitamin D is prescribed during pregnancy?

Answer 16

10mcg daily.

Question 17

When should you start to feel foetal movements?

Answer 17

After 20 weeks, if not this might signify a problem.

Question 18

What is SFH?

Answer 18

Symphyseal fundal height - measures top of the fundus to the pubic symphysis and Is plotted on a chart.

It can detect intrauterine growth restrictions.

Question 19

What is ECV in pregnancy?

Answer 19

External cephalic version, offered when baby is still in breech position after 36 weeks. if this fails a cesarian will be done.

Question 20

Which infections are screened for?

Answer 20

Syphilis
HIV
Hep B
UTI

Question 21

Which trisomies are screened for?

Answer 21

13 - Patau’s syndrome
18 - Edwards syndrome
21 - downs syndrome

Question 22

When is the first trimester screening done?

Answer 22

10-14 weeks gestation.

Question 23

What is Nuchal Translucency?

Answer 23

the collection of fluid under the skin behind the metal neck in the first trimester.

It increases with age

The higher the Nuchal translucency, the higher the risk of trisomy and cardiac problems.

Question 24

What are the types of sampling for trisomies?

Answer 24

Chorionic villus sampling (1-2% risk of miscarriage)
Amniocentesis (15 risk of miscarriage)
Maternal blood (no risk of miscarriage)

Question 25

what are the signs of Neural tube defects in screening?

Answer 25

Banana sign of the cerebellum.

Lemon shaped skull sign.

Question 26

What is the second trimester ultrasound good for?

Answer 26

Good - picking up major structural abnormalities

Poor - at picking up trisomies

Question 27

Which medication must be stopped before pregnancy?

Answer 27

Ramipril (all ACE inhibitors contraindicated in pregnancy).