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3A - Reproductive System > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

What fraction of pregnancies are unplanned?

A

1/3

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2
Q

What is the incidence of maternal mortality?

A

9/100000

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3
Q

What are the most common causes of maternal death?

A
  1. Heart disease
  2. Blood clots
  3. Epilepsy and stroke
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4
Q

What is covered in pre-pregnancy counselling?

A
  • General health measures
    • Improve diet
    • Optimise BMI
    • Reduce alcohol consumption
    • Smoking cessation
  • Folic acid
  • Up to date cervical smear
  • Medical history
    • Optimise known medical problems
    • Stop/change unsuitable drugs
    • Occasionally advice against pregnancy
      • Significant cardiac disease
  • Previous pregnancy problems
    • Maternal
      • Pre-eclampsia – aspirin 150mg during pregnancy and regular BP monitoring
      • Gestational diabetes – HbA1C booking and OGTT at 28 weeks
      • Previous caesarean section – consider elective caesarean section
      • DVT or PE – consider antenatal thromboprophylaxis and 6 weeks postnatal treatment
    • Foetal
      • Intrauterine growth restriction – aspirin 150mg during pregnancy and serial USS
      • Preterm birth – transvaginal cervical length scans or cervical suture
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5
Q

What are some previous medical problems that need discussed at pre-pregnancy counselling?

A
  • Maternal
    • Pre-eclampsia – aspirin 150mg during pregnancy and regular BP monitoring
    • Gestational diabetes – HbA1C booking and OGTT at 28 weeks
    • Previous caesarean section – consider elective caesarean section
    • DVT or PE – consider antenatal thromboprophylaxis and 6 weeks postnatal treatment
  • Foetal
    • Intrauterine growth restriction – aspirin 150mg during pregnancy and serial USS
    • Preterm birth – transvaginal cervical length scans or cervical suture
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6
Q

What does antenatal examination involve?

A
  • Abdominal palpation
    • Assess symphyseal fundal height (SFH)
    • Estimate size of baby
    • Estimate liquor volume
    • Determine foetal presentation
  • Listen to foetal heart
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7
Q

What does abdominal palpating when pregnant allow?

A
  • Assess symphyseal fundal height (SFH)
  • Estimate size of baby
  • Estimate liquor volume
  • Determine foetal presentation
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8
Q

What does SFH stand for?

A

Symphyseal fundal height

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9
Q

What are examples of antenatal screening offered to woman?

A
  • Screening for infection (carried out in 1st trimester)
    • Hep B
    • Syphilis
    • HIV
      • Maternal treatment and planning reduces vertical transmission
    • MSSU
      • UTI
  • Anaemia and isoimmunisation (1st trimester and at 28 weeks)
    • Isoimmunisation is high levels of certain red cell antibodies that can cause anaemia in the foetus
  • Anomalies by USS
    • Ensure pregnancy is viable and identify abnormalities incompatible with life
    • First scan carried out between 11 and 14 weeks
    • Second scan in 2nd trimester
  • Chromosomal abnormalities
    • 1st trimester screening
      • Carried out at 10-14 weeks
      • Uses maternal factors, serum B-human chorionic gonadotrophin (B-hCG) and pregnancy associated plasma protein A (PAPP-A) and foetal nuchal translucency (NT) measurement
    • 2nd trimester screening
      • Sometimes NT measurement not possible due to foetal position or maternal BMI
    • Checks for down syndrome (trisomy 21), Edward’s syndrome (trisomy 18) and Patau’s syndrome (trisomy 13)
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10
Q

Screening for what infections is carried out?

A
  • Hep B
  • Syphilis
  • HIV
    • Maternal treatment and planning reduces vertical transmission
  • MSSU
    • UTI
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11
Q

Why are anomilies checked for with USS?

When do these scans occur?

A
  • Ensure pregnancy is viable and identify abnormalities incompatible with life
  • First scan carried out between 11 and 14 weeks
  • Second scan in 2nd trimester
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12
Q

What chromosomal abnormalities are checked for?

A
  • Checks for down syndrome (trisomy 21), Edward’s syndrome (trisomy 18) and Patau’s syndrome (trisomy 13)
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13
Q

How are chromosomal abnormalities checked for during screening?

A
  • Uses maternal factors, serum B-human chorionic gonadotrophin (B-hCG) and pregnancy associated plasma protein A (PAPP-A) and foetal nuchal translucency (NT) measurement
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14
Q

When would NT measurements not be possible?

A

Due to foetal position or maternal BMI

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15
Q

What does NT measurement stand up for?

A

Nuchal translucency measurement

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16
Q

When is 1st trimester screening for chromosomal abnormalities carried out?

A

Between 10-14 weeks

17
Q

When do US anomaly scans take place?

A
  • First scan carried out between 11 and 14 weeks
  • Second scan in 2nd trimester
18
Q

When does screening for anaemia and isoimmunisation take place?

A

1st trimester and at 28 weeks

19
Q

If chromosomal screening reveals high risk, what can then be done?

What is considered to be high risk?

A

High risk is >1/150 chance

More testing is offered

20
Q

What additional testing is offered if chromosomal screening reveals high risk?

A
  • Chorionic villus sampling (CVS)
    • Between 10-14 weeks
    • 1-2% of miscarriage
  • Amniocentesis
    • 15 weeks onwards
    • 1% risk of miscarriage
  • Non-invasive prenatal testing
    • Maternal blood taken to detect foetal cell free DNA and look for chromosomal trisomy
21
Q

What can be a consequence of CVS or amniocentesis?

A

Miscarriage

22
Q

When does CVS take place?

A

Between 10-14 weeks

23
Q

When can amniocentesis take place?

A

Beyond 15 weeks

(amniocentesis = medical procedure used primarily in prenatal diagnosis of chromosomal abnormalities)

24
Q

What does CVS stand for?

A

Chorionic villus sampling

25
Q

Describe non-invasive prenatal testing as an additional form of testing after high risk chromosomal abnormality is identified?

A
  • Non-invasive prenatal testing
    • Maternal blood taken to detect foetal cell free DNA and look for chromosomal trisomy
    • Not offered on NHS
26
Q

How does the risk of morbidity change with a twin pregnancy?

A

Increased risk

27
Q

What is the incidence of twin pregnancy?

A

2-3% of all births, increasing due to assisted conception

3A - Reproductive System (34 decks)

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