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a11. Reproductive (Physiology) > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

What is screening?

A

A process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition

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2
Q

What promotion/advice can be given to expecting mothers in primary care to provide pre-pregnancy counselling?

A
  • General health measures:
    • Improved diet
    • Optimize BMI
    • Reduce alcohol consumption
  • Smoking cessation
  • Folic acid (400mcg standard, 5mg high dose)
  • Vitamin D (10mcg daily)
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3
Q

What is the:

a) Standard dose of folic acid prescribe pre-pregnancy?
b) High dose of folic acid prescribe pre-pregnancy?

A

a) 400 mcg
b) 5 mg

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4
Q

What is the dose of Vitamin D prescribed to women pre-pregnancy?

A

10 mcg daily

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5
Q

When should folic acid be started?

A

3 months before pregnancy

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6
Q

Which mothers should be on the higher dose of folic acid?

A
  • BMI <30
  • Medications: epilepsy using valproate
  • Previous baby with spina bifida
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7
Q

What is important to cover in pre-pregnancy counselling?

A
  • Optimizing maternal health
  • Psychiatric health
  • Stop/change unsuitable drugs
  • Advise on complications associated with maternal medical problems
  • Occasionally advise against pregnancy
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8
Q

What conditions is it important to be aware of if a woman had had them in a previous pregnancy to reduce the risk of recurrence in the present pregnancy?

A

Actions can be taken to reduce the risk of recurrence

Maternal

  • C section
  • DVT → thromboprophylaxis
  • Pre-eclampsia→ low dose aspirin (150 mg until birth)

Fetal

  • Pre-term delivery → treatment of infections
  • Intrauterine growth restriction
  • Fetal abnormality → high dose folic acid, low dose aspirin
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9
Q

What inquiry is involved in the antenatal examination?

A
  • Routine
    • Feeling well? Feeling fetal movements (after 20 weeks)
  • Blood pressure
    • Hypertension (pre-eclampsia)
    • Urinalysis
  • Abdominal palpation:
    • Assess symphyseal fundal height (SFH)
    • Estimate size of baby
    • Estimate liquor volme
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10
Q

What are the screens that are done antenatally for infection?

A

Offered routinely

  • Hepatitis B: if infective, passive and active immunization for baby
  • Syphilis: treated with penicillin
  • HIV: Matrenal treatment, planning reduced vertical transmission
  • MSSU: UTI
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11
Q

What screening is done at weeks 12 and 28 of gestation?

A
  • Iron deficiency anemia
  • Isoimmunisation:
    • Rhesus disease
    • Anti-c antibody, Anti-Kell antibody
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12
Q

What is the purpose of the first trimester visit ultrasound scan?

A
  • Ensure viable pregnancy
  • Multiple pregnancies (type of pregnancy: monochorionic, dichorionic)
  • ID abnormalities incompatible with life
  • Offer/carry out Down’s / Pataus/ Edwards syndrome screening
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13
Q

What is the purpose of the detailed anomaly scan?

A
  • Attempt to get systematic structural review of baby
  • Not possible to ID all problems, but can ID intrauterine/postnatal treatment
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14
Q

Which condition that can be found on the detailed anomaly scan at the 1st trimester, are not viable with life?

A
  • Anencephaly (spina bifida spectrum): skull bone doesn’t form, may survive a few hrs after birth, no long term survival
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15
Q

What information can be provided by the screening tests for Trisomy 13, 18 and 21?

A

The tests for foetal abnormality only provide a risk of their baby being affected

Prenatal screening may cause parents to make difficult decisions regarding termination of pregnancy

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16
Q

When is the 1st trimester screening carried out?

A

Weeks 10-14 gestation

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17
Q

What is measured during the 1st trimester combined test?

A

Uses:

  • Maternal risk factors (age)
  • Serum beta-human chorionic gonadotrophin (B-hCG)
  • Pregnancy associated plasma protein A(PAPP-A) and
  • Fetal nuchal translusency (NT) measurement
  • Gestational age claculated from crown rump length (CRL)

All these factors are used to calculate e the chance of the pregnancy being affected by T21 or T18/T13

18
Q

When is the optimal time to perform the 1st trimester combined test?

A

11+2 weeks to 14+1 weeks of gestation, which corresponds to a CRL (Crown rump length) of 45.0 mm to 84.0 mm.

19
Q

If nuchal translucency cannot be measure during the 1st trimester combined test, when should it be offered?

A

At least 1 other attempt (same day/later date)

  • Otherwise woman can be referred to 2nd trimester screening pathway
20
Q

What is the Nuchal translucency (NT)? How is this measurement used?

A

Between 11+2 weeks and 14+1 weeks of pregnancy the thickness of fluid in the tissue space within the nape of the fetal neck, the nuchal translucency can be measured. An increased amount of fluid may indicate that the fetus has Down’s syndrome, structural or genetic anomaly. By combining the mother’s age and the gestation of the pregnancy with information from the scan an individual statistical chance of an anomaly can be given for that particular pregnancy. If the chance is between 1 in 2 and 1 in 150 a diagnostic test, such as CVS, will be offered

21
Q

By what stage in the pregnancy must the screening pathway be completed?

A

23 weeks of gestation

22
Q

What conditions are screened for during the 2nd trimester fetal anomaly scan?

A
23
Q

What is the 2nd trimester quadruple screen?

A

The quadruple test uses:

  • maternal age and
  • four biochemical markers measured from 14+2 weeks until 20+0 weeks - AFP, hCG (total, intact or free beta subunit), uE3 and Inhibin-A
24
Q

What are the next steps if the CRL measurement is:

a) Below 45.0 mm?
b) Above 84.0mm?

A

a) Recall woman for further scan to measure Nuchal traslusency
b) 2nd trimester scan quadruple test offered

25
Q

If a woman receives a high risk result from the 1st trimester screening for trisomy’s, what is/can be done?

A

Results of 1/150 are high risk

  • Further testing offered if risk of Down’s is 1 in 150
  • Options
    • Chorionic villous sampling
    • Amniocentesis
    • Non-invasive Prenatal testing
26
Q

How is non-invasive prenatal testing carried out?

A
  • Maternal blood taken (no risk of miscarriage)
  • Can detect fetal cell free DNA released from the placenta
  • Not diagnostic, so if gives a high risk result, parents are offered CVS/amniocentesis
27
Q

At what stage of pregnancy can Chorionic villous sampling be carried out?

A

10-14 weeks gestation

28
Q

At what stage of pregnancy can amniocentesis be carried out?

A

15 weeks onward

29
Q

What are the risks of CVS and Amniocentesis screening?

A
  • CVS: 1-2% risk of miscarriage
  • Amniocentesis: ~1% risk of miscarriage
30
Q

What advice is given to couples who have a personal/family history of neural tube defects?

A

They are at higher risk

  • Take 5mg folic acid to reduce risk
31
Q

What 2 conditions can be detected in the 1st trimester scan that are variants of neural tube defect?

A
  • Spina Bifida
  • Anencephaly
32
Q

What 2nd trimester screening is done to screen for neural tube defects?

A

Biochemical screening (carried out if nuchal translucency measurement was not possible in 1st trimester)

  • Maternal serum tested for alpha fetoprotein (>2.0 MoM is high risk → investigation)
33
Q

What percentage of neural tube defects will be detected at 2nd trimester scan (20 wks)

A

> >90%

34
Q

Why is second trimester ultrasound a poor test for chromosomal abnormalities?

A
  • 50% of fetuses with T21 will have a normal detailed USS•
  • 17% of fetuses with T18 will have a normal detailed USS•
  • 9% of fetuses with T13 will have a normal detailed USS
35
Q

What major abnormalities is looked for in 2nd trimester ultrasound?

A

Hypoplastic left heart: no left ventricle forms (multiple stage surgeries required to amend this)

Exomphalos: protrusion of bowel within a sac into the umbilical for (30% association with chromosomal abnormalities and underlying trisomies)

Cleft lip: termination for this is under ethical discussion. Its not considered to be a major abnormality

36
Q

When is a foetal anomaly scan (FASP) recommended to be carried out?

A

18weeks - 20 weeks and 6 days

37
Q

What are the choices of screening options for foetal anomaly screening (FASP) from which women can choose?

A
  • not to have screening
  • to have screening for T21 and T18 / T13
  • to have screening for T21 only
  • to have screening for T18 / T13 only
38
Q

Define amniocentesis

A

An invasive procedure undertaken from about 15 completed weeks (15+0) onwards to obtain a sample of amniotic fluid (liquor) surrounding the fetus. Using an aseptic technique whilst under continuous ultrasound guidance, a sterile needle is passed through the mother’s abdomen, uterus and amniotic sac. A sample of amniotic fluid is aspirated with a syringe and sent for analysis to test for a range of chromosomal and inherited disorders. Up to 1 out of every 100 women who have an amniocentesis will miscarry.

39
Q

Define Chorionic villous sampling

A

An abdominal or cervical procedure performed under continuous ultrasound guidance after 10 completed weeks in pregnancy to obtain a sample of placental tissue for chromosomal or genetic analysis. The range of chromosomal and genetic conditions that can be detected is similar to those for amniocentesis. Up to 1 out of every 100 women who have a CVS will miscarry.

40
Q

Define Crown rump length (CRL)

A

Ultrasound measurement between the top of the head (crown) to the bottom of the buttocks (rump). To be eligible for first trimester combined screening as part of the NHS screening programme the CRL should measure between 45.0mm and 84.0mm.

a11. Reproductive (Physiology) (4 decks)

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