Antenatal care and screening Flashcards
Physiological changes in the mother associated with normal pregnancy
multiple systems affected in the body
what topics should be covered in pre pregnancy counselling
General health measures
Improve diet
Optimise BMI
Reduce alcohol consumption
Smoking cessation advice
Folic acid 400 mcg standard dose or 5mg high dose
Vitamin D 10mcg daily
what actions may be necessary following pre pregnancy counselling
Optimise maternal health
Psychiatric health is important Stop/Change any unsuitable drugs Advise regarding complications associated with maternal medical problems Occasionally advise against pregnancy
Good examples are diabetes or epilepsy
previous pregnancy problems that may affect the mother
Pre-eclampsia
DVT/PE
Previous delivery – LSCS or perineal tear
previous pregnancy problems which may affect the baby
Fetal abnormality (if present first baby higher chance second)
Intrauterine growth restriction
Preterm birth
first visit scan role
Ensure pregnancy viable
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s syndrome screening
detailed anomaly scan role
Systematic structural review of baby
Not possible to identify all problems
Can identify problems that need intrauterine or postnatal treatment
screening for trisomy 13,18,21
Multiple screening tests are available
Women and their partners must be aware prior to any screening taking place that tests for fetal abnormality only provide a risk of their baby being affected.
Further testing will be offered to definitively tell if a baby is affected - may result in termination
nuchal translucency scan
NT measurements are taken between Crown Rump Length’s of 45-84mm
what does the screening test involve
NT measurement
CRL
Blood test for PAPP-A (pregnancy associated plasma protein-A), hCG (human chorionic gonadotrophin)
Maternal age
what should happen if not able to get an NT measurement
If not able to get NT measurement or pregnancy is over this gestation, a second trimester screening test can be done between 14+2 and 20+0
Alpha-fetoprotein, Oestriol, hCG and inhibin-A
what happens if the result of screening is high risk
Further testing is offered if risk of a trisomy is >1 in 150
Options:
CVS
Amniocentesis
Non-invasive Prenatal testing
anencephaly
foetus develops without a brain
most common neural tube defect
spina bifida
how successful is second trimester ultrasound in testing chromosomal abnormalities
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
