Antenatal Care and Screening

Question 1

What women are at higher risk of heart disease in pregnancy?

Answer 1

Older, obese, smoke, diabetic and have a FH

Question 2

What is the most common cause of death during pregnancy?

Answer 2

Heart disease

Question 3

What are women prescribed if have risk factors for pre-eclampsia during pregnancy?

Answer 3

Aspirin from 12 weeks of pregnancy

Question 4

What are general health measures to consider pre-pregnancy?

Answer 4

Improve diet, optimise BMI and reduce alcohol consumption
Smoking cessation advise
Folic acid and Vitamin D

Question 5

What previous pregnancy problems are considered for the mother pre-pregnancy counselling?

Answer 5

Pre-eclampsia
DVT/ PE
Previous delivery - LSCS or perineal tear

Question 6

What previous pregnancy problems are considered for the baby pre-pregnancy counselling?

Answer 6

Foetal abnormality
Intrauterine growth restriction
Preterm birth

Question 7

Describe antenatal screening

Answer 7

Offered but not compulsory
Appropriate counselling prior to screening
Allows conditions to be detected early

Question 8

What is picked up during the first visit scan?

Answer 8

Ensures pregnancy is viable
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s syndrome screening

Question 9

What is included in the detailed anomaly scan?

Answer 9

Systematic structural review of the baby
Not possible to identify all problems
Can identify problems that need intrauterine or postnatal treatment

Question 10

What chromosomal screening tests are offered?

Answer 10

Trisomy 13, 18 and 21

Question 11

Where are nuchal translucency measurements taken?

Answer 11

Between crown rump lengths of 45-84mm

Question 12

What does a screening test involve?

Answer 12

NT measurement
CRL
Blood test for PAPP-A and hCG
Maternal age

Question 13

If NT measurement is unable to get or pregnancy is over gestation then what screening test is done?

Answer 13

In second trimester between 14+2 and 20+0
Alpha-fetoprotein, oestriol, hCG and inhibin-A

Question 14

What happens if there is a high risk result in the screening tests?

Answer 14

Further testing is offered if risk of trisomy is > 1 in 150
CVS, amniocentesis and non-invasive prenatal testing

Question 15

What is the purpose of the second trimester US?

Answer 15

Detecting foetal abnormality - good for structural abnormalities but not chromosomal

Question 16

What are examples of abnormalities picked up on second trimester US?

Answer 16

Hypoplastic left heart, exomphalos and cleft lip

Question 17

What is involved in the antenatal examination?

Answer 17

Routine enquiry - feeling well and feeling foetal movements
BP - detect evolving hypertension
Urinalysis
Abdominal palpation
Foetal presentation

Question 18

What is included in abdominal palpation in the antenatal examination?

Answer 18

Assess symphyseal fundal height
Estimate size of baby and liquor volume