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LMCC Study - OBGYN > Antenatal care and Screening > Flashcards

Antenatal care and Screening Flashcards

1
Q

Organogenesis can initiate as early as how many weeks?

A

3-8 weeks

- important for pre-conception counselling as this often begins before people realize they are pregnant

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2
Q

What would you recommend wrt folic acid supplementation to a patient wishing to become pregnant?

A
  • Folic acid supplementation 8-12 weeks preconception
  • Continue until the end of T1 (week 14) to prevent NTD
  • 0.4-1mg in all women
  • 5mg if:
    • previous NTD
    • anticonvulsant use
    • DM
    • BMI > 35
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3
Q

When would you recommend a woman take 5mg of folic acid to prevent NTD?

A

1) Previous NTD (n other preg, or family hx)
- 10 fold increase in risk

2) Antiepileptic medications
- carbamazapine
- valproic acid

3) DM
- Increased risk

4) BMI > 35
- Increased risk
- uptodate doesn’t recommend using higher dose though?

5) Other (decreased absorption)
- Celiac disease
- Gastric bypass
- IBD

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4
Q

What infection screening is done in pregnancy? (6)

A
  • Rubella (immunity)
  • HBsAg
    • hep B surface antigen (marker for previous infection)
    • if positive baby should be vaccinated, as some patients develop chronic infection which can be passed
  • VDRL
  • Pap smear (if due)
  • Gonorrhea/Chlamydia testing
  • HIV
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5
Q

What is Naegles rule?

A
  • Used to estimate date of delivery using LMP
  • 1st day of LMP + 7 days - 3 months
  • If cycle > 28d modify by adding number of days over 28
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6
Q

Your patient’s LMP was March 10th, using Naegles rule what would their EDD be? Assume 28d cycle

A
  • December 17th
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7
Q

Which investigations would you order for a patient during their first prenatal visit?

A
  • CBC
  • Blood group and Rh status
  • Rh antibody screen
  • Infection screening as per preconception councelling
  • Urine R & M, midstream urine for C&S
  • Screen for proteinuria and bacteruria
  • Urine or cervical gonorrhea and chlamydia PCR testing
  • Pap if due
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8
Q

How frequently should a woman be seen for prenatal vists in uncomplicated pregnancy?

A

1) under 30 weeks
- every 4-6 weeks

2) 30 weeks to 36 weeks
- every 2-3 weeks

3) 36 weeks until delivery
- every 1-2 weeks

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9
Q

Describe what would be part of your pre-natal visits?

A

1) Estimate GA
2) History
- fetal movement
- BP
- Weight change
- SFH
- Leopolds maneuve in 3rd trimester
- position and presentation of fetus
- Urinalysis for glucosuria, proteinuria
- fetal heart rate starting at 10-12 weeks using doppler

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10
Q

What is leopolds maneuver? How is it performed? When do you start doing it?

A

1) physical exam to determine the position of the fetus in the uterus
2)
First:
- determine which fetal part is lying furthest from the pelvic inlet
Second:
- Determine the location of the fetal back
Third:
Determine which fetal part is lying above the pelvic inlet
Fourth:
Locate the fetal brow
- Performed after 30-32 weeks (T3)

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11
Q

Who is at highest risk of Thalassemia?

A
  • Mediterranean
  • SE Asian
  • Western Pacific (pacific islanders)
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12
Q

How do you screen for thalassemia?

A
  • CBC

- Hb electrophoresis or high pressure liquid chromatography

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13
Q

Who is at high risk of sickle cell?

A
  • African

- Caribbean

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14
Q

Who is at high risk of cystic fibrosis?

A
  • Family history of CF or condition closely associated (like male infertility)
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15
Q

How do you screen for cystic fibrosis?

A

CFTR gene DNA analysis

  • cystic fibrosis transmembrane conductance regulator gene
  • Codes for ion channel that conducts chloride
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16
Q

How do you screen for sickle cell?

A
  • CBC

- Hb electrophoresis or HPLC

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17
Q

Who is at high risk of parvovirus B19? what tests would you order on someone at risk?

A

1)

  • Someone with exposure to small children (at home, work, etc..)
  • Showing symptoms such as febrile illness with rash or arthopathy

2) Parvovirus IgM and IgG
- IgM indicates acute infection
- IgG is produced shortly after infection and persists for life

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18
Q

How would you interpret a parvovirus B19 test showing

1) Positive IgM and IgG
2) Positive IgG and negative IgM

A

1) Acute infection

2) Immune, was exposed in the past, no recent infection

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19
Q

Your patient has positive IgM for parvovirus what is the next step? How do you counsel her?

A
  • This indicates acute infection in the mother
  • Next step is PCR testing of maternal serum for parvovirus DNA
  • No increased risk of fetal abnormality, but increased risk of hydrops fetalis and fetal loss
20
Q

When is the uterine fundus at the level of the pubic symphysis?

A

12 weeks

21
Q

When is the uterine fundus at the umbilicus?

A

20 weeks

22
Q

What should the symphysis fundal height be between weeks 20 and 36?

A

+/- 2cm of the gestational age

23
Q

When is the uterine fundus at the sternum?

A

37 weeks

24
Q

When should a dating ultrasound ideally take place?

A

Between weeks 8 and 12

- using crown-rump length

25
Q

What is nuchal translucency? What does its measurement tell you? When do you check it?

A
  • Measures the amount of fluid behind the neck of the fetus
  • Early screen for trisomy 21
  • May also detect cardiac and other aneuploidies like Turner
  • Scan done between 11 and 14 weeks (Typically try to overlap the dating U/S and nuchal scan so week 11 or 12)
  • Also the NT scan relies on having accurate dates so a dating ultrasound should be done
26
Q

When is a growth and anatomy u/s scan done?

A
  • between 18 and 20 weeks
27
Q

What is noninvasive pre-natal testing? When is it performed?

A

Analysis of maternal blood for circulating fetal cells

  • if detected use fetal DNA to assess for chromosomal abnormalities
  • Done at 10 weeks ($ in ontario, but covered in women over 35 years)
28
Q

What are the disadvantages of non-invasive prenatal testing?

A

1) Low specificity
- All positive results still must be confirmed with amniocentesis

2) Less sensitive for trisomy 18 and 13
3) Doesn’t screen for NTD

29
Q

Describe the direct and indirect coombs tests. Which is used in prenatal screening?

A

Coombs reagent is an antibody made in an animal against the autoantibodies attacking Rh antigens

1) Direct
- Blood is taken from the patient
- Coombs reagent is added
- If there are autoantibodies against the Rh antigen present, the coombs reagent will bind causing agglutination
* Looking for autoantibodies bound to patient’s RBC *

2) Indirect
- Blood is taken from the mother, plasma is separated
- Rh+ blood is added to maternal plasma
- If the mothers plasma contained autoantibodies against Rh antigen, the blood will agglutinate
* Looking for autoantibodies in maternal serum *

  • Indirect used in pre-natal screening. Looking to see if mother has these autoantibodies which can cross placenta and destroy fetal RBC
30
Q

The prophylactic administration of Rhogam is administered to which women and at what time?

A
  • Administered to all Rh negative women who do not have alloimmunization
  • Given at 28 weeks (start of third trimester)
  • Reason being, 3rd trimester is most common period to have asymptomatic bleeding which could potentially lead to alloimmunization
  • Also give to all Rh negative woman as above withing 72 hours of giving birth to Rh + child
31
Q

Atypical antibodies capable of producing hemolytic disease of the newborn are identified on prenatal screening how do you proceed?

A
  • Serial titres of antibody levels
  • Referral to tertiary center
  • Early delivery if appropriate
32
Q

How do you perform a pap smear on a pregnant woman?

A
  • Do not insert the cervical broom into the cervical os after 10 weeks gestation
33
Q

What is first trimester screening? (FTS) When is it done? What does it involve, What does it test for?

A

1) First trimester screening (FTS)
- Measured between 11 weeks, 0 days and 13 weeks 6 days
a) Pregnancy associated plasma protein A (PAPP-A)
b) B-hCG
c) Nuchal translucency
* Tests for trisomy 21, trisomy 18
* U/S also screens for anencephaly

34
Q

What screening options are available in the second trimester? What do they involve, what do they test for? When can it be done?

A

Maternal serum screening

  • Maternal serum alpha fetoprotein (MSAFP)
  • B-hCG
  • Estriol
  • Inhibin A
    2) Test for Trisomy 18, 21 and open NT defects
    3) Can be done between 15 and 20 weeks
  • best at 16, when it is more accurate but there is still time to act on results
35
Q

What is integrated prenatal screening (IPS)? When is it done? What does it involve, What does it test for?

A

1) Combined first and second trimester test

2a) First trimester
- PAPP-A
- NT
- B-hCG? i think

2b) Second trimester
- MSAFP
- B-hCG
- Estriol
- Inhibin-A

3)
- Trisomies 18 and 21
- ONTD
* Highest detection rate for downs and lowest false positive rates

36
Q

How can prenatal genetic screening differ in women over the age of 35?

A
  • They are offered invasive testing (amniocentesis or chorionic villous sampling) instead of others
37
Q

What is chorionic villous sampling? When can it be done?

A
  • sample of the chorionic villi is removed and sampled for testing
  • tests for chromosomal abnormality and is definitive
  • Can be done between 10 and 12 weeks gestation
38
Q

What is amniocentesis and when can it be done?

A
  • taking sample of the amniotic fluid for testing
  • used as definitive testing for chromosomal abnormality
  • Can be done from 15-16 weeks and onward
39
Q

When and how is a patient screened for gestational diabetes in a normal pregnancy?

A
  • Between 24 and 28 weeks

- with 50g OGCT

40
Q

When is GBS screening done?

A
  • 35-37 weeks
41
Q

What results would you expect on a FTS of a down syndrome pregnancy?

A

1) Increased NT
2) Increased B-hCG
3) Decreased PAPP-A

42
Q

What would you expect on a FTS of an edward syndrome pregnancy?

A

Trisomy 18

1) Increased NT
2) DECREASED B-hCG
- this is what differs from downs
3) Decreased PAPP-A

43
Q

What would you expect on a MSS of a kid with down syndrome?

A

1) Decreased MSAFP
2) Increased B-hCG
3) Decreased unconjugated estrogen
4) INCREASED inhibin A

44
Q

What would you expect on a MSS of an edward syndrome pregnancy?

A

Trisomy 18

1) Decreased MSAFP
2) DECREASED B-hCG
3) Decreased unconjugated estrogen
4) Decreased inhibin

45
Q

What is Rhogam? How does it work?

A
  • Rh IgG

- Binds of Rh antigens of the baby which prevents the mothers immune system from reacting

46
Q

What is the Kleihauer-Betke test?

A
  • Used to determine the extent of fetomaternal hemorrhage by estimating amount of fetal blood in maternal circulation
  • Used to dose rhogam

LMCC Study - OBGYN (21 decks)

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