Antenatal Care and Screening

Question 1

How common is morning sickness and what makes it worse

Answer 1

• 80-85% of women

- Worse when Human Chorionic Gonadotrophin is higher e.g. twin or molar pregnancy

Question 2

What can morning sickness progress to

Answer 2

• Hyperemesis Gravidarum (essentially severe morning sickness)

Question 3

What happens to Cardiac Output and Heart rate in pregnancy

Answer 3

• CO increases by 30-50%
• HR increases from 70-90 BPM
• Palpitations are a common complaint

Question 4

What happens to blood pressure in the 2nd trimester

Answer 4

• It drops, due to expansion of uteroplacental circulation
• A reduction in sensitivity to Angiotensin
• BP usually returns to normal in the 3rd trimester

Question 5

What renal related changes occur in pregnancy

Answer 5

• Increased urine output
  Renal plasma flow increases by 20-25%
  GFR increases by 50%
  Serum urea and creatinine decrease
• Increase in UTI’s
  Increase in urinary stasis
  Hydronephrosis is physiological in the 3rd trimester and makes pyelonephritis more common
  Can be associated with preterm labour so important to treat

Question 6

Haematological problems in pregnancy

Answer 6

• Anaemia
• Plasma volume increases by ~50% and RBC mass by ~25%
• Platelet count falls by dilution
• WBC increase slightly to 9000-12000

Question 7

Respiratory changes in pregnancy

Answer 7

- Increased; 
Tidal volume 
Plasma pH
RR
O2 consumption (by 20%)
- Progesterone acts centrally to reduce CO2

Question 8

GI problems in pregnancy

Answer 8

• Oesophageal peristalsis and gastric emptying slow/reduce
• Cardiac Sphincter relaxes
• GI motility reduced due to increased progesterone and reduced motilin

Question 9

What disease do you confirm immunity to during pre-pregnancy counselling

Answer 9

Rubella

Question 10

What is assessed during antenatal examination

Answer 10

• Feeling well?
• Feel for foetal movements (after 20 weeks)
• Blood pressure (detect evolving hypertension)
• Urinalysis
• Assess Symphyseal Fundal Height (SFH)(estimates size of baby)
• Determine foetal position + listen to foetal heart beat

Question 11

When does the first trimester scan occur

Answer 11

• 10-14 weeks

Question 12

3 methods of testing for genetic conditions

Answer 12

• CVS
• Amniocentesis
• Non-invasive prenatal testing

Question 13

When is CVS and Amniocentesis appropriate to use and what’s their risk of miscarriage

Answer 13

• CVS = 10-14 weeks, 1-2% risk of miscarriage

- Amniocentesis = 15 weeks onwards, ~1% risk of miscarriage

Question 14

Describe non-invasive prenatal testing

Answer 14

• Maternal blood is taken
• Can detect foetal cell free DNA
• Can look for chromosomal trisomies
• Not offered on the NHS

Question 15

Describe neural tube defect screening

Answer 15

• Not routinely offered due first trimester screening
• Personal or family hx of NTD are at increased risk (should be advised to take 5mg folic acid to reduce risk)
• First trimester ultrasound to detect anencephaly and sometimes spina bifida (variants of NTD)
• Second trimester Biochemical screening
• Second trimester (20wk) ultrasound detects >90% of NTD

Question 16

1 advantage and 1 disadvantage of second trimester screening

Answer 16

• Good for detecting major structural abnormalities

- Useless in detecting chromosomal abnormalities