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Year 3 Repro (JK) > Antenatal care and screening > Flashcards

Antenatal care and screening Flashcards

1
Q

When is morning pregnancy worse?

A

when hCG is high eg molar pregnancy and twins

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2
Q

what percentage of women experience morning sickness?

A

80-85%

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3
Q

What is a molar pregnancy?

A

sperm fertilises an empty egg and the placenta grows

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4
Q

What is hyperemesis gravidarum?

A

excess nausea and vomiting - severe morning sickness

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5
Q

Cardiac problems in pregnancy

A

CO increases and so does HR –> palpitations

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6
Q

5 steps in bp dropping in 2nd trimester

A

uteroplacental circulation expands
fall in systemic vascular resistance
reduced blood viscosity
reduced sensitivity to angiotensin

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7
Q

When does bp return to normal?

A

3rd trimester

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8
Q

What happens to GFR, urea and creatinine in pregnancy?

A

GFR up

urea and creatinine down

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9
Q

Why are UTI’s more common in pregnancy?

A

urinary stasis

hydronephrosis in 3rd trimester -> pyelonephritis

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10
Q

Why is it important to treat UTI in pregnancy?

A

associated with pre term labour

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11
Q

Explain anaemia in pregnancy simply

A

RBC increases but so does plasma volume so is a relative dilution - platelets drop
need more iron in pregnancy
WBC increase

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12
Q

GI problems in pregnancy

A

GORD, heartburn

GI motility, gastric emptying and peristalsis reduced

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13
Q

Why does GI motility reduce in pregnancy

A

progesterone is increased and motilin is decreased

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14
Q

Resp problems in pregnancy

A

oxygen consumption increases and increased plasma pH - increased resp rate
hyperaemia

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15
Q

List some main causes of maternal deaths

A 
cardiac problems 
sepsis 
thrombosis 
psychiatric 
pre eclampsia
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16
Q

3 general health measures in pre-pregnancy counselling

A

optimise BMI
improve diet
reduce alcohol consumption

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17
Q

3 steps in pre-pregnancy counselling taken

A

smoking cessation
folic acid 400mcg
confirm immunity to rubella

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18
Q

known medical problems measures in pre-pregnancy counselling

A

stop or change unsuitable drugs eg valproate

occasionally give advice against pregnancy eg aortic stenosis

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19
Q

counsel regarding risks of recurrence - maternal

A

caesarean
DVT
pre-eclampsia

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20
Q

counsel regarding risk of recurrence - fetal

A

pre-term delivery
intra uterine growth restriction
abnormality

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21
Q

actions to reduce risk of recurrence - maternal

A

thromboprophylaxis

low dose aspirin

22
Q

actions to reduce risk of recurrence - fetal

A

treatment of infection
high dose folic acid
low dose aspirin

23
Q 
problems identified with 
a - mother 
b - fetus 
c - social 
at antenatal examination
A

a - illness, minor pregnancy problems eg anaemia
b - small for gestational age, abnormality
c - support, violence, psychiatric

24
Q

Routine enquiry at antenatal examination

A

feeling well

baby movements - over 20 weeks

25
Q

Other tests undertaken at antenatal examination

A

blood pressure

urinalysis

26
Q

3 things you are doing on abdominal examination of a pregnant woman

A 
assess symphysial fundal height 
estimate size of baby 
estimate liquor volume 
listen to fetal heart 
fetal presentation eg breech
27
Q

What can be offered if a baby is In the breech position?

A

ECV

28
Q

Is antenatal screening compulsory?

A

no

29
Q

Screening for infection - antenatally

A

Hep B - passive and active immunisation for baby
syphilis - easily treat with penicillin
HIV - maternal treatment and planning reduces vertical transmission
MSS for UTI

30
Q

isoimmunisation

A

development of antibodies against blood groups

31
Q

2 isoimmunisation in pregnancy

A

rhesus disease

anti-c, anti-kell

32
Q

How is iron deficiency anaemia handled?

A

picked up on FBC - additional iron

33
Q

4 aims of 1st visit scan

A

ensure pregnancy viable
multiple pregnancy
abnormalities incompatible with life eg anencephaly
offer and carry out down’s syndrome screening

34
Q

aims of detailed anomaly scan

A

systematic structural review of baby

identify problems requiring intra-uterine or postnatal treatment

35
Q

downs syndrome - trisomy …?

A

21

36
Q

risk of downs syndrome

A

1 in 700

37
Q

High risk of downs syndrome is…

A

1 in 150

38
Q

risk of downs syndrome at maternal age of 20 and 45

A

1 in 1667

1 in 30

39
Q

2 main determinants of downs syndrome

A

maternal age

FH of chromosomal abnormality

40
Q

What does screening for downs syndrome provide and what is needed after?

A

a risk

definitive test – termination??

41
Q

What week is first trimester screening carried out?

A

10-14 weeks

42
Q

What 4 things does first trimester screening use?

A

maternal risk factors
serum beta hCG
PAPP-A
fetal nuchal translucency

43
Q

nuchal translucency

A

the size not the appearance
crown to rump length of 45-84mm
increases with gestational age

44
Q

What happens with a high risk downs syndrome result?

A

further testing if >1 in 150

options - CVS, amniocentesis, non invasive prenatal testing

45
Q

CVS weeks carried out and risk of miscarriage

A

10-14 weeks

1-2% miscarriage

46
Q

amniocentesis weeks carried out and risk of miscarriage

A

15 weeks +

about 1% miscarriage

47
Q

Explain non-invasive prenatal testing

A

maternal blood taken and detect fetal cell free DNA and detect chromosomal trisomies
not on NHS
still high risk? invasive testing

48
Q

Screening for NTD

A

increase to 5mg folic acid if high risk
1st trimester USS
2nd trimester biochemical screening

49
Q

2nd trimester biochemical screening for NTD

A

not able to measure NT

alpha fetoprotein >2.0Mom high risk and investigate

50
Q

What % of NTD will 2nd trimester USS detect?

A

> 90%

51
Q

Second trimester USS

A

detect fetal abnormality eg hypoplastic left heart, cleft lip, exomphalos
poor for chromosomal abnormalities

Year 3 Repro (JK) (33 decks)

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