Antenatal care and screening

Question 1

When is morning pregnancy worse?

Answer 1

when hCG is high eg molar pregnancy and twins

Question 2

what percentage of women experience morning sickness?

Answer 2

80-85%

Question 3

What is a molar pregnancy?

Answer 3

sperm fertilises an empty egg and the placenta grows

Question 4

What is hyperemesis gravidarum?

Answer 4

excess nausea and vomiting - severe morning sickness

Question 5

Cardiac problems in pregnancy

Answer 5

CO increases and so does HR –> palpitations

Question 6

5 steps in bp dropping in 2nd trimester

Answer 6

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

Question 7

When does bp return to normal?

Answer 7

3rd trimester

Question 8

What happens to GFR, urea and creatinine in pregnancy?

Answer 8

GFR up

urea and creatinine down

Question 9

Why are UTI’s more common in pregnancy?

Answer 9

urinary stasis

hydronephrosis in 3rd trimester -> pyelonephritis

Question 10

Why is it important to treat UTI in pregnancy?

Answer 10

associated with pre term labour

Question 11

Explain anaemia in pregnancy simply

Answer 11

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

Question 12

GI problems in pregnancy

Answer 12

GORD, heartburn

GI motility, gastric emptying and peristalsis reduced

Question 13

Why does GI motility reduce in pregnancy

Answer 13

progesterone is increased and motilin is decreased

Question 14

Resp problems in pregnancy

Answer 14

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

Question 15

List some main causes of maternal deaths

Answer 15

cardiac problems 
sepsis 
thrombosis 
psychiatric 
pre eclampsia

Question 16

3 general health measures in pre-pregnancy counselling

Answer 16

optimise BMI
improve diet
reduce alcohol consumption

Question 17

3 steps in pre-pregnancy counselling taken

Answer 17

smoking cessation
folic acid 400mcg
confirm immunity to rubella

Question 18

known medical problems measures in pre-pregnancy counselling

Answer 18

stop or change unsuitable drugs eg valproate

occasionally give advice against pregnancy eg aortic stenosis

Question 19

counsel regarding risks of recurrence - maternal

Answer 19

caesarean
DVT
pre-eclampsia

Question 20

counsel regarding risk of recurrence - fetal

Answer 20

pre-term delivery
intra uterine growth restriction
abnormality

Question 21

actions to reduce risk of recurrence - maternal

Answer 21

thromboprophylaxis

low dose aspirin

Question 22

actions to reduce risk of recurrence - fetal

Answer 22

treatment of infection
high dose folic acid
low dose aspirin

Question 23

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

Answer 23

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

Question 24

Routine enquiry at antenatal examination

Answer 24

feeling well

baby movements - over 20 weeks

Question 25

Other tests undertaken at antenatal examination

Answer 25

blood pressure | urinalysis

Question 26

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

Answer 26

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

Question 27

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

Answer 27

ECV

Question 28

Is antenatal screening compulsory?

Answer 28

no

Question 29

Screening for infection - antenatally

Answer 29

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

Question 30

isoimmunisation

Answer 30

development of antibodies against blood groups

Question 31

2 isoimmunisation in pregnancy

Answer 31

rhesus disease | anti-c, anti-kell

Question 32

How is iron deficiency anaemia handled?

Answer 32

picked up on FBC - additional iron

Question 33

4 aims of 1st visit scan

Answer 33

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

Question 34

aims of detailed anomaly scan

Answer 34

systematic structural review of baby | identify problems requiring intra-uterine or postnatal treatment

Question 35

downs syndrome - trisomy …?

Answer 35

21

Question 36

risk of downs syndrome

Answer 36

1 in 700

Question 37

High risk of downs syndrome is...

Answer 37

1 in 150

Question 38

risk of downs syndrome at maternal age of 20 and 45

Answer 38

1 in 1667 | 1 in 30

Question 39

2 main determinants of downs syndrome

Answer 39

maternal age | FH of chromosomal abnormality

Question 40

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

Answer 40

a risk | definitive test -- termination??

Question 41

What week is first trimester screening carried out?

Answer 41

10-14 weeks

Question 42

What 4 things does first trimester screening use?

Answer 42

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

Question 43

nuchal translucency

Answer 43

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

Question 44

What happens with a high risk downs syndrome result?

Answer 44

further testing if >1 in 150 | options - CVS, amniocentesis, non invasive prenatal testing

Question 45

CVS weeks carried out and risk of miscarriage

Answer 45

10-14 weeks | 1-2% miscarriage

Question 46

amniocentesis weeks carried out and risk of miscarriage

Answer 46

15 weeks + | about 1% miscarriage

Question 47

Explain non-invasive prenatal testing

Answer 47

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

Question 48

Screening for NTD

Answer 48

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

Question 49

2nd trimester biochemical screening for NTD

Answer 49

not able to measure NT | alpha fetoprotein >2.0Mom high risk and investigate

Question 50

What % of NTD will 2nd trimester USS detect?

Answer 50

>90%

Question 51

Second trimester USS

Answer 51

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