Antenatal Care and Screening

Question 1

How many antenatal meetings are normally made prior to 20 weeks gestation?

Answer 1

4

Question 2

When assessing screening test, what is meant by ‘sensitivity’?

Answer 2

True positive (positive and false negative)

Question 3

When assessing screening test, what is meant by ‘specifity’?

Answer 3

True negative (negative and false positive)

Question 4

List points in the history and examination carried out at booking visit

Answer 4

HISTORY: menstrual, medical, obstetric, family, social
EXAM: height, weight, BP, CVS, abdomen

Question 5

What is Naegele’s rule?

Answer 5

Estimate due date based in onset of women’s LMP (add 9 months and 7 days)

Question 6

What tests are usually done in an antenatal booking appointment?

Answer 6

Hb
Antibodies (Rhesus)
Syphilis, HIV, Hep B+C
Urinalysis, MSSU C+S
Ultrasound

Question 7

What markers are used to estimate gestational age?

Answer 7

Biparietal diameter

Femur length

Question 8

What sign suggests a pregnancy is viable on ultrasound?

Answer 8

Fetal heart present

Question 9

List points in the history and examination carried out at a follow up antenatal visit

Answer 9

HISTORY: physical and mental health, fetal movements
EXAM: BP, urinalysis, symphysis (fundal height), lie and presentation, engagement of presenting part, fetal heart auscultation

Question 10

What common clinical maternal condition is characterised by high BP and proteinuria on urinalysis?

Answer 10

Preclampsia

Question 11

What is “foetal lie”?

Answer 11

Relation of foetal spine to maternal spine
Longitudinal lie: parallel to maternal spine
Transverse lie: horizontal to maternal spine

Question 12

What is “foetal engagement”?

Answer 12

Relation of foetal head to pelvic rim

Question 13

Which scan is used to screen for foetal anomaly? When is this carried out?

Answer 13

Ultrasound

20 weeks

Question 14

High AFP and low HCG is associated with increased risk of what particular foetal anomaly?

Answer 14

Spina bifida

Question 15

List fetal anomalies screened for during pregnancy

Answer 15

Cleft lip
Anencephaly
Spina bifida
Diaphragmatic hernia
Cardiac abnormality
Renal agenesis
Edward's syndrome
Patau's syndrome

Question 16

State the chromosomal mutation found in Edward’s Syndrome

Answer 16

Trisomy 18

Question 17

State the chromosomal mutation found in Patau’s Syndrome

Answer 17

Trisomy 13

Question 18

What is ‘placenta praevia’? How is this managed?

Answer 18

A low-lying placenta, overlying the cervical os, after 20 weeks of pregnancy
32 week ultrasound scan followed by a vaginal scan

Question 19

State the chromosomal mutation found in Down’s Syndrome

Answer 19

Trisomy 21

Question 20

What tests can be used to detect the risk of Down’s syndrome in 1st trimester?

Answer 20

Skin thickness behind foetal neck (Nuchal translucency)

bHCG and PAPP-A levels

Question 21

What tests can be used to detect the risk of Down’s syndrome in 2nd trimester?

Answer 21

Blood sample

HCG and AFP levels

Question 22

Low AFP and high HCG increases/decreases risk of Down’s syndrome

Answer 22

Low AFP and high HCG increases risk of Down’s syndrome

Question 23

What is a normal ‘Nuchal translucency’ of a fetus?

Answer 23

<3.5mm when CRL is between 45 and 84mm

Question 24

Low risk on Down’s syndrome screening excludes Down’s syndrome. True/ False?

Answer 24

False

Question 25

A risk >1:250 of Down’s Syndrome is classed as high risk and requires further investigation. What is recommended as the next best test?

Answer 25

Amniocentesis

Question 26

List biochemical markers screened for in second trimester

Answer 26

AFP
HCG
Unconjugated oestradiol (UE3)
Inhibin A

Question 27

What are the 2 main specific diagnostic tests that can be done for foetal karyotyping?

Answer 27

Amniocentesis

Chorionic villus sampling

Question 28

Which two major haemaglobin disorders are screened for during pregnancy?

Answer 28

Sickle cell anaemia (distorted shape of red blood cells)

Thalassemias (abnormal form or low amount of Hb)

Question 29

Describe how Rhesus disease can be acquired in the foetus.

Answer 29

Rh+ father and Rh- mother have a Rh+ baby –>
Blood cells enter mother’s bloodstream –>
Invading blood cells produce Rh Igs at delivery –>
In a later pregnancy, Rh Igs attack baby’s blood cells causing Rh disease

Question 30

List risk factors indicating further testing in women for gestational diabetes

Answer 30

BMI >30
Previous macrosomic baby
Previous gestational diabetes
FHx of diabetes (1st degress relative)
Minority ethnic family origin with high rates of DM

Question 31

What measurement of symphysis fundal height would require referral for US measurement of fetal sixe?

Answer 31

Below 10th centile

Slow or static growth, e.g. crossing centiles

Question 32

List factors relating to high risk of maternal preclampsia. How should this be managed?

Answer 32

Previous preclampsia
Hypertension during previous pregnancy
CKD
Autoimmune disease (SLE, APS)
Diabetes (type 1 or type 2)
Chronic hypertension

75mg aspirin daily from 12 weeks until birth

Question 33

What clinical conditions can urinalysis pick up during antenatal screening?

Answer 33

UTI
Asymptomatic bacteriuria
PET (Preclampsia)
Diabetes

Question 34

How is Rhesus disease prevented in the pregnant women?

Answer 34

Anti-D prophylaxis throughout pregnancy