Antenatal Care and Screening

Question 1

Pregnancy symptoms

Answer 1

Morning sickness
Decreased BP in 2nd trimester
Increased urine output 
UTI
Anaemia 
SOB
GORD
Constipation 
Heartburn

Question 2

Pregnancy physiology changes

Answer 2

Increased CO
Decreased BP in 2nd trimester
Increased GFR and renal plasma flow
Decreased serum urea and creatinine 
Bladder capacity reduced in 3rd trimester because of pelvic pressure 
Progesterone decreased CO2 (increased tidal volume, increased RR, plasma pH increases)
O2 consumption increases
oesophageal peristalsis decreases
gastric emptying decreases
cardiac sphincter relaxes

Question 3

Causes of maternal deaths

Answer 3

Cardiac disease
sepsis 
thrombis
neurological 
psychiatric 
haemorrhage
amniotic fluid embolism 
pre-eclampsia
anaesthesia
indirect malignancies

Question 4

Pre-pregnancy counselling for all women should include

Answer 4

Diet
Optimise BMI
Reduce alcohol 
Smoking cessation 
Folic acid 400mg
Confirm immunity to rubella

Question 5

Pre pregnancy counselling for women with known medical problems should include

Answer 5

Optimise maternal health 
Psychiatric health important 
Stop/change unsuitable drugs 
advise regarding complications associated with maternal medical problems 
occasionally advise against pregnancy

Question 6

Previous C-sections affecting future births

Answer 6

1 previous C section for a non referring cause such as a breach then she will be fine to undertake labour

2 previous C sections it is customary to deliver by elective caesarean again

Question 7

Pre-eclampsia is predominately a condition of

Answer 7

nulliparity

Question 8

How many pregnancies predisposes a woman to post partum haemorrhage (PPH)?

Answer 8

Grand multiparity (4 or more deliveries)

Question 9

Grand multiparity meaning

Answer 9

4 or more deliveries

Question 10

What substance misuse drugs are associated with addiction to the foetus?

Answer 10

Heroin
Methadone
Benzodiazepines

Question 11

What are cocaine/crack associated with?

Answer 11

Abruption resulting in foetal death

Question 12

Antenatal screening for infections

Answer 12

Hep B
Syphilis
HIV 
MSSU (UTI)
Rubella

Question 13

First visit scan looks at

Answer 13

Ensure pregnancy viable
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s Syndrome Screening

Question 14

Association between Down’s Syndrome and Maternal age

Answer 14

The incidence of Downs Syndrome increases with advancing maternal age

Question 15

What is taken to reduce neural tube defects?

Answer 15

Folic acid 5mg

Question 16

When is CVS done?

Answer 16

10-14 weeks

Question 17

Risks of CVS

Answer 17

1-2% risk of miscarriage

Question 18

When is Amniocentesis done?

Answer 18

15 weeks onwards

Question 19

Risks of amniocentesis

Answer 19

Approx. 1% risk of miscarriage

Question 20

Purpose of second trimester US

Answer 20

Detecting foetal abnormality (Good for structural, bad for chromosomal)

Question 21

What does NIPT stand for?

Answer 21

Non invasive pre natal testing

Question 22

What does foetal screening look at?

Answer 22

Disease
Growth
Abnormality

Question 23

What does maternal screening look at>

Answer 23

Pre existing disease

Gestational disease

Question 24

Conditions in which all pregnant women should be offered screening

Answer 24

Anaemia
Bacteruria
Blood group, Rheus status and anti red cell antibodies
Downs syndrome
Foetal abnormalities
Hep B
HIV
NT defects
Risk factors for pre eclampsia
Rubella immunity
Syphillis