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Reproductive system > Antenatal care and screening > Flashcards

Antenatal care and screening Flashcards

1
Q

Why do physiological changes occur during pregnancy?

A

It is essential to allow the body to cope with the added strain

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2
Q

How many women are affected by morning sickness when they are pregnant?

A

80-85%

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3
Q

When do symptoms of morning sickness normally improve?

A

By 16 weeks

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4
Q

What happens to cardiac output during pregnancy?

A

It increases by 30-50% - HR increases from about 70-90bom

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5
Q

What symptom can pregnant women get as a result of highly increased cardiac output?

A

Palpitations

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6
Q

What happens to blood pressure in the second trimester?

A

It drops

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7
Q

What causes reduction of blood pressure in the second trimester?

A

Expansion of the uteroplacental circulation
Fall in sytemic vascular resistance
Reduction in blood viscosity
Reduction in angiotensin sensitivity

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8
Q

What happens to urine output in pregnancy?

A

It is increased - Renal plasma flow increases by 25-50%
GFR increases by 50%
Serum urea and creatinine decrease

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9
Q

What happens to bladder capacity in the third trimester?

A

It is reduced to do increased pelvic pressure from the expanding uterus

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10
Q

Why is there increased risk of UTI during pregnancy?

A

Increase in urinary stasis

Hydronephrosis is physiological which leads to pyelonephritis being more common

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11
Q

Why is anaemia common during pregnancy?

A

Plasma volume increases by 50% and RBC mass increases by 25%, leading to an overall drop in haemoglobin due to dilution

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12
Q

How much are iron requirements increase by in pregnancy?

A

1g

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13
Q

What effect does increased progesterone have on the respiratory system during pregnancy?

A

Reduces CO2 by increasing tidal volume and respiratory rate, leading to an increase in plasma pH
Oxygen consumption is increase by 20% byt PO2 of oxygen in plasma is unchanged

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14
Q

What effects does pregnancy have on the GI system?

A

Oesophageal peristalsis is reduced
Reduced rate of gastric emptying
Cardiac sphincter relaxes
GI motility decreases due to increased progesterone and decreased motilin

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15
Q

What symptoms may women experience as a result of GI changes?

A

Constipation due to reduced rate of gastric emptying

Heartburn/GORD due to relaxation of cardiac sphincter

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16
Q

What is the most common cause of death in pregnancy?

A

Cardiac disease

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17
Q

What advice are women given in pre-pregnancy counselling?

A

General health measures - improve diet, optimise BMI, reduce alcohol consumption
Smoking cessation
To take 400mcg folic acid each day

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18
Q

How are women advised in pre-pregnancy counselling in regards to known medical problems?

A

Optimise their health
Look after their psychiatric health
Stop or change unsuitable drugs
Advise regarding complications associated with maternal medical problems
Occasionally advice against pregnancy ie diabetes or epilepsy

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19
Q

What problems are to be identified during antenatal examination?

A

Problems with the mother
Problems with the fetus
Social problems

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20
Q

What problems can be identified with the mother in antenatal examination?

A

Pre-existing or developing illness

Common problems of pregnancy such as anaemia

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21
Q

What fetal problems can be identified in antenatal examination?

A

Small for gestational age

Fetal abnormality

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22
Q

What social problems can be identified in antenatal examination?

A

Offer support if needed
Domestic violence
Psychiatric issues

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23
Q

What is examined in antenatal examination?

A

Routine enquiry
Blood pressure
Urinalysis
Abdominal palpation - assess symphyseal fundal height, estimate size of baby
Determine fetal presentation - listen to fetal heart

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24
Q

What infections can be picked up through antenatal screening?

A 
Hepatitis B
Syphilis
HIV
UTI
Rubella
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25
Q

What is done when screening by ultrasound on the first visit scan?

A

Ensure pregnancy is viable - no miscarriage
Identify if it is a multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out down syndrome screening

26
Q

What is the overall risk of Down Syndrome?

A

1 in 700

27
Q

How does maternal age impact risk of down syndrome?

A

As maternal age increases risk increases

28
Q

What is used in Down Syndrome screening?

A

Maternal risk factors - Serum beta-human chorionic gonadotrophin, pregnancy associated plasma protein, and fetal nuchal translucency measurement

29
Q

When is a pregnancy considered to have high risk of Down Syndrome?

A

When the risk is greater than 1 in 150

30
Q

What is non-invasive prenatal testing for Down Syndrome?

A

Maternal blood is take, fetal cell free DNA is detected and examined for trisomies

31
Q

What are positives and negatives of second trimester USS?

A

It is very good for detecting major structural abnormalities but very poor for chromosomal abnormalities

32
Q

What happens to white cell count in pregnancy?

A

It increases

33
Q

What happens to platelet count in pregnancy?

A

Decreases due to dilution

34
Q

If a woman is pregnant and has previously delivered 2 babies through cesarean, can she deliver via spontaneous vaginal birth?

A

No - must have elective cesarean

35
Q

What should be done in pre-pregnancy counselling regarding maternal complications of previous pregnancies?

A

Counsel about risk of recurrence, especially of - Required C section, DVT, and preeclampsia
Actions to reduce risk - Thromboprophylaxis, low dose aspirin

36
Q

What should be done in pre-pregnancy counselling regarding fetal complications of previous pregnancies?

A

Counsel about risk of recurrence, especially of - pre-term delivery, intrauterine growth restriction, fetal abnormality
Actions to reduce risk - Treatment of infection, high dose folic acid, low dose aspirin

37
Q

What is the first sign of pregnancy on ultrasound?

A

Thickening of the endometrium

38
Q

What is tested for in the bloodspot test when a neonate is born?

A

Phenylketonuria
Cystic fibrosis
Hypothyroidism

39
Q

What happens at 4.5 weeks pregnancy on ultrasound?

A

Fluid filled intrauterine sac appears

40
Q

What happens at 5 weeks pregnancy on ultrasound?

A

Yolk sac appears within the uterus

41
Q

What happens at 5.5 weeks pregnancy on ultrasound?

A

Tiny fetal pole is visible

42
Q

What happens at 6 weeks pregnancy on ultrasound?

A

Fetal heart beat becomes visible

43
Q

How is gestational age and therefore estimated due date determined?

A

Once the fetal pole is visible a crown rump measurement is made, which correlates closely to gestational age

44
Q

What is anencephaly?

A

Neural tube defect - vault of the skull doesn’t develop and brain matter is unprotected from the environment and becomes worn away

45
Q

How is anencephaly identified?

A

Normal fetal skull can’t be seen on ultrasound, usually first trimester

46
Q

At what weeks gestation can combined ultrasound and biochemical screening take place?

A

11-14

47
Q

What invasive confirmatory investigation can be done if screening tests for Down’s come back positive?

A

Invasive test - amniocentesis

48
Q

What screening test can be done for down’s after 14 weeks?

A 
Second trimester screening:
Serum alphafetoprotein
Serum Total human chorionic gonadotrophin
Serum unconjugated eostriol
Serum inhibin-A
49
Q

What is the detection rate in second trimester down’s screening?

A

75%

50
Q

What is the detection rate of combined ultrasound and biochemical screening?

A

85% - 5% false positive rate

51
Q

What is used to assess risk of neural tube defect?

A

Alphafetoprotein at 15-20 weeks

Ultrasound - preferred test

52
Q

What is the most common neural tube defect?

A

Spina bifida

53
Q

What is the purpose of the second trimester ultrasound?

A

Identify structural abnormalities - almost all abnormalities that can be seen on USS can be seen by week 20

54
Q

What organ systems should be assessed in the second trimester USS?

A 
Central nervous system
Genitourinary tract
Gastrointestinal tract
Musculoskeletal system
Cardiovascular - heart
55
Q

What effects can neural tube defects have on the skull shape?

A

Frontal bossing

Lemon shape

56
Q

What abnormalities can be seen in second trimester USS?

A 
Cystic hygroma
Diaphragmatic hernia
Duodenal atrasia
Dilated renal pelvises
Exomphalos/gastroschisis
57
Q

What is the purpose of third trimester USS?

A

Assess fetal wellbeing

58
Q

How is diaphragmatic hernia diagnosed?

A

Abdominal organs found within chest

59
Q

What sign is indicative of duodenal atresia?

A

Double bubble at level of stomach

60
Q

What is elevated alphafetoprotein a sign of other than neural tube defects?

A 
Incorrect gestational age
Multiple pregnancy
Bleeding in pregnancy
Fetal death
Abdominal wall abnormalities

Reproductive system (26 decks)

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