Antenatal care and screening

Question 1

Why do physiological changes occur during pregnancy?

Answer 1

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

Question 2

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

Answer 2

80-85%

Question 3

When do symptoms of morning sickness normally improve?

Answer 3

By 16 weeks

Question 4

What happens to cardiac output during pregnancy?

Answer 4

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

Question 5

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

Answer 5

Palpitations

Question 6

What happens to blood pressure in the second trimester?

Answer 6

It drops

Question 7

What causes reduction of blood pressure in the second trimester?

Answer 7

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

Question 8

What happens to urine output in pregnancy?

Answer 8

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

Question 9

What happens to bladder capacity in the third trimester?

Answer 9

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

Question 10

Why is there increased risk of UTI during pregnancy?

Answer 10

Increase in urinary stasis

Hydronephrosis is physiological which leads to pyelonephritis being more common

Question 11

Why is anaemia common during pregnancy?

Answer 11

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

Question 12

How much are iron requirements increase by in pregnancy?

Answer 12

1g

Question 13

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

Answer 13

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

Question 14

What effects does pregnancy have on the GI system?

Answer 14

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

Question 15

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

Answer 15

Constipation due to reduced rate of gastric emptying

Heartburn/GORD due to relaxation of cardiac sphincter

Question 16

What is the most common cause of death in pregnancy?

Answer 16

Cardiac disease

Question 17

What advice are women given in pre-pregnancy counselling?

Answer 17

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

Question 18

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

Answer 18

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

Question 19

What problems are to be identified during antenatal examination?

Answer 19

Problems with the mother
Problems with the fetus
Social problems

Question 20

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

Answer 20

Pre-existing or developing illness

Common problems of pregnancy such as anaemia

Question 21

What fetal problems can be identified in antenatal examination?

Answer 21

Small for gestational age

Fetal abnormality

Question 22

What social problems can be identified in antenatal examination?

Answer 22

Offer support if needed
Domestic violence
Psychiatric issues

Question 23

What is examined in antenatal examination?

Answer 23

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

Question 24

What infections can be picked up through antenatal screening?

Answer 24

Hepatitis B
Syphilis
HIV
UTI
Rubella

Question 25

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

Answer 25

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

Question 26

What is the overall risk of Down Syndrome?

Answer 26

1 in 700

Question 27

How does maternal age impact risk of down syndrome?

Answer 27

As maternal age increases risk increases

Question 28

What is used in Down Syndrome screening?

Answer 28

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

Question 29

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

Answer 29

When the risk is greater than 1 in 150

Question 30

What is non-invasive prenatal testing for Down Syndrome?

Answer 30

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

Question 31

What are positives and negatives of second trimester USS?

Answer 31

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

Question 32

What happens to white cell count in pregnancy?

Answer 32

It increases

Question 33

What happens to platelet count in pregnancy?

Answer 33

Decreases due to dilution

Question 34

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

Answer 34

No - must have elective cesarean

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

What is the first sign of pregnancy on ultrasound?

Answer 37

Thickening of the endometrium

Question 38

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

Answer 38

Phenylketonuria Cystic fibrosis Hypothyroidism

Question 39

What happens at 4.5 weeks pregnancy on ultrasound?

Answer 39

Fluid filled intrauterine sac appears

Question 40

What happens at 5 weeks pregnancy on ultrasound?

Answer 40

Yolk sac appears within the uterus

Question 41

What happens at 5.5 weeks pregnancy on ultrasound?

Answer 41

Tiny fetal pole is visible

Question 42

What happens at 6 weeks pregnancy on ultrasound?

Answer 42

Fetal heart beat becomes visible

Question 43

How is gestational age and therefore estimated due date determined?

Answer 43

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

Question 44

What is anencephaly?

Answer 44

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

Question 45

How is anencephaly identified?

Answer 45

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

Question 46

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

Answer 46

11-14

Question 47

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

Answer 47

Invasive test - amniocentesis

Question 48

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

Answer 48

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

Question 49

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

Answer 49

75%

Question 50

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

Answer 50

85% - 5% false positive rate

Question 51

What is used to assess risk of neural tube defect?

Answer 51

Alphafetoprotein at 15-20 weeks | Ultrasound - preferred test

Question 52

What is the most common neural tube defect?

Answer 52

Spina bifida

Question 53

What is the purpose of the second trimester ultrasound?

Answer 53

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

Question 54

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

Answer 54

``` Central nervous system Genitourinary tract Gastrointestinal tract Musculoskeletal system Cardiovascular - heart ```

Question 55

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

Answer 55

Frontal bossing | Lemon shape

Question 56

What abnormalities can be seen in second trimester USS?

Answer 56

``` Cystic hygroma Diaphragmatic hernia Duodenal atrasia Dilated renal pelvises Exomphalos/gastroschisis ```

Question 57

What is the purpose of third trimester USS?

Answer 57

Assess fetal wellbeing

Question 58

How is diaphragmatic hernia diagnosed?

Answer 58

Abdominal organs found within chest

Question 59

What sign is indicative of duodenal atresia?

Answer 59

Double bubble at level of stomach

Question 60

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

Answer 60

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