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Year 3 - Reproduction > Antenatal care and screening > Flashcards

Antenatal care and screening Flashcards

1
Q

What percentage of woman are affected by morning sickness?

A

80-85%

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2
Q

Which conditions can make morning sickness worse?

A

Anything that raises human chorionic gonadotrophin e.g. twins or hydatidiform molar pregnancy

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3
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum

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4
Q

When does morning sickness usually get better?

A

After the first trimester (Or after the first 16 weeks)

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5
Q

What happens to cardiac output during pregnancy? Why is there a change?

A

Cardiac output increases by 30-50% due to an increase in the heart rate from 70 to 90bpm

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6
Q

In terms of cardiac issues what is a common complaint during pregnancy and why can this be an issue?

A

Palpitations, differentiating between changing physiology and pathology can be hard.

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7
Q

What happens to blood pressure throughout the pregnancy?

A

It rises during the second trimester but returns to normal by the third

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8
Q

Why does the blood pressure rise during the second trimester?

A

> Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin

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9
Q

What happens to the bladder capacity during pregnancy, when does this occur?

A

The bladder capacity is reduced during the third trimester due to the increase in pressure of the pelvis by the ever expanding uterus.

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10
Q

What happens to urine output during pregnancy?

A

Increases

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11
Q

Why does urine output increase during pregnancy

A

> Renal plasma flow increases by 25-50%

> Glomerular Filtration Rate increases by 50%

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12
Q

What changes to serum urea and creatinine are their during pregnancy and why does this occur?

A

There is a decrease due to the increase in glomerular filtration rate and partly due to the dilution effect of increased plasma volume.

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13
Q

What urinary condition other than increased urine output are pregnant woman at higher risk of?

A

1) Urinary tract infections

2) Pyelonephritis

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14
Q

Why are pregnant woman at higher risk of UTI’s?

A

There is an increase in urinary stasis

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15
Q

Why are pregnant woman at higher risk of pyelonephritis?

A

As hydronephrosis is physiological during the third trimester which increases the risk of pyelonephritis.

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16
Q

What can UTis/pyelonephritis increase the risk of?

A

Preterm labour

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17
Q

During pregnancy what happens to plasma volume?

A

Increases by roughly 50%

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18
Q

During pregnancy what happens to RBC mass?

A

Increases by roughly 25%

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19
Q

What does an increase in the plasma volume and RBC mass lead to?

A

A drop in the haemoglobin by dilution from 133 to 121g/L

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20
Q

What happens to the iron requirement during pregnancy and why?

A

Increase by 1g, most of increased iron requirement is for the fetoplacental unit

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21
Q

When should iron supplements be given in pregnancy ?

A

If HB is <110 on routine testing at 28 weeks

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22
Q

What happens to the platelet count during pregnancy and why?

A

Falls by dilution

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23
Q

What happens to the white blood cell count in pregnancy?

A

Increases slightly from 9000 to 12000 uL

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24
Q

What is the effect of progesterone on the respiratory system?

A

Acts to centrally reduce CO2 by:
> Increasing tidal volume
> Increasing respiratory rate
> Increasing plasma PH

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25
Q

What effect does pregnancy have on O2 consumption?

A

Increase by roughly 20%

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26
Q

What effect does pregnancy have on plasma PO2?

A

None, its unchanged

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27
Q

What effect does pregnancy have on the respiratory mucous membranes?

A

Hyperaemia

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28
Q

What effect does pregnancy have on peristalsis?

A

> Reduces oesophageal peristalsis

> Gastric emptying is also slowed

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29
Q

Why is GI motility reduced during pregnancy?

A

1) Increase in progesterone

2) Decrease in motilin

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30
Q

In Scotland, what percentage of pregnancies are unplanned?

A

33%

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31
Q

When is pre-planning pregnancy vital?

A

Ideally everyone would be screened.

However for those with pre-existing health issues or past issues with pregnancy it is vital

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32
Q

What are the major causes of death during pregnancy?

A

> Cardiac issues
Sepsis
Thrombosis
Neurological issues

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33
Q

What is more common in obese pregnancies?

A 
> Miscarriage
> Still borns 
> Uterus dysfunction during Labour 
> Venous thromboembolic events
> Issues in routine measurements
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34
Q

What is done/talked about during pre-pregnancy counselling?

A

> General health measures:

  • Diet
  • BMI
  • Alcohol consumption

> Smoking cessation advice

> Folic acid levels

> Confirm Rubella immunity

> Risk assessment:

  • Age (Old or young)
  • Parity (Pre-eclampsia)
  • Occupation
  • Substance misuse

> Medication review

> Pschiatric assessment

> Advice on current and future medical problems

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35
Q

What is phenylketonuria and what does it put a newborn baby at risk of?

A

An inborn error of protein metabolism of the essential amino acid phenylalanine.

It increases the risk of mental developmental disorders.

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36
Q

If a mother has phenylketonuria what should she do during pregnancy?

A

Have a low phenylalanine diet to prevent high levels reaching the developing fetes and putting it at risk of mental development disorders.

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37
Q

What is the most common thyroid disease encountered during pregnancy? What should be taken into account?

A

Hypothyroidism, the patient will require a higher dose of thyroxine. Normal levels are required for the fatal brain development

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38
Q

If a type two diabetic woman gets pregnancy what needs to be done?

A

> Diabetic mothers are at higher risk of eclampsia, stilbirth and amcrosomic infants.

> They should have their oral medications changed to insulin.

> There should be tight control of the blood glucose levels.

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39
Q

What are renal patients more likely to develop when pregnant?

A

Pre-eclampsia, this can be hard to diagnose due to already having proteinuria and pre-existing hypertension

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40
Q

What is the main concern of patients with epilepsy and pregnancy?

A

Their medications on the developing fetus.

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41
Q

What is Sodium valproate associated with in pregnancy?

A

An increased risk of spina bifida for the baby

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42
Q

After how many caesarian birth is it customary to choose elective caesarian delivery?

A

After 2 c-sections

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43
Q

What is the role of the antenatal examination?

A

Aims to identify problems of the mother, fetus or social issues

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44
Q

What may be tested in an antenatal examination?

A

> Routine enquiry

> BP

> Urinanalysis

> Diabetes

> Abdominal palpitation:

  • Asses how baby lies (Fetal presentation)
  • Symphyseal fundal height (SFH)
  • Size of baby
  • Liquor volume

> Listen to metal heart

> Screen for infection

> Iron-deficiency anaemia

> Isoimmunisation:

  • Rhesus disease
  • Anti-C, Anti-Kell
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45
Q

If a baby is still breeched at 36 weeks what is usually done?

A

Firstly ECV is offered. If this fails then elective caesarian is then offered.

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46
Q

Which infections are screened for in pregnancy?

A

1) Rubella
2) Syphilis (Easily treated with penicillin)
3) Hepatitis B (If infected passive and active immunisation for the baby)
4) HIV (Maternal treatment and careful planning reduces the risk of vertical transmission)
5) MSSU (UTI)

47
Q

What can congenital rubella syndrome lead to?

A

> Mental handicap
Blindness
Deafness
Heart defects

48
Q

What can congenital syphilis lead to?

A 
> Intrauterine growth restriction
> Hepato-splenomegaly
> Anaemia
> Thrombocytopenia
> Skin rashes
49
Q

What is looked for in the first visit scan?

A

> Is pregnancy viable?
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down syndrome screening

50
Q

What is the overall risk of Down syndrome?

A

1 in 700

51
Q

What is the risk of Down syndrome in a woman pregnant at 20 years old?

A

1 in 1667

52
Q

What is the risk of Down syndrome in a woman pregnant at 45 years old?

A

1 in 30

53
Q

What are the biggest determining factors in a baby having down syndrome?

A

> Maternal age = Older leads to an increased risk

> Family history = Translocation in some family members

54
Q

What does screening for Down syndrome offer?

A

It only provides a risk of the baby being affected not a definitive answer.

Further testing will be offered to confirm.

55
Q

When it the first trimester screening carried out?

A

Between 10 and 14 weeks gestation

56
Q

What is tested at the first trimester screening?

A 
> Maternal risk factors
> Serum B-hCG
> Pregnancy associated plasma protein A (PAPP-A)
> Fetal nuchal translucency (NT)
> Trisomy 21
57
Q

What are the rates for detection of Trisomy 21 at the first trimester screening?

A

85-90% detected, with a 5% false positive rate.

58
Q

What is a normal nuchal translucency measurement?

A

45-84mm

59
Q

What is used within nuchal transluceny ?

A

The size rather than the translucency.

60
Q

If there is higher nuchal translucency what may be done?

A

1) CVS:
- Performed at 10-14 weeks
- 1-2% risk of miscarriage

2) Amniocentesis:
- 15 weeks onwards
- 1% risk of miscarriage

3) Non-invasive pre-natal testing:
- Maternal blood taken
- Look for fatal cell free DNA, chromosomal trisomies

61
Q

If there is a high risk of neural tube defects what is offered to the pregnant woman?

A

5mg folic acid supplementation

62
Q

In terms of neural tube defects what can be detected in the first trimester US screening?

A

> Anencephaly

> Spina bifida sometimes

63
Q

In second trimester what is tested to detect neural tube defects?

A

> Maternal serum us tested for alpha fetoprotein (>2.0MoM is high risk and warrants investigation)

> US will detect 90% of NTDs

64
Q

What is the main goal of the ultrasound in the second trimester (20weeks)?

A

Detection of fatal abnormalities

65
Q

What cannot always be detected in second trimester US?

A

Chromosomal abnormalities:
> 50% of fetuses with T21 will have a normal detailed USS
> 17% of fetuses with T18 will have a normal detailed USS
> 9% of fetuses with T13 will have a normal detailed USS

66
Q

What is the first ultrasound sign of a pregnancy?

A

> Thickening of the lining of the womb.

67
Q

What an be seen at 4.5 weeks gestation on US.

A

A fluid filled intrauterine gestational sac appears

68
Q

What an be seen at 5 weeks gestation on US.

A

A yolk sac appears within the uterus

69
Q

What an be seen at 5.5 weeks gestation on US.

A

A tiny fatal pole

70
Q

What an be seen at 6 weeks gestation on US.

A

Fetal heart pulsation may be visible

71
Q

Once a fetal pole is identified what is measured?

A

Crown rump length (CRL) measurement is made from one end of the embryo to the other

72
Q

What can the crown rump length give as indication of?

A

The length correlates closely to gestational age, therefore it can be used to estimate the due date

73
Q

What is testing in first trimester US?

A 
> Gestational age
> Miscarriage
> Multiple pregnancy
> Early abnormalities (Hydatidiform mole, ectopic pregnancy)
> Some major structural abnormalities
> Neural tube defects (Anencephaly, spinal bifida)
> Examine maternal ovaries
> Ectopic pregnancy
74
Q

Estimated date of delivery can really be established by?

A

1st trimester USS, using the crown rump length.

75
Q

What is the first sign on pregnancy on USS?

A

Thickening of the lining of the uterus

76
Q

Fatal heart pulsation can be seen on transvaginal USS by?

A

6+ weeks gestation

77
Q

How is gestation age calculated in the first trimester?

A

Crown rump length

78
Q

When should the first US visit be performed?

A

At 11-12 weeks gestation

79
Q

When is the CUB (combined ultrasound and biochemical) screening carried out in Grampian?

A

Between 11 and 14 weeks

80
Q

If a patient books their first screening after 14 weeks what will be tested within their blood?

A

Serum markers:

1) Alpha feto-protein (AFP)
2) Total human chorionic gonadotrophin (hCG)
3) Unconjugated eostriol (UE3)
4) Inhibin-A

This is known as the quadruple test and is carried out between 15-20 weeks

81
Q

What is the detection rate of the quadruple test?

A

Carried out between 15-20 weeks, the quadruple test carries a 75% sensitivity.

Tests for serum markers:

1) Alpha feto-protein (AFP)
2) Total human chorionic gonadotrophin (hCG)
3) Unconjugated eostriol (UE3)
4) Inhibin-A

82
Q

What is the usual cut off for considered high risk in a pregnancy for trisomy?

A

1 in 200

83
Q

If there is a high risk reporting of 1 in 200 what is offered?

A

An invasive test, usually amniocentesis, to identify fatal chromosomes and make a definitive diagnosis.

84
Q

What is the risk of a miscarriage with invasive testing (e.g. aminocentesis)?

A

1% risk of miscarriage

85
Q

What is nuchal translucency?

A

The measure of the fluid-filled area at the back of the baby’s neck

It is often used in combination with Human Chorionic Gonadotrophin (hCG) and Pregnancy Associated Plasma Protein-A (PAPP-A) in the maternal blood to calculate a risk of chromosomal abnormality.

86
Q

Which tests may be combined with US in combined ultrasound and biochemical test (CUBS) ?

A

1) Human Chorionic Gonadotrophin (hCG)
2) Pregnancy Associated Plasma Protein (PAPP-A)

Used to calculate a risk of maternal chromosomal abnormality

87
Q

What is the sensitivity of combined ultrasound and biochemical test (CUBS) in identifying Trisomy 21 (Down syndrome)?

A

Detects around 85% of cases and carries a false positive rate of 5%

88
Q

Which biochemical marker may be used to determine neural tube defects (Spina bifida)?

A

Alpha fetoprotein (AFP) at second trimester screening between 15-20 weeks

89
Q

What is considered an abnormal AFP?

A

An Alpha fetoprotein, >2.0 multiples of the median (MoM) is considered abnormal and will detect 85% of NTDs (Neural tube defects)

90
Q

What rate of sensitivity does USS carry for NTDs?

A

USS will detect >90% of neural tube defects

91
Q

What is myelomeningocele?

A

Spina Bifida

92
Q

Where is AFP (Alpha fetoprotein) produced?

A

AFP is a fetal glycoprotein produced sequentially by the yolk sac, fetaI gastrointestinal tract and liver.

93
Q

When is second trimester screening offered?

A

15-20 weeks

94
Q

Which fatal parameters are used to monitor fatal growth?

A

> Head circumference
Abdomen
Femur length

95
Q

Why may a third trimester scan be offered?

A

> Confirm/monitor structural abnormalities
Help in deciding delivery plan E.g. Looking at the lie of the baby ad whether C-section would be advisable
Check/monitor placenta issues
Size of the baby E.g. Static growth? Large, is mum diabetic?

96
Q

How frequently would you expect to scan to monitor fatal growth?

A

> Spaced a minimum of 2 weeks apart but usually 4 weeks

97
Q

True or false. Most structural anomalies can be picked up on first trimester?

A

False, most seen on second

98
Q

True or false. A 2nd trimester USS will detect 75% of CNS structural abnormalities?

A

True

99
Q

True or false. Detailed scan at 20 weeks is offered so that major structural anomalies can be recognised?

A

True

100
Q

True or false. Detailed scan at 20 weeks will detect at least 50% of structural cardiac defects?

A

False, it is closer to 15% of cardiac abnormalities

101
Q

True or false. PAPP-A is a protein raised in the maternal serum if the foetus has an open neural tube defect?

A

False, PAPP-A is used to determine Chromosomal abnormalities e.g. Trisomy 21

Alpha fetoprotein is used to determine NTDs

102
Q

True or false. Third trimester USS is routinely performed at 28 weeks?

A

False, third trimester is not routinely performed

103
Q

True or false. Detailed scan at 20 weeks will detect at least 50% of structural GIT abnormalities?

A

False, it is closer to 40%

104
Q

True or false. Detailed scan at 20 weeks will detect at least 50% of structural MSS abnormalities?

A

False, it is closer to 25%

105
Q

If the foetus head is lemon shaped (frontal bossing), banana shaped cerebellum and enlarged ventricles what does this indicate?

A

A neural tube defect

106
Q

What does a cystic hygroma of the neck associated with?

A

Chromosomal abnormality

107
Q

What does the presence of abdominal organs in the chest indicate?

A

Diaphragmic hernia

108
Q

What does a double bubble sign indicate?

A

Duodenal atresia

109
Q

In addition to NTDs AFP is elevated in a number of other situations, what are they?

A

These include incorrect gestational age, multiple pregnancy, bleeding in pregnancy, fetal death and abdominal wall abnormalities.

110
Q

If abdominal contents are seen to have herniated into the umbilical cord what is the called?

A

Exomphalos

111
Q

If the bowel is shown to have herniated through the abdominal wall alongside the cord what does this indicate?

A

Gastroschisis

112
Q

What may a third trimester USS be performed?

A

To ensure fetal well-being, it is not routine. It is usually indicated it the baby feels large or small

113
Q

What may be measured during a third trimester USS?

A

1) Measurements of the head, abdomen and femur and plotting standardised growth charts
2) Liquor volume (Fluid round baby)
3) Placental site

Year 3 - Reproduction (25 decks)

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