Antenatal care and screening Flashcards

1
Q
  • To understand the physiological changes associated with normal pregnancy in the mother
  • To understand pre-pregnancy counselling
  • To understand the procedure and implications of the antenatal examination
  • To understand the basis of screening for fetal abnormality
  • To know what screening tests are offered to women and understand their limitations
  • To be aware of the ethical dilemmas associated with detection of fetal abnormalities
A

listen to the PODCAST on Hyperemesis Gravidarum

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2
Q

Morning sickness is worse in conditions where what is increased

A

Human Chorionic gonadotrophin (hCG) - higher in twin pregnancies

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3
Q

Physiological changes in normal pregnancy

A

Cardio

  • CO increases
  • BP drops in 2nd trimester

Renal

  • Increased urine output
  • Increase in urinary stasis –> higher UTI risk

Haematology
-Anaemia - plasma volume increases by 50% but RBC mass only by 25%; iron only given if Hb low

Resp
-reduced CO2 output, increased O2 consumption

GI
-reduced GI motility

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4
Q

What is physiological in the 3rd trimester, making pyelonephritis more common

A

Hydronephrosis - build up of urine in kidneys because bladder capacity reduced due to pressure from expanding uterus

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5
Q

GI motility is reduced in pregnancy due to a increase and decrease in which hormones

A

Increased progesterone

Decreased motilin

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6
Q

Why is pre-pregnancy counselling important

A

To consider any existing health or previous pregnancy problems that could factor in to new pregnancy

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7
Q

What does pre-pregnancy counselling involve discussion of

A

General measures

  • improve diet
  • optimise BMI
  • avoid alcohol

Stop smoking

Folic acid supplements

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8
Q

What risks should be assessed in pre-pregnancy counselling

A

Age

Parity - nulliparity (never having completed a pregnancy beyond 20 wks) predisposes to pre-eclampsia, grand multiparty (4+ deliveries predisposes to postpartum haemorrhage)

Occupation - busy jobs not good or those exposed to dangerous substances

Substance misuse - alcohol or drugs

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9
Q

Those with known medical problems should discuss what in pre-pregnancy counselling

A

Optimise maternal health

Psychiatric health is important

Stop/Change any unsuitable drugs

Advise regarding complications associated with maternal medical problems

Occasionally advise against pregnancy

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10
Q

Antenatal examination aims to identify what problems in the MOTHER

A

pre-exisiting or developing illness

‘minor’ problems of pregnancy such as anaemia

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11
Q

Antenatal examination aims to identify what problems in the FOETUS

A

Small for gestational age

Foetal abnormality

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12
Q

Antenatal examination aims to identify what SOCIAL problems

A

Domestic violence

Psychiatric Illness

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13
Q

What to do on antenatal examination

A

Inspection

  • size
  • scars, stretch marks

Abdo palpation

  • assess symphyseal fundal height
  • assess lie (longitudinal or transverse)
  • estimate liquor volume
  • assess engagement/presentation (breech or cephalic)

Auscultate

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14
Q

Is antenatal screening compulsory

A

No, just offered but appropriate counselling should be given prior to screening

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15
Q

What screening tests are offered to women (7)

A
Hep B
Syphilis
Rubella
HIV
MSSU
Anaemia - iron deficiency anaemia
Isoimmunisation (antibodies against blood groups) - commonest is rhesus disease
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16
Q

What are you looking for on the first visit scan

A

Ensuring pregnancy is viable
Identify number of pregnancies
Identify any abnormalities
Offer Down’s syndrome screening

17
Q

Down syndrome is a chromosomal abnormality characterised by

A

3 copies of chromosome 21

18
Q

Down’s syndrome increases with

A

maternal age

19
Q

Multiple screening tests are available for down’s syndrome but what should parents be aware of in regards to these tests

A

They only provide a risk of their baby being affected

Further testing will be offered to definitively tell if a baby is affected

20
Q

Ethical dilemmas associated with detection of fetal abnormalities

A

Terminating

21
Q

First trimester USS occurs at how many weeks

A

10-14

22
Q

What test is done for Down’s syndrome screening

If there’s a high risk result, what further testing options can be overfed

A

Nuchal translucency - very difficult

CVS (chorionic villous sampling) – sample from placenta
Amniocentesis – sample from amniotic fluid
Non-invasive Prenatal testing (bloods taken and checked specially)

23
Q

Screening for neural tube defect isn’t routine since introduction of 1st trimester screening

What neural abnormalities can the 1st trimester US detect

A

anencephaly and sometimes spina bifida

24
Q

2nd trimester biochemical screening is carried out for neural tube defects if…

A

not able to get nuchal translucency measurement in 1st trimester US

25
Q

What marker is raised in neural tube defects

A

AFP

26
Q

2nd trimester US is performed for what purpose

A

Detecting foetal abnormality

2nd trimester is good time to screen fro major structural abnormalities BUT is poor for chromosomal abnormalities (50% with down’s have normal USS)

27
Q

What major structural abnormalities can be detected on 2nd trimester USS

A

Hypoplastic left heart

Exomphalos (weak abdominal wall –> abdominal contents protrude out but still covered in sac)

Cleft lip

28
Q

Screening for foetal abnormalities generally comprises of (3)

A

Features in history
Ultrasound
Maternal serum biochemistry