Antenatal Care and Screening

Question 1

In what conditions is morning sickness worse for pregnant women?

Answer 1

Conditions where Human Chorionic Gonadotropin is higher e.g twin, molar pregnancy.

Question 2

What is a molar pregnancy?

Answer 2

Abnormal pregnancy in which a non-viable fertilised egg implants in the uterus and will fail to come to term.

Question 3

What is Hyperemesis gravidarum?

Answer 3

Excessive nausea and vomiting during early pregnancy.

Question 4

What are the symptoms of hypermedia gravidarum?

Answer 4

Prolonged and severe nausea and vomitng - can be up to 50x a day.

Dehydration
Ketosis
Weight loss
Hypotension when standing

Question 5

When does morning sickness normally stop?

Answer 5

16 weeks

Question 6

How does pregnancy affect the urinary system?

Answer 6

Increased urine output - renal plasma flow increases by 25-50%.
GFR increases by 50% and serum urea and creatinine decrease.

Increase in urinary stasis so UTI is more common. Hydronephrosis is physiological in 3rd trimester and makes pyelonephritis more common.
UTIs can be associated with preterm labour so important to treat.

Question 7

How does pregnancy affect haematology?

Answer 7

Plasma volume increases by 50% 
RBC mass increases by 25%
Hb drops by dilution.
WBC increase slightly to 9000-12000/uL
Platelet count falls by dilution.

Question 8

When should iron supplements be given to a pregnant women?

Answer 8

Iron supplements should be given if HB is <110 or less than 100 on routine testing at 28weeks.

Adjust starting Hb with diet, liquid iron and tablets.

Question 9

How does Progesterone affect CO2?

Answer 9

Progesterone acts centrally to reduce CO2.

This means tidal volume, respiratory rate, plasma pH and O2 consumption all increase.

Question 10

How does pregnancy affect the GI tract?

Answer 10

Oesophageal peristalsis is reduced.
Gastric emptying slows
Lower oesophageal sphincter relaxes - reflux, heartburn.
GI motility reduced due to increase in progesterone and decrease in motilin.

Question 11

What are some examples of pre-pregnancy counselling?

Answer 11

Improving diet
Optimise BMI
Reduce alcohol consumption
Smoking cessation advice
Folic acid- 400mcg to reduce risk of spina bifida.
Occupation - does job but them/baby at risk.
Substance misuse

Question 12

What is Phenylketonuria?

Answer 12

Inborn error of protein metabolism which causes an inability to metabolise essential amino acid phenylalanine.

Results in mental development impairment.

Question 13

What extra measures need to be taken if an expecting mother has Graves disease (hyperthyroid)?

Answer 13

Need treatment to keep their thyroid hormone levels normal.

Neonate will also need to be checked as thyroid stimulating antibodies can cross the placenta to the foetus.

Question 14

What happens to type 2 diabetic women who are pregnant?

Answer 14

They need to be switched from oral hyopglycaemic medications to insulin.

They are more at risk of stillbirth, pre-eclampsia and marcosomic infants.

Question 15

What are some maternal complications that need to be counselled to pregnant women who have previously given birth?

Answer 15

Risk of recurrence of:
Caesarean section
DVT
Pre-eclampsia

Question 16

What are the actions required for previous pregnancy mothers to reduce their risk of recurrence?

Answer 16

Thromboprophylaxis

Low dose aspirin

Question 17

What are some fetal conditions that have a risk of recurrence in women who have already had a pregnancy?

Answer 17

Pre-term delivery
Intrauterine growth restriction
Fetal abnormality

Question 18

What are the actions required to prevent the recurrence of the fatal conditions that may affect woman who have had previous pregnancies?

Answer 18

Treatment of infection
High dose folic acid
Low dose aspirin

Question 19

What are some examples of problems that could be picked up upon antenatal examination?

Answer 19

Mother - pre-existing or developing illness, anaemia, evolving hypertension, diabetes, pre-eclampsia.

Foetus - Small for gestational age, Foetal abnormality

Social - support, domestic violence, psychiatric illness.

Question 20

What is checked upon abdominal palpation of a pregnant woman?

Answer 20

Assess symphyseal fundal height (SFH)
Estimate size of baby
Estimate liquor volume
Lie of the baby
Presentation

Question 21

What can be offered if a baby remains in breech presentation after 36weeks?

Answer 21

ECV - external cephalic version.

Process of turning a breech baby into a cephalic baby so a vaginal delivery can occur.

Question 22

What are some infections that are screened for in expectant mothers?

Answer 22

Hepatitis B - can provide passive and active immunisation for baby.
Syphilis - easily treated with penicillin.
HIV - maternal treatment and careful planning reduces vertical transmission
MSSU - UTI
Rubella antibodies indicating immunity due to prior infection or immunisation.

Question 23

What can congenital rubella syndrome result in in the foetus and when does it occur?

Answer 23

Mental handicap
Blindness
Deafness
Heart defects

16 weeks

Question 24

What does congenital syphilis result in the foetus?

Answer 24

Intrauterine growth restriction
Hepato-splenomegaly
Anaemia
Thrombocytopenia
Skin rashes

Question 25

How is iron deficiency anaemia screened for?

Answer 25

Full blood counts at booking and 28weeks gestation.

Question 26

What is Isoimmunisation?

Answer 26

The development of antibodies against blood groups. The commonest is rhesus disease where anti-D antibodies occur.

Question 27

What happens if a Rhesus negative woman is carrying a rhesus positive baby?

Answer 27

Develop anti D antibodies if the whole if the foetal RBC enter the maternal circulation. These tend to develop following the first pregnancy.
In subsequent pregnancies the anti D antibodies cross the placenta and lead to destruction of RBC causing fatal anaemia.

Question 28

What is screened for at the first scan?

Answer 28

Ensure pregnancy is viable
Check for multiple pregnancies
Identify abnormalities incompatible with life
Offer and carry out Down syndrome screening.

Question 29

What is screened for during a detailed anomaly scan?

Answer 29

Systemic structural review of baby

Identify problems that need intrauterine or postnatal treatment.

Question 30

What is the usual cut off to classify a woman as high risk for Down syndrome baby?

Answer 30

1 in 150

Question 31

What are some risk factors for having a Down syndrome Baby?

Answer 31

1 in 700 overall risk
Maternal age
Personal or family history of chromosomal abnormality.

Question 32

What happens at first trimester screening?

Answer 32

Carried out at 10-14weeks
Uses maternal risk factors , serum beta-human chorionic gonadotrophin and pregnancy associated plasma protein A and fatal nuchal translucency measurements.

Question 33

What happens if a women has a high risk of downs syndrome result?

Answer 33

Further testing is offered if risk is >1 in 150.

Options include CVS, amniocentesis and non-invasive prenatal testing.

Question 34

What is the risk of miscarriage with Chorionic villus sampling?

Answer 34

1-2%

Question 35

What is the risk of miscarriage with Amniocentesis?

Answer 35

Approx. 1%

Question 36

What is non-invasive prenatal testing?

Answer 36

Maternal blood is taken to detect fatal cell free DNA and chromosomal trisomies.
It is not offered on the NHS.

Question 37

What neural tube defects should be picked up upon a first trimester ultrasound?

Answer 37

Anencephaly

Spina bifida

Question 38

What is tested during second trimester biochemical testing?

Answer 38

Maternal serum is tested for alpha fetoprotein.
>2.0MoM is high risk and warrants investigation.
Carried out if not able to get NT measurement.