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3 Reproduction > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

how do you asses robustness of screening

A

sensitivity

specificity

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2
Q

how do you calculate sensitivity

A

true positive/positive +false negative

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3
Q

how do you calculate sensitivity

A

true negative/negative + false positive

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4
Q

what is the sensitivity for first trimester Down’s syndrome screening

A

90%

false positive - 5%

so 1/20 women who are high risk will have a baby thats not effected

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5
Q

what history is taken in the firs antenatal appointment

A 
PMH
Past obsectric history 
Past surgical history 
medications 
allergies 
social histories 
family history 
mental health (screened at every appointment) 
FGM
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6
Q

how do you asses gestation before first scan

A

add nine months and 7 days onto onset of last period

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7
Q

what investigations are done at the booking visit

A 
Hb
ABO, rhesus 
Syphilis, HIV, hep B&C
Urinalysis, MSSU, C&S
Ultrasound

scan

  • confirm vitality
  • multiple pregnancies
  • estimate gestational age
  • detect major structural abnormalities that may be identified
  • offer Down syndrome screening
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8
Q

what is done at follow up visits ( 3)

A

History

  • physical and mental health
  • fetal movements

examination:
- BP and urinalysis
- Symphysis - fundal height
- lie and presentation
- engagement of presenting part
- fetal heart auscultation

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9
Q

why is ultrasound screening done

A

Reduction in perinatal mortality and morbidity

Potential for in utero treatment

Identification of conditions amenable to neonatal surgery

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10
Q

what foetal abnormalities are checked for at a 20 week scan

A 
Anencephaly 
Open spina bifida 
Cleft lip 
Diaphragmatic hernia 
Gastroschisis 
Exomphalos 
Serious cardiac abnormalities 
Bilateral renal agenesis 
Lethal skeletal dysplasia 
Edward's syndrome (trisomy 18) 
Parau's syndrome (trisomony 13)
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11
Q

what is placenta praaevia

A

placenta is low lying in the womb and covers all or part of the entrance (cervix)

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12
Q

what increases risk of Down syndrome

A

increased maternal age

1/100 when 40

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13
Q

what is the first trimester down’s risk assessment

A

Nuchal translucency
HCG and PAPP-A
Value of <3.6 is normal when the crown rump length is between 45 and 84mm

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14
Q

what is second trimester Down syndrome screening

A

Blood sample at 15-20 weeks
Assay of HCG and AFP
less accurate

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15
Q

what is considered high risk for downs

A

> 1:250 is high risk and needs amniocentesis (optional)

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16
Q

what is the risk of baby having Down syndrome is nuchal translucency is >3.5

A

1/20

higher the NT the higher the risk

17
Q

what biological markers are used for second trimester screening

A

Alpha fetoprotein
Human chorionic gonadotrophin
Unconjugated estradiol
Inhibit A

18
Q

what is diagnostic testing for Down’s syndrome

A

Amniocentesis

  • after 15 weeks
  • miscarriage rate of 1%

Chorionic villus sampling

  • performed after 12 weeks
  • miscardage rate of 2%
19
Q

what is amniocentesis

A

thin needle into amniotic sac

20
Q

what is chorionic villus sampling

A

biopsy of the placenta

21
Q

what major haemoglobin disorders are screened for in pregnancy

A

HbS (sickle cell anaemia)

Thalassemias

both are autosomal recessive

need screened for

50% risk of carrier
25% change of being effected
25% of not being affected at all

22
Q

why is maternal anaemia an issue

A

65% increase in risk in pregnancy

can cause foetal anaemia

causes by:

  • iron deficiency
  • folate deficiency
  • B12 deficiency
  • screened at 28 weeks
  • optimise Hb prior to birth
23
Q

what do you give a Rh - mother if her baby is Rh+

A

Anti-D antibody

24
Q

how do you pick up foetal anaemia

A

ultrasound doppler

if >32 weeks they get C section

if <32 weeks they get a foetal blood transfusion

25
Q

what are the risk factors for gestational diabetes

A

BMI >30
Previous macrocosmic baby weight 4.5 to above
Previous gestational diabetes
Family history of diabetes
Minority ethnic family origin with high prevalence of diabetes

26
Q

how do you measure foetal growth

A

symphysis fundal height measured at each antenatal appointment from 24 weeks of pregnancy

plotted on a customised charge

27
Q

what should you advise women who are at high risk of pre-eclampsia to take

A

75mg of aspirin daily from 12 weeks until the birth of the baby

28
Q

what makes women at high risk of pre-eclampsia

A

hypertensive disease in previous pregnancy

chronic kidney disease

autoimmune disease eg. lupus or antiphospholipis

type 1 or type 2 diabetes

chronic hypertension

29
Q

what makes a women at moderate risk of pre-eclampsia

A 
first pregnancy 
>40 y/o 
pregnancy at interval of more than 10 years 
BMI of 35 or more 
family history of pre-eclampsia 
multiple pregnancy
30
Q

what is screened for via urinalysis

A

UTI
Asymptomatic bacteria
PET
Diabetes

3 Reproduction (49 decks)

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