Antenatal care and screening

Question 1

what does an increase inn Human Chorionic gonadotrophin hormone cause?

Answer 1

worse morning sickness

Question 2

what can morninng sickness progress to?

Answer 2

hyperemesis gravidarum - persistent vomiting = weight loss, dehyration, acidosis. (be concerned when you see tachycardia and hypotension) (may find ketones on urine if she hasn’t eaten anything)

Question 3

how is hypermesis gravidarum treated?

Answer 3

iv fluids, electrolyte correction

Question 4

what conditions are suggested by the presence of hypermesis gravidarum?

Answer 4

multiple pregnancy, thyrotoxicosis, UTI, molar pregnancy.

Question 5

how much does cardiac output increase by in pregnnancy?

Answer 5

50%, 90bmp average too (CO = SV x HR)

Question 6

why does blood pressure drop in the second trimester?

Answer 6

Expansion of the uteroplacental circulation, A fall in systemic vascular resistance, A reduction in blood viscosity, A reduction in sensitivity to angiotensin, BP usually returns to normal in the third trimester

Question 7

what happens to the urinary system?

Answer 7

incrseased urinne output (plasma flow increases by 25%, gfr by 50%), inncreased risk of UTI’s

Question 8

what Haematological problems are there?

Answer 8

Anaemia, iron requirements increases, wbc increases, platelets annd rbc’s fall, there is a drop in hb by dilution

Question 9

resp changes

Answer 9

Progesterone acts centrally to reduce CO2, howevere it increases Tidal volume, Respiratory rate, Plasma pH, O2 consumption increases by 20%, however plasma PO2 is unchanged, Hyperaemia of respiratory mucous membranes.

Question 10

GI changes

Answer 10

Oesophageal peristalsis is reduced, Gastric emptying slows, Cardiac sphincter relaxes, GI motility is reduced due to  progesterone and  motilin

Question 11

general advice to pregnant women

Answer 11

diet, optimise bmi, reduce alcohol connsumption, smokinn cessation advice, folic acid

Question 12

what features of.a womens background can effect her outcome of pregnancy

Answer 12

obesity, alcohol, age, parity, occuptation, substance misuse, smoking.

Question 13

in pre-pregnancy councellingn which conditions would be important?

Answer 13

DM, epilepsy (sodium valproate associated with spina bifida), thyroid disease, Phenylketonuria, renal issues (pre-eclampsia), so monitor physical and psychological health, stop/change any unsuitable drugs, advice regarding complicaitons.

Question 14

what are the common maternal previous pregnanncy problems?

Answer 14

Counsel regarding risk of recurrence: Caesarean Section, DVT, Pre-eclampsia, Actions to reduce risk of recurrence, Thromboprophylaxis, Low dose aspirin.

THINK OF ANYTHING THAT CAN GO WRONG IN PREVIOUS PREGNANCIES.

Question 15

what are the common Fetal previous pregnanncy problems?

Answer 15

Counsel regarding risk of recurrence: Pre-term delivery, Intrauterine growth restriction, Fetal abnormality. Actions to reduce risk of recurrence: Treatment of infection, High dose folic acid, Low dose aspirin.

Question 16

what is done in the antenatal examination?

Answer 16

bp, urinalysis, abdo palpation (symphyseal fundal height, size of baby, liquor volume, fetal lie), fetal presentaiton, fetal heart (ECV),

Question 17

what infections are screened for?

Answer 17

Hep B, syphilis, HIV, Rubella

Question 18

what else is screened for in terms of blood?

Answer 18

anaemia annd isoimmunisation (the development of antibodies against blood groups. The commonest isoimmunisation is Rhesus disease where anti-D antibodies occur), anti-c or anti-Kell.

Question 19

when using US for screenninng what is looked for?

Answer 19

Ensure pregnancy viable, Multiple pregnancy, Identify abnormalities incompatible with life, Offer and carry out Down’s syndrome screening, Detailed anomaly scan, Systematic structural review of baby, Not possible to identify all problems, Can identify problems that need intrauterine or postnatal treatment.

Question 20

how is the first trimester screening for Downs syndrome done? Also outline down syndrome…

Answer 20

at 10-14 weeks - Uses maternal risk factors, serum beta--human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein A (PAPP-A) and fetal nuchal translucency (NT) measurement.
Nuchal translucency (NT): NT measurements are taken between Crown Rump Length’s of 45-84mm, NT increases with gestational age and the incidence of chromosomal and other abnormalities is related to the size, rather than the appearance of NT.
Down Syndrome is a chromosomal abnormality characterised by 3 copies of chromosome 21, Overall risk is 1 in 700, Usual cut off for ‘high risk’ reporting is 1 in 150. Maternal age: 1in 1667 risk at age 20yrs, 1 in 30 risk at age 45yrs, Personal or family history of chromosomal abnormality.

Question 21

what is done with a high risk result of first tirmester screening?

Answer 21

further testing offered if risk is >1 in 150, options are: CVS, Aminocentesis, non invasive prennatal testing (maternal blood taken, cann detect fetal cell free DNA, can look for chromosomal trisomies).

Question 22

What is CVS (chorionic villus sampling)?

Answer 22

Chorionic villus sampling (CVS): A needle, guided by ultrasound, is inserted through the mother’s abdomen to take a sample of cells from the placenta. These are tested for missing, extra or abnormal chromosomes. The procedure is done between 11 and 14 weeks of pregnancy, 1-2% risk of miscarriage.

Question 23

How is screeninng fo rNeural tube defects done?

Answer 23

Personal or family history of NTD are at increased risk. First trimester ultrasound to detect anencephaly and sometimes spina bifida (variants of NTD)
Second trimester biochemical screening: Carried out if not able to get NT measurement, Maternal serum is tested for alpha fetoprotein, >2.0MoM is high risk and warrants investigation. Second trimester (20wk) ultrasound will detect >90% of NTD.

Question 24

what reduces the risk of NTD?

Answer 24

5mg folic acid

Question 25

give examples of abnnormalities foundon the second trimester US

Answer 25

This is a good screening test for major structural abnormalities but a poor test for chromosomal abnormalities. Hypoplastic heart, exomphalos, cleft lip.

Question 26

What are TORCH infections?

Answer 26

toxoplasmosis, rubella, cytomegalovirus, herpes simplex,

and other organisms including syphilis, parvovirus, and Varicella zoster.