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Reproductive & Sexual Health > Antenatal care and screening > Flashcards

Antenatal care and screening Flashcards

1
Q

Any screening programme should be

A
  • highly sensitive
  • highly specific
  • have a high positive predictive value
  • easily used in a large population
  • safe and cheap
  • quick and straightforward to perform
  • able to detect a disease with a known natural history and where early diagnosis has a proven benefit
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2
Q

What is sensitivity

A

True positive /(positive + false negative)

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3
Q

What is specificity?

A

True negative/(negative + false positive)

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4
Q

What happens at the booking visit?

A
  • History:
    • Menstrual
    • Medical
    • Obstetric
    • Family
    • Social
  • Examination:
    • Ht; Wt; BP; CVS; Abdomen
  • Investigation
    • Hb
    • ABO; thesus
    • syphillis; HIV; hep B&C
    • Urinalysis; MSSU C&S
    • Ultrasound
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5
Q

What is the purpose of the US at the booking visit

A
  • confirm viability
  • singleton/multiple pregnancy
  • estimate gestational age- explain most accurate time/method to establish EDD
  • detect major structural anomalies that may be identified in early pregnancy
  • offter DSS
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6
Q

What is done at antenatal follow up visits?

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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7
Q

What are the objectives of ultrasound screening for foetal anomaly?

A
  • reduction in perinatal mortality and morbidity
  • potential for in utero treatment
  • identification of conditions amenable to neonatal surgery
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8
Q

Major structural abnormalities occur in _-_% of pregnancies

A

Major structural abnormalities occur in 2-3% of pregnancies

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9
Q

What do the NHS Fetal anomaly screening programme guidelines say?

A

“All pregnant women should be offered the 18+0 to 20+6 weeks fetal anomaly scan by a midwife or clinician (at first contact visit and/or booking visit).”

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10
Q

What is placenta praevia?

A

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

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11
Q

If an early ultrasound scan between 18 weeks and 20+6 weeks detects placenta praevia what should be done?

A

Offered another abdominal scan at 32 weeks and if this is unclear a vaginal scan

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12
Q

How is the down’s risk assessment carried out in first trimester?

A

Measure of skin thickness behind fetal neck using ultrasound (nuchal thickness)

Measured at 11- 13+6 weeks

Combined with HCG and PAPP-A

A value of <3.5mm would be considered normal with the CRL is between 45 and 85mm

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13
Q

What sould all pregnant woman undergoing down’s screening have before blood is taken?

A

A dating USS to accurately establish gestation

CRL is only used up to 13 weeks and HC should be used after this

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14
Q

What is done in down’s assessment in 2nd trimester?

A

Blood sample at 15-20 weeks

Assay of HCG and AFP

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15
Q

What should be done for women who miss 1st trimester down’s screening

A
  • Maternal Age + Biochemical Markers
    • Alpha-fetoprotein (AFP)
    • human Chorionic Gonadotrophin (hCG)
    • unconjugated oestradiol (UE3)
    • inhibin A
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16
Q

What are the specific antenatal diagnostic tests?

A

Amniocentesis

Chorionic villus sampling

17
Q

When is amniocentesis performed and what is the miscarriage rate?

A

after 15 weeks

1%

18
Q

When is chorionic villus sampling performed and what is the miscarriage rate?

A

After 12 weeks

2%

19
Q

What are the major haemoglobin disorders?

A

HbS and thalassemias

20
Q

What is maternal anaemia?

When is it screened for?

A

Iron deficiency, folate deficiency, B12 deficiency

Screened at booking and 28 weeks

21
Q

What is important in the management of maternal anaemia?

A

Hb should be optimised prior to birth

22
Q

When should all women have their blood group antibody status determined?

A

At booking and at 28 weeks gestation

23
Q

How does Rh haemolytic disease develop?

A

When father is Rh positive and mother is Rh negative

Baby is Rh+, at birth Rh positive babies blood cells enter mother’s bloodstream

Invading Rh +ve blood cells cause the production of Rh antibodies

Rh antibodies remain in mothers bloodstream

The Rh antibodies attack the babies blood cells, causing Rh disease.

24
Q

What mental health screening questions should be asked to mothers?

A
  • Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
  • Are you experiencing thoughts of suicide or harming yourself in violent ways?
  • Are you feeling incompetent as a mother, as though you can’t cope or feeling distanced or estranged from your baby? Are these feeling persistent?
  • Do you feel you are getting worse?
25
Q

How should risk of gestational diabetes be assessed?

A

At the booking appointment;

  • BMI above 30kg/m2
  • previous macrosomic baby weighing 4.5kg or above
  • previous gestational diabetes
  • family history of diabetes (first-degree relative with diabetes)
  • minority ethnic family origin
26
Q

If women have risk factors for gestational diabetes what test should be done?

A

2 hour 75g oral glucose tolerance test

+ve if woman has;

a fasting plasma glucose of 5.6mmol/litre or above

OR

a 2 hour plasma glucose level of 7.8mmol/litre or above

27
Q

What are the major risk factors for SGA?

A
  • maternal age > 40
  • smoker >11 cigarettes a day
  • paternal SGA
  • cocaine
  • daily vigourous exercise
  • previous SGA baby
  • previous stillbirth
  • maternal SGA
  • chronic hypertension
  • diabetes with vascular disease
  • renal impairment
  • antiphospholipid syndrome
  • heavy bleeding similar to menses
  • PAPP-A <0.4 MoM
28
Q

What are the minor risk factors for SGA?

A
  • Maternal age >35
  • IVF singleton pregnancy
  • nulliparity
  • BMI <20
  • BMI 25-34.9
  • smoker 1-10 cigarettes per day
  • low fruit intake pre-pregnancy
  • previous pre-eclampsia
  • pregnancy interval < 6 months
  • pregnancy interval > 60 months
29
Q

If mum has 3 or more minor risk factors then what should be done?

A

Reassess at 20 weeks

UAD at 20-24 weeks

If normal then assessment of fetal size and umbilical artery doppler in third trimester

30
Q

If mum has one major risk factors then what should be done?

A

Reassess at 20 weeks

PAPP-A <0.4 MOM

Fetal echogenic bowel (major)

31
Q

What is PAPP-A

A

Placental associated plasma protein A

32
Q

What is foetal echogenic bowel?

A

observation in antenatal ultrasound imaging

fetal bowel appears to be brighter than it is supposed to be.

It is a soft marker for trisomy 21 and has several other associations.

needs to be interpreted in the context of other associated abnormalities

33
Q

What is recommended at each antenatal appointment to predict SGA neonate

A

serial measurement of symphysis fundal height from 24 weeks of pregnancy

34
Q

Which women should be considered for ultrasound measurement of fetal size?

A

women with a single SFH which plots below the 10th centile or serial measurements which demonstrate slow or static growth by crossing centiles

35
Q

What is important about the plotting of SFH?

A

Needs to be plotted on a personalised chart

36
Q

In which women is measurement of SFH inaccurate?

A

BMI > 35

Large fibroids

Hydraminos

37
Q

What should women at high risk of pre-eclampsia be asked to do?

A

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

38
Q

Which women are at high risk of preeclampsia?

A

Women with any of;

  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
  • type 1 or type 2 diabetes
  • chronic hypertension
39
Q

Which women are at moderate risk of pre-eclampsia?

A

Women who have more than one of;

  • first pregnancy
  • age 40 or older
  • pregnancy interval of more than 10 years
  • BMI of 35kg/m2 or more at first visit
  • family history of pre-eclampsia
  • multiple pregnancy

Reproductive & Sexual Health (54 decks)

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