Antenatal Care and Screening Flashcards
Describe the antenatal care timeline
Booking scan before 10 weeks (8-12)
Dating scan 10-13 weeks (down syndrome/nuhal translucency screening also)
Antenatal appointment 16 weeks
Anomaly scan 18-20 weeks
28 weeks second screening for anaemia
Further antenatal appointments at 25, 31, 34, 36, 38 etc
What is covered at routine antenatal appointments?
Symphisis-fundal height measurement from 24
Fetal presentation from 36
Urine dipstick and protein
BP
Urinalysis, for asymptomatic bacteriuria
What bloods are done at booking?
FBC
- Anaemia
Haemoglobinopathy
- Thalassaemia, for all women
- Sickle cell, for women at high risk
Blood group
Rhesus status
Viral screen
When are women screened for anaemia in pregnancy?
Booking
28 weeks gestation
Why does anaemia occur in pregnancy?
During pregnancy, the plasma volume increases, and so the blood is more diluted, resulting in reduced haemoglobin concentration
What dose of folic acid is reccomended in pregnancy?
400mcg
Women with neural tube risk factors should be given 5mg instead
What supplements, other than folic acid, should also be advised for pregnant women?
Vitamin D 10 micrograms
What supplements are not reccomended in pregnancy?
Vitamin A in high doses can be teratogenic
(Liver is high in this so should also be avoided)
What foods should be avoided in pregancy?
Vitamin A
- Liver
Listeriosis
- Unpasteurised milk
- Ripened soft cheeses
- Pate
- Undercooked meat
Salmonella
- Raw or partially cooked eggs and meat, especially poultry
What medications cannot be used in pregnancy?
Methotrexate
Lithium, avoided unless other options have failed
Sodium valproate
DOACs
ACEI/ARBs
B Blockers, switch for labetalol
NSAIDs typically avoided unless necessary
Opiates, can cause neonatla withdrawl
Warfarin
Roaccutane
When should methotrexate be stopped before conception?
Both men and women must stop methotrexate 6 months prior to conception
When should NSAIDS be stopped in pregnancy?
May be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus
What anti-depressants are used in pregnancy and breast feeding?
Sertraline or paroxetine are the SSRIs of choice in breastfeeding women
What are the safest epileptic drugs to use in pregnancy?
Carbamazepine and lamotrigine
Sodium valporate carries the highest risk of congenital defects
Give drug contraindications for breastfeeding
Antibiotics
- Ciprofloxacin
- Tetracycline
- Chloramphenicol
- Sulphonamides
Lithium
Benzodiazepines
Aspirin
Carbimazole
Methotrexate
Sulfonylureas
Cytotoxic drugs
Amiodarone
Describe the pathophysiology of rhesus disease in pregnancy
If a Rh -ve mother delivers a Rh +ve child, a leak of fetal red blood cells may occur
This causes anti-D IgG antibodies to form in mother
In later pregnancies, these antibodies can cross the placenta and cause haemolysis in fetus
When is anti-D immunoglobulin therapy given in pregnancy?
Delivery of a Rh +ve infant, whether live or stillborn
Any termination of pregnancy
Miscarriage if gestation is > 12 weeks
Ectopic pregnancy if managed surgically
External cephalic version
Antepartum haemorrhage
Amniocentesis, chorionic villus sampling, fetal blood sampling
Abdominal trauma
When should anti-d therapy be given to unsensitised Rh - mothers?
28 and 34 weeks
What infections are screened for in pregnancy?
HIV
Rubella
Hep B
Syphillis
What vaccines are offered to pregnant women?
Whooping cough/pertussis) from 16 weeks
Influenza when available in autumn or winter
What organism causes Rubella?
Togavirus
How does congenital rubella syndrome present?
Aqueductal stenosis and congenital hydrocephalus
Sensorineural deafness
Congenital cataracts
Congenital heart disease/patent ductus arteriosus
Congenital cataracts
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Chorioretinitis
Microphthalmia
Cerebral palsy
When is there a risk of congenital rubella syndrome?
In first 8-10 weeks risk of damage to fetus is as high as 90%
Damage is rare after 16 weeks
When are Rubella patients infectious?
Individuals are infectious from 7 days before symptoms to 4 days after the onset of rash
When is the MMR vaccine offered?
Offered in post natal women but not offered to pregnant women or those attempting to get pregnant
Describe the management of chickenpox exposure in pregnancy
If less than 20 weeks and not immune, give varicella zoster immunoglobulin (VZIG) as soon as possible, effective up to 10 days post exposure
If more than 20 weeks and not immune, give either VZIG or aciclovir 7-14 days after exposure
If any doubt on the patient having previous chickenpox, check for varicella antibodies
Describe the managemet of chickenpox in pregnancy
If over 20 weeks and presenting within 24 hours of onset of rash, give aciclovir
If less than 20 weeks aciclovir should be given with caution
How does congenital varicella zoster virus present?
Low birth weight
Limb hypoplasia
Skin scarring
Microcephaly
Eye defects
Learning disability
What is the management of pregnant mothers who are hepatitis B positive?
Babies should receive vaccination at 1-2 months and 6 months and hepatitis B immunoglobulin within 12 hours of birth
Little evidence to suggest caesarean section reduces vertical transmission rates
hepatitis B cannot be transmitted via breastfeeding
What is the management of pregnant mothers who are HIV positive?
Zidovudine infusion should be started four hours before beginning the caesarean section
Zidovudine administered orally to neonate
Advised not to breastfeed
What is asymptomatic bacteriuria and what is the relevance in pregnancy?
Refers to bacteria present in the urine, without symptoms of infection
Pregnant women with asymptomatic bacteriuria are at higher risk of developing UTIs and pyelonephritis, and subsequently at risk of preterm birth
How are UTIs managed in pregnancy?
7 days of antibiotics
Nitrofurantoin, avoid in the third trimester due to neonatal haemolysis
Amoxicillin, only after sensitivities are known
Cefalexin
Why should cats be avoided in pregnancy?
Toxoplasmosis
Why should unpasturised cheese be avoided in pregnancy?
Listeria monocytogenes/listeriosis
What causes increased alpha feto protein?
Neural tube defects
- Meningocele
- Myelomeningocele
- Anencephaly
Abdominal wall defects
- Omphalocele
- Gastroschisis
Multiple pregnancy
What causes decreased alpha feto protein?
Down’s syndrome
Trisomy 18/Edward’s syndrome
Maternal diabetes mellitus
Give risk factors for neural tube defects
Previous child with NTD
Diabetes mellitus
Women on antiepileptic
Obese
HIV +ve taking co-trimoxazole
Sickle cell
What causes increased nuhal translucency?
Down’s syndrome
Congenital heart defects
Abdominal wall defects
What tests are used in down syndrome screening?
Increased serum b-human chorionic gonadotrophin (b-hCG)
Decreased pregnancy associated plasma protein A (PAPP-A)
Increased fetal nuchal translucency (NT) measurement
What are the air travel rules in pregnancy?
Women over 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
Women with uncomplicated, multiple pregnancies should avoid travel by air over 32 weeks
How does fetal alcohol syndrome present?
Microcephaly (small head)
Thin upper lip
Smooth flat philtrum (the groove between the nose and upper lip)
Short palpebral fissure (short horizontal distance from one side of the eye and the other)
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
What vaccinations are offered to pregnant women?
Pertussis and influenza
Give complications of CVS
Foetal limb abormalities if performed before 11 weeks gestation
