Antenatal care and screening Flashcards
general health measures discussed in pre-pregnancy counselling
improving diet optimise BMI reduce alcohol consumption smoking cessation advice folic acid up to date smear
pre-pregnancy counselling PKU
needs to restart low phenylalanine diet to prevent high levels reaching foetal brain
diabetes pre-pregnancy counsellin g
ideally Glc optimised pre-conception
women with T2 on oral hypolgycaemics need switched to insulin
previous gestational diabetes
HbA1c at booking and OGTT at 28wks
mode of delivery if had previous c.section
if 1 previous C.sec for non-recurring cause e.g. breech presentation then can undertake trial of labour
if had 2 previous c.sections then another c.section customary
what is done during pregnant abdominal examination
assess symphyseal fundal height (SFH) estimate size of baby estimate liquor volume determine foetal position/lie listen to foetal heart
first stage antenatal screening
CUBS - combined ultrasound and biochemical screening
USS: nuchal translucency
biochemical: free BHCG and PAPP (pregnancy assoc plasma protein)
when is first stage antenatal screening carried out
11-14wks gestation - crown rump length 45-84mm
who is offered 2nd stage screening
those who recieve a high chance result after 1st stage (result higher than 1 in 150)
what is second stage antenatal screening
non-invative prenatal testing
what is NIPT
cell free foetal DNA is present in mothers blood. A mother’s blood sample is taken and NIPT uses it to analyse foetal genome
who is offered 3rd stage antenatal screenig
highe risk result from NIPT
what is 3rd line antenatal screening
diagnostic testing: foetal cells or placental tissue obtained in order to perform genetic testing
chorionic villus sampling or amniocentesis
chorionic villus sampling procedure
introducing spinal needle percutaneously into long axis of placenta under USS
villi aspirated into 10ml syringe then placed in tissue culture media
when can chorionic villus sampling be performed
11-13wks
amniocentesis procedure
performed with spinal needle introduced percutaneously into amniotic cavity under USS
15-20mls aspirated
when can amniocentesis be performed
15wks onwards (if before 15wks then early amniocentesis)
when are infections screened for
first trimester
what infections are screened for
rubella, hep B, syphilis, HIV
what can congenital rubella cause
mental handicap, blindness, deafness, heart defects
what can congenital syphilis cause
intrauterine growth restriction, hepato-splenomegaly, anaemia, thrombocytopenia, skin tashes
when is iron deficiency anaemia screened for
at booking (1st trimester) and at 28wks
what is isoimmunisation
development of antibodies against blood groups. high levels of certain red cell antibodies can cause anaemia in foetus
what are Rhesus D negative women offered
anti-D at 28wks gestation and following any sensitising event (e.g. vaginal bleed, amniocentesis) to reduce risk of transplacental passage of antibodies
how should poorly controlled T1 diabetic glc levels be controlled in labour
slide scale infusion of insulin-dextrose
2 hour plasma glucose - what level indicates gestational diabetes
7.8mmol/l
previous pre-eclampsiea
apirin 150mg during pregnancy an regular BP monitoring
previous DVT/PE
consider antenatal thromboprophylaxis and 6wks postnatal Rx
prev fetal IUGR
150mg aspirin during pregnancy and serial USS
prev preterm birth
consider transvaginal cervical length scans or cervical suture
2nd trimester biochemical screening
Hcg
uncongugated oestradiol
alpha-feotoprotein
inhibin A
