Antenatal care and screening

Question 1

general health measures discussed in pre-pregnancy counselling

Answer 1

improving diet 
optimise BMI 
reduce alcohol consumption 
smoking cessation advice 
folic acid 
up to date smear

Question 2

pre-pregnancy counselling PKU

Answer 2

needs to restart low phenylalanine diet to prevent high levels reaching foetal brain

Question 3

diabetes pre-pregnancy counsellin g

Answer 3

ideally Glc optimised pre-conception

women with T2 on oral hypolgycaemics need switched to insulin

Question 4

previous gestational diabetes

Answer 4

HbA1c at booking and OGTT at 28wks

Question 5

mode of delivery if had previous c.section

Answer 5

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

Question 6

what is done during pregnant abdominal examination

Answer 6

assess symphyseal fundal height (SFH)
estimate size of baby 
estimate liquor volume 
determine foetal position/lie
listen to foetal heart

Question 7

first stage antenatal screening

Answer 7

CUBS - combined ultrasound and biochemical screening

USS: nuchal translucency
biochemical: free BHCG and PAPP (pregnancy assoc plasma protein)

Question 8

when is first stage antenatal screening carried out

Answer 8

11-14wks gestation - crown rump length 45-84mm

Question 9

who is offered 2nd stage screening

Answer 9

those who recieve a high chance result after 1st stage (result higher than 1 in 150)

Question 10

what is second stage antenatal screening

Answer 10

non-invative prenatal testing

Question 11

what is NIPT

Answer 11

cell free foetal DNA is present in mothers blood. A mother’s blood sample is taken and NIPT uses it to analyse foetal genome

Question 12

who is offered 3rd stage antenatal screenig

Answer 12

highe risk result from NIPT

Question 13

what is 3rd line antenatal screening

Answer 13

diagnostic testing: foetal cells or placental tissue obtained in order to perform genetic testing

chorionic villus sampling or amniocentesis

Question 14

chorionic villus sampling procedure

Answer 14

introducing spinal needle percutaneously into long axis of placenta under USS
villi aspirated into 10ml syringe then placed in tissue culture media

Question 15

when can chorionic villus sampling be performed

Answer 15

11-13wks

Question 16

amniocentesis procedure

Answer 16

performed with spinal needle introduced percutaneously into amniotic cavity under USS

15-20mls aspirated

Question 17

when can amniocentesis be performed

Answer 17

15wks onwards (if before 15wks then early amniocentesis)

Question 18

when are infections screened for

Answer 18

first trimester

Question 19

what infections are screened for

Answer 19

rubella, hep B, syphilis, HIV

Question 20

what can congenital rubella cause

Answer 20

mental handicap, blindness, deafness, heart defects

Question 21

what can congenital syphilis cause

Answer 21

intrauterine growth restriction, hepato-splenomegaly, anaemia, thrombocytopenia, skin tashes

Question 22

when is iron deficiency anaemia screened for

Answer 22

at booking (1st trimester) and at 28wks

Question 23

what is isoimmunisation

Answer 23

development of antibodies against blood groups. high levels of certain red cell antibodies can cause anaemia in foetus

Question 24

what are Rhesus D negative women offered

Answer 24

anti-D at 28wks gestation and following any sensitising event (e.g. vaginal bleed, amniocentesis) to reduce risk of transplacental passage of antibodies

Question 25

how should poorly controlled T1 diabetic glc levels be controlled in labour

Answer 25

slide scale infusion of insulin-dextrose

Question 26

2 hour plasma glucose - what level indicates gestational diabetes

Answer 26

7.8mmol/l

Question 27

previous pre-eclampsiea

Answer 27

apirin 150mg during pregnancy an regular BP monitoring

Question 28

previous DVT/PE

Answer 28

consider antenatal thromboprophylaxis and 6wks postnatal Rx

Question 29

prev fetal IUGR

Answer 29

150mg aspirin during pregnancy and serial USS

Question 30

prev preterm birth

Answer 30

consider transvaginal cervical length scans or cervical suture

Question 31

2nd trimester biochemical screening

Answer 31

Hcg
uncongugated oestradiol
alpha-feotoprotein
inhibin A