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Reproduction > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

What are the objectives of antenatal care?

A

Detect and manage pre-existing maternal disorders that may affect pregnancy outcomes
Prevent or detect maternal and foetal complications
Detect congenital foetal problems if requested

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2
Q

What antenatal appointments are offered to low risk pregnancies?

A

Booking visit = 8-12 weeks Review at 16 weeks
Foetal anomaly scan = 20 weeks
Reviews at 25, 29, 31, 34 and 35 weeks

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3
Q

When are women seen by the midwife if they haven’t given birth after 36 weeks?

A

38, 40, 41 and 42 weeks

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4
Q

What is covered in the history and examination at the booking appointment?

A 
History = obstetric, medical, surgical, medications, allergies, mental health, family, social 
Examination = height, weight, blood pressure
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5
Q

What bloods are done at the booking appointment?

A

Haemoglobin, Rhesus status and antibodies, syphilis, HIV, hep b and C, urinalysis

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6
Q

What is the purpose of the US done at the booking appointment?

A

Confirm viability and whether singleton/multiple
Confirm gestational age = most accurate time
Detect major structural abnormalities
Offer trisomy screening

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7
Q

What is Naegele’s rule used to predict?

A

Estimated due date = add nine months and seven days (280 days) to date of onset of last menstrual period, only used until US scan is performed

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8
Q

What is used to estimate gestational age in late bookers?

A

Head circumference

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9
Q

What are the objectives of the 20 week scan for foetal abnormalities?

A

Reduction in perinatal mortality and morbidity
Potential for in utero treatment
Identification of conditions amenable to neonatal surgery
Prepare women/families and offer reproductive choice

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10
Q

What areas are covered by the foetal antenatal screening programme (FASP)?

A

Head and neck, face, chest, abdomen, spine, limbs, uterine cavity

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11
Q

What abnormalities are looked for by the foetal antenatal screening programme (FASP)?

A

Edward’s and Patau’s syndromes
Open spina bifida and lethal skeletal dysplasia
Cleft lip, exomphalos and anencephaly
Diaphragmatic hernia and gastroschisis
Congenital heart disease and bilateral renal agenesis

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12
Q

How common are major structural abnormalities in pregnancy?

A

Occur in 2-3% = majority occur in low risk pregnancies

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13
Q

What is placenta praevia?

A

Placenta is low lying and covers all/part of cervix = identified at 20 week anomaly scan

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14
Q

What should be done in women with a low placenta on their 20 week scan?

A

Repeat another US scan at 32 weeks

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15
Q

Why may you need to do a transvaginal scan to assess placental position?

A

If foetus is in front of placenta = transabdominal scan can’t get adequate view

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16
Q

What trisomies can be screened for in the first trimester?

A

Trisomy 21 = Down’s syndrome
Trisomy 18 = Edward’s syndrome
Trisomy 13 = Patau’s syndrome

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17
Q

What are some features of Down’s syndrome?

A

Impossible to predict outcomes
50% have normal scans
Cardiac defects are common

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18
Q

What are some features of Edward’s syndrome?

A

Complete trisomy carries high risk of stillbirth

Partial trisomy is life limiting and associated with severe disability

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19
Q

What are some features of Patau’s syndrome?

A

Complete trisomy is usually lethal

Multiple abnormalities can be seen on scan

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20
Q

What additional tests are offered if there is a high chance for any trisomy?

A

NIPT = non-invasive prenatal testing

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21
Q

How is trisomy screened for in the first trimester?

A

Measure thickness of skin behind foetal neck (Nuchal thickness) = measured at 11-13+6 weeks with US, combined with HCG and PAPP-A

22
Q

What value of Nuchal thickness would be considered normal?

A

Value <3.5mm considered normal if CRL is between 45-84mm

23
Q

What should all women undergoing screen for Down’s syndrome have before bloods are taken?

A

A dating US scan

24
Q

What is offered to if Nuchal thickness is unable to be measured?

A

Offer second trimester blood test = can only detect Down’s syndrome

25
Q

What screening can be done for Down’s syndrome in the second trimester?

A

Blood sample at 15-20 weeks

Assay of HCG and AFP

26
Q

What is the relationship between Down’s syndrome and maternal age?

A

Down’s syndrome is associated with older maternal age

27
Q

What is NIPT also known as?

A

Cell free foetal DNA

28
Q

What does NIPT do?

A

Detects foetal DNA fragments in blood sample from mother

29
Q

When is free foetal DNA detectable in maternal blood?

A

From 10 weeks = amount rise as pregnancy advances

30
Q

What are the benefits of NIPT?

A

More accurate than combined tests
More successful at detecting Down’s syndrome
Carries no risk of miscarriage

31
Q

What diagnostic tests can be done for Down’s syndrome?

A

Amniocentesis = usually performed after 15 weeks, carries miscarriage rate of <1%
Chorionic villus sampling = usually performed after 12 weeks, carries miscarriage rate of <2%

32
Q

What are two common heritable haematological disorders?

A

Sickle cell anaemia and thalassemias

33
Q

What are some risks associated with sickle cell anaemia during pregnancy?

A

Anaemia, C-section, amnionitis, sickle chest syndrome, thrombophlebitis, premature birth, placenta praevia, bone crisis, perinatal mortality, miscarriage, stroke

34
Q

When is maternal anaemia screened for?

A

At booking and 28 days = aim to optimise Hb before birth, may have deficiency of iron, folate or B12

35
Q

When should all women have their blood groups and Rhesus status determined?

A

At booking and at 28 weeks

36
Q

Why is it important to identify red cell antibodies?

A

Incase transfusion needed = need antibody matching
Some red cell antibodies cause foetal anaemia
So anti-D injection can be given to prevent D antigens forming in Rhesus negative women

37
Q

When are anti-D injections given?

A

Routinely at 28 weeks and after sensitising event

After birth if baby is Rhesus positive

38
Q

What are the risk factors for gestational diabetes?

A

BMI >30, previous macrosomic baby (>=4.5kg), previous gestational diabetes, family history of diabetes

39
Q

What is offered to women with any risk factors for gestational diabetes?

A

2hr OGTT = diagnostic if fasting >=5.6 mmol/l or 2hr >=7.8 mmol/l

40
Q

What is recommended at each appointment from 24 weeks onwards?

A

Serial measurement of symphysis fundal height (SFH)

41
Q

When should women be referred for US measurement of foetal size?

A

Single SFH plot <10th centile
Serial measurement shows slowing/static growth
If measurement inaccurate (e.g BMI >35)

42
Q

What prophylaxis is given to women at high risk of pre-eclampsia?

A

150mg aspirin daily from 12-36 weeks

43
Q

What women are considered high risk of pre-eclampsia?

A

Hypertensive disease during previous pregnancy, CKD, autoimmune disease, diabetes, chronic hypertension

44
Q

What is given as prophylaxis to women at moderate risk of pre-eclampsia?

A

75mg daily from 12 weeks until birth

45
Q

What women are considered at moderate risk of pre-eclampsia?

A

First pregnancy, age >=40, pregnancy interval >10 years, BMI >=35, family history, multiple pregnancy

46
Q

What conditions are screened for using urinalysis?

A

UTI, asymptomatic bacteriuria, pre-eclampsia, diabetes

47
Q

Why are all women screened for domestic abuse and FGM?

A

Possible need for deinfibulation during pregnancy or labour to enable vaginal delivery

48
Q

What conditions are screened for at the booking appointment?

A

Haemoglobulinopathies, hep B and C, HIV, syphilis, red cell antibodies, anaemia, multiple pregnancy, trisomy

49
Q

What conditions are screened for at the 20 week foetal scan?

A

Cleft lip, congenital heart disease, limb defects, placenta praevia, diaphragmatic hernia, abdominal wall defects, lung/brain/urinary tract anomalies

50
Q

What is screened for at the 28 week appointment?

A

Red cell antibodies, anaemia

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