Antenatal Care and Screening in Pregnancy Flashcards
how do you work out the sensitivity of a test?
true positive / (positive + false negative)
how do you work out the specificity of ates?
true negative / (negative + false positive)
what examinations are done at the patient’s 1st presentation to the antenatal clinic?
height weight BP CVS abdomen
how do you work out the due date of a mother?
add 9 months and 7 days to the date of the last mentrual period ie 280 days
what Ix is done at the patient’s first presentation to an antenatal clinic?
Hb ABO; rhesus syphilis/HIV/hep b+c urinalysis (MSSU) protein c and protein s USS
what is examined on follow up appointments?
BP urinalysis symphyseal-fundal height lie and presentation of foetus engagement of presenting part foetal heart auscultation
at what gestation do women get a fetal anomaly scan?
18-21 wks
what is placenta praevia?
placenta is low lying in the womb AND
covers all or part of the cervix entrance
Ix for placenta praevia
- initial USS scan (18-20wks)
- if detected get another abdo USS at 32 weeks
- transvaginal USS if unclear
what is nuchal thickness and what conditions is it present in?
neck thickness
chromosomal abnormalities eg DS
what is CRL? what does it measure
crown rump length
length from the top of the head to the bottom of the buttocks
gestational age
when is nuchal thickness measured in downs screening?
11-14 weeks
outline the downs risk assessment procedures and when they are done
"CUBS" - combined USS biochemical screening: nuchal thickness between 11-14 weeks blood sample at 15-20 weeks assay of hCG and AFP in 2nd trimester do amniocentesis if high risk
amniocentesis is performed at what gestation?
15 weeks
chrionic villus sampling is performed at what gestation?
12 weeks
when are mothers screened for anaemia?
booking
28 weeks
what is taken in the history of mothers on a follow up antenatal visit?
physical and mental health
fetal movements
when would you do a second trimester screening for aneuploidy?
women who miss 1st trimester screening
if CUBS is unsuccessful
what questions can help to screen for depression in mothers?
new thoughts that werent there before?suicide/self harm thoughts?
feeling incompetent as a mother?
do you feel distanced estranged from baby?
is it getting worse? persistent?
risk factors for gestational diabetes?
BMI >30 previous macrosomic baby >4.5kg previous gestational diabetes FH of diabetes (1st degree) minority ethnic family with T1DM
Ix of small for gestational age foetus
- uterine artery doppler
2. umbilical artery doppler (do this first if high risk)
risk factors for SGA foetus?
low/high BMI smoking maternal age drugs previous small baby previous stillbirth chronic hypertension/vascular disease/diabetes anti-phospholipid syndrome heavy bleeding renal impairment
when should symphyseal fundal height first be measured?
24 weeks
what women will have an inaccurate SFH?
BMI >35
hydramnios
large fibroids
when should a mother be referred for USS of fetal size because of her SFH measurement?
if its under the 10th centile OR
slow/static growth
prophylactic Tx of preeclampsia? when should it be given and for how long?
75mg aspirin OD
from 12 weeks - birth
who is high risk for preeclampsia?
hypertensive disease during previous pregnancy CKD autoimmune disease eg lupus/APLS T1/T2DM chronic hypertension
name moderate risk factors for preeclampsia
first pregnancy age 40+ pregnancy interval >10yrs BMI >35 FH multiple pregnancies
why is urinalysis routinely done in pregnant mothers?
checks for: UTI asymptomatic bacteriuria preeclampsia diabetes
