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Reproduction and Sexual Health > Antenatal Care and Screening in Pregnancy > Flashcards

Antenatal Care and Screening in Pregnancy Flashcards

1
Q

Outline the objectives of antenatal care.

A
  • Detect and manage pre-existing maternal disorders that may affect pregnancy outcome
  • Prevent or detect and manage maternal complications of pregnancy
  • Prevent or detect and manage fetal complications of pregnancy
  • Detect congenital fetal problems if requested by parents
  • Plan with the mother the circumstances of birth to ensure maximum safety for the mother and baby and the maximum parental satisfaction
  • Provide advice regarding lifestyle
  • Offer reproductive choice
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2
Q

Outline the main principles of any screening test.

A
  • Highly sensitive.
  • Highly specific.
  • Have a positive predictive value.
  • Easily used in a large population.
  • Safe and cheap.
  • Quick and straightforward to perform.
  • Able to detect a disease with a known natural history and where early diagnosis has a proven benefit.
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3
Q

How do we assess the robustness of a screening test?

A

By assessing sensitivity and specificity.

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4
Q

Sensitivity =

A

True positive / (positive + false negative

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5
Q

Specificity =

A

True negative / (negative + false positive )

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6
Q

Outline the sensitivity and false positive rate of Down’s Syndrome screening in the 1st trimester.

A

A sensitivity of 90% for a false positive rate of 5%.

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7
Q

What should history cover in a women’s booking visit?

A
  • Menstrual.
  • Medical.
  • Obstetric.
  • Family.
  • Social.
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8
Q

What should examination cover in a women’s booking visit?

A
  • Height.
  • Weight.
  • BP.
  • CVS.
  • Abdomen.
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9
Q

Other than scanning, how can due date be estimated?

A

With Naegele’s Rule which predicts estimated due date based on the onset of the woman’s LMP.

  • Simply add on nine months and seven days to arrive at the due date – 280 days.
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10
Q

What investigations should be carried out at booking visit?

A

Bloods for:

  • Hb. (look for iron deficiency anaemia)
  • ABO; Rhesus.
  • Syphilis; HIV; Hep B + C.

Urinalysis: MSSU C+S.

Ultrasound.

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11
Q

Why is an ultrasound used at the booking visit?

A
  • To confirm viability.
  • Singleton or multiple pregnancy?
  • Estimate gestational age – explain most accurate time/method to establish EDD.
  • Detect major structural anomalies that may be identified in early pregnancy.
  • Offer DSS.
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12
Q

What is the function of the yolk sac?

A

Supports the pregnancy as it develops up until the placenta forms.

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13
Q

Dichorionic twins on US shows what sign?

A

Lambda

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14
Q

What circumference do you measure to give the babies due date?

A

Head circumference

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15
Q

In follow-up visits, what aspect of the history are we interested in?

A
  • Physical and mental health.

* Foetal movements.

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16
Q

What aspects are covered in examination during follow-up visits?

A
  • BP and urinalysis.
  • Symphysis-fundal height.
  • Lie and presentation. (if baby is transverse at 36weeks, start to worry as there is a danger of cord prolapse and malposition)
  • engagement of presenting part.
  • Fetal heart auscultation.
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17
Q

What are the objectives for screening for foetal anomaly with US?

A
  • Reduction in perinatal mortality and morbidity.
  • Potential for in-utero treatment.
  • Identification of conditions amenable to neonatal surgery.
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18
Q

In how many pregnancies, do major structural abnormalities occur?

A

2-3%

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19
Q

The majority of major structural abnormalities occur in ___ risk women

A

LOW

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20
Q

All pregnant women should be offered the 18+0 to 20+6 weeks foetal anomaly scan

A

True

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21
Q

At how many weeks gestation, should all women be offered a foetal anomaly scan?

A

18+0 to 20+6

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22
Q

What is placenta praaevia?

A

When the placenta is low-lying in the womb and covers all or part of the entrance (the cervix).

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23
Q

Why does placenta praevia not cause a problem in most women?

A

The womb usually grows upwards, and the placenta moves with it so that it is in a normal position before birth.

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24
Q

If an earlier US scan (between 18+6 and 20+6) showed that your placenta extends over the cervix, what should be done?

A

You should be offered another abdominal scan at 32 weeks.

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25
Q

If you are shown to have placenta praevia and the other abdominal scan at 32 weeks confirms this, what should be done?

A

A vaginal scan

26
Q

In the first trimester, what factors contribute to the risk assessment for Down’s syndrome in a baby?

A
  • Measuring of skin thickness behind the fetal neck using ultrasound – Nuchal thickness; NT.
  • Combined with HCG and PAPP-A.
27
Q

When is nuchal thickness measured?

A

At 11-13+6 weeks.

28
Q

Describe what nuchal thickness is considered normal.

A

A nuchal thickness of <3.5mm, when the CRL (crown rump length) is between 45 and 84mm.

29
Q

In the 2nd semester, what factors contribute to the Down’s Syndrome risk assessment.

A
  • Blood sample at 15-20weeks.

* Assay of HCG and AFP.

30
Q

How is personal risk evaluated? (in both 1st and 2nd trimester for Down’s)

A

By incorporating the above-mentioned measurements/results with maternal age and gestation.

31
Q

What is regarded as ‘high risk’ for Down’s? What does this require?

A

> 1:250 risk.

  • requires further investigation e.g. amniocentesis
32
Q

Outline the Down’s risk assessment.

A
  • Requires accurate pregnancy dating.
  • Requires detailed counselling.
  • ‘Low risk’ doesn’t exclude Down’s Syndrome.
33
Q

Who gets 2nd trimester screening for Aneuploidy?

A

Those women who miss first trimester screening.
or
Those women in whom CUBS in unsuccessful.

34
Q

What factors are looked at in 2nd trimester screening for aneuploidy?

A

Maternal Age + Biochemical Markers:

  • Alpha-fetoprotein (AFP)
  • human Chorionic Gonadotrophin (hCG)
  • unconjugated oestradiol (UE3)
  • inhibin A
35
Q

What is Cell Free Foetal DNA Testing/Non-Invasive Prenatal Testing (NIPT)?

A

A test that can identify pregnant women who are at higher risk of having a baby with certain genetic and chromosomal conditions, such as Down’s syndrome (also known as Trisomy 21), Edwards’ syndrome (Trisomy 18) and Patau’s syndrome (Trisomy 13).

36
Q

When is amniocentesis usually performed?

A

After 15 weeks

37
Q

What is the rate of miscarriage associated with amniocentesis?

A

1%

38
Q

When is chorionic villus sampling usually performed?

A

After 12 weeks.

39
Q

What is the rate of miscarriage associated with chorionic villus sampling?

A

2%

40
Q

Only high risk women are screened for sickle cell anaemia and thalassemia

A

TRUE

41
Q

Sickle cell anaemia and thalassemia are both autosomal _________

A

Recessive

42
Q

Name 3 deficiencies which may lead to maternal anaemia.

A
  • Iron deficiency.
  • Folate deficiency.
  • B12 deficiency.
43
Q

When is maternal anaemia screened for?

A

At booking, and 28 weeks.

44
Q

What should you aim for in maternal anaemia?

A

To optimise Hb prior to birth.

45
Q

What % of the population are rhesus -ve?

A

15%

46
Q

Why does rhesus disease take a while to develop after pregnancy?

A

IgG antibodies take a while to develop, so it’s not until the following pregnancy where there’s a problem.

47
Q

When should all women have their blood group and antibody status be determined?

A

At booking + 28 weeks gestation

48
Q

It is important to assess mental health in mothers !! What questions should be asked at every appointment?

A
  • Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
  • Are you experiencing thoughts of suicide or harming yourself in violent ways?
  • Are you feeling incompetent as a mother, as though you can’t cope, or feeling distanced or estranged from your baby? Are these feelings persistent?
  • Do you feel you are getting worse?
49
Q

What should you assess risk of gestational diabetes using?

A

Risk factors in a healthy population.

50
Q

At the booking appt, what risk factors for gestational diabetes should be determined?

A
  • BMI above 30 kg/m2
  • Previous macrosomic baby weighing 4.5 kg or above
  • Previous gestational diabetes
  • Family history of diabetes (first degree relative with diabetes)
  • Minority ethnic family origin with a high prevalence of diabetes.
51
Q

Who should be offered testing for gestational diabetes?

A

A woman with any single risk factor

52
Q

What should be used to test for gestational diabetes in women with risk factors?

A

The 2-hour 75g oral glucose tolerance test (OGTT).

53
Q

What are the diagnostic parameters for gestational diabetes?

A

Fasting plasma glucose level of 5.6mmol/litre or above.
OR
2-hour plasma glucose level of 7.8mmol/litre or above.

54
Q

What is recommended as it improves prediction of a small for gestational age (SGA) neonate?

A

Serial measurement of symphysis fundal height (SFH) is recommended at each antenatal appointment from 24 weeks of pregnancy.

55
Q

What should SFH (symphyseal fundal height) be plotted on? Why?

A

A customized chart rather than a population – this may improve P predication of a SGA neonate.

56
Q

Who should be referred for US measurement of foetal size?

A

Women with a single SFH which plots below the 10th centile, or serial measurements which demonstrate slow or static growth by crossing centiles.

57
Q

Who should be referred for serial assessment of foetal size using ultrasound?

A

Women in whom measurement of SFH is inaccurate (e.g. BMI >35, large fibroids, hydramnios).

58
Q

What should you advise women at high risk of pre-eclampsia to take?

A

75mg of aspirin daily from 12 weeks until the birth of the baby.

59
Q

List women who are at high risk of pre-eclampsia.

A
  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
  • type 1 or type 2 diabetes
  • chronic hypertension.
60
Q

What factors would indicate moderate risk of PET?

A
  • first pregnancy
  • age 40 years or older
  • pregnancy interval of more than 10 years
  • body mass index (BMI) of 35 kg/m2 or more at first visit
  • family history of pre-eclampsia
  • multiple pregnancy.
61
Q

What does urinalysis look for in pregnancy?

A
  • UTI.
  • Asymptomatic bacteriuria.
  • PET (proteinuria)
  • Diabetes.

Reproduction and Sexual Health (51 decks)

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