Antenatal Care and Screening in Pregnancy (incomplete)

Question 1

What gestatational age is the booking scan performed?

Answer 1

11-13 weeks

Question 2

What is the objective of booking scan?

Answer 2

Assess viability (ex. mole)
Number of babies 
Down's Syndrome
Estimate gestational age
Detect major structural anomalies 
Offer DSS

Question 3

Are the tests and antenatal screening/care regimes compulsory?

Answer 3

No. Choice of mother whether or not to undergo them.

Question 4

Most accurate way to determine EDD on scan?

Answer 4

Crown - rump length

Question 5

Why is it important to check for maternal anaemia?

Answer 5

Post partum haemorrhage is the leading cause of maternal death

Question 6

How to calculate sensitivity and specificity

Answer 6

Sensitivity = True positive /(positive + false negative)
Specificity = True negative/(negative + false positive)

Question 7

What are the two categories of pregancies?

Answer 7

Green pathway - routine antenatal care, normal pregnancy

Red pathway - complicated pregnancy, specific antenatal care

Question 8

Aspects of history to cover during the booking visit

Answer 8

Menstrual
Medical
Surgical
Obstetric
Family
Social

Question 9

Physical examination to perform during booking visit

Answer 9

Height
Weight
BP
BMI
CVS 
Abdomen

Question 10

Calculating EDD

Answer 10

Naegele’s Rule:

to the LMP simply add on nine months and seven days to arrive at the due date

Question 11

Investigations to be performed during booking

Answer 11

Hb
ABO; Rhesus
Syphilis; HIV; Hep B&C;
Urinalysis; MSSU C&S
Ultrasound:

Question 12

What history is covered during follow up visits?

Answer 12

Physical and mental health

Fetal movements

Question 13

What examination is performed during follow up?

Answer 13

BP and urinalysis
Symphysis- fundal height
Lie and presentation
Engagement of presenting part
Fetal heart auscultation

Question 14

What is the normal lie and presentation upto 36 weeks?

Answer 14

longitudinal lie
cephalic presentation
No engagement

Question 15

Objectives for ultrasound in fetal anomaly screening

Answer 15

Reduction in perinatal mortality and morbidity
Potential for in utero management
Identification of conditions amenable to neonatal surgery

Question 16

Name an abnormality associated with Down’s syndrome

Answer 16

Cleft palate

Question 17

What is placenta previa?

Answer 17

when the placenta is low lying in the wombandcovers all or part of the entrance (the cervix

Question 18

Is a low lying placenta detected in early pregnancy reversible?

Answer 18

Yes
In most women, as the womb grows upwards, the placenta moves with it so that it is in a normal position before birth and does not cause a problem.

If an earlier ultrasound scan (usually between 18weeks0days and 20weeks6days) showed that your placenta extends over the cervix, you should be offered another abdominal scan at 32weeks. If this second abdominal scan is unclear, you should be offered a vaginal scan

Question 19

What is the impact of increasing maternal age on pregnancy?

Answer 19

increases risk of Down’s Syndrome

Question 20

Down’s Risk Assessment in 1st Trimester

Answer 20

Measure of skin thickness behind fetal neck using ultrasound (Nuchal thickness; NT)
Measured at 11-13+6 weeks
Combined with HCG and PAPP-A
A value of < 3.5 mm would be considered normal when the CRL is between 45 and 84mm.

Question 21

Down’s Risk Assessment in 2nd Trimester

Answer 21

Blood sample at 15-20 weeks

Assay of HCG and AFP

Question 22

Downs risk assessment in both first and second trimester

Answer 22

Incorporation of these measurements / results with maternal age and gestation to give a personal risk
>1:250 high risk and requires further investigation (e.g. amniocentesis)

Question 23

Specific Diagnostic Tests

Answer 23

Amniocentesis:

• Usually performed after 15 weeks
• Carries a miscarriage rate of 1%

Chorionic villus sampling:

• Usually performed after 12 weeks
• Carries a miscarriage rate of 2%

Question 24

Second trimester screening for aneuploidy

Answer 24

For those women who miss first trimester screening

For those women in whom CUBS is unsuccessful

Maternal Age + Biochemical Markers: 
- Alpha-fetoprotein (AFP)
human Chorionic Gonadotrophin (hCG)
- Unconjugated oestradiol (UE3) 
- Inhibin A

Question 25

What are the najor Hb disorders?

Answer 25

Sickle cell

Thalassemia

Question 26

Maternal anaemia

Answer 26

Iron deficiency
Folate deficicy 
B12 deficiency
Screened at booking and 28 weeks
Aim to optimise Hb prior to birth