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REPRODUCTION & GYNAECOLOGY > Antenatal Care and Screening in Pregnancy > Flashcards

Antenatal Care and Screening in Pregnancy Flashcards

1
Q

What are the aims of antenatal care?

A
  • pre existing maternal disorders
  • manage maternal complications
  • manage fetal complications
  • detect congenital fetal problems if requested by parents
  • prepare circumstances of birth to ensure maximum safety for the mother and baby
  • Give advice regarding lifestyle
  • Offer reproductive choice
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2
Q

What makes a good screening test?

A
  • highly sensitive and specific
  • high positive predictive value
  • easily used in a large population
  • safe, cheap, quick
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3
Q

How can we calculate specificity and sensitivity?

A 
Sensitivity = True positive /(positive + false negative)
Specificity = True negative/(negative + false positive)
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4
Q

At what stages during a woman’s pregnancy does she normally have a scan?

A

11-13 weeks (as close to 12 as possible)
= Booking Scan

20 weeks
= Anomaly Scan

may have further scans closer to 40 wks if high risk

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5
Q

What parts of the history are involved in the booking appointment consultation?

A
  • Menstrual and Obstetric Hx
  • PMHx - risk of VTE?
  • FHx - any inherited conditions?
  • SHx
  • DHx - do these need stopped in pregnancy?
  • Surgical Hx (important if pt may require emergency C-section at end of pregnancy)
  • Choose GREEN (midwife) or RED (obstetric input) pathway
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6
Q

What components of surgical history are important for the surgeon to know?

A
  • any previous spinal surgery? (may contraindicate anaesthesia)
  • Any previous ops? What anaesthesia was used? Was it straightforward?
  • previous gynae operations that have caused complications?
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7
Q

What is used to prevent VTE in pregnancy if patients are high risk?

A

Fragmin

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8
Q

What is measured on a booking appointment to calculate an accurate due date?

A

Crown-Rump Length

more accurate than gestational calculator - 280 days from 1st day of last period

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9
Q

What investigations are carried out at an antenatal booking appt?

A
  • Haemoglobin
  • Blood group + Rhesus
  • STIs - Syphilis, HIV, Hep B/C
  • Urinalysis
  • US
  • Aneuploidy screening (Trisomies - Down’s Syndrome (21), Edwards Syndrome (18), Patau’s Syndrome (13))
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10
Q

What is the function of the booking appointment US scan?

A
  • confirm viability of pregnancy OR ectopic/molar
  • multiple pregnancy? (twins sharing placenta = highest risk!)
  • Estimate gestational age
  • Detect major structural anomalies
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11
Q

Screening for Down’s syndrome is offered to ALL pregnant mothers. TRUE/FALSE?

A

TRUE

  • offered to all BUT they can decline
  • mothers choice
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12
Q

What is involved in the antenatal follow up appointments carried out by the midwife?

A

Hx

  • Physical and mental health
  • Foetal movements

Examination

  • BP and urinalysis
  • fundal height
  • Foetal Lie and presentation
  • presenting part
  • Foetal heart auscultation
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13
Q

What do clinicians aim to pick up on the 20 week foetal anomaly scan?

A
  • Neural Tube defects (spina bifida, anencephaly)
  • Cleft lip/palate
  • heart defects
  • abdominal wall defects (gastrochisis)
  • placenta previa (placenta lying too low in womb and obscuring cervix)
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14
Q

Why is it important to identify Cleft lip/palate BEFORE a baby is born?

A
  • relatively common 1 in 100
  • prepare parents for baby needing surgery
  • Speech and Language involved
  • NG tube feeding potentially needed at birth
  • may be associated with other genetic syndromes => check if foetus also has these
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15
Q

How can pregnant mothers essentially “grow out” of placnta previa?

A
  • womb grows upwards
  • placenta moves with it so that it is in a normal position before birth
    => No problems during labour
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16
Q

How is placenta previa investigated during pregnancy?

A
  • If US scan (between 18 and 21 weeks) showed placenta extends over the cervix
  • offer another abdominal scan at 32weeks
  • If this second scan is unclear, offer a vaginal scan.
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17
Q

Why may parents choose to terminate a Down’s Syndrome pregnancy?

A

Many babies are born with severe disability and require lifelong treatment and care
=> Lot of work for parents

18
Q

What percentage of foetus’ diagnosed with Down’s syndrome are terminated during pregnancy?

A

70%

19
Q

What tests are used to detect Down’s Syndrome in the first trimester?

A

Bloods
PAPP-A (Decreased)
HCG (Increased)

Nuchal Translucency

20
Q

What DIAGNOSTIC testing can be used for Down’s Syndrome?

A

Amniocentesis

21
Q

Which of the antenatal tests carries the highest risk of Down’s syndrome if HIGH?

A

Nuchal translucency (more fluid behind neck = more likely to have DS)

22
Q

Down’s Syndrome increases with increasing maternal age. TRUE/FALSE?

A

TRUE

23
Q

Blood tests for Down’s syndrome can be taken in the second trimester. TRUE/FALSE?

A

TRUE
Blood sample at 15-20 weeks
Assay of HCG and AFP

BUT they are less accurate

24
Q

What is involved in new Non-Invasive Prenatal Testing (NIPT)?

A

Cell free fetal DNA (cffDNA) testing
- can identify pregnant women at higher risk of baby with genetic conditions

  • Blood sample from mother
  • detects DNA from the mother but some fragments are from unborn baby
    => cell free fetal DNA (cffDNA) (detectable from 7 wks and rises as the pregnancy continues)
25
Q

How will Non-Invasive Prenatal Testing (NIPT) become involved in the NHS antenatal guidelines?

A
  • offered if high risk after first trimester screening

- less amniocentesis carried out as result (=> less miscarriages)

26
Q

Describe the difference between amniocentesis and chorionic villus sampling as diagnostic tests

A

AMNIOCENTESIS (after 15 wks)

  • no anaesthetic used (due to thin needle)
  • US guided
  • Miscarriage rate 1%

CHORIONIC VILLUS SAMPLING (after 12 weeks)

  • Local anaesthetic used (as having to remove placental cells)
  • US guided
  • Miscarriage rate 2%
27
Q

What major haemoglobin disorders are usually screened for with the first FBC at the booking appointment?

A

Sickle cell anaemia
Thalassemia

(both are Autosomal Recessive disorders causing abnormally shaped RBCs which carry inadequate Hb)

28
Q

What can cause maternal anaemia and should be screened for antenatally?

A

Iron deficiency
Folate deficicy
B12 deficiency

29
Q

Mothers are initially tested for anaemia at their booking scan. When is this followed up?

A

28 week appointment where bloods are repeated

30
Q

Why is it important to regularise a mother’s haemoglobin before birth?

A

Low Hb = HIGH risk of post-partum haemorrhage and maternal death

31
Q

What other tasks are carried out at the 28 week appointment?

A

If rhesus neg. give anti D prophylaxis

32
Q

How can foetal anaemia be picked up on investigation?

A

Picked up on US scan
- peak Middle cerebral artery (MCA) flow indicates baby does not have enough Hb, and it is mostly being used to perfuse brain

33
Q

How can mental health be screened throughout a woman’s pregnancy?

A
  • Do you have new feelings and thoughts making 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? Are these feelings persistent?
  • Do you feel you are getting worse?
34
Q

What risk factors increase the likelihood of developing gestational diabetes?

A
  • BMI >30
  • previous macrosomic baby
  • previous gestational diabetes
  • FHx diabetes
  • minority ethnic family origin with a high prevalence of diabetes
35
Q

If a mother is deemed as high risk at her 20 scan, how many extra scans are normally offered and when?

A

24 wks
32 wks
36 wks
40 wks

36
Q

Why is it important to take serial measurements of fundal height at each antenatal appt after 24 weeks?

A
  • improves prediction of a Small for Gestational Age neonate
37
Q

Women with moderate or high risk of pre-eclampsia are advised to start taking what medication from 12 weeks pregnancy until birth?

A

Low dose aspirin 75mg

this does NOT increase PP haemorrhage risk

38
Q

Give examples of moderate Pre-eclampsia risk factors

A
  • first pregnancy
  • > 40years
  • pregnancy interval >10years
  • BMI >35
  • FHx of pre-eclampsia
  • multiple pregnancy.
39
Q

What would be considered a high risk factor for the development of pre-eclampsia?

A
  • previous pre-eclampsia
  • chronic kidney disease
  • autoimmune disease (e.g lupus/ antiphospholipid)
  • Type 1/ 2 diabetes
  • chronic hypertension.
40
Q

What are we hoping to pick up on urinalysis in antenatal care?

A

UTI
Asymptomatic bacteriuria (assoc. with preterm labour)
PET
Diabetes

REPRODUCTION & GYNAECOLOGY (58 decks)

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