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Reproduction > Antenatal Care and Screening in Pregnancy > Flashcards

Antenatal Care and Screening in Pregnancy Flashcards

1
Q

what is aneuploidy

A

an abnormal number of chromosomes

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2
Q

what are the tests for aneuploidy in pregnancy

A

First trimester screening
- Combined ultrasound and biochemical screening (CUBS)
Second trimester serum screening
Non-invasive pre-natal testing (NIPT)

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3
Q

what is the formula for sensitivity

A

true positive / (positive + false negative)

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4
Q

what is formula for specificity

A

true negative / (negative + false positive)

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5
Q

how sensitive is the first trimester screening for downs syndrome and what is the false positive rate

A

90%

FP 5%

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6
Q

how may women who are high risk in down syndrome first trimester screening will have a baby NOT affected by the conditions

A

in on 20

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7
Q

what are the green and red pathways

A

green= low risk pregnancies, midwife led

red= obstetric led care, higher risk pregnancies

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8
Q

what do you start if patient is at higher risk of a VTE

A

fragmin

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9
Q

is FGM illegal in UK

A

yes and illegal to facilitate someone leaving country to do it
have to involve social work if think mother will do it to daughter

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10
Q

what tests are done at the booking visit (12 weeks)

A 
BMI
BP 
cardio exam 
abdo exam 
Hb
ABO, Rhesus
syphilis, HIV, Hep B+C
urinalysis 
USS
offer down syndrome screening anencephaly, gastroschisis, absent limbs
blood group and rhesus status
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11
Q

how do you predict due date from LMP

A

ass on nine months and 7 days- 280 days

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12
Q

what do you look for the booking USS

A 
viability 
singleton/ multiple pregnancy 
gestational age 
major structural anomalies 
molar pregnancy  
estimated date of delivery (CRL)
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13
Q

is there a yolk sac in an ectopic pregnancy

A

no

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14
Q

what is needed to confirm a pregnancy is viable

A

heart beat

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15
Q

how do you differentiate a non continuing or ectopic pregnancy if USS is inconclusive

A

hCG

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16
Q

what is a dichorionic twins

A

twins that have own placenta and yolk sac

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17
Q

when should screening for sickle cell disease and thalassaemia should be offered

A

before 10 weeks

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18
Q

what is assessed at the follow up visits (20 weeks)

A 
history - physical and mental health, fetal movements 
BP 
urinalysis 
symphysis- fundus height 
lie and presentation 
engagement of presenting part (shouldnt be there <36 weeks)
fetal heart auscultation 
gender
cleft lip 
heart defects 
placenta praevia
talipes
spina bifida 
anecephaly (neural tube defect, skull doesnt form)
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19
Q

when should be be worried about a babies lie

A

36 weeks onwards

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20
Q

what are the objectives of USS foe feral anomaly

A

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

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21
Q

why do you screen for cleft lip

A

needs surgical correction, sometime SL therapists or NG tubes, generally no long term complications.

  • to prevent shock to mother if not expecting it, so she can meet surgeons
  • Also can be associated with trisomy 13 and 18 and other genetic syndromes that cause structural abnormalities- do extended scan to look for other abnormalities and if found genetic testing
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22
Q

what anomalies are USS screened for at 20 weeks

A 
cleft lip 
cardiac 
anecephaly 
gross abnormalities- limbs, hands, feet  
abdominal waal defects- gastoschisis and omphaloceole 
spina bifida
diaphragmatic hernia
exomphalos 
bilateral renal agenesis 
lethal skeletal dysplasia 
trisomy 13 and 18
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23
Q

are trisomy 13 and 18 compatible with life

A

generally no

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24
Q

what is pataus syndrome

A

trisomy 13

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25
Q

what is edwards syndrome

A

trisomy 18

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26
Q

what is placenta praevia

A

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

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27
Q

what should you be offered If an earlier ultrasound scan (usually between 18weeks0days and 20weeks6days) showed that your placenta extends over the cervix

A

another abdo scan at 32 weeks
if this unclear vaginal scan

if still low then strongly suggest CS

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28
Q

do all women get offered down syndrome screening

A

yes

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29
Q

what increases the risk of downs syndrome

A

maternal age

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30
Q

what is included in the risk assessment for downs syndrome in the first trimester

A 
nuchel thickness 
HCG (goes up in DS)
PAPP-A (goes down in DS)
maternal age
AFP (alpha feta protein) (goes down)
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31
Q

what is the nuchel thickness

A

Measure of skin thickness behind fetal neck using ultrasound done at 11+3-13+6 weeks

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32
Q

what is a normal NT value

A

< 3.5 mm (when the CRL is between 45 and 84mm)

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33
Q

what is a diagnostic test offered for downs syndrome

A

when 1st trim screening result less than 1 in 250

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34
Q

what is the risk of amniocintesis causing miscarriage

A

1%

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35
Q

what should be done before downs syndrome screening

A

counselling

dating US before blood taken to establish gestation

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36
Q

when should you use CRL up until

A

13 weeks gestation

after this head circumference

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37
Q

who gets 2nd trim screening for aneuploidy (15 to 20+6 weeks)

A

For those women who miss first trimester screening

For those women in whom CUBS is unsuccessful

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38
Q

what is included in 2nd trim aneuploidy screening

A 
Alpha-fetoprotein (AFP)
human Chorionic Gonadotrophin (hCG)
unconjugated oestradiol (UE3) 
inhibin A
maternal weight,
smoking status, and if applicable, previous affected pregnancy and assisted conception
39
Q

what does 2nd trim aneuploidy screening

A

risk of downs syndrome

40
Q

what is NIPT

A

non invasive prenatal testing
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)
detects fetal DNA fragments in a sample of blood taken from the mother

41
Q

what is FASP

A

Fetal Anomaly Screening Programme

42
Q

when is an amniocentesis done

A

after 15 weeks
maternal choice
if high risk of DS

43
Q

what are the specific diagnostic tests for DS

A

amniocentesis

chorionic villus sampling

44
Q

when is chorionic villus sampling done

A

after 12 weeks

45
Q

what is the miscarriage rate of chorionic villus sampling

A

2%

46
Q

is LA needed for amniocentesis and CVS

A

only CVS (bigger needle that samples placenta)

47
Q

what are haemoglobinopathies screened for

A

booking appointment

48
Q

what are haemoglobinopathies

A

autosomal recessive RBC disorders that result in abnormal haemoglobin

49
Q

what are the main types of haemoglobinopathies

A

thalassemias and sickle cell anaemia

50
Q

how are haemoglobinopathies inherited

A

AR

50% risk of carrier, 25% not affected, 25% affected

51
Q

what is thalassemia characterised by

A

low haemoglobin and RBCs

52
Q

what can happen in sickle cell anaemia in pregnancy

A

sickle cell crisis

lot of other complications

53
Q

what can cause maternal anaemia

A

Iron deficiency
Folate deficicy
B12 deficiency

54
Q

when are mothers screened for anaemia

A

booking and 28 weeks

55
Q

what is the aim for anaemia treatment

A

optimise Hb prior to birth

56
Q

when are rhesus incompatabilities a problem

A

negative mum
positive baby
worry about mum being previously sensitised and acquiring anti D antibodies

57
Q

when should all pregnanct women have their blood group and antibody status (e.g. O- is o group and rh -ve) determined

A

at booking and again at 28 weeks

58
Q

which type of HDN is more severe

A

ABO is more common but less severe

Rhesus is more severe but less common

59
Q

when is jaundice of a newborn pathological

A

if within 1st day of life

60
Q

what mental health screening questions should you ask all pregnant women

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

61
Q

what are the risk factors for gestational diabetes

A

BMI above 30kg/m2
previous macrosomic baby weighing 4.5kg or above
previous gestational diabetes
family history of diabetes (first‑degree relative with diabetes)
minority ethnic family origin with a high prevalence of diabetes

62
Q

what should you offer women with any one of these risk factors for gestational diabetes

A

testing for gestational diabetes;

2‑hour 75g oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors

63
Q

what result = gestational diabete

A

in a 2‑hour 75g oral glucose tolerance test (OGTT)

a fasting plasma glucose level of 5.6mmol/litre or aboveor
a 2‑hour plasma glucose level of 7.8mmol/litre or above.

64
Q

what does monitoring symphysis fundal height prevent

A

undetected intrauterine growth restriction

65
Q

what are the major risk factors for small for gestational age of babies

A 
maternal age > 40 
smoker >11/ per
paternal/paternal SGA
cocaine
daily vigorous exercise 
previous SGA/ still birth
chronic hypertension 
diabetes with vascular disease 
renal impairment
66
Q

when should you measure SFH

A

each antenatal appointment from 24 weeks

67
Q

why might FSH be inaccurate

A

BMI > 35, large fibroids, hydramnios

68
Q

what should you do if a FSH is below the 10th percentile/ inaccurate

A

USS to measure fetal size

69
Q

what should women at risk of pre eclampsia take a prevention

A

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

70
Q

who is at high risk for 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

71
Q

what are contraindications to aspirin

A

asthma, previous gastric ulcer

72
Q

who is at moderate risk for pre eclampsia

A 
first pregnancy
age 40years or older
pregnancy interval of more than 10years
body mass index (BMI) of 35kg/m2or more at first visit
family history of pre-eclampsia
multiple pregnancy
73
Q

what is look for in urinalysis

A

UTI
Asymptomatic bacteriuria- may not have any urinary symptoms, associated with pre term labour
PET- proteinuria
Diabetes

74
Q

what is screened for at 28 weeks

A

Glucose tolerance test if they are high risk based on their history
Repeat haemoglobin- haemorrhage is biggest cause of maternal death world wide, want to correct anaemia before surgery/ birth
Repeat antibodies
Intra uterine growth restriction
Macrosomia
Urine: pre eclampsia, UTI (higher risk of preterm labour if untreated)

75
Q

what can cause increased NT

A

chromosomal abnormalities (trisomy 13, 18 and 21, turners), cardiac abnormalities

76
Q

what is MSAFP

A

maternal serum AFP - produced by liver of developing foetus

77
Q

what can cause raised MSAFP

A

twins (more placenta, more AFP)
spina bifida
gastoschisis
(organs in contact with amniotic fluid)

78
Q

what does hypertension and proteinuria in pregnancy suggest

A

pre eclampsia

79
Q

what systems can pre eclampsia affect

A

any

80
Q

what is the treatment of pre eclampsia

A 
labetalol orally/ IV (nifedinpine or methyldopa if others not suitable) (to reduce BP)
betamethasone IM (to reduce brain inflammation, prevent haemorrhage, help fetal lungs develop, prevent necrotising enterocolitis)
hydrasalazine  oral (peripheral vasodilators, relaxes vascular smooth muscle) 
magnesium sulphate IV (peripheral + cerebral vasodilator, membrane stabiliser, anti convulsant to prevent eclamptic seizures, prevent eclampsia)
81
Q

what is meant by Rhesus -ve

A

no d antigen on RBCs

82
Q

what would you expect to find in a Rhesus sensitised mother

A

she will be rhesus -ve (no anitgen on RBCs) but will have develop anti body

83
Q

what happens to Hb and bilirubin and coombs test in a Rh +ve affected baby

A

Hb down
haemolysis up
coombs test +ve (is a measure of haemolysis)

84
Q

when can anti D be given to prevent immunisation following event of fetal maternal transfusion

A

ideally within 72 hours, can be within 10 days

85
Q

how does anti D work

A

mops up D antigen covered RBCs from fetus, stops them interacting with maternal antibodies

86
Q

what is the ideal route and dose of anti D

A 
after sensitising event 500 IU IM
IV if in large foetal maternal haemorrhage 
prophylaxis 
<20 weeks 250 IU
>20 weeks 500 IU
87
Q

what events in pregnancy would you administer anti D after

A 
miscarriage 
TOP 
amniocentesis 
trauma 
surgical intervention for ectopic pregnancy 
after delivery
88
Q 
would you give anti D to: 
Rh -ve mother 
ABO compatible 
Rh +ve baby 
coombs test -ve 
infant bilirubin level normal
A

yes- at delivery RBCs will mix and cause sensitisation, problems for later pregnancies

89
Q 
would you give anti D to: 
Rh -ve mother 
ABO incompatible 
Rh -ve baby 
coombs test -ve 
infant bilirubin level normal
A

no

not high risk as baby Rh -ve

90
Q 
would you give anti D to: 
Rh -ve mother 
ABO compatible 
Rh +ve baby 
coombs test +ve 
infant bilirubin level increased
A

yes- probably already sensitised though

91
Q 
would you give anti D to: 
Rh +ve mother 
ABO incompatible 
Rh -ve baby 
coombs test +ve 
infant bilirubin level increased
A

no - haemolysis will be due to ABO incompatability

92
Q

is anti D given in all pregnancies

A

yes at 28 weeks

93
Q

if both parents are Rh -ve what will the baby be

A

Rh -ve

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