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Semester 1 > Antenatal care, Down's, Abortion > Flashcards

Antenatal care, Down's, Abortion Flashcards

antenatal care and screening downs abortion act disability rights

1
Q

when are the ultrasounds done in pregnancy

A

10-12 w at booking scan- dating, viability, position

20w at anomoly scan

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2
Q

what is screened for before the booking scan and when

A

before 10 weeks screen for sickle cell and thalassaemia

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3
Q

what is screened for at the booking scan

A

10-12 w
infectious diseases: HIV, hep B, syphillis
rhesus disease and anaemia
combined test for Down’s Edward’s, Patau’s

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4
Q

what is the anomoly scan

A

20w
USS for 12 conditions, including
Edward’s
Patau’s
Cleft lip
Anencephaly
Open Spina bifida

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5
Q

what other tests are performed throughout antenatal care

A

urine tests

  • protein= UTI/ sign pre-eclampsia, esp second half preg
  • nitrites= UTI
  • sugar= gestational diabetes

blood pressure
- raise= sign pre- eclampsia

anaemia at 28 w and booking

if pre existing diabetes have eye screening

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6
Q

what screens for Down’s, Edward’s, Patau’s

A

Down’s: combined, quadruple test
Edward’s, Patau’s: Combined, 20w anomoly scan

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7
Q

what/ when is the combined test

A

offered at booking scan
for between 10-14 w
for Down’s, Ed, Pat

combines blood test, NT, mat age

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8
Q

what does the blood test for the combined test look for

A

in Down’s:

PAPP-A is low
beta-hCG is raised

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9
Q

what is the ultrasound used for in the combined test

A

measure nuchal translucency

measures the subcutaneous fluid-filled space between back of spine and skin on neck

in Down’s, NT is raised

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10
Q

why can’t you use nuchal translucency to screen for Down’s after a time

A

NT increases with gestational age and disappears week 14

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11
Q

probability of a screen positive result in 25yo vs 45yo

A

25 yo 1 in 100
45yo 1 in 4

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12
Q

When/ why is quadruple test offered

A

between 15w and 20w
if too late for combined test or baby in wrong position for it

only for Down’s

not as accurate as combined

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13
Q

what is the quadruple test and what does it test for

A

only a blood test, tests for:

AFP, alpha-fetoprotein, in Down’s = low
uE3, unconjugated oestriol, in Down’s= low
beta hCG= in Down’s= high
inhibin, in Down’s= high

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14
Q

alpha- fetoprotein is made by?

A

baby

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15
Q

quadruple test also screens for?

A

spina bifida and anencephaly
alpha-fetoprotein high

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16
Q

what is the role of genetic counselling

A

genetic counselling is the process of helping people understand and adapt to the medical/psych/familial implications of genetic contributions to disease

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17
Q

what is screening

A

identifying healthy people who are at increased risk of disease or a condition

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18
Q

examples of requirements of a screening test to be a part of the screening programme

A

condition should be important

treatment available

diagnostic test or exam available

cost of case-finding economicall balanced in relation to medical care expenditure

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19
Q

what do genetic counsellors do for pts

A

interpret family and medical hisoties to assess chance of disease occ/recurr

education on inheritance, testing,management

counselling to promote informed choice and adaptation to the risk/condition

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20
Q

info about miscarriage stats

A

1 in 4 pregnancies miscarry
85% spontaneous miscarriages happen in first trimester
risk factors: age, smoking, obesity, alcohol, drugs

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21
Q

recurrent miscarriage?

A

1% women will have
= over 3 consecutive miscarriages
reason often unknown

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22
Q

most common genetic causes of miscarriage?

A

aneuploidy, disrupts cell equilibrium so significantly most not compatible with life

trisomies= 35% all miscarriages before 20w

all autosomal monosomies are lethal

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23
Q

accuracy of screening tests for down’s requirement

A

screening test must detect 75% of babies with Down’s,
false positives no more than 3%

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24
Q

what if get high risk screening result

A

invasive testing (or, now on, non invasive)

NIPT
chorionic villus sampling
amniocentesis

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25
Q

why offer further testing after positive screen result

A

could influence whether abort
help prepare for life w disabled child
may facilitate early intervention/treatment that would influence outcome

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26
Q

what/ when/ risks chorionic villus sampling

A

chorionic villus sampling performed from 11 weeks

placenta has same genetics as fetus so sample tissue from placenta with ultrasound probe and fine needle through abdomen
—- check genes and chromosomes

miscarriage risk 1% on top of background 2-3%

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27
Q

what/when/ risks amniocentesis

A

amniocentesis from 15 weeks
amniotic fluid has fetal genetics
sapmple amniotic fluid, ultrasound probe and fine needle, centrifuge, chromosome analysis

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28
Q

what is NIPT

A

non invasive prenatal screening now offered with NHS if positive screen

= maternal blood test, from 9 weeks, refines T21/T18/T13 risk, reduces need invasive testing

99% plus sensitive for Down’s

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29
Q

how does NIPT work

A

examines cell free fetal DNA (cffDNA) which is released from placenta and can be detected in mothers blood

most cell free DNA (cfDNA) is mums, 10-20% is cffDNA (fetus’s)

if fetus has Down’s, more chromosome 21 specific DNA in mat circulation

cell fee fetal DNA leaves mum circ after birth so only relevant to current preg

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30
Q

considerations with NIPT

A

if multiple pregnancies then can’t distinguish
BMI may influence
not as simple as a regular blood test- need counselling and fully informed consent

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31
Q

how does mat age influence Down’s risk

A

age 25, 1 in 1250 Down’s
age 35, 1 in 350 Down’s
age 40, 1 in 100 Down’s
age 45, 1 in 30 Down’s

(thought that) with age reduced spindle protein levels, leads to instability in chromsomes, to increased likelihod chromosome division uneven, to incr rate chromosomal abnormalities

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32
Q

what causes Down’s syndrome

A

95% from non-disjunction giving Trisomy 21
2% from Robertsonian translocation, half familial, half de novo
2% gonadal mosaicism (some cells normal some abn)
1% other chromosomal rearrangment

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33
Q

what is Down’s syndrome

A

trsomy 21 (extra copy of chromosome 21)

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34
Q

distinctive features of Down’s

A

developmental delay, learning disability
flat facial features
bulging tongue
almond eyes
epicanthal folds
single palmar crease
short neck
hypotonia (decr muscle tone)

35
Q

health problems assoc with downs

A

congenital heart defects common
GI problems
hearing and vision
hypothyroidism
suscptible to infection
dementia
autism

spermatogenesis defects males
premature menopause women

70-85% women infertile
most men infertile

36
Q

lifespan and independence down’s

A

5% babies don’t survive first year
avg lifespan 60
impact varies, can have good quality life, semi independent
most need significant support

37
Q

medical termination of preg

A

‘abortion pill’ tablets to end pregnancy and break down lining of womb
take at home or in hospital, dependent on gestation
up to around 10 weeks

38
Q

surgical termination of preg

A

under sedation, local or general anaesthetic

cervix dilated, pregnancy removed by vacuum aspiration or forceps (dilation and evacuation)

on NHS up to 13 weeks,
other providers up to 24 weeks

39
Q

termination after 21 weeks

A

surgical maybe
may be necessary to inject fetus with potassium chloride to ensure fetal asystole, induce labour

40
Q

considerations when having a baby with a disability

A

longer mat leave
need more family help
prep for birth if high risk
support groups
grief for loss of imagined child
prep sibilings
fear and anger may take away joy of having child

41
Q

supporting someone whose child will have down’s

A

give clear, accurate info, in writing
ask they avoid google, use NHS site
give balanced view life with down’s
don’t predict baby’s future with wills/won’ts
recommend formal counselling and support groups

42
Q

what acts are also in place, alongside abortion act

A

the offenses against the person act 1861
infant life preservation act 1929
abortion act 1967
human fertilisation and embryology act 1990

43
Q

offenses against the persons act and infant life preservation act

A

have not been repealed, still apply, therefore illegal to get/given an abortion outside the criteria of the abortion act

offenses against the persons act- attempt/perform/receive= life sentence, supply meds/ equipment= prison

infant life preservation- for child in process of being born, child destruction if 28w or older unless ot save life of mother

NOT PUT INTO PRACTICE

44
Q

abortion act

A

1967

2 registered medical practitioners in good faith opinion:

if less than 24w pregnant- continuing pregnancy greater risk than terminating to phys/mh of woman/children/family

no time limit- to prevent grave permanent injury to phys/mh of woman
continuing preg risks womans life
substantial risk of phys/mental abnormalities child seriously handicapped

45
Q

what moved the cut off for the time limited abortion

A

from 28w in abortion act to 24w in human fertilisation and embryology act 1990

46
Q

other elements of abortion act 1967

A

must in licensed clinic/hospital
records must be kept- central register with why
any practitioner may conscientously object, unless the womans life is at risk (not required to say why)

47
Q

who has final say in abortion, how much is dad/other involved

A

the mother, only the mother
dad has no say

48
Q

abortion laws in NI

A

in NI, offenses against the person and infant life act applied until 2020. Abortion act DID NOT, was illegal except to save womans life

in March 2020, The abortion regulations

49
Q

the abortion regulations NI

A

up to 12 w on request by a doctor in a clinic if believed under 12w

12-24 w if 2 Drsfeel necessary to protect mh/phys of woman

unlimited- to save womans life, avoid risk to life/grave injury, severe impairment

50
Q

conscientous objection to abortion

A

doctor must explain do not provide abortions, not why.
give support and info, refer to another practitioner

51
Q

can you get an abortion for down’s

A

yes, could under severe handicap clause

however, may be subject to change as disability groups are against this, down’s not always severe etc. this would have impact on screening

52
Q

what do you call a child you cannot talk and how may they communicate

A

children who cant talk= non-verbal, communicate by other means such as alternative and augmentative communication (AAC)

non-verbal may be developmental or acquired, temporary or permanent, variety of causes

53
Q

types of AAC

A

no equipment- makaton (symbols, signs, speech), nodding, signing

low tech- communication chart with pics and words

high tech- activated by child’s movement (point, touch, scanning, eye contact, head mvmt) to select word/pic/letter into electronic voice

54
Q

tips for consultations with non-verbal children

A

use triadic consultations
plan ahead- gather info about how they communicate
allow extra time
consider the space
don’t assume life is awful for parent
take lead from parent, ask for their help

55
Q

reasonable adjustments for learning disabilities 5 examples

A

extra time for appt/split in two to process info
make info accessible, try send it in advamce
check for understanding
offer first or last day of appt
demonstrate phys exam on self or carer
read their history/ hospital passport

56
Q

social model of disability

A

dev by disability rights mvmt in 1970s, distinguishes impairment and disability

was initially for those w physical and sensory impairments, expanded to include intellectual and developmental impairments

57
Q

impairment and disability as considered by social model

A

impairment= loss or lack of functioning part of body

disability= meaning society attaches to presence of impairment, disability is the loss or limitation of opportunities to take part in normal life on equal level as those without impairments

58
Q

how do biomedical models of disability see impairment and disability

A

person is impaired so difficulties are the direct and inevitable consequence of bio and psych impairment

59
Q

what are the 3 care groups that deliver antenatal care and what do they do

A

Midwives- booking, check ups, most pregnancy care, give info

GP- community care for minor conditions of pregnancy

OB- specialist care in high risk pregnancies

60
Q

how does antenatal care differ on how many children you have had

A

if 1st pregnancy seen 10 times by midwife + anomolu scan
if 2nd preg seen 7 times + anomoly scan

61
Q

what are the 4 phases of antenatal care and what do they include

A

1st trimester 0-12 w
booking scan, risk assessment, screening

2nd trimester
Fetal anomoly assessment (20w scan)

3rd trimester
fetal growth assessment, ob complication screening, delivery

Puerperium
delivery to 4 w
breastfeeding, recovery, neonatal care

all women will have at least 2 hospital visits- booking and 20w scan

62
Q

purpose of maternity care

A

identify complications by checking

  • bp
  • urine screen
  • USS 12 and 20 weeks
  • fetal growth with tape measure

for screening
health education
planning for labour and care of newborn

63
Q

what happens in 1st trimester antenatal care

A

at 10-12 weeks have booking scan

midwife takes medical and pregnancy histories, bp, urine sample, blood tests

Ultrasound dating scan- confirm location and number of fetus and viability (heartbeat)

fetal heartbeat visible USS as flicker from week 6.5

combined test!! USS, mat age, blood test (screen down’s, edward’s, patau’s)

test for active infections that could be passd on ie HIV, hep B, syphyllis, rhesus disease

64
Q

what happens in 2nd trimester antenatal care

A

20 week anomoly scan

USS for structural abormalities

65
Q

what happens in 3rd trimester antenatal care

A

bp and urine samples to screen pre-eclampsia

check for fetal growth restriction- if low risk w tape if high risk with USS

66
Q

how do ultrasound scans work

A

high frequency sound waves sent in pulses, reflected off tissue interfaces
level of reflection dependent on tissue density

2D= flat 
3D= computer remodels 2D to 3D 
4D= 3D with movement
67
Q

home birth stats

A

less than 5% births happen at home
risk of baby facing harm 1.75% higher in first time mothers delivering at home vs in hospital
4/10 times for first time mums must transfer to hospital, less so for 2nd time

best to choose location on risk potential and number prev pregnancies

68
Q

pregnancy outcomes 1st trimester

A

20% miscarry
80% of eggs in women over 40 have chromosomal defects
vs 17% in women in 20s

69
Q

pregnancy outcomes 2nd trimester

A

1% miscarry
4% fetal abnormalities

70
Q

pregnancy outcomes 3rd trimester

A

lowest risk period
1% born prematurely at 28 weeks
1 in 225 stillborn

71
Q

UK stillbirth and death within 28 days has…

A

more than halved in last 40 years,
now 5.5/1000

72
Q

what is behind 50% stillbirths

A

fetal growth restriction
failure to reach genetic growth potential
affects 5% pregnancies
75% cases are missed
leads to preterm birth, neonatal morbidity, lifelong diability

73
Q

how does risk of maternal death vary across countries

A

risk of maternal death is much much much higher in lesser developed countries

somalia 1 in 15
UK 1 in 5000
norway 1 in 8000

74
Q

what are the most common causes of maternal deaths

A

heart disease
blood clots
epilepsy or stroke
sepsis

75
Q

how is mat mortality reduced

A

hygeine
haemorrage management
antenatal care to identify complications
c-section
antibiotics
blood pressure treatment

76
Q

ethnic differences in maternal deaths

A

4-5 times as many black women die in childbirth than their proportion of mothers who gave birth

77
Q

how are pregnancy demographics changing

A

5 times as many women given birth over the age of 40 compared to 20 years ago

78
Q

why take folic acid

A

take whilst trying to conceive until 12 weeks
aids the development of neural tubes so helps prevent birth defects like spina bifida
leafy greens natural source but difficult to get optimal amount

79
Q

what does social support have beneficial effects on

A

mental health
fetal weight
progress in labour
longterm inflamm markers at 3 months
AGPAR scores at birth

continuous support in labour improves outcomes for both

80
Q

What screening is offered after baby is born

A

Heel prick test Hearing Physical exam

81
Q

What/ when is heel prick test

A

5 days old newborn Prick heel, draw 4 drops blood onto card Screens for 9 rare conditions including Sickle cell Cystic fibrosis PKU

82
Q

What/ when newborn physical exam

A

Within 72hrs after birth A 2nd exam offered 6-8 weeks at GP Checks eyes, hearts, hips, testicles, general check

83
Q

Newborn hearing check

A

Before discharge if hospital, wishing first couple weeks by health visitor if home. Finding out early gives better chance of child developing language/communication/speech as non hearing greatly influences dev

Semester 1 (18 decks)

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