Antenatal Care: Pregnancy Timeline, Chronic Conditions in Pregnancy, Rhesus Flashcards
1
Q
Define gestational age
A
The duration of the pregnancy starting from the date of the last menstrual period
2
Q
Define gravida (G)
A
The TOTAL number of pregnancies a woman has had
3
Q
Define primigravida
A
the patient is pregnant for the 1st time
4
Q
Define multigravida
A
patient that is pregnant for at least the 2nd time
5
Q
Define parity (P)
A
number of times the woman has given birth after 24 weeks gestation, regardless of whether the foetus was alive or stillborn
6
Q
Define nulliparous
A
a patient that has never given birth after 24 weeks gestation
7
Q
Define primiparous
A
a patient that has given birth after 24 weeks gestation once before
8
Q
Define multiparous
A
a patient that has given birth after 24 weeks gestation two or more times
9
Q
Multiparous vs multigravida
A
Multiparous refers only to pregnancies PAST 24 weeks
10
Q
Give the G and P for a pregnant woman with three previous deliveries at term
A
G4 P3
11
Q
Give the G and P for a non-pregnant woman with a previous birth of healthy twins
A
G1 P1
12
Q
Give the G and P for a non-pregnant woman with a previous miscarriage
A
G1 P0 + 1
13
Q
Give the G and P for a non-pregnant woman with a previous stillbirth (after 24 weeks gestation)
A
G1 P1
14
Q
What is the 1st trimester?
A
From start of pregnancy to 12 weeks gestation
15
Q
What is the 2nd trimester
A
From 13 weeks until 26 weeks
16
Q
What is the 3rd trimester?
A
27 weeks - birth
17
Q
When do foetal movements begin?
A
Around 20 weeks gestation
18
Q
What are the 5 key appointments during pregnancy? When do they occur?
A
1) Booking clinic: 8 - 12 weeks but preferably before 10 weeks
2) Dating scan: between 10 and 13+6 weeks
3) Down’s syndrome screening: between 11 and 13+6 weeks
4) Antenatal appointment: 16 weeks
5) Anomaly scan: between 18 and 20+6
6) Antenatal appointments for routine care: 25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks
19
Q
When does the booking visit occur?
A
8-12 weeks (ideally <10 weeks)
20
Q
What happens at the booking visit?
A
Offer baseline assessment and plan pregnancy:
1) General info e.g. diet, smoking, alcohol, folic acid, vit D, antenatal classes, vaccinations
2) Vitals; BP, urine dipstick, check BMI
3) Booking bloods/urine
a) FBC, rhesus status, red cell alloantibiodies, haemoglobinopathies
b) hep B, syphilis
c) HIV test offered
d) urine culture to detect asymptomatic bacteriuria
4) Risk assessment:
a) rhesus negative –> book anti-D prophylaxis
b) VTE –> provide prophylactic LMWH if high risk
c) pre-eclampsia –> provide aspirin if high risk
d) gestational diabetes –> book OGTT
e) foetal growth restriction –> book additional growth scans
5) Ensure woman has access to a midwife/care at the begninning and throughout 40 weeks and post-partum
21
Q
When does the dating scan occur?
A
Between 10 and 13 + 6
22
Q
Purpose of the dating scan?
A
1) Accurate gestational age calculated from crown rump length (CRL)
2) Multiple pregnancies are identified
23
Q
When is the Down’s syndrome screening appointment?
A
Between 11 - 13+6 weeks
24
Q
Purpose of Down’s syndrome screening appointment?
A
The purpose is to decide which women should receive more invasive tests to establish a definitive diagnosis - it is the choice of the woman whether to go ahead with the screening
25
Purpose of the antenatal appointment at 16 weeks?
To discuss results (anomaly and blood results) and plan future appointments
26
When is the anomaly scan?
Between 18 and 20+6 weeks
27
Purpose of anomaly scan?
An ultrasound to identify any anomalies e.g. heart conditions
28
Purpose of antenatal appointments at weeks 25, 28, 31, 34, 36, 38, 40, 41, 42?
Monitor the pregnancy and discuss future plans
Information e.g. breastfeeding, vitamin K, 'baby blues', labour plans, possibility of induction
29
1st line screening test for Down's syndrome?
Combined test: combining results from US and maternal blood tests
30
What does the US measure in Down's syndrome screening?
Measures nuchal translucency (thickness of the back of the neck of the foetus)
31
What is nuchal translucency?
Thickness of back of neck of foetus
32
Nuchal thickness in Down's syndrome?
Down’s syndrome is one cause of a nuchal thickness > 6mm
33
What maternal blood tests are done in Down's syndrome screening?
1) beta-hCG
2) pregnancy-associated plasma protein-A (PAPPA)
34
What maternal blood test results indicates a greater risk of Down's syndrome?
1) Higher beta-hCG
2) Lower PAPPA
35
What hCG indicates a higher risk of Down's?
Higher
36
What PAPPA indicates a higher risk of Down's?
Lower
37
What are the 3 options for screening in Down's syndrome?
1) combined test
2) triple test
3) quadruple test
38
When does a triple test screening for Down's syndrome occur?
performed between 14 and 20 weeks gestation
39
What does a triple test screening for Down's syndrome involve?
What results indicate a greater risk for it?
Only involves maternal blood tests:
1) beta-hCG - higher
2) Alpha-fetoprotein (AFP) - lower
3) Serum oestriol uE3 (female sex hormone) - lower
40
What AFP indicates a lower risk for Down's?
Higher
41
What is involved in a quadruple test Down's syndrome?
identical to triple test BUT also includes maternal blood testing for inhibin-A (higher result indicates greater risk)
42
The screening tests for Down's syndrome provide a risk score for the foetus having Down’s syndrome.
What risk leads to a woman being offered further investigations?
1 in 150 (occurs in 5% of tested women)
43
What are the next investigations for Down's syndrome?
What do these tests involve?
Amniocentesis or chorionic villus sampling
These tests involve taking a sample of the foetal cells to perform karyotyping for a definitive answer about Down's
44
When should you take folic acid in pregnancy? Purpose? How much?
When: from before pregnancy to 12 weeks
Why: Reduces neural tube defects
How much: 400mcg
45
General lifestyle advice in pregnancy?
1) Take folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
2) Take vitamin D supplement (10 mcg or 400 IU daily)
3) Avoid vitamin A supplements and eating liver or pate (vitamin A is teratogenic at high doses)
4) Don’t drink alcohol when pregnant (risk of fetal alcohol syndrome)
5) Don’t smoke (smoking has a long list of complications, see below)
6) Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
7) Avoid undercooked or raw poultry (risk of salmonella)
8) Continue moderate exercise but avoid contact sports
9) Sex is safe
10) Flying increases the risk of venous thromboembolism (VTE)
11) Place car seatbelts above and below the bump (not across it)
46
What does chorionic villus sampling involve?
US guided biopsy of placental tissue (used when testing is done earlier in pregnancy i.e. before 15 weeks)
47
What does amniocentesis involve?
US guided aspiration of amniotic fluid using needle and syringe (used later in pregnancy once there is enough amniotic fluid to make it safer to take a sample)
48
Supplements to take in pregnancy?
1) folic acid
2) vitamin D
3) vitamin A
49
What can alcohol in early pregnancy lead to?
1) Miscarriage
2) Small for dates
3) Preterm delivery
4) Fetal alcohol syndrome
50
Why should you not drink alcohol whilst pregnant?
Risk of foetal alcohol syndrome
51
What is foetal alcohol syndrome?
Fetal alcohol syndrome refers to certain characteristics that can occur in children of mothers that consumed alcohol during pregnancy.
52
Why should pregnant women avoid unpasteurised dairy or blue cheese?
risk of listeriosis (a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes)
53
When are the effects of alcohol greatest in pregnancy?
first 3 months
54
What features can be seen in foetal alcohol syndrome?
1) microcephaly (small head)
2) thin upper lip
3) smooth flat philtrum (groove between the nose and upper lip)
4) short palpebral fissure (short horizontal distance from one side of the eye to the other)
5) learning disability
6) behavioural difficulties
7) Hearing and vision problems
8) Cerebral palsy
55
What can smoking in pregnancy increase the risk of?
1) Fetal growth restriction (FGR)
2) Miscarriage
3) Stillbirth
4) Preterm labour and delivery
5) Placental abruption
6) Pre-eclampsia
7) Cleft lip or palate
8) Sudden infant death syndrome (SIDS)
56
Can you fly in pregnancy? Up to what dates in:
a) a single pregnancy
b) in a twin pregnancy
The RCOG advises flying is generally ok in uncomplicated healthy pregnancies up to:
a) 37 weeks in a single pregnancy
b) 32 weeks in a twin pregnancy
After 28 weeks gestation, most airlines need a note from a midwife, GP or obstetrician to state the pregnancy is going well and there are no additional risks.
57
What pregnancy-related topics are covered during the booking clinic?
1) What to expect at different stages of pregnancy
2) Lifestyle advice in pregnancy (e.g. not smoking)
3) Supplements (e.g. folic acid and vitamin D)
4) Plans for birth
5) Screening tests (e.g. Downs screening)
6) Antenatal classes
7) Breastfeeding classes
8) Discuss mental health
9) Can Discuss female genital mutilation
10) Can discuss domestic violence
58
A set of booking bloods are taken at the booking clinic. What bloods are taken?
1) Blood group, antibodies and rhesus D status
2) Full blood count for anaemia
3) Screening for thalassaemia (all women) and sickle cell disease (women at higher risk)
Patients are also offered screening for infectious diseases, by testing antibodies for:
1) HIV
2) Hepatitis B
3) Syphilis
59
Other investigations at booking clinic?
1) Weight, height and BMI
2) Urine for protein and bacteria
3) Blood pressure
60
Women are assessed for risk factors for other conditions, and plans are put in place with additional appointments booked.
These conditions include:
1) Rhesus negative (book anti-D prophylaxis)
2) Gestational diabetes (book oral glucose tolerance test)
3) Fetal growth restriction (book additional growth scans)
4) Venous thromboembolism (provide prophylactic LMWH if high risk)
5) Pre-eclampsia (provide aspirin if high risk)
61
What is offered to women at high risk of pre-eclampsia at booking clinic?
Aspirin
62
What is offered to women at high risk of VTE at booking clinic?
prophylactic LMWH
63
What is the purpose of the initial Down's syndrome screening test?
To decide which women should receive more invasive tests to establish a definitive diagnosis.
64
Give 5 examples of chronic conditions that must be monitored during pregnancy
1) Hypothyroidism
2) Hypertension
3) Epilepsy
4) Rheumatoid arthritis
5) Diabetes
65
Potential adverse pregnancy outcomes of hypothyroidism?
1) miscarriage
2) anaemia
3) small for gestational age
4) pre-eclampsia
66
Management of hypothyroidism in pregnancy?
Levothyroxine (T4) --> can cross the placenta and provide thyroid hormone to the developing foetus
67
How does levothyroxine need to be adjusted in pregnancy?
Dose needs to be increased during pregnancy (usually 30-50%)
68
Women with existing hypertension may need changes to their medications during pregnancy.
What are 3 classes of HTN drugs that may cause congenital abnormalities?
1) ACEi e.g. ramipril
2) ARBs e.g. losartan
3) Thiazide and thiazide-like diuretics e.g. indapamide
69
What are 3 classes of HTN drugs that are NOT known to be harmful in prengnacy?
1) Labetalol: a beta blocker (although other beta blockers may have an adverse effect)
2) Calcium channel blockers (e.g. nifedipine)
3) Alpha blockers (e.g. doxazosin)
70
Which beta blocker is not known to be harmful in pregnancy?
Labetalol
71
How can women with epilepsy reduce the risk of neural tube defects in pregnancy?
Take folic acid 5mg daily from before conception
72
How may pregnancy affect women with epilepsy?
Pregnancy may worsen seizure control due to the additional stress, lack of sleep, hormonal changes, and medication regimes.
73
Are seizures harmful to the pregnancy?
Seizures are not known to be harmful to the pregnancy, other than the risk of physical injury.
74
How should epilepsy be controlled BEFORE becoming pregnancy?
Epilepsy should be controlled with a single anti-epileptic drug before becoming pregnant
75
What are the 3 safer anti-epileptic options in pregnancy?
1) Levetiracetam
2) Lamotrigine
3) Carbamazepine
76
What 2 anti-eplileptic drugs are not safe during prengnacy?
1) sodium valproate
2) phenytoin
77
What can sodium valproate cause in pregnancy?
Causes neural tube defects and developmental delay.
Must be avoided in girls or women unless there are no suitable alternatives and strict criteria are met to ensure they don’t get pregnant (Prevent – valproate pregnancy prevention programme)
78
What can phenytoin cause in pregnancy?
causes cleft lip and palate
79
How can pregnancy affect symptoms of rheumatoid arthritis (RA)?
Often symptoms of RA will improve during pregnancy and may flare up after delivery.
80
RA is treated with DMARDs.
Which DMARD is NOT safe during pregnancy?
Methotrexate
81
What can methotrexate cause in pregnancy?
contraindicated, is teratogenic, causing miscarriage and congenital abnormalities
82
What 3 DMARDs are considered safe during pregnancy?
1) Hydroxychloroquine
2) Sulfasalazine
3) Corticosteroids: may be used in flare ups
83
What is 1st line DMARD for RA in pregnancy?
Hydroxychloroquine
84
How long do men and women on methotrexate have to wait before becoming pregnant/fathering a child?
Women - 6 months after stopping treatment
Men - 3 months
85
What is gestational diabetes?
those who are newly diagnosed with diabetes during pregnancy
86
What is the most common medical disorder complicating pregnancy?
HTN
87
Risk factors for gestational diabetes?
1) BMI of > 30 kg/m²
2) previous macrosomic baby weighing 4.5 kg or above
3) previous gestational diabetes
4) first-degree relative with diabetes
5) family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
88
Potential foetal complications of gestational diabetes?
1) macrosomia (birthweight >4kg)
2) Preterm delivery: may lead to respiratory distress syndrome
3) Hypoglycaemia in the baby shortly after birth
4) Increased risk of developing T2D for baby in later life
89
Potential foetal complications of pre-existing diabetes?
1) Neonatal hypoglycaemia
2) Macrosomia
3) Polycythaemia (raised haemoglobin)
4) Jaundice (raised bilirubin)
5) Congenital heart disease
6) Cardiomyopathy
90
How can gestational diabetes lead to macrosomia?
Due to excess maternal blood glucose crossing the placenta and inducing increased neonatal insulin production
91
What can macrosomia increase the risk of?
a) shoulder dystocia
b) birth injuries
c) emergency caesarean section
92
How can gestational diabetes lead to hypoglycaemia in the baby shortly after birth?
Due to sustained high foetal insulin levels after delivery
93
How can hypoglycaemia in the baby shortly after birth affect the baby?
can lead to seizures in the baby
94
Maternal complications of gestational diabetes?
1) Increased risk of hypertension
2) Increased risk of pre-eclampsia
95
Test of choice for screening for gestational diabetes?
the oral glucose tolerance test (OGTT)
96
When should those at risk of gestational diabetes (i.e. risk factors) be screened?
Those at risk should be screened with OGTT at 24-28 weeks gestation
97
When should those with previous gestational diabetes be screened?
1) Women with previous gestational diabetes should have OGTT soon after booking clinic
2) 2nd test at 24-28 weeks if the first test is normal.
98
OGTT results for gestational diabetes?
gestational diabetes is diagnosed if either:
1) fasting glucose is >/= 5.6 mmol/L
2) 2 hour glucose is >/= 7.8 mmol/L
Remember the cutoff for gestational diabetes as 5-6-7-8.
99
What 3 features may suggest gestational diabetes
1) Large for dates foetus
2) Polyhydramnios (increased amniotic fluid)
3) Glucose on urine dipstick
100
What happens in an OGTT?
1) Patient drinks 75g glucose drink at start of test
2) Blood sugar levels measured before sugar drink (fasting) and then 2 hours after
101
Monitoring of gestational diabetes?
1) Joint diabetes & antenatal clinics with input from dietician
2) 4 weekly US scans to monitor foetal growth and amniotic fluid volume from 28 to 36 weeks gestation
3) Women should be taught about self-monitoring of blood glucose
4) advice about diet (including eating foods with a low glycaemic index) and exercise should be given
102
If a fasting blood glucose is <7mmol/l in pregnancy, what can be done?
1) a trial of diet and exercise should be offered
2) if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
3) if glucose targets are still not met insulin should be added to diet/exercise/metformin
103
If a fasting blood glucose is <7mmol/l at time of gestational diabetes diagnosis, what can be done?
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
104
Medical management of gestational diabetes in:
1) Fasting glucose <7 mmol/l
2) Fasting glucose >7 mmol/l
3) Fasting glucose >6 mmol/l plus macrosomia (or other complications)
1) Fasting glucose <7 mmol/l --> trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
2) Fasting glucose >7 mmol/l --> start insulin +/- metformin
3) Fasting glucose >6 mmol/l plus macrosomia (or other complications) --> start insulin +/- metformin
105
What can be suggested as an alternative for women who decline insulin or cannot tolerate metformin?
Glibenclamide (a sulfonylurea
106
In gestational diabetes, blood glucose levels must be monitored daily.
What are target levels for:
a) fasting
b) 1 hour post meal
c) 2 hours post meal
a) 5.3 mmol/l
b) 7.8 mmol/l
c) 6.4 mmol/l
107
Management of pre-existing diabetes in pregnancy?
1) weight loss for women with BMI of > 27 kg/m^2
2) stop oral hypoglycaemic agents, apart from metformin, and commence insulin
3) folic acid 5 mg/day from pre-conception to 12 weeks gestation
4) detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
5) tight glycaemic control reduces complication rates
6) treat retinopathy as can worsen during pregnancy
108
Is gestational diabetes managed with short-acting or long-acting insulin?
Short-acting
109
Who should glibenclamide be offered to in gestational diabetes?
glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment
110
What is rhesus?
The name rhesus refers to various types of rhesus antigens on the surface of red blood cells.
The antigens on the red blood cells vary between individuals.
The rhesus antigens are separate to the ABO blood group system.
111
Within the rhesus group, many different types of antigens can be present or absent, depending on the person’s blood type.
What is the most relevant antigen within the rhesus blood group system?
Rhesus-D antigen
When we refer to someone’s rhesus status in relation to pregnancy (e.g. “she is rhesus-negative”), we are usually referring to whether they have the rhesus-D antigen present on their red blood cell surface.
112
Rhesus-D positive vs rhesus-D negative in pregnancy?
Rhesus-D positive --> do NOT need any additional treatment during pregnancy.
Rhesus-D negative --> further management required
113
What must be considered if a patient with Rhesus-D negative in a FIRST pregnancy?
We have to consider the possibility that her child will be rhesus positive.
1) It is likely at some point in the pregnancy (i.e. childbirth) that the blood from the baby will find a way into the mother’s bloodstream.
2) When this happens, the baby’s red blood cells display the rhesus-D antigen (i.e. rhesus-D positive).
3) The mother’s immune system will recognise this rhesus-D antigen as foreign, and produce antibodies to the rhesus-D antigen.
4) The mother has then become sensitised to rhesus-D antigens.
Usually, this sensitisation process does not cause problems during the first pregnancy.
114
What must be considered if a patient with Rhesus-D negative in a SECOND pregnancy?
1) During subsequent pregnancies, the mother’s anti-rhesus-D antibodies can cross the placenta into the fetus.
2) If that fetus is rhesus-D positive, these antibodies attach themselves to the red blood cells of the fetus and causes the immune system of the fetus to attack them, causing the destruction of the red blood cells (haemolysis).
3) Haemolytic disease of the newborn.
115
What condition can arise from rhesus incompatibility in pregancy?
haemolytic disease of the newborn.
116
Management of rhesus incompatibility?
Prevention of sensitisation --> giving intramuscular anti-D injections to rhesus-D negative women.
117
Why is prophylaxis so impoirtant in rhesus incompatibility?
There is no way to reverse the sensitisation process once it has occurred, which is why prophylaxis is so essential.
118
How does anti-D medication work in rhesus incomptability?
1) Attaches itself to the rhesus-D antigens on the fetal RBCs in the mothers circulation, causing them to be destroyed.
2) This prevents the mother’s immune system recognising the antigen and creating it’s own antibodies to the antigens
3) It acts as a prevention for the mother becoming sensitised to the rhesus-D antigen.
119
Anti-D injections are given routinely on what two occasions?
1) 28 weeks gestation
2) Birth (if the baby’s blood group is found to be rhesus-positive)
120
Anti-D injections should also be given at any time where sensitisation may occur.
Give some examples
1) Antepartum haemorrhage
2) Amniocentesis procedures
3) Abdominal trauma
121
When should anti-D be given in a sensitisation event?
within 72 hours
122
The Kleinhauer test is performed in rhesus-negative women.
a) when?
b) what is this?
c) purpose?
a) After any sensitisation event after 20 weeks gestation
b) Checks how much fetal blood has passed into the mother’s blood during a sensitisation event.
c) assess whether further doses of anti-D is required
123
What does the Kleihauer test involve?
1) The Kleihauer test involves adding acid to a sample of the mother’s blood.
2) Foetal Hb is naturally more resistant to acid, so that they are protected against the acidosis that occurs around childbirth.
3) Therefore, fetal haemoglobin persists in response to the added acid, while the mothers haemoglobin is destroyed.
4) The number of cells still containing haemoglobin (the remaining fetal cells) can then be calculated.
124
What is the leading cause of indirect maternal death during or up to six weeks after the end of pregnancy?
Cardiac disease
125
What is the leading cause of direct maternal death during or up to six weeks after the end of pregnancy?
Thrombosis and thromboembolism
126
What is the leading cause of maternal mortality worldwide?
Obstetric haemorrhage: accounting for up to 50% of maternal deaths in some countries.
127
Define postpartum haemorrhage (volume)
Blood loss ≥500ml
128
Define major obstetric haemorrage (volume)
Blood loss ≥2500ml
or blood transfusion ≥25 units of red cells
or treatment of coagu
129
What are some RED FLAGS for severe maternal mental health and require urgent senior psychiatric review?
1) Recent significant change in mental state or emergence of new symptoms
2) New thoughts or acts of violent self halm
3) New and persistent expressions of incompentency as a mother or estrangement from the infant
130
What should prompt consideration for admission to a mother and baby unit?
- rapidly changing mental state
- suicidal ideation
- pervasive guilt or hopelessness
- significant estrangement from infant
- new or persistent beliefs of inadequacy as a mother
- evidence of psychosis
131
What is the leading cause of maternal mortality in the UK?
Mental illness.
The largest proportion of maternal deaths result from suicide.
132
When can the expected date of delivery (EDD) be calculated?
If the first day of the last menstrual period is known and she has a normal menstrual cycle.
133
How many antenatal appointments are there for multiparous women?
8
Booking (ideally by 10wks) then seen at 16, 28, 34, 36, 38 & 40, 41 wks
134
How many antenatal appointments are there for nulliparous women?
10
Booking (ideally by 10wks) then seen at 16, 25, 28, 31, 34, 36, 38, 40 & 41 wks
135
Antenatal care pathway
https://www.mkuh.nhs.uk/wp-content/uploads/2022/10/Antenatal-Care-Pathway-Guideline-.pdf
136
What blood tests are done at the booking scan?
1) FBC & ferritin
2) Haemoglobinopathies
3) Blood Group and Antibody screen.
4) HIV
5) Hep B
6) Syphilis
137
When is the dating USS done?
12 weeks (combined with screening for nuchal translucency)
138
When is the anomaly scan done?
20 weeks
139
What is the 'combined test'?
This involves nuchal translucency scan + maternal blood test for:
- beta-hCG
- pregnancy-associated plasma protein-A
Screening for Down's syndrome and other chromosomal conditions.
140
What should be included in booking scan?
1) Discuss and give specific patient information leaflets as appropriate e.g. smoking, diet & lifestyle, vitamin D, folic acid, vaccinations
2) Identify maternity service users who should be cared for by the Safeguarding Team.
3) Measure height & weight (and calculate BMI)
4) Measure BP
5) Urinalysis (and send MSU if the woman/birthing person consents for asymptomatic bacteruria)
6) Recommend and offer to perform Carbon Monoxide (CO) monitoring.
7) Determine risk factors for pre-eclampsia to assess the need for Aspirin 150mg
8) Antenatal Booking VTE risk assessment
9) Determine risk factors for SGA
10) Determine risk factors for gestational diabetes (if indicated complete glucose plasma bloods)
11) Blood tests
12) FGM risk
13) Mental health assessment
14) Occupatioons, risks & maternity rights/benefits
141
What combined screening result is deemed high risk?
1 in 150 or less
142
When is the combined test offered?
Between 11+0 and 13+6
143
if women miss the combined screening (i.e. too late), what can be offered?
Quadruple test
Note - this only screens for Down's
144
What does the combined test screen for?
Down's, Patau & Edward's
145
What is non-invasive prenatal testing (NIPT)?
NIPT is a blood test that is more accurate than the first pregnancy screening test.
It’s offered to women who are carrying a baby identified from previous screening tests as having a higher chance of having either Down’s syndrome, Edwards’ syndrome, or Patau’s syndrome.
146
Risks of NIPT?
NIPT is completely safe and will not harm you or your baby.
147
When is NIPT not suitable?
NIPT is not suitable if you’re pregnant with 3 or more babies.
148
Who would be offered Hep C screening?
History of drug abuse or obstetric cholestasis
149
Who would be offered Chlamydia screening?
Those <25
150
What is a high risk pregnancy?
One in which the probability of an adverse outcome in the mother and/or baby is greater than that for a pregnant woman in general
151
Some categories of causes of high risk pregnancies:
- Maternal conditions
- Social factors
- Obstetric issues in previous pregnancies
- Problems in this pregnancy
- Problems during labour
152
What are some maternal conditions that can make a pregnancy high risk?
- Obesity
- Diabetes
- HTN
- Chronic disease: renal, autoimmune, respiratory
- Infections
- Previous VTE
153
What are some social factors that can deem a pregnancy to be high risk?
- Teenage pregnancy
- Maternal age >40
- High parity and low interpregnancy interval
- Poor socioeconomic conditions
- Alcohol intake
- Substance abuse
154
What are some obstetric issues in previous pregnancies that can cause problems in future pregnancies?
1) C-section
2) Preterm delivery
3) Recurrent miscarriage
4) Stillbirth
5) Pre-eclampsia
6) Gestational diabetes
7) 3rd degree tear
155
What are some problems during current pregnancy that can cause problems?
- Multiple pregnancy
- Small for gestational age
- Placenta praevia (low lying placenta)
- Gestational diabetes
- Pre-eclampsia
156
What are some problems during labour that can be high risk?
- Meconium stained liquor
- Blood stained liquor
- Worrying features on CTG
- Need for oxytocin infusion
- Lack of progress
157
Who leads care in an uncomplicated pregnancy?
Midwives & GP-led models
158
Who leads care in a high risk pregnancy?
Consultant-led
159
160
What number of recurrent miscarriages makes you high risk?
3
161
