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Year Three - Reproductive System > Antenatal Care & Screening > Flashcards

Antenatal Care & Screening Flashcards

1
Q

What five general lifestyle advice to we give pregnant women?

A

Folic Acid Supplements

Vitamin D Supplements

Alcohol Cessation

Smoking Cessation

Medication Alteration

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2
Q

How long should folic acid supplements ideally be taken prior to pregnancy?

A

Three months

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3
Q

Why do we promote pregnant patients taking folic acid supplements?

A

They decrease the risk of the baby developing neural tube defects

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4
Q

What dose of folic acid supplements are recommended?

A

400mcg daily

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5
Q

In what three patient groups is a dose of folic acid 5mg daily recommended?

A

Those who have a BMI > 30

Those who take valproate for epilepsy

Those who have had a previous child with spina bifida

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6
Q

What dose of vitamin D supplements is recommended in pregnant patients?

A

A dose of 10mcg daily throughout the whole pregnancy

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7
Q

Why is alcohol cessation recommended to pregnant patients?

A

Alcohol can cross the placenta, enter the foetus, and disrupt fetal development

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8
Q

Is there a safe level of alcohol in pregnancy?

A

No

Women are encouraged not to drink at all

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9
Q

What are the three complications of alcohol during pregnancy?

A

Miscarriage

Preterm Delivery

Fetal Alcohol Syndrome

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10
Q

What are the seven clinical features of fetal alcohol syndrome?

A

Microcephaly

Smooth Flat Philtrum

Short Palpebral Fissure

Thin Upper Lip

Learning Disability

Hearing & Vision Problems

Cerebral Palsy

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11
Q

What are the six complications that can arise due to smoking during pregnancy?

A

Fetal Growth Restriction

Sudden Infant Death Syndrome (SIDS)

Miscarriage

Stillbirth

Preterm Delivery

Pre-Eclampsia

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12
Q

What is the first pregnancy appointment called? When does it take place?

A

Booking clinic

10 weeks gestation

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13
Q

What four investigations take place at the booking clinic?

A

Antenatal Examination

Bloods

Blood Pressure

Urinalysis

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14
Q

What two measurements are taken during the antenatal examination in the booking clinic?

A

Symphyseal Fundal Height (SFH)

Fetal Presentation

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15
Q

What is the SFH?

A

This is the distance between the pubic symphysis to the fundus of the uterus

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16
Q

What is the SFH used to measure?

A

This measurement is then plotted on a chart allowing us to measure the growth of the foetus and whether this is normal or not

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17
Q

In what two circumstances can the SFH measurement not be obtained?

A

High BMI

Uterine fibroids

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18
Q

Why is fetal presentation important?

A

If abnormal, it can have implications for delivery

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19
Q

What is offered when the baby remains in a breech presentation after 36 weeks?

A

External cephalic aversion

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20
Q

What is external cephalic aversion?

A

This is a procedure used to turn a fetus from a breech position into a vertex position before labour begins

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21
Q

What happens if an external cephalic version fails?

A

The baby will be delivered by elective c-section

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22
Q

What seven blood tests taken during the booking clinic?

A

FBC

Blood Group

Antibodies

Rhesus D Status

Alpha Fetoprotein

Infectious Disease Screening

Inherited Blood Disorder (Haemoglobinopathy) Screening

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23
Q

Why is a FBC conducted during the booking clinic?

A

To look for anaemia

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24
Q

What alpha fetoprotein level at the booking clinic indicates further investigation?

A

> 2MoM

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25
Q

What is rhesus?

A

It refers to various types of rhesus antigens on the surface of red blood cells

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26
Q

What is the most relevant antigen within the rhesus blood group system?

A

Rhesus-D antigen

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27
Q

How do we manage pregnant women who are rhesus-D positive?

A

There is no need for any additional treatment during pregnancy

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28
Q

Explain why rhesus-D negative pregnant women need to be managed

A

There is a possibility that her child will be rhesus positive.

It is likely that at some point during the pregnancy that the blood from the baby will find a way into the mother’s bloodstream.

When this happens, the baby’s red blood cells display the rhesus-D antigen.

The mother’s immune system will recognise these antigens as foreign and produce antibodies against them.

The mother has then become sensitised to rhesus-D antigens.

This sensitisation process doesn’t cause problems during the first pregnancy.

However, in subsequent pregnancies, the mother’s rhesus-D antibodies can cross the placenta into the fetus.

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.

The red blood cell destruction (haemolysis) caused by the antibodies of the mother is called haemolytic disease of the newborn.

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29
Q

How do we manage rhesus-D negative women during pregnancy?

A

All women are given intramuscular anti-D injections

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30
Q

How does anti-D medication work to prevent sensitisation?

A

It works by attaching to the rhesus-D antigens on the fetal red blood cells in the mother’s circulation, causing them to be destroyed

This prevents the mother’s immune system recognising the antigen and creating its own antibodies to the antigen

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31
Q

When do we give anti-d injections - three circumstances?

A

28 weeks’ gestation

Sensitisation events

At birth (if the baby’s blood group is found to be rhesus-positive)

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32
Q

What is the Kleihauer test?

A

It checks how much fetal blood has passed into the mother’s blood during a sensitisation event

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33
Q

When is the Kleihauer test conducted? Why?

A

It is used after any sensitising event past 20 weeks’ gestation

To assess whether further doses of anti-D are required

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34
Q

How is the Kleihauer test conducted?

A

This test involves adding acid to a sample of the mother’s blood

Fetal haemoglobin is naturally more resistant to acid, therefore it persists in response to the added acid, whilst the mother’s haemoglobin is destroyed

The number of cells still containing haemoglobin can then be calculated

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35
Q

What three infectious diseases are screened during the booking clinic? In which women do we screen these diseases?

A

Hepatitis B

HIV

Syphilis

This is part of the routine antenatal screening, which is recommended for every pregnancy

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36
Q

What two inherited blood disorders are screened during the booking clinic? In which women do we screen these diseases?

A

Sickle cell disease - only those that are at high risk are screened

Thalassaemia -all pregnant women are offered screening

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37
Q

Why is blood pressure measured at the booking clinic?

A

It is conducted to screen for hypertension

A hypertensive pregnancy can be indicative of pre-eclampsia

38
Q

Why is a urinalysis investigation conducted at the booking clinic?

A

It is used to screen for excess protein and bacteria

This can then allow diagnosis of a UTI or pre-eclampsia

39
Q

After the booking clinic what is the next pregnancy appointment? When is this conducted?

A

Dating scan

10-14 weeks

40
Q

What investigation is conducted at the dating scan?

A

Ultrasound scan

41
Q

What are the six things screened for at the dating scan?

A

It is used to check the baby’s heartbeat, growth and development

It is used to estimate the stage of the pregnancy and the due date

It confirms whether there is a multiple pregnancy

It allows screening for trisomy abnormalities. These screening tests only provide a risk of their baby being affected however cannot provide a confirmed diagnosis

It is used to measure the nuchal translucency (NT)

It screens for neural tube defects

42
Q

What measurement is used to calculate the gestational age?

A

Crown rump length

43
Q

What are the three types of trisomy abnormalities?

A

Down’s syndrome (trisomy 21)

Edward’s syndrome (trisomy 18)

Patau’s syndrome (trisomy 13)

44
Q

Can screening for trisomy abnormalities confirm a diagnosis?

A

No, they can only estimate a risk

45
Q

What is the first line antenatal screening for Down’s syndrome?

A

Combined test

46
Q

At what gestation is the combined test conducted?

A

11-14 weeks gestation

47
Q

What is the combined test?

A

It involves combining results from ultrasound and maternal blood tests

48
Q

What does the ultrasound scan in the combined test measure?

A

Nuchal translucency

49
Q

What is the nuchal translucency?

A

This is the sonographic appearance of a collection of fluid under the skin behind the fetal neck

50
Q

What two things increase the nuchal translucency?

A

Gestational age

Chromosomal abnormalities

51
Q

What nuchal translucency thickness is indicative of Down’s syndrome?

A

> 6mm

52
Q

What investigation should be conducted when individuals have a high nuchal translucency and a low trisomy risk? Why?

A

Cardiac scan

This is due to fetal cardiac abnormalities are associated

53
Q

What two maternal blood tests are included in the combined test?

A

Beta-Human Chorionic Gonadotrophin (beta-hCG)

Pregnancy-Associated Plasma Protein-A (PAPPA)

54
Q

What beta-hCG result indicates a greater risk of Down’s syndrome?

A

Higher

55
Q

What PAPPA result indicates a greater risk of Down’s syndrome?

A

Lower

56
Q

When is the triple test conduced?

A

14-20 weeks gestation

This investigation is only conducted if it is not possible to obtain a nuchal translucency measurement or the patient is over 14 weeks pregnant

57
Q

What three maternal blood tests are included in the triple test?

A

Beta-Human Chorionic Gonadotrophin (beta-hCG)

Alpha-Fetoprotein (AFP)

Serum Oestriol

58
Q

What AFP result indicates a greater risk of Down’s syndrome?

A

Lower

59
Q

What serum oestriol result indicates a greater risk of Down’s syndrome?

A

Lower

60
Q

When is the quadruple test conducted?

A

14-20 weeks gestation

This investigation is only conducted if it is not possible to obtain a nuchal translucency measurement or the patient is over 14 weeks pregnant

61
Q

What is the quadruple test?

A

It is identical to the triple test, but also includes maternal blood testing for inhibin-A

62
Q

What inhibin-A result indicates a greater risk of Down’s syndrome?

A

Higher

63
Q

What three investigations should be offered to individuals when individuals have a Down’s syndrome risk score greater than 1 in 150?

A

Non-Invasive Prenatal Testing

Chronic Villus Sampling (CVS)

Amniocentesis

64
Q

What is the first line investigation used for high nuchal translucency?

A

Non-invasive prenatal testing

65
Q

What is non-invasive prenatal testing?

A

It involves sampling maternal blood, which will contain fetal cell free DNA that has been released from the placenta

66
Q

Does non-invasive prenatal screening carry a risk of miscarriage?

A

No

67
Q

What happens if the risk of chromosomal abnormalities is determined low from non-invasive prenatal screening?

A

No further investigations are required

68
Q

What happens if the risk of chromosomal abnormalities is determined high from non-invasive prenatal screening?

A

These parents are offered amniocentesis and chronic villus sampling to further investigate this

69
Q

When is CVS conducted?

A

10-14 weeks gestation

70
Q

What is CVS?

A

It involves a fine needle being guided through the abdomen to take a small sample of tissue from the placenta

The chromosomes from the placenta can be counted from the sample

71
Q

What is the % risk of miscarriage with CVS?

A

1-2%

72
Q

When is amniocentesis conducted?

A

15 weeks gestation

73
Q

What is amniocentesis?

A

It involves a fine needle being guided through the abdomen to take a small sample of amniotic fluid

The chromosomes from the fluid can be counted from the sample

74
Q

What is the % risk of miscarriage with amniocentesis?

A

1%

75
Q

What is the routine screening test offered to women for Down’s syndrome?

A

Combined ultrasound/biochemical (CUB) investigation

76
Q

What are the two types of neural tube defects?

A

Anencephaly

Spina Bifida

77
Q

What is ancephaly?

A

It is characterised by an absence of cortical tissue and cranial vault

78
Q

What are the three features of ancephaly on the dating scan?

A

The presence of no parenchymal tissue

A low crown-rump length

A “frog eye” appearance due to absent cranial bone and bulging orbits

79
Q

What is spina bifida?

A

It is characterised by incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy

80
Q

What are the three features of spina bifida on the dating scan?

A

The presence of dorsal ossification centres or lateral pedicles are being splayed apart

The lemon sign, which is when the shape of the fetal skull appears flattened and inwardly scalloped

The banana sign, which is the appearance of the cerebellum wrapped around the medulla

81
Q

What next pregnancy appointment occurs after the dating scan?

A

Anomaly scan

82
Q

When is the anomaly scan carried out?

A

18 and 21 weeks gestation

83
Q

What does the anomaly scan screen for?

A

Neural tube defects

84
Q

What are the three neural tube defects screened for on the anomaly scan?

A

Hypoplastic Left Heart

Exomphalos

Cleft Lip

85
Q

What is hypoplastic left heart syndrome?

A

It is a birth defect in which the left side of the heart is critically underdeveloped and affected individuals have profound cyanosis and cardiac failure

86
Q

What are the three features of hypoplastic left heart syndrome on an anomaly scan?

A

A small ascending aorta

A thick-walled left ventricle

An enlarged right heart chamber

87
Q

What is exomphalos?

A

It is an abdominal wall defect in which the baby’s intestines protrude inside the umbilical cord

88
Q

What is exomphalos associated with?

A

Trisomy chromosome abnormalities

89
Q

What is cleft lip?

A

An opening or split in the upper lip

90
Q

What is the cause of a cleft lip?

A

It results when facial structures that are developing in an unborn babe don’t close completely

Year Three - Reproductive System (52 decks)

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