Antenatal care screening Flashcards
what is antenatal care
Antenatal care (ANC) can be defined as the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy. The components of
ANC include: risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion
aim of antenatal care
Aim is to prevent, identify and manage conditions that cause maternal and neonatal morbidity, and which may result in or contribute to maternal mortality, stillbirth and neonatal death
what does antenatal care start with
pre-conceptional care
Opportunity to assess perspective parents health & provide information to help them make choices.
organisation of antenatal care
maternal characteristics where additional care is required
PMH examples where additional care is required
obstetric issues where additional care is required
WHO screening principles
Respond to a recognised need
Objectives defined
Target population
Integrate education, testing, services and management
Quality assurance
Ensure informed choice, confidentiality, autonomy
Promote equity and ensure access
Benefits outweigh harm
differences between screening and diagnostic tests
what is screening
Screening (think of a sieve) is the process of identifying healthy people who may have an increased chance of a disease or condition.
The screening provider then offers information, further tests and treatment. This is to reduce associated problems or complications.
Screening should always be a personal choice.
what is diagnosis
Diagnosis involves interpreting the history, clinical observations, laboratory test results, or imaging studies—all of which are “tests” undertaken to help doctors refine their estimate of the probability that a patient has a particular condition.
6 NHS antenatal and newborn ANNB screening programmes
Fetal anomaly screening (FASP)
Infectious diseases in pregnancy screening (IDPS)
Sickle cell and thalassaemia screening (SCT)
Newborn and infant physical examination (NIPE)
Newborn blood spot screening (NBS)
Newborn hearing screening (NHSP)
what will fetal anomaly screening screen for
Edwards’ syndrome (T18)
Patau’s syndrome (T13)
anencephaly
spina bifida
cleft lip
congenital diaphragmatic hernia
gastroschisis
exomphalos
congenital heart disease
bilateral renal agenesis
lethal skeletal dysplasia
limitations of screening
Screening is not a diagnostic test
Expectation
False negative
False positives
when is booking appointment
before 10 weeks gestation
0-12 weeks screening
Infectious diseases including HIV, hepatitis B and syphilis (blood test) Reoffer at 20weeks if initially declined. No longer screen for Rubella
preconception, 12 weeks screening
Sickle cell disease and thalassaemia (blood test)
screening trisomy
Screening Trisomy 21 (Down’s syndrome) is offered to all pregnant women from 11 weeks and two days’ gestation, up to 20 weeks’ gestation (blood test and scan)
screening Edwards syndrome and Pataus
Screening for Edward’s syndrome & Patau’s syndrome is offered to all pregnant women from 11 weeks and 2 days gestation to 14 weeks and one day gestation only (blood test and scan)
advice given in booking appointment
Folic acid / vitamin D / Exercise / smoking – CO monitoring / Alcohol.
Maternal VTE assessment
Mental health assessment
BMI / BP / Urine
Growth assessment – Symphysio fundal height chart
Screening
aim of booking appointment
e aim of the booking visit is to facilitate planning of immediate antenatal care and to formulate a plan for ongoing antenatal care.
It is also an important opportunity to screen women for potential adverse pregnancy outcomes
Due to large vols of info needed the booking appointment may be divided into two parts
Hospital Trusts have an online tool for information gathering prior to face to face appointment. Completed by the patient.
taking history at booking appointment
* her general health and wellbeing
* whether she has any concerns that she would like to discuss – also ask her partner about this, if present
* her obstetric history, and the medical and family history of both biological parents
* previous or current mental health concerns, including any severe mental illness, trauma or psychiatric treatment
* current and recent medicines, health supplements and herbal remedies
* allergies
* her nutrition and diet, physical activity, smoking status, alcohol consumption and recreational drug use
* her occupation, discussing any risks and concerns
* her family and home situation – if she is alone, also ask about domestic abuse
* her support network, including other people who may be involved in the baby’s care
* any health or other issues affecting her partner or family members that may be significant for her health and wellbeing
* contact details for her partner and her next of kin.
If a woman books late in pregnancy, also ask about the reasons for the late booking because it may reveal social, psychological or medical issues that need to be addressed.
sickle cell and thalassaemia screening
trisomy screening process
Edwards syndrome
Babies with Edwards Syndrome have an extra copy of Chromosome 18 in some or all cells.
13% survival past 1st birthday
pataus syndrome
Babies with Pataus Syndrome have an extra copy of Chromosome 13 in some or all cells.
11% survival past 1st birthday
anomaly ultrasound scan
non-invasive prenatal screening test
In addition to tests commonly used for screening forT21,
The NSC are currently reviewing the use of non invasive prenatal testing of cell free fetal DNA in maternal screening
Non-invasive prenatal testing (NIPT) is based on analysis of cell-free DNA (cfDNA) in maternal blood. It emanates from the placenta, but represents the entire fetal genotype and is rapidly cleared from the maternal circulation with hours of delivery, making it pregnancy specific.
As NIPT tests all cfDNA in maternal blood (fetal and maternal) and the cffDNA comes from the placenta, results that are discordant with the fetal karyotype can arise from detection of maternal chromosomal rearrangements or mosaicism, maternal malignancy, confined placental mosaicism, or vanishing twin pregnancies.
False negatives can also occur through low levels of cffDNA or laboratory technical issues.
As such, NIPT is not diagnostic and confirmation of a positive result by invasive testing (CVS or amniocentesis) is required.
NIPT has a much greater sensitivity than traditional screening methods and significantly reduces the need for invasive testing.
NIPT is less accurate in twin pregnancies.
Predicted values are what the test results tell you
diabetic mothers
Pre pregnancy, offered diabetic eye screening (DES) annually.
0- 12 weeks pregnant, Type 1 & Type 2 diabetics offered DES
16 - 20 weeks follow up DES if evidence of diabetic retinopathy at the first screen
28 weeks T1 & T2 diabetic woman is offered a further eye test to screen for diabetic retinopathy.
Diabetic eye screening is not offered to women who develop Gestational Diabetes
gestational diabetes screening
Diabetes that first presents in pregnancy and resolves after delivery
Long term effects on mothers & fetus
NICE criteria
Oral Glucose tolerance test vs Blood glucose monitoring
NICE criteria for risk factors
antenatal appointments
vitamin D in pregnancy
maternal vit d status in late pregnancy and during lactation influence the newborn infants vit d status and subsequent bone development.
low maternal vit d
Low birthweight
Hypocalcaemia in the new born (seizure)
Decreased knee to heel length
Reduced spine bone mineral content in children age 9
Autoimmune conditions, infectious disease, allergy and asthma
Some studies suggest an increase risk of PET
common STI in pregnancy
Chlamydia is one of the most common STI and for pregnant women can lead to complications for both the mother and the baby, including low birthweight &PTL. Currently NICE does not recommend screening as part of routine antenatal care.
opportunistic chlamydia screening
Offensive discharge
PV bleeding
At risk population
saving babies lives campaign
The Saving babies lives campaign is a care bundle that aims to reduce the number of still births, one component of the care bundle is risk assessment and surveillance for fetal growth restriction, there is strong evidence to suggest FGR is the biggest RF for SB.
risk factors in pregnancy
Smoking [CO >4PPM
Obesity >35
Previous SGA
Previous IUD
Medical Co Morbidity (Diabetes, epilepsy, IBD, heart disease / auto immune)
Substance misuse Alcohol
Age over 40
Hypertension
IVF
Low PAPPa
Fibroids
Unexplained APH
