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
sickle cell and thalassaemia screening
trisomy screening process
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
NICE criteria for risk factors
antenatal appointments
