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Unit 7 > Antenatal Care Screening > Flashcards

Antenatal Care Screening Flashcards

1
Q

What is the definition of antenatal care?

A

Care provided by health care professionals to preganant women to ensure the best health outcomes for the mother and the foetus during pregnancy.
Aims to prevent maternal mortality, still birth and neonatal death.

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2
Q

What is included in antenatal care?

A

Risk identification
Prevention and managementnof pregnancy related or concurrent diseases
Health education
Health promotion

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3
Q

What influences the decisions in antenatal care?

A

Research-based evidence
Practitioner availability
Family experience and insight

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4
Q

What are some statistics regarding the amount of women who die during childbirth?

A

10.9 per 100,000 died whilst giving birth
27 babies dies and 366 motherless children remained.
Most women die in the postnatal period.
Post natal suicide rates are increasing

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5
Q

What are some inequaltiies in natal outcomes?

A

1 in 9 mothers to die had severe and multiple disadvantages
Black women are 3.7 x more likey to die during childbirth and asian women are 1.8x more likley to die during childbirth.

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6
Q

What is the thought behind preconceptual care?

A

Opportunity to assess perspective parents health and provide information to help them make informed decisions.
This can inlcude managing diabetes and anemia before pregnancy.
Often given folic acid.
However, this is often not the case as most pregnancies are unplanned.

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7
Q

What are the seven principles of decisions making and consent?

A
  1. All patients have the right to be involved in decision-making and should be supported to make informed decisions.
  2. Decision making is ongoing, information should be exchanged continously with the patient
  3. All patients should be listened to, provided with appropriate information and time.
  4. Doctors should talour information and options to what the patient regards as the most important
  5. All adults should be presumed to have the capacity to consent until evidence otherwise
  6. It a patient does not have the capacity to consent all decision making should be in their best interest, and in consultation with those who know them best
  7. Patients laking capcity by law, should still be involved and exercise choice where possible.
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8
Q

How broad is the team involved in antenatal care?

A

Interprofessional and multiagency - including private and public decisions

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9
Q

How can you be referred to antenatal care?

A

Self referral
Midwife
GP
Early Pregnancy Assessment
Direct Access to treatment centre (walk in)
Fertility clinic

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10
Q

What is an Early Pregnancy Assessment?

A

Centre that treats women between 6 and 13 weeks pregnant,
Must be experiencing bleeding or pain
Is ran by nurses but aided by gynecologists.
Often recieve a scan by a radiologist to identify the problems.

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11
Q

Where can antenatal care happen?

A

Midwife at patients home
Obstetric unit
Health centre
Childrens Centre
A midwifery unit

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12
Q

What is meant by universal care or additional care?

A

Universal Care is offered to every pregnant woman
Additional care is only offered to select at risk groups, such as diabetics or if it is your first pregnancy

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13
Q

How does your level of required additional care affect the team you work with?

A

Normal level care is often led by midwifery team and focuses on universal care screening and diagnostic testing
Intermediate care is shared
High level care is consultant led care, often in a obsteric unit/ specialist unit, this includes additional monitorting such as glucose levels or renal system function.

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14
Q

What maternal characteristics may require additional antenatal care?

A

BMI > 30
BMI < 18
Smoking or substance misuse
Age >40
Teenage mothers

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15
Q

What previous medical conditions may require a patient to have additional antenatal care?

A

Cardiac disease
Renal disease
Endocrine disease
Diabetes
Haematological disorders
Autoimmune disorders

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16
Q

What obstetric issue may require a patient to have additional antenatal care?

A

Recurrent miscarriage
Preterm birth
Pregnancy induced hypertension Eclampsia
Rhesus Isoimmuniszation
APH/PPH antepartum haemorrhage and postpartum haemorrhage
Still birth/ neonatal death
If child is identified as small or large for gestational discharge.

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17
Q

What are the WHO screening needs?

A

Respons to a recognised need
Objectives defined
Target population
integrate education, testing, services and management
Quality assurance
Ensure informed choice, confidentiality and autonomy
Promote equity and ensure access
Benefits outweight the harm.

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18
Q

What is the deal with screening in antenatal care?

A

To detect potential risk factors and disease indicators.
Looks at a large population of at risk but asymptomatic individuals
Simple and safe tests
Generally accepted as low risk
Results indicate the suspicion but not diagnose theactual presence of a disease
Cheap to access

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19
Q

What is the deal with diagnostic tests in antenatal care?

A

To determine if a disease is or is not present
Often symptomatic individuals who have already been identified as at risk by screening programmes
May be invasive, expensive and more high risk.
More complex decisions to decide to take a diagnostic test
Gives a definite result.

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20
Q

What may be the care outcomes after a screening test?

A

May be recommended diagnostic testing
Information
Further tests
Treatment

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21
Q

What type of tests may be involved in diagnostic testing?

A

History taking
Clincal observations
Laboratory test results
Imaging studies

22
Q

What are the 6 different NHS antenatal and newborn screening programmes?

A

Fetal anomlay screening (FASP)
Infectious disease 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)

23
Q

What are some limitations of screening programmes?

A

Does not give a difinitive results only indicates risk - this can confuse patients
If not highly selective may give false positives and false negatives.
Women expect all tests to have good/normal results, isnt really an informed choice.

24
Q

When should different screening tests occur?

A

0-12 weeks infectious disease screening (HIB, hepatitis B and syphilis. - test can be reoffered ar 20 weeks
preconceptions - 12 weeks - sickle cell anemia and thalassemia
11 weeks and 2 days to 13 weeks and 6 days = T21, T18, T13
11 to 12 weeks - baby blood group (rhesus)
FBC may be done at booking scan and at 28 weeks for mum
A MSU or midstream speciement of urine - is taken regularly from mum, often first as dating scan, indicates, for UTI or preenclampsia and HCG levles

25
Q

What is a booking appointment in antenatal care?

A

Ideally held before week 10.
This is the first appointment with the midwife.
Book later tests and scans
Midwife colects general health infromation and history
Chance to tell midwife of any concerns that may affect yours or your babies safety during pregnancy including domestic abuse or FGM.
Bloos test is completed for infectious diseases and hCG levels.
Start to develop maternity notes
Health education on how to encourage a healthy pregnancy and good labour.

26
Q

What happens in a sickle cell and Thalassemia screening?

A

Happens from preconception to 10 weeks gestation
All women are offered thalassaemia but not all are offered sickle cell anemia but it can be requested
Sickle cell may be offered if you are in a high risk area.
Done by a famliy origin questionnaire (genetic pedigree)
May have a blood test.

27
Q

What is the combined test?

A

A blood test and scan between 11 weeks and 14 weeks
Measures the nuchal translucency (part of anomaly scan)
Results combined with the mother’s age to calculate the risk of DS. ES and PS.
imaging test may also look at the shape of the babys nose, DS are more likely to flat a flat nose bridge, will have a greater presnasal thickness to nasal bone ratio.
Mothers blood test to identify hormones from the placenta and levels of DNA from the placenta relating to chromosome T21 T18 and T13..

28
Q

How does the nuchal transluency test relate to down syndrome?

A

Measures the thickness of the tissue at the back of the unborn babies neck using ultrasound imaging
An increases thickness indicates a risk of downsyndrome
At eleven weeks low risk id below 2mm and 13 weeks and 6 days low risk is below 2.8mm

29
Q

What is the quadruple test in antenatal screening?

A

Is offered if the gestation is over 14 weeks at the first routine scan
Blood test only between 14 and 20 weeks for the risk of Down Syndrome
Screening for Edwards and Pataus takes place later at the anomaly scan
Is less accurate than the combined test.

30
Q

What are the short hand genetric term mutations for Down Syndrome, Edwards Syndrome and Pataus Syndrome?

A

DS is T21
ES is T18
PS is T13

31
Q

What are the different screening tests for trisomy condition options?

A

Down Syndrome Only
Edwards and Pataus Syndrome Only
All three.

32
Q

When is the anomaly ultrasound scan?
What does it do?

A

Is between 18 weeks and 21 weeks of pregnancy
Nuchal translucency measurement
Abnormalities and birth defects
Open spins bifida
Gastrochises
Cleft Clip
Placenta position.
More complex diagnosis may require a sonographer

33
Q

What are some indications that there is an increased risk of an underlying foetal chromosomal disorder?

A

Echogenic bowel (brighter then usual), often transient
Shortened feotal long bones in trimester 3
single Umbilical cord artery
Clenched fists indicate T13 and T18
Rocker bottom feet T13 and T18
Sandal Gap T21
Choroid plexu cysts
Absent Nasal bone
Ventriculomegaly >10mm (brain ventricles)

34
Q

What are some features of T21 on ultrasound?

A

Reduced or no nasal bone
Sandal Gap
Increased Nuchal Transluceny

35
Q

What are some fatures of Edwards and Pataus syndrome on ultrasound?

A

Rocker bottom Feet
Clenched First
Still born (no heart beat).

36
Q

What is a NIPT (Non invasive prenatal screening test)?

A

Often done is a previous combined or quadruple screening test indicates an increased risk
Has very high specificity for T21, T18 and T13.
Analyses mothers smal cell free DNA fragments in the blod from the placenta.

37
Q

What is chorionic villous sampling?

A

A diagnostic test, that removes and samples a small amount of DNA from the placenta either transabdominally or transcervically.
Done ideally between 11 and 14 weeks of preganancy.
Has a 1 in 200 (monozgotic) and 1 in 100 (dizygotic) risk of miscarriage, and a risk of infection
Done if a screening test indicates an increased risk.

38
Q

What is amniocentesis?

A

A diagnositc test done if a screening test indicates an increased risk of a genetic condition.
Occurs between week 15 and week 20.
A thin needles is inserted transabdominally to sample amniotic fluid from the amniotic sac.
Risk of miscarriage and infection (1 in 200 for a monozygotic pregnancy).

39
Q

What additional tests are offered for a diabetic mother?

A

Pre-pregnancy are offered diabetic eye screening annually. (high blood sugar can damage the retina)
0-12 weeks pregnant, type 1 and type 2 diabetic mothers are offered a diabetic eye screening
16-20 weeks are offered a follow up retina scan if retinopathy was seen at the first scan
28 weeks Offered a further eye test for daibetic retinopathy
Diabetic eye screening is not offered to women who develop gestational diabetes.

40
Q

What is gestational diabetes screening?

A

Offered to women who have gestational diabetes, often occurs during the first pregnancy and resolves after delivery.
At 24 to 18 weeks (or earlier if increased risk) will recieve an oral glucose tolerance test, given a glucose drink in the morning after fasting, blood test two hours later to see how glucose was handled
Regular blood glucose monitoring, adivce on exercise and diet

41
Q

What are some of the long term efffects of gestational diabetes on the mother?

A

Increased risk of gestation diabetes in future preganancies
Increased risk of developing type 2 diabetes in the future.
Increased risk of cardiovascular disease, chronic kidney disease and cancer.

42
Q

What are some of the long term effects of gestational diabetes on the foetus?

A

Increased risk of still birth
Increased risk of type two diabetes or obesity in later life.

43
Q

What are the NICE criteria of an increased risk of gestational diabetes?

A

BMI > 30
Previous baby over 4.5kg
Ethnic origin - south asian, black caribbean, middle eastern are at increase risk
Previous gestational diabetes
Glycosuria
First degree relative with diabetes

44
Q

What are the main problems that antenatal care aims to indentify?

A

Foetal congential or genetic abnormalities
Pregnancy induced hypertension and eclampisa
Gestation diabetes
Restricted interuterine growth
Mental health and wellbeing
Prematurity
UTI
APH - antepartum hemmorrhage.

45
Q

What tests are done at almost all antenatal care appointments?

A

Blood pressure
urinalysis
Abdominal palpitation
Odema
Mood/emotional wellbeing.

46
Q

What additional antenatal appointments are offered to women who are pregnancy for the first time?

A

25 weeks appointment - with doctor of the midwife to measure the size of the uterus, measure the blood pressure and urine.
31 weeks appointment - discuss any previous screening results, uterus size and urine.
40 weeks appointment - info about what happens in the pregnancy lasts longer than 41 weeks, uterus size and urine.

47
Q

What should happen at the first appointment with the midwife or doctor?

A

Information about folic acid, nutritional information, lifestyle factors and antenatal screening
Tell the doctor of any risks or complications from any previous pregnancies.
Genetic risk of conditions.

48
Q

What tests and screening should be given to a newborn baby?

A

Newborn physical examination within 72 hours.
Newborn hearing screen - between 0 and 5 weeks
Newborn blood spot scans ideally day 5 for metabolic, blood and infectious disease.
Infant physical examination at 6-8 weeks.

49
Q

What is the infectious disease in pregnancy screening?

A

IDPS
Is a routine screen, a blood test is offered at the dirst antenatal appointment
Blood test form arm for HIV, Syphylis and Hepatitis B.

50
Q

What happens in a newborn and infant physical examination?

A

Ask about baby alterness, feeding and wellbeing
Baby is undressed
Examine the eyes for the pupil reflex using the light
Exam the hip joints.
Listen to the babies heart.
In male examine to see if the testes have extended into the scrotum

51
Q

What happens during a newborn hearing screening?

A

An automated otoacoustic emission
An ear piece plays gentl clicking sounds into the babies ear
Used to identify permanent hearing loss, unclear results are offered another appointment at 8 weeks pregnancy.

Unit 7 (20 decks)

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