Antenatal Care Screening

Question 1

What is antenatal care?

Answer 1

-Provides pregnancy, labour & postnatal (after birth) care
-Provided by skilled health-care professionals to pregnant women & adolescent girls
-Ensures best health conditions for both mother & baby

Question 2

Components of antenatal care?

Answer 2

-Risk identification
-Prevention & management of pregnancy-related or concurrent diseases
-Health education
-Health promotion

Question 3

Aims of antenatal care?

Answer 3

Prevent, identify & manage conditions that cause maternal & neonatal morbidity - & which may result in/contribute to:
-Maternal mortality
-Stillbirth
-Neonatal death

Question 4

Organisation of antenatal care - who gets involved & in what order?

Answer 4

Question 5

When might additional care be required for expectant mothers?
-Maternal characteristics
-Past medical history
-Obstetric issues

Answer 5

Question 6

What are the WHO screening principles?

Answer 6

-Respond to recognised need
-Objectives defined
-Target population
-Integrate education, testing, services & management
-Quality assurance
-Ensure informed choice, confidentiality, autonomy
-Promote equity & ensure access
-Benefits outweigh harm

Question 7

Screening VS diagnostic testing?

Answer 7

-Screening = ALL (e.g.,) pregnant women offered – will highlight any increased chances of certain conditions in babies of some women – who will then be offered further diagnostic tests​
–> so screening = sieve

-Diagnostic = used to provide more information following screening – i.e., so can either confirm a diagnosis or not
–> involves interpreting history, clinical obs, lab test results or imaging studies -> all are “tests” to refine estimate of probability patient has a condition.

Question 8

Give the order of tests done prior to, in pregnancy & after pregnancy.

Answer 8

1. Pre-conception screening
2. Screening tests = antenatal
3. Diagnostic tests = antenatal
4. Newborn screening

Question 9

What is preconception screening used to do & when is it used?

Answer 9

For prospective parents to understand carrier status before are pregnant​ (use of Family Origin Questionnaire)
-Used ideally 12 weeks before plan to become pregnant

Question 10

Examples of diseases preconception screening can look for?

Answer 10

-Sickle cell
-Thalassaemia

Question 11

What are some antenatal tests - split them into screening & diagnostic?

Answer 11

Screening:
-Booking appointment
-Combined test - ‘12 week scan/dating scan’
= involves nuchal translucency
-Quadruple test
-FASP (foetal anomaly screening scan) - ‘20 week scan’
-Blood test -> screening for sickle cell & thalassaemia in parents - see if are carriers
-NIPT (non-invasive prenatal screening test)
-IDPS (infectious diseases in pregnancy screening)

Diagnostic:
-CVS (chorionic villus sampling)
-Amniocentesis

Question 12

Summarise sickle cell & thalassaemia testing.

Answer 12

Question 13

Summarise combined, quadruple & FASP.

Answer 13

Question 14

Summarise nuchal translucency (part of combined test).

Answer 14

Question 15

Summarise NIPT.

Answer 15

Question 16

Summarise CVS & amniocentesis.

Answer 16

Question 17

What are some newborn tests?

Answer 17

-Newborn & infant physical examination (NIPE)
-Newborn blood spot screening (NBS)
-Newborn hearing screening (NHSP)

Question 18

Limitations of screening?

Answer 18

Question 19

When is the booking appointment?

Answer 19

8-12 weeks

Question 20

When is the dating scan?

Answer 20

8-14 weeks

Question 21

What is done at the booking appointment?

Answer 21

-Blood group & antibodies (Rh status!)
-Infectious disease status = 0-12 weeks or @ any point in pregnancy if woman or partner deem they are at risk of infection

Question 22

What may be discussed during history taking in booking appointment?

Answer 22

Taking a history
Ask the woman about:
* her general health and well-being
* 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 books late in pregnancy - ask reasons for late booking -=may reveal social, psychological or medical issues - need to be addressed!)

Question 23

What happens in the case of a diabetic mother?

Answer 23

Question 24

What is gestational diabetes?

Answer 24

Diabetes that first presents in pregnancy & resolves after delivery

Question 25

What is the NICE criteria for gestational diabetes screening?

Answer 25

Question 26

What is assessed during all antenatal appointments?

Answer 26

Question 27

Summarise tests - before, during & after pregnancy.

Answer 27