Antenatal Checks

Question 1

What happens in first meeting? when does it occur?

Answer 1

• weeks 8-10
• used to calculate EDD
• arrange dating scan
• gain consent for antenatal screening
• health promotion (folic acid, vit D, flu vac, smoking cessation)
• risk assessment
• obs (BP, FBC, STI’s etc)

Question 2

what is measured in the dating scan that can calculate Downs syndrome risk?

Answer 2

• nuchal translucency
• B- HCG, raised in abnormalities
• PAPP A levels

Question 3

What is done in the examination in antenatal visits?

Answer 3

• BP and urinalysis (UTI)
• fundal height
• lie and presentation
• engagement of the presenting part
• foetal heart auscultation

Question 4

What is checked at 20 week scan?

Answer 4

• anomaly scan
• low lying placenta
• development of foetus

Question 5

what is checked at 25 weeks?

Answer 5

• serial growth measurements begin

- screening for IUGR

Question 6

What is done at 41 weeks if baby not born?

Answer 6

• membrane sweep to try and induce labour

Question 7

what happens in rhesus sensitisation?

what events may this occur in?

Answer 7

• small amounts of foetal blood enter maternal circulation
• sensitising events:
  delivery, placental abruption and amniocentesis

Question 8

What happens if the mother develops immunity?

Answer 8

• second exposure causes mass antibody escalation
• cross placenta and bind to foetal blood cells causing anaemia. jaundice
• worsens with successive pregnancies

Question 9

What is done in prophylaxis for rhesus?

Answer 9

• anti-D given even if mother and father rhesus negative at birth at 28 and 34 weeks
• also given at any sensitising event

Question 10

When is the Downs and Turners test performed?

what determines high or low risk?

what happens to those in high risk?

Answer 10

• at the booking scan (b-HCG and PAPPA)
• > 1 in 150 is low risk, less is high risk
• offered chorionic villus sampling from 11 weeks or amniocentesis from 15 weeks

risk of miscarriage

Question 11

what other viral tests are done?

Answer 11

• HIV screening: occurs at booking bloods, must consent
• Hep B screening: high risk if mother antigen + and antibody negative mother, baby given immunoglobulin at birth
• syphilis
• rubella
• haemoglobinopathy

Question 12

what test can be done in late Downs syndrome? when?

Answer 12

• AFP
• B-HCG
• uE3
• inhibit A
• quadruple test
• 14-20 weeks

Question 13

what are the risks in smoking in pregnancy?

Answer 13

• increased IUGR
• miscarriage
• stillbirth
• Sudden infant death

Question 14

what are the minor side effects of pregnancy? PART 1

Answer 14

• Itching: > blood flow to skin, check for cholestasis/ jaundice
• Abdo pain: usually benign and unexplained
• reflux: common in 70% of women, pre-eclampsia can present with epigastric pain
• backache
• constipation

Question 15

Minor side effects of pregnancy?

PART 2

Answer 15

• ankle oedema: poor predictor of pre-eclampsia, sudden increase requires BP and urinalysis
• leg cramps affects 30%
• carpal tunnel syndrome
• vaginitis: candidiasis common, itchy, non-offensive white-grey discharge associated with excoriation
• N+V: Only 1/10 experience nausea after week 20.

Question 16

How should hyperemesis gravidarum be treated?

Answer 16

• exclude predisposing factors (UTI/ molar pregnancy)

- IV rehydration, anti-emetics and thiamine

Question 17

what is done at the booking scan?

Answer 17

- first booking has great importance: 
> FBC 
> Blood grouping 
> haemoglobinopathies 
> Group and save 
> Infection status ( HIV, syphilis and Hep B)