Antenatal examination Flashcards
what is involved in the abdominal palpation?
Assess symphyseal fundal height
estimate size of baby
estimate liquor volume
what is the medical term for excess amniotic fluid?
How would you detect this on examination?
What complication can arise from this?
polyhydramnios
tummy will feel hard on palpation
umbilical cord prolapse through the vagina
what is linea nigra?
hyperpigmentation line in the midline of the abdomen which usually lies between the umbillicus to the pubic symphysis
often referred to as pregnancy line
what is meant by engagement?
a measurement of how far down baby is / measure of how far babys head is in the pelvis
(5/5ths = not in pelvis at all)
when can the due date be reliably established?
1st trimester USS
what is the first sign of pregnancy on ultrasound?
thickening of the lining of the uterus
when can a foetal heart be seen on a transvaginal USS?
6 weeks gestation
how is foetal gestation age calculated in the first trimester?
crown rump length
when should the first USS be given?
between 11-12 weeks gestation
what are the 3 main reasons of a first trimester pregnancy?
confirm viable pregnancy
detect any obvious abnormalities
detect multiple pregnancies
date of delivery
what is one of the main and first structure abnormalities you can view from a USS?
anencephaly
why might a third trimester scan be requested?
orientation i.e. if they are breech
any foetal concern i.e. size
placenta praaevia
placenta erecta
what foetal parameters are used to monitor growth of the foetus?
head circumference
femur length
abdominal circumference
why is it important to monitor the growth of the foetus using the 3 parameters?
using the 3 help to correlate the measurement to detect if there are any structure abnormalities
i.e. foetus with down syndrome will typically have a large head compared to femur and abdo
at what gestation is second trimester serum screening offered? and what is this serum screening called?
20-24 weeks
Quad test
high levels of AFP indicate what type of abnormalities?
neural tube defects i.e. spina bifida
low levels of AFP indicate what abnormality?
down syndrome
how frequently in the 3rd trimester would you scan a mother to monitor foetal growth?
low risk - wouldn’t scan
high risk - every 4 weeks
a rise in what hormone indicates down syndrome?
PAPP-A
when are mothers scanned in normal pregnancies?
12 weeks and 20 weeks
what are pregnant women routinely screened for?
hep B syphillis HIV MSSU (UTI) iron deficiency anaemia isoimmunisation i.e. Rhesus disease
what is rhesus disease and what impact can it have not he baby?
in rhesus disease, the mothers produces anti-D antibodies in response to the foetal RBC’s in the maternal circulation.
the antibodies then pass into the placenta and cause destruction of the babies RBC causing foetal anaemia and jaundice
anaemia in a foetus can result in foetal death
what is the risk of the baby being down syndrome if the mother is 45yrs old?
1 in 30 risk
if a patient is termed as high risk for down syndrome, what is their risk of the foetus having down syndrome?
1 in 150
what is measured on USS which can detect risk of down syndrome?
nuchal translucency
what are the accurate methods of investigating abnormalities of the foetus? and what is their risk of miscarriage?
chorionic villus sampling (risk of miscarriage 2%)
amniocentesis (risk 1%)
at what weeks can you perform a CVS and amniocentesis?
CVS - 10-14 weeks
Amniocentesis - 15 weeks
what prophylaxis can reduce risk of neural tube defect?
5mg folic acid
when can non-invasive prenatal testing be carried out?
week 10
what is the first trimester combined test used to investigate?
what does it involve?
down syndrome
nuchal translucency,
crown-rump length
nasal bone