Antenatal examination

Question 1

what is involved in the abdominal palpation?

Answer 1

Assess symphyseal fundal height
estimate size of baby
estimate liquor volume

Question 2

what is the medical term for excess amniotic fluid?
How would you detect this on examination?
What complication can arise from this?

Answer 2

polyhydramnios
tummy will feel hard on palpation
umbilical cord prolapse through the vagina

Question 3

what is linea nigra?

Answer 3

hyperpigmentation line in the midline of the abdomen which usually lies between the umbillicus to the pubic symphysis
often referred to as pregnancy line

Question 4

what is meant by engagement?

Answer 4

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)

Question 5

when can the due date be reliably established?

Answer 5

1st trimester USS

Question 6

what is the first sign of pregnancy on ultrasound?

Answer 6

thickening of the lining of the uterus

Question 7

when can a foetal heart be seen on a transvaginal USS?

Answer 7

6 weeks gestation

Question 8

how is foetal gestation age calculated in the first trimester?

Answer 8

crown rump length

Question 9

when should the first USS be given?

Answer 9

between 11-12 weeks gestation

Question 10

what are the 3 main reasons of a first trimester pregnancy?

Answer 10

confirm viable pregnancy
detect any obvious abnormalities
detect multiple pregnancies
date of delivery

Question 11

what is one of the main and first structure abnormalities you can view from a USS?

Answer 11

anencephaly

Question 12

why might a third trimester scan be requested?

Answer 12

orientation i.e. if they are breech
any foetal concern i.e. size
placenta praaevia
placenta erecta

Question 13

what foetal parameters are used to monitor growth of the foetus?

Answer 13

head circumference
femur length
abdominal circumference

Question 14

why is it important to monitor the growth of the foetus using the 3 parameters?

Answer 14

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

Question 15

at what gestation is second trimester serum screening offered? and what is this serum screening called?

Answer 15

20-24 weeks

Quad test

Question 16

high levels of AFP indicate what type of abnormalities?

Answer 16

neural tube defects i.e. spina bifida

Question 17

low levels of AFP indicate what abnormality?

Answer 17

down syndrome

Question 18

how frequently in the 3rd trimester would you scan a mother to monitor foetal growth?

Answer 18

low risk - wouldn’t scan

high risk - every 4 weeks

Question 19

a rise in what hormone indicates down syndrome?

Answer 19

PAPP-A

Question 20

when are mothers scanned in normal pregnancies?

Answer 20

12 weeks and 20 weeks

Question 21

what are pregnant women routinely screened for?

Answer 21

hep B
syphillis 
HIV 
MSSU (UTI)
iron deficiency anaemia 
isoimmunisation i.e. Rhesus disease

Question 22

what is rhesus disease and what impact can it have not he baby?

Answer 22

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

Question 23

what is the risk of the baby being down syndrome if the mother is 45yrs old?

Answer 23

1 in 30 risk

Question 24

if a patient is termed as high risk for down syndrome, what is their risk of the foetus having down syndrome?

Answer 24

1 in 150

Question 25

what is measured on USS which can detect risk of down syndrome?

Answer 25

nuchal translucency

Question 26

what are the accurate methods of investigating abnormalities of the foetus? and what is their risk of miscarriage?

Answer 26

chorionic villus sampling (risk of miscarriage 2%)

amniocentesis (risk 1%)

Question 27

at what weeks can you perform a CVS and amniocentesis?

Answer 27

CVS - 10-14 weeks

Amniocentesis - 15 weeks

Question 28

what prophylaxis can reduce risk of neural tube defect?

Answer 28

5mg folic acid

Question 29

when can non-invasive prenatal testing be carried out?

Answer 29

week 10

Question 30

what is the first trimester combined test used to investigate?
what does it involve?

Answer 30

down syndrome
nuchal translucency,
crown-rump length
nasal bone