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Repro > Antenatal Screening > Flashcards

Antenatal Screening Flashcards

1
Q

What is difference between diagnostic and screening test?

A

Screening - no symptoms, evaluate individual’s risk of developing a disease whereas diagnostic - symptoms often, identifies presence of specific disease

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2
Q

How do we assess the robustness of a screening test?

A

Sensitivity and specificity

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3
Q

What blood tests are carried out at booking visit? (6)

A 
Hb, 
ABO; Rhesus status and antibodies, 
syphillis; 
HIV; 
Hep B + C, 
urinalysis
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4
Q

What is the purpose of the ultrasound performed at booking scan? (5)

A 
Confirm viability, 
singleton/multiple pregnancy chorionicity, 
estimate gestational age & EDD, 
detect major structural abnormalities, 
offer trisomy screening
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5
Q

What is Naegele’s Rule?

A

Predicts an estimated due date based on the onset of woman’s last menstrual period. Add on nine months and seven days (280 days)

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6
Q

What are 3 possible reasons for an empty gestational sac in uterus in ultrasound?

A

anembyronic thus non-viable,
OR very early so no foetal pole visible yet,
OR pseudosac which is caused by hormone reaction in ectopic pregnancy

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7
Q

What history (3) and examinations (6) are done at antenatal midwife appointment?

A 
History: Physical & mental health, fetal movements. 
Examinations: 
BP, 
urinalysis, 
symphsis-fundal hieght, 
lie and presentation, 
engagement of presenting part, 
fetal heart auscultation
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8
Q

List 11 conditions screened for in the 20 week scan.

A 
Edward's syndrome, 
Patau's syndrome, 
anencephaly, 
spina bifida, 
cleft lip, 
congenital diaphragmatic hernia, 
gastroschisis, 
exomphalos, 
congenital heart disease, 
bilateral renal agenesis, 
 lethal skeletal dysplasia
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9
Q

The combined test screens for what conditions and between what weeks is it carried out?

A

Screens for Down’s, Edward’s and Patau’s syndrome and is carried out between 10-14 weeks

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10
Q

What is the combined test?

A

Combined blood test (HCG and PAPP-A),

USS to check nuchal translucency/nuchal thickness

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11
Q

The quadruple test screens for what condition and what weeks of pregnancy is it carried out?

A

Screens for just Down’s syndrome and is carried out between 14-20+6 weeks

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12
Q

What is the quadruple test?

A 
Maternal age, gestation and levels of 
bHCG, 
unconjugated estriol (UE3), 
alpha-fetoprotein,
inhibin A
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13
Q

Which is more accurate - combined or quadruple test?

A

Combined more accurate for screening for Down’s syndrome

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14
Q

Major structural abnormalities occur in what percentage of pregnancies?

A

2-3%

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15
Q

What is placenta praevia and at what scan is it identified?

A

Low-lying placenta that covers all or part of the cervix, identified at the anomaly scan (AKA 20 week scan)

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16
Q

When are normal pregnancy USS scans?

A

10-14 weeks (12 week) and 18-21 weeks (20 week)

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17
Q

What is the management plan if the placenta is seen to be lying low on anomaly scan?

A

Placental site is rechecked at 32 weeks by USS, sometimes transvaginal

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18
Q

What are 2 conditions that can cause increased nuchal thickness?

A

Chromosomal abnormalities and fetal heart abnormalities

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19
Q

What are the approximate sensitivity and false positive rates for combined test?

A

95% sensitivity and 5% false positive

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20
Q

A value of < what is considered normal NT?

A

<3.5mm

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21
Q

What is CRL and what is it used to measure?

A

Crown Rump length - the length of the foetus from top of the head to bottom of torso. It’s used in early pregnancy to measure gestation

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22
Q

The CRL must be between what mm for first trimester trisomy risk assessment NT test to be carried out?

A

Between 45 and 84mm

23
Q

What is offered as a secondary screening test if high chance result for any trisomy test?

A

Non-invasive prenatal testing: analysis of circulating fetal DNA fragments in maternal blood

24
Q

Trisomy assessment >1:150 is high risk. What should be carried out next?

A

NIPT or CVS/amniocentesis

25
Q

NIPT (AKA cell free fetal DNA (cffDNA)) is accurate from around how many weeks pregnancy?

A

around 10 weeks

26
Q

cffDNA is less accurate than the combined test for identifying risk of Down’s syndrome. True/false?

A

False - more accurate

27
Q

What is the approximate sensitivity and false positive rate of NIPT?
What can cause the false positive rate?

A

Sensitivity rate: >99% and false positive rate: <0.1%. False positive rate could be caused by placenta having trisomy but not foetus

28
Q

Chorionic villus sampling carries a miscarriage rate of 2%. After how many weeks is it usually performed?

A

after 12 weeks

29
Q

Aminocentesis carries a miscarriage rate of 1%. After how many weeks is it usually performed?

A

after 15 weeks

30
Q

What is the difference between sickle cell disease and thalassemias genetically and clinically?

A

Genetically: sickle cell affected have two abnormal haemoglobin genes whereas thalassemia affected has missing genes

31
Q

Thalassaemia can cause symptoms when there are >2 genes. The severity of anaemia in thalassemias depends on the number of genes missing. True/false?

A

True

32
Q

What is the worldwide leading cause of maternal death?

A

Postpartum haemorrhage

33
Q

Maternal aneamia is common and can be caused by what 3 deficiencies? Which is most common?

A

Iron (most common), folate and B12 deficiency

34
Q

When are mothers screened for anaemia?

A

Screened at booking and at 28 weeks

35
Q

When are mothers blood group and red cell antibodies status checked?

A

At booking scan and at 28 weeks

36
Q

When should non-invasive fetal genotyping (of D, C, c, E, e and K antigens) using maternal blood be carried out?

A

Should be done for relevant antigen when maternal red cell antibodies are present

37
Q

How does Rhesus haemolytic disease develop?

A

Rhesus -ve mother has rhesus +ve baby, rhesus +ve blood cells can enter mother at delivery or sensitising event, rhesus antibodies produced by mother, rhesus antibodies then attack next pregnancy’s red blood cells

38
Q

What can cause fetal hydrops?

A

Haemolytic disease of the newborn

39
Q

When is Anti-D given to pregnant women?

A

Given routinely at 28weeks to Rh-ve mothers and after any sensitising event, also given again afer birth if baby Rh+ve

40
Q

List 5 risk factors for gestational diabetes that should be identified at the booking appointment.

A
  1. BMI >30kg.m2
  2. previous macrosomic baby weighing >4.5kg
  3. previous gestational diabetes
  4. FH diabetes (first-degree relative)
  5. minor ethnic family origin with high prevalence of diabetes
41
Q

Who should be offered testing for gestational diabetes? What is the diagnostic test?

A

Women with any one of the 5 risk factors. Test is the 2-hr 75g oral glucose tolerance test. +ve gestational diabetes if woman has either a fasting plasma glucose level of 5.6mmol/l or above OR a 2-hour plasma glucose level of 7.8mmol/L or above

42
Q

What is recommended at each antenatal appointment from 24 weeks pregnancy?

A

Symphysis fundal height measuring to improve prediction of SGA neonate

43
Q

Who should be referred for USS measurement of fetal size? (2) Which needs serial SFH measurements?

A

Women with a single SFH which plots below 10th centile or serial measurements which show slow growth AND
women who won’t be able to accurately measure SFH e.g. BMI>35, fibroids, hydramnios - these need serial SFH measurements

44
Q

List 5 examples of women at high risk of pre-eclampsia.

A

Women with hypertensive disease in previous pregnancy, CKD, autoimmune disease (e.g. lupus or antiphospholipid), T1/T2 DM, chronic hypertension

45
Q

Women at high risk of pre-eclampsia should be managed how?

A

Should take 150mg aspirin daily from 12wks to 36 wks

46
Q

List 6 examples of women with moderate risk of pre-eclampsia.

A 
First pregnancy, 
age 40 or above, 
pregnancy interval >10yrs, 
BMI of 35kg/m or more, 
FH pre-eclampsia, 
multiple pregnancy
47
Q

Women with more than one moderate risk of pre-eclampsia are managed how?

A

Should take 150mg daily from 12 weeks until birth

48
Q

What 4 problems does urinalysis screen for?

A

UTI, asymptomatic bacteriuria (associated with risk of miscarriage, sepsis), proteinuria (pre-eclampsia) and diabetes

49
Q

In which scan are the following tests carried out?
Haemogloinopathies, Hep B & C, HIV, Syphillis, red cell antibodies, anaemia, no. foetuses, viability, PMH, PSH, obstetric Hx, DH, allergies, SH, FH, past mental health history, FGM, BMI. Trisomy screening offered

A

Booking

50
Q

In which scan are the following tests carried out?
Cleft, heart, limb, neural tube & abdo wall defects, lung, brain and urinary tract abnormalities, placental site and diaphragmatic hernia

A

20wk anomaly scan

51
Q

In which scans are the following tests carried out?

red cell antibodies and anaemia

A

Booking & 28wk

52
Q

In which scan are the following tests carried out?

BP, urine, macrosomia/IUGR, mental health, abuse and support

A

All ANC

53
Q

CRL is useful as a measurement of gestational age from 6-13weeks. What is used afterwards?

A

Head circumference, biparietal diameter and femur length

54
Q

After what maternal age does risk of Down’s Syndrome steeply increase?

A

from age 40

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