Antenatal Screening Flashcards

1
Q

how do you calculate sensitivity?

A

true positive/(all positive + false negative)

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2
Q

how do you calculate specificity?

A

true negative/(all negative + false positive)

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3
Q

when is the booking visit completed?

A

between 8-12 weeks gestation

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4
Q

what four things are done at the booking visit?

A

history
examination
blood tests
urinalysis

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5
Q

what three examinations are done during the booking visit?

A

height
weight
blood pressure

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6
Q

what bloods are done at the booking visit?

A
haemoglobin 
rhesus status 
syphilis 
HIV
Hep B+C
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7
Q

when is the first ultrasound done?

A

8-12 weeks gestation

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8
Q

what does the first ultrasound scan look for?

A

viability
how many
estimate gestational age
structural anomalies

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9
Q

when is the most accurate time to establish the EDD?

A

8-12 weeks

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10
Q

what is EDD?

A

estimated date of delivery

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11
Q

what rule can be used to calculate EDD?

A

naegele’s rule

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12
Q

what is naegele’s rule?

A

add on nine months and seven days/280 days to the date of onset of a woman’s LMP = EDD

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13
Q

when is the foetal anomaly scan done?

A

20 weeks

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14
Q

what should be investigated in a history at the foetal anomaly scan?

A

physical/mental health of mother

foetal movements

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15
Q

what examinations should be done at the foetal anomaly scan?

A
BP
urinalysis 
SFH
lie + presentation 
foetal heart auscultation
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16
Q

what is SFH?

A

symphysis fundal height

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17
Q

what is placenta praevia?

A

when the placenta is low lying in the uterus and covers the cervix

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18
Q

if placenta praevia is seen at 20 weeks, when is another scan done?

A

32 weeks

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19
Q

what trisomy’s can be screened for?

A

21
18
13

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20
Q

what is trisomy 21?

A

downs syndrome

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21
Q

what is trisomy 18?

A

Edwards syndrome

22
Q

what is trisomy 13?

A

patau’s syndrome

23
Q

what secondary screening test is offered if there is a high risk result for a trisomy?

A

NIPT

24
Q

how is trisomy screening performed in the first trimester?

A

measure nuchal thickness (NT)

combine this with HCG and PAPP-A for a full assessment

25
Q

when is trisomy screening done in the first trimester?

A

11-13+6 weeks

26
Q

what is a normal result for NT in the first trimester?

A

<3.5mm if the CRL is 45-85mm

27
Q

what is CRL?

A

crown rump length

28
Q

what trisomy can be screened for in the second trimester?

A

trisomy 21

29
Q

why would second trimester screening for T21 be done?

A

first missed

first unsuccessful

30
Q

when is second trimester screening for T21 done?

A

15-20 weeks

31
Q

what is involved in second trimester screening for T21?

A

blood sample for biochemical markers

look at maternal age

32
Q

what biochemical markers are checked as part of trisomy screening in trimester two?

A

AFP
hCG
unconjugated oestradiol
inhibin A

33
Q

when is further investigation for trisomy 21 done?

A

> 1:150 risk of the condition

34
Q

how can further investigation of trisomy’s be completed?

A

NIPT

CVS/amniocentesis

35
Q

what does NIPT stand for?

A

non invasive prenatal testing

36
Q

what is another name for NIPT?

A

cell free foetal DNA testing (cffDNA)

37
Q

what does NIPT detect?

A

foetal DNA fragments in the maternal blood

38
Q

when is cffDNA detectable?

A

from around 10 weeks

increases as pregnancy continues

39
Q

what is done if NIPT is positive for trisomy?

A

diagnostic testing

NIPT IS JUST ANOTHER SCREENING TEST

40
Q

what are the two diagnostic tests for trisomy’s?

A

amniocentesis

chorionic villus sampling (CVS)

41
Q

what risk is associated with amniocentesis and CVS?

A

miscarriage

42
Q

when is amniocentesis performed?

A

after 15 weeks

43
Q

when is CVS performed?

A

after 12 weeks

44
Q

when is maternal anaemia screened for?

A

booking

28 weeks

45
Q

name five risk factors for gestational diabetes

A
BMI >30
previous macrosomia - >4.5kg 
previous gestational diabetes 
family history of diabetes 
minority ethnic origin with high prevalence of diabetes
46
Q

when should SFH be measured and why?

A

all antenatal appointments from 24 weeks

improves prediction of an SGA neonate

47
Q

who should be referred for ultrasound measurement of foetal height?

A

one SFH < 10th gentile

serial measurements showing slow/static growthh

48
Q

when can measuring SFH be difficult and what is done for these patients?

A

BMI>30, large fibroids, hydramnios etc.

ultrasound assessment of foetal size

49
Q

what should women at high risk for pre-eclampsia take?

A

150mg aspirin daily from 12-36 weeks

50
Q

what makes you high risk for pre-eclampsia?

A
hypertensive disease during a previous pregnancy 
CKD
autoimmune disease
diabetes 
chronic hypertension
51
Q

what should women at moderate risk for pre-eclampsia take?

A

more than one moderate risk factor = 150mg aspirin daily from 12 weeks til birth

52
Q

what makes you moderate risk for pre-eclampsia?

A
first pregnancy 
>40 
pregnancy interval >10 years
BMI >35 
family history of pre-eclampsia
multiple pregnancy