Antenatal Screening Flashcards

1
Q

Cardiac physiology of pregnant women?

A
  • Cardiac output increases by 30-50%

- Blood pressure drops in 2nd trimester (expansion of uteroplacental circulation, fall in systemic vascular resistance)

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2
Q

Urinary physiology of pregnant women?

A
  • Increased urine output (increased renal plasma flow)

- UTI (can be associated with preterm labour, must treat)

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3
Q

Blood physiology of pregnant women?

A
  • Anaemia (plasma volume up, RBC up but not as much)
  • Iron requirements increase by 1g during pregnancy
  • WBC increases slightly
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4
Q

Respiratory physiology of pregnant women?

A
  • Progesterone reduces CO2
  • O2 consumption increases
  • Plasma PO2 unchanged
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5
Q

GI physiology of pregnant women?

A
  • Oesophageal peristalsis reduced
  • Gastric emptying slows, cardiac sphincter relaxes (GORD + heartburn)
  • GI motility reduced (constipation)
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6
Q

What are the general aspects of pre-pregnancy counselling?

A
  • General health - Smoking, alcohol, diet, BMI
  • Folic acid optimisation
  • Up to date cervical smear
  • Optimise maternal health - control existing conditions e.g. diabetes
  • Stop/change unsuitable (e.g. ACEi, sodium valproate)
  • Advise regarding complications
  • Advise against pregnancy if significant risk to maternal health
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7
Q

How to monitor/manage Pre-eclampsia?

A

Aspirin 150mg during pregnancy and regular BP check

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8
Q

How to monitor/manage Gestational diabetes?

A

HbA1c at booking and OGTT at 28 weeks

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9
Q

How to monitor/manage Previous C-section?

A

Consider elective C-section or vaginal birth after C-section (VBAC)

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10
Q

How to monitor/manage DVT or PE?

A

Consider antenatal thromboprophylaxis and 6 weeks postnatal treatment

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11
Q

How to monitor/manage Intrauterine growth restriction?

A

Aspirin 150mg during pregnancy and serial US scan

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12
Q

How to monitor/manage Preterm birth?

A

Consider transvaginal cervical length scan or cervical suture

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13
Q

What infections are screened for in antenatal care?

A

Hep B
UTI
Syphilis
HIV

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14
Q

How to monitor/manage these infections?

A

Hep B - passive and active immunisation for the baby
UTI - take MSSU
Syphilis - Penecillin
HIV - Maternal treatment and careful planning reduces risk of vertical transmission

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15
Q

What blood disorders are screened for in antenatal care?

A

Iron deficiency anaemia
Haemolytic disease of newborn

Rhesus -ve women can attack Rhesus +ve baby. They are offered anti-D at 28 weeks and/or following any sensitising event (e.g. vaginal bleeding, amniocentesis) to reduce the risk of passage of antibodies.

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16
Q

First visit scan purposes?

A

Ideally performed between 11 and 14 weeks gestation

Check for:
• Viable pregnancy 
• Multiple pregnancies
• Abnormalities  incompatible with life
• Offer and carry out Down’s syndrome screening
17
Q

What are the screening tests for chromosomal abnormalities?

A
  • Combined Test
  • Triple Test
  • Quadruple Test
  • Chorionic villus sampling
  • Amniocentesis
  • Non-Invasive Pre-Natal Testing
  • 2nd Trimester USS
18
Q

What is the first line test for Down’s, Edward’s and Patau’s Syndrome?

A

Combined Test - Ultrasound and maternal blood tests.

First line and most accurate, carried out at around 11-14 weeks.

19
Q

What are the abnormal findings on ultrasound?

A

Measures nuchal translucency: the thickness of the back of the neck.

DS is one cause of a nuchal thickness of >6mm.

20
Q

What are the abnormal findings on blood test?

A

Beta-hCG - a higher result indicates a greater risk.

Pregnancy-associated plasma protein-A (PAPPA) – a lower result indicates a greater risk.

21
Q

What is the triple test?

A

Performed between 14 and 20 weeks.

It only involves maternal blood tests.

22
Q

What blood tests does the triple test include?

A
  • Beta-hCG
  • Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
  • Serum oestriol – a lower result indicates a greater risk
23
Q

What is the quadruple test?

A

Performed between 14 and 20 weeks.

Identical to the triple test, but also includes blood testing for inhibin-A.

A higher inhibin-A indicates a greater risk.

24
Q

What is the significance of these tests?

A

When the risk is greater than 1 in 150, the woman is offered:
Chorionic villus sampling
Amniocentesis

25
Q

What is Chorionic villus sampling?

A

Carried out between 10 and 14 weeks

US guided sample of the placental tissue. There is a 1-2% risk of miscarriage.

26
Q

What is Amniocentesis?

A

Carried out after 15 weeks, Later in pregnancy, enough amniotic fluid.

US guided aspiration of amniotic fluid.

27
Q

What is Non-Invasive Pre-Natal Testing (NIPT)?

A

Fancy way to look at maternal blood for foetal DNA. Check that for abnormalities.

28
Q

What is the 2nd Trimester USS for?

A

Structural abnormalities, not so much chromosomal.