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Reproduction and Sexual Health > antenatal screening > Flashcards

antenatal screening Flashcards

1
Q

what blood tests are taken during the booking visit?

A
  • Hb
  • ABO: rhesus status and antibodies
  • syphilis: HIV, Hep B+C
  • urinalysis
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2
Q

US confirms what during booking visit?

A
  • viability of px
  • singleton/multiple pregnancy chorionicity
  • estimate gestational age
  • detect major structural anomalies - identified in early pregnancy
  • offer trisomy screening
  • possible ectopic
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3
Q

when is booking visit?

A

8-12 weeks

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4
Q

after how many weeks would you be concerned about lack of fetal movement?

A
  • after 24 weeks
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5
Q

at how many weeks is an US given for fetal anomalies?

A
  • 18-20+6 weeks
  • at this point reproductive choice is given and offer targeted pregnancy investigation?
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6
Q

what is the name of the screening programme?

A
  • NHS fetal anomaly screening programme (FASP)
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7
Q

what does the FASP screening programme guidelines state around when pregnant women should be offered a scan?

A
  • should be offered the 18+0 to 20+6 weeks fetal anomaly scan by midwife or clinician at first contact/booking visir
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8
Q

what is placental praevia?

A
  • when placenta is low lying in the uterus and covers all or part of cervix
  • identified during anomaly scan
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9
Q

when is placenta rechecked by US in women w placenta praevia?

A
  • 32 weeks
  • sometimes transvaginal scan is also required for placental site
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10
Q

what point can you be screening for trisomy 21, T18 (edwards), T13 (pataus)

A
  • first trimester
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11
Q

first trimester what investigations are carried out when doing a trisomy risk assessment

A
  • measure skin thickness behind fetal neck using US - measured 11-13+6 weeks
  • <3.5mm considered normal when CRL is 45-84mm
  • also combined w HCG and PAPP-A
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12
Q

what should risk of Down’s syndrome be estimated from?

A
  • FbhCG MoM
  • PAPP-A
  • NT MoM
  • maternal age
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13
Q

if you miss first semester screening, second trimester screening can only screen for what trisomy anomaly?

A
  • trisomy 21
  • 15-20+6 weeks
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14
Q

name 2 diagnostic tests?

A
  • amniocentesis
  • chorionic villus sampling
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15
Q

amniocentesis performed at how many weeks?

A
  • after 15 weeks
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16
Q

CVS is carried out at how many weeks?

A
  • after 12 weeks
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17
Q

what diagnostic test carries more risk of miscarriage?

A
  • CVS
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18
Q

when is maternal aenamia screened for?

A
  • booking
  • 28 weeks
  • also looks at antibody status -> Rh haemolytic disease (rhesus D status)
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19
Q

why is maternal anaemia screened for?

A
  • optimise Hb prior to birth
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20
Q

how can you identify Rh disease in fetus

A
  • middle cerebral artery of fetus
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21
Q

why is blood group and red cell antibodies importnant to screne for?

A
  • if transfusion is needed
  • some red cell antibodies can cause fetal anaemia - treatable and identifiable condition
  • anti D injections can be given to prevent D antigens forming in Rh negative women
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22
Q

when is anti D injections given?

A
  • routinely at 28 weeks
  • after any sensitizing event - TOP, APH, invasive procedure, fall, RTA
  • after birth if baby Rh +ve (cord blood tested)
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23
Q

when is routine screening for gestational diabetes offered to mum?

A
  • BMI >30kg/m2
  • previous macrosomic baby 4.5kg or above
  • previous gestational diabetes
  • FH of diabetes - 1st degree relative w diabetes
  • minority ethnic family origin w high prevalence of DM
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24
Q

what test is given for gestational diabetes in women w risk factors?

A
  • 2hr 75g oral glucose tolerance test (OGTT)
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25
Q

what fasting plasma glucose level diagnoses gestational diabetes?

A
  • 5.6mmol/litre or above
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26
Q

what 2 hour plasma glucose level diagnoses maternal gestational diabetes?

A
  • 7.8mmol/litre or above
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27
Q

after 24 weeks of pregnancy what type of serial measurement can be carried out to predict a SGA (small for gestational age) neonate?

A
  • symphysis fundal height (SFH)
  • should be plotted on a customised chart rather than a pop-based chart
28
Q

what centile score for a single SFH would indicate referral for US or fetal size?

A
  • 10th centile or below
29
Q

what are high risk factors for pre-eclampsia?

A
  • hypertensive disease during a previous pregnancy
  • chronic kidney disease
  • autoimmune disease e.g. systemic lupus erythematosis or antiphospholipid syndrome
  • type 1 or type 2 DM
  • chronic hypertension
30
Q

what is the advise given to those at high risk of pre-eclampsia?

A
  • 150mg of aspirin daily from 12 weeks until 36 weeks
31
Q

what are factors indicating moderate risk for pre eclampsia?

A
  • first pregnancy
  • 40 or older
  • pregnancy interval of more than 10 years
  • BMI of 35kg/m2 or more at first visit
  • FH of pre-eclampsia
  • multiple pregnancy
32
Q

what does a urinalysis look to identify for as a maternal screening test?

A
  • UTI
  • asymptomatic bacteriuria
  • PET (pre eclampsia toxicaemia)
  • diabetes
33
Q

what kind of procedure may be required for women who have been found to have FGM and are pregnant?

A
  • deinfibulation during pregnancy or labour to enable SVD (spontaneous vaginal delivery)
34
Q

name some conditions that are screened for at the booking clinic?

A
  • haemoglobinopathies
  • hep B+C
  • HIV
  • syphilis
  • red cell antibodies
  • anaemia
  • no of fetuses
  • viability
  • PMH
  • obs hx
  • allergies
  • SH, FH
  • PMH
  • FGM
  • BMI
  • trisomy screening offered
35
Q

what are some conditions screened for at 20 weeks? (anomaly scan)

A
  • cleft
  • heart
  • NTD
  • limb defects
  • placental site
  • diaphragmatic hernia
  • abdominal wall defects
  • lung abnormalities
  • urinary tract abnormalities
36
Q

what conditions are screened for at 28 weeks?

A
  • red cell antibodies
  • anaemia
37
Q

what is rhesus?

A
  • refers to rhesus antigens on the surface of red blood cells
  • antigens on red blood cells vary between individuals
  • rhesus antigens are separate to ABO blood group system
38
Q

the most relevant antigen within the rhesus blood group system is the ?

A
  • rhesus-D antigen
39
Q

what rhesus D antigen is particularly important to consider in pregnant women?

A
  • rhesus-D negative
  • possibility that her child will be rhesus positive
  • this can cause problems to future pregnancies
40
Q

what happens to a rhesus negative mother if her baby is rhesus positive?

A
  • some point in pregnancy (i.e. childbirth) the blood from the baby can find a way into the mothers bloodstream
  • mothers immune system will then recognise this rhesus-D antigen as foreign, and produce antibodies to the rhesus-D antigen
  • mother has then become sensitised to these rhesus-D antigens
  • thus in the next pregnancy, the mothers anti-rhesus- D antibodies can cross the placenta into the fetus, and attach themselves to the RBC’s of the fetus and cause immune system of fetus to attack them causing destruction of RBC’s (haemolysis)
  • RBC destruction caused by antibodies from the mother is called haemolytic disease of the newborn
41
Q

what is the management for rhesus-D negative women?

A
  • prevention of sensitisation is the mainstay of managment
  • giving IM anti-D injections to rhesus-D negative women
  • prophylaxis! as there is no way to reverse the sensitisation process once is has occured
42
Q

how does the anti-D medication work?

A
  • works by attaching itself to the rhesus-D antigens on the fetal red blood cells in the mothers circulation, causing them to be destroyed
  • prevents mother’s immune system recognising the antigen and creating its own antibodies to the antigen
  • it acts as a prevention for the mother becoming sensitised to the rhesus-D antigen
43
Q

what point are anti-D injections given?

A
  • 28 weeks gestation
  • birth (if baby’s blood group is found to be rhesus positive)
  • also at any time where sensitisation may occur e.g. -> antepartum haemorrhage
    > amniocentesis procedure
    > abdominal trauma
44
Q

what is time frame for anti-D to be given after a sensitisation event?

A
  • within 72 hours
45
Q

what is the kleinhauer test?

A
  • test performed after 20 weeks gestation (after a sensitising event), to see how much fetal blood has passed into the mothers blood, to determine whether further doses of anti-D are required
  • involves adding acid to a sample of the mother’s blood - fetal haemoboglobin persists in respose to added acid, however mothers is destroyed allowing for a calculation of remaining fetal cells
46
Q

what 2 points are women screended for for anaemia?

A
  • booking clinic
  • 28 weeks gestation
47
Q

during pregnancy, plasma volume increases resulting in a reduction in the haemoglobin concentration? true or false?

A
  • true
  • the blood is diluted due to the higher plasma volume
48
Q

why is it important to optimise the treatment of anaemia during pregnancy?

A
  • so the women has reasonable reserves in case there is significant blood loss during the delivery
49
Q

what is the presentation of anaemia in pregnancy?

A

often asymptomatic however women may have:
- SOB
- fatigue
- dizziness
- pallor

50
Q

what is the normal range for haemoglobin during booking bloods?

A

> 100 g/l

51
Q

what is the normal range for haemoglobin around 28 weeks gestation?

A

> 105g/l

52
Q

what is the normal range for haemoglobin post partum?

A

> 100g/l

53
Q

what is mean cell volume (MCV)?

A
  • measurement that can indicate the cause of the anaemia
54
Q

what can a low MCV suggest?

A
  • iron deficiency
55
Q

what can a normal MCV suggest?

A
  • a physiological anaemia due to the increased plasma volume of pregnancy
56
Q

what can a raised MCV indicate?

A
  • B12 or folate deficiency
57
Q

what appointment are women offered haemoglobinopathy screeing for thalassaemia (all women) and sickle cell disease (women at higher risk)?

A
  • booking clinic
  • both of these diseases are causes of significant anaemia in pregnancy
58
Q

what are some other non-routine investigations that can help establish causes of anaemia?

A
  • ferritin
  • B12
  • folate
59
Q

what is the mx of anaemia in pregnancy?

A
  • iron replacement - e.g. ferrous sulphate 200mg 3x daily
  • when women are not anaemic but have a LOW ferritin, they may be started on supplementary iron
60
Q

what two factors can result in a low B12 in pregnancy?

A
  • increased plasma volume
  • low B12 in pregnancy
61
Q

women with a low B12 should be tested for what kind of anaemia?

A
  • pernicious anaemia
  • done by checking for intrinsic factor antibodies
62
Q

treatment options for low B12 include?

A
  • IM hydroxocobalamin injections
  • oral cyanocobalamin tablets
63
Q

women who are pregnant should take folic acid daily? true or false?

A
  • true
  • should be taking 400mcg per day
    -> women with folate deficiency are started on folic acid 5mg daily
64
Q

women w thalassaemia and sickle cell anaemia are managed by a specialist haematologist and offered high dose folic acid at what dosage?

A
  • 5mg folic acid
65
Q

MMR vaccines can be administered to pregnant women as a one off dose if they have not had their vaccine yet. True or False?

A
  • false
  • MMR vaccine should not be given to women who are known to be pregnant, attempting to get pregnant and to avoid becoming pregnant for 28 days after MMR vaccine
    -> risk of congenital rubella syndrome
66
Q

what is features of congenital rubella syndrome?

A
  • SNHL
  • congenital cataracts
  • congenital HD - patent ductus arteriosus
  • growth retardation
  • hepatosplenomegaly
  • purpuric skin lesions
  • cerebral palsy
67
Q

Ix into congenital rubella syndrome

A
  • suspected cases discussed w health protection unit
  • IgM antibodies raised in women exposed to virus recently
  • pravovirus B19 and rubella difficult to distinguish clinically so check both serology

Reproduction and Sexual Health (29 decks)

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