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Obs (Owen) > Antenatal screening > Flashcards

Antenatal screening Flashcards

1
Q

When is booking appointment done

A

By 10 weeks
If later presentation then must within 2 weeks

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2
Q

What do in antenatal booking appointment

A

History
- obs history
- PMH
- medications
- social- job, smoking, alcohol, illicit drugs
Examination
- BP and BMI
Investigations
- urine dip for asymptomatic bacteriuria, protein ad glycosuria
- bloods- FBC, rhesus D, blood group, screen for auto-antibodies, haemoglobinopathies, Hep-B, syphyllis and HIV
Assess risk of VTE, GDM and pre-eclampsia
Advice
- antenatal classes
- diet
- vitamin D
- screening for infections, blood disorders, anomaly scans

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3
Q

What is vitamin D advice for pregnant women

A

Should take 10mcg/day

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4
Q

Who should have an OGTT based on identification at booking

A

People with family history of DM
Previous baby over 4.5kg
BMI over 30
Ethnicity with high DM prevalence
Previous GDM (has OGTT straight away)

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5
Q

Management if has any of risk factors for GDM noticed at booking

A

If history of GDM have an OGTT ASAP
If 1 of other rfx then have it at 24-28 weeks

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6
Q

If have had previous GDM and initial OGTT is negative what do

A

Repeat at 24-28 weeks but can also offer self monitoring

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7
Q

When would glycosuria prompt consideration of GDM

A

Glycosuria 2+
Glycosuria 1+ On 2 occasions

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8
Q

Immediate management if diagnosis of GDM made

A

Referral to joint DM and antenatal clinic within 1 week

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9
Q

What is management of GDM

A

Advise about exercise and low glycaemic index foods
If fasting glucose under 7
- lifesyle and exercise first line
- if not met within 2 weeks metformin then second line insulin
- consider treating straightaway with insulin if evidence of macrosomia, polyhydramnios or
If fasting glucose over 7
- use insulin straight away

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10
Q

What type of insulin is used in GDM/ chronic DM

A

Short acting

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11
Q

When consider treating GDM with insulin if fasting glucose under 7

A

Macrosomia
Polyhydramnios

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12
Q

What defines GDM

A

Fasting glucose above 5.6
2 hour glucose is over 7.8
REMEMBER AS COUNTING 5 6 7 8

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13
Q

Management of pre-existing DM

A

Ensure low BMI
Good exercise and diet
Folic acid until end of first trimester
Stop all hypoglycaemics except insulin and metformin
Screen for renal and retinal damage within first 3 months

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14
Q

Targets for self monitoring glucose in GDM

A

Fasting- 5.3
1 hour after eating- 7.8
2 hours after eating- 6.4

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15
Q

Management if history of VTE

A

Antenatal LMWH and until 6 weeks after
If provoked by a major surgery then do from 28 weeks

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16
Q

Assessing VTE risk factors

A

Look at table of rfx
If 2 then LMWH for 10 days post partum
If 3 then LMWH from 28 weeks but make postnatal assessment
If 4 or more then LMWH through whole pregnancy but make postnatal assessment

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17
Q

When do you advise folic acid to all women

A

400mcg up until 13 weeks

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18
Q

What is monitored in antenatal urine dips

A

Asymptomatic bacteriuria
Glycosuria
Protein

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19
Q

Management if develop heartburn during pregnancy

A

Advise about diet changes
If does not work then can trial antacids or alginate

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20
Q

Management of recurrent pelvic girdle pain

A

Refer to physio and consider non-rigid lumbopelvic belt

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21
Q

Management of abnormal vaginal discharge in pregnancy

A

Reassure that it is normal
If symptomatic at all then consider high vaginal swab

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22
Q

Treating vaginal candidiasis in pregnancy

A

Vaginal clotrimazole

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23
Q

Treating bacterial vaginosis in pregnancy

A

Can treat with twice daily metronidazole or intravaginal metronidazole gel
If recurrent change the treatment method

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24
Q

Management if unexplained bleeding post 13 weeks in pregnancy

A

Refer to secondary care
If rhesus negative give anti-D

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25
Q

Ideal preparation for dating scan

A

Come with a full bladder

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26
Q

What happens at dating scan

A

Estimated date of delivery
Check if more than 1 pregnancy
That it is growing in the correct place
Detect any gross anomalies
Nuchal translucency if opted in

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27
Q

If opt in for congenital syndrome screening what are options

A

If book early then offered between 11 and 13+6 weeks the COMBINED test
Between 14+2 and 20+0 offered QUADRUPLE test

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28
Q

What does combined test include

A

B-HcG and PAPP-A from mothers blood
Nuchal translucency

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29
Q

What does quadruple test include

A

B-HcG
Inhibin A
Unconjugated oestriol
AFP

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30
Q

What indicates down syndrome on combined test

A

Thickened nuchal translucency
High bHCG
Low PAPPA-A

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31
Q

What indicates edwards or pataus in combined test

A

Thickened nuchal translucency
Low PAPP-A
Raised bHCG too but no where near as high as in down’s

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32
Q

How does combined and quadruple test categorise people

A

Into either high or low chance
Low- more than 1 in 150 chance
High- less than 1 in 150 chance

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33
Q

What qualifies someone for extra testing after combined or quadruple tests

A

If chance is lower than 1 in 150 then can be offered second screening test the NIPT or invasive diagnostic testing for the syndromes

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34
Q

How does non-invasive prenatal testing work

A

Is a blood test which involves analysing cell free fetal DNA (cffDNA) which is DNA from placental cells which have broken off from placenta which are identical to DNA of foetus

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35
Q

What invasive diagnostic tests are offered for screening of chromosomal disorders

A

Amniocentesis
Chorionic villous sampling

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36
Q

What is screened for in booking visit bloods

A

HIV
Hep B
Syphillis
Red cell autoantibodies
Haemoglobinopathies
Anaemia

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37
Q

What are quadruple test results for downs, edwards, pataus or neural tube defects

A

Downs- HIgh, bHcg, InhIbIn
Edwards- HEs down, low Hcg and Estradiol
Pataus- think P, high AFP
Neural tube defect- high AFP

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38
Q

What is sensitivity and specificity of NIPT

A

99%

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39
Q

What is done at anomaly scan

A

Check location of placenta
Babies growth
Sex of baby if want
Checking for 11 conditions and offering options surrounding
- termination
- management if necessary

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40
Q

How is a babies growth assessed at anomaly scan

A

Crown rump length
Femur length
Abdominal circumfrence
Biparietal diameter

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41
Q

What do at 16 week visit

A

Discuss results of blood tests
- infections
- autoantibodies
- rhesus D
- Hb and folate etc
Treat Hb
Offer vaccinations
- pertussis
- influenza ideally in Oct-jan
Discuss mid-pregnnacy scan

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42
Q

What are the dates of 7 normal antenatal visits if uncomplicated and not nullioarous

A

Booking
16 weeks
28 weeks
34 weeks
36 weeks
38 weeks
41 weeks

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43
Q

What are dates of 10 antenatal visits if uncomplicated and nulliparous

A

Booking
16 weeks
25 weeks
28 weeks
31 weeks
34 weeks
36 weeks
38 weeks
40 weeks
41 weeks

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44
Q

What is done at extra primip meetings

A

25 and 31
- measure SFH
- BP and urine dip
40
- measure SFH
- BP and urine dip
- offer membrane sweep

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45
Q

What is done at 28 week visit

A

BP and urine dip
Measure SFH
Bloods for second screening of
- antibodies
- Hb
- folate and B12
Offer first anti rhesus D

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46
Q

When is anti-D antibodies given

A

28 weeks
34 weeks
Can give just at 28 weeks depends on site

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47
Q

What is done at 34 week visit

A

BP and urine dip
Measure SFH
Discuss birth plan and give information on them

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48
Q

What is done at 36 week visit

A

BP and urine dip
Measure SFH
Check presentation and offer ECV
Discuss neonatal management and breastfeeding

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49
Q

What is done at 38 week visit

A

BP and urine dip
SFH
Information about prolonged pregnancy

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50
Q

What is done at 41 week visit

A

Measure BP and urine dip
Offer induction of labour

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51
Q

When are bloods taken in pregnancy

A

Booking and 28 weeks

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52
Q

How long are pregnnacy VTEs treated for

A

3 months after

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53
Q

Management if VTE provoked by major surgery

A

Antenatal LMWH from 28 weeks and 6 weeks postnatally

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54
Q

What can cause folic acid deficiency

A

Methotrexate
Phenytoin
Pregnancy
Alcohol
IBD

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55
Q

In which women do you advise taking 5mg folic acid while trying to conceive

A

BMI over 30
Either partner has a neural tube defect
History of thalassaemia, coeliac, diabetes
Taking an anti-epileptic drug

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56
Q

What dose of folic acid is given to all pregnant women up until end of first trimester

A

400mcg

57
Q

What is sensitisation with regards to rhesus

A

Process whereby fetal RhD positive RBCs enter maternal circulation when mother is RhD negative which can cause antibodies to form which haemolyse fetal RBCs

58
Q

What is purpose of giving anti-D

A

If fetal RBC have entered maternal circulation then these can destroy all of them before sensitisation occurs

59
Q

What events indicate anti-D administration

A

Delivery of any rhesus-D infant
Any termination of pregnancy
Miscarriage if gestation over 12 weeks
Ectopic pregnancy managed surgically
Evacuation of miscarriage
ECV
Antepartum haemorrhage
Trauma to abdomen
Amniocentesis
Chorionic villous sampling

60
Q

Post natal management of rhesus negative mothers

A

Cord blood taken and coombs test done
Give anti-D

61
Q

What is kleihauer test

A

Determines proportion of fetal RBCs present

62
Q

If possible sensitisation event occurs in second/trimester of rhesus negative pregnancy what do

A

Large dose of anti-D and perform Kleihauer test

63
Q

How is LMWH treatment for DVT monitored in pregnancy

A

Anti-Xa activity

64
Q

Who is treatment with LMWH monitored in

A

Those at extremes of weight (under 50kg or over 90kg)
Renal impairment
Recurrent VTE

65
Q

Symptoms of GDM

A

Polyuria and polydipsia

66
Q

How does OGTT work

A

Fast for 8-10 hours including water
Take fasting blood glucose
Glucose drink then measure glucose 2 hours later

67
Q

Causes of raised AFP in pregnancy

A

Gastro wall defects
Neural defects
Multiple pregnancies
Pataus

68
Q

Causes of low AFP in pregnancy

A

Maternal DM
Edwards
Downs

69
Q

When is a kleihauer test indicated

A

Any sensitising event after 20 weeks

70
Q

If want invasive testing for congenital syndromes what determines options available

A

Chorionic villous sampling between 11 and 13+6
Amniocentesis from 15 weeks onwards

71
Q

What are cutoffs for treating anaemia in pregnancy

A

First trimester- 110
Second anf third- 105
Post partum -100

72
Q

How is anaemia treated in pregnancy

A

Oral iron and recheck in 2 weeks
If no response then refer to combined obs/haematology clinic where will do haematinics

73
Q

What do if cant tolerate iron supplements

A

Refer to secondary care for parenteral iron

74
Q

What is ferritin cutoff for treating IDA in pregnancy

A

Anything less than 30 should be treated

75
Q

If someone is diabetic what test should be done to assess before trying to conceive

A

HbA1c

76
Q

What are risks if diabetic mother

A

Increased miscarriage rate
Risk of cardiac abnormalities
Macrosomia
Increased birth injuries
Perinatal mortality

77
Q

What do with thyroxine dose if hypothyroid and pregnant

A

Increase by 25mcg and repeat TFTs in 2 weeks to ensure euthyroid

78
Q

When monitor TFTs if hypothyroid and pregnant

A

2 weeks after a dose change
Once a trimester

79
Q

What is fetal hydantoin syndrome

A

Constellation of symptoms caused by taking phenytoin or carbamezepine in pregnancy

80
Q

Symptoms of fetal hydantoin syndrome

A

IUGR
Cleft lip
Intellectual disability
Hypoplastic fingernails
Distal limb deformities

81
Q

What defines proteinuria

A

Urinary protein of over 300mg/24 hours

82
Q

What do if hypertensive woman wants to start getting pregnant

A

Stop ARB/ACEi and switch to labetalol

83
Q

If CTG questionable despite changing position and are fully dilated what do

A

Fetal sampling to assess lactate and pH

84
Q

How often should women with existing DM be monitored in pregnancy

A

Every 2 weeks in joint antenatal diabetes

85
Q

What volume constitutes polyhydramnios

A

Over 2L

86
Q

What is best anti-epileptic during pregnancy

A

Lamotrigine or carbamezepine

87
Q

Risks of using NSAIDs in pregnancy

A

PPHN
Oligohydramnios
Premature closure of DA

88
Q

Which is best analgesic in pregnancy

A

Paracetamol

89
Q

How is DVT in pregnancy treated

A

Treatment dose LMWH until at least 6 weeks post natally
Should always be for at least 3 months

90
Q

If metformin is not tolerated in GDM what use instead

A

Glibenclamide- sulphonylurea

91
Q

What is exercise recommendation for pregnancy

A

30 mins of moderate exercise a day
- swimming, brisk walking, strength training

92
Q

If obese in pregnnacy how managed

A

BMI over 30 refer to dietitian
BMI over 40 refer to obsetrician

93
Q

What are options for rhesus administration regime

A

Single 1500IU dose at 28 weeks
2 500IU doses at 28 and 34 weeks

94
Q

If taking an enzyme inducing anti-epileptic, what is important peripartum management

A

Take 1mg IM vitamin K

95
Q

What is association of phenytoin in pregnancy

A

Cleft lip

96
Q

What is maangement of methotrexate use if trying to conceive

A

Both partner and patient must stop 6 months before trying

97
Q

What criteria determines approriateness of a screening programme for a disease

A

Wilson

98
Q

Main risk to baby at birth of ICP

A

Meconeum ingestion

99
Q

What are 5 points to saving babies lives bundle

A

Set of legislation aimed at reducing incidence of still births
1. Reducing smoking impact
2. Awareness of RFM
3. Proper monitoring in labour
4. Identifying FGR
5. Preventing pre-term

100
Q

How is smoking in pregnancy assessed

A

CO testing at booking and then at 36 weeks

101
Q

How is CO measurement assessed

A

Above 4ppm then offer referral to assisted smoking cessation services and serial measurements

102
Q

Which women are inappropriate for monitoring with SFH

A

BMI over 35
Fibroids

103
Q

How are women inappropriate for monitoring with SFH monitored

A

USS every 4 weeks from 32 weeks

104
Q

What is management if EFW or abdo circumfrence under 10th percentile at anomaly scan

A

Serial USS

105
Q

What are moderate risk factors for FGR

A

Previous SGA
Smoker at booking
Previous stillbirth
Drug misuse
Age over 40

106
Q

Management if moderate rfx for FGR

A

USS every 4 weeks from 32 weeks

107
Q

What are high risk factors for FGR

A

Medical history
- Maternal medical conditions
[chronic kidney disease,
hypertension, autoimmune
disease (SLE, APLS), cyanotic
congenital heart disease]
Obstetric history
- Previous FGR
- Hypertensive disease in a
previous pregnancy
- Previous SGA stillbirth
Current pregnancy
- PAPPA <5th centile
- Echogenic bowel
- Significant bleeding
- EFW <10th centile

108
Q

Management if high risk factors for FGR

A

Do additional uterine artery doppler

109
Q

Assessment of additional uterine artery doppler done in high risk of FGR

A

Normal- serial USS from 32 weeks
Abnormal with EFW above 10th percentile- serial USS from 28 weeks
Abnormal with EFW below 10th percentile- discuss with feotal medicine

110
Q

Interpretation of uterine artery doppler

A

Best
Raised pulsatility index above 90th percentile
Reduced end diastolic flow
Absent end diastolic flow
Reversed end diastolic flow
Worst

111
Q

Is chemo contraindicated in pregnancy

A

Yes in the first trimester however in the 2nd and 3rd is possible

112
Q

How long after chemo treatment is labour recommended

A

2-3 weeks to allow for regeneration of the BM

113
Q

If in question asks for investigation for PE what suggest

A

VQ

114
Q

What positiion do you need to put woman in when having an eclamptic fit

A

Left sided tilt

115
Q

Best way of assessning EDD before and after 14 weeks

A

Before 14- crown rump length
After 14- Biparietal diameter

116
Q

If refuse induction of labour at 42 weeks what is needed

A

Twice weekly CTG and USS

117
Q

What is involved in triple test

A

AFP
bHCG
Oestriol

118
Q

Triple test for downs

A

High bHCG
Low AFP
Low oestriol

119
Q

What physiologically causes a raised AFP

A

A break in foetal skin normally caused by spina bifida and anencephaly

120
Q

What condition is hypothyroidism associated with in pregnancy

A

Pre-eclampsia

121
Q

What is most appropriate method for monitoring SGA

A

Doppler of umbilical artery

122
Q

If SFH is noted to be faltering, what is next thing do

A

USS to estimate foetal size

123
Q

What are indications to do an USS to estimate foetal size

A

SFH faltering
SFH below 10th centile

124
Q

Management if epileptic has seizure during labour

A

IV lorazepam
Second line IV phenytoin and tocolysis

125
Q

Differentiating acute fatty liver and HELLP

A

Anaemia only in HELLP
Hypoglycaemia in acute fatty liver

126
Q

If pregnant or peuperal comes in with suspicion of DVT what do

A

LMWH and duplex USS

127
Q

What do if pregnant or peuperal woman has come in with DVT suspicion and duplex USS negative despite high suspicion

A

Treat anyway and rescan on days 3 and 7

128
Q

If pregnant or peuperal woman comes in presenting with PE what do

A

ECG and CXR with treatment

129
Q

If pregnant or peuperal woman comes in with PE and DVT signs what do

A

ECG and CXR with treatment
Duplex USS

130
Q

If pregnant or peuperal woman has comes in with DVT and PE signs with positive duplex what do

A

No further investigations needed

131
Q

If pregnant or peuperal woman has comes in with DVT and PE signs with negative duplex what do

A

CTPA or V/Q

132
Q

If pregnant or peuperal woman has comes in with PE and no DVT signs what do

A

CTPA or V/Q

133
Q

If CXR is abnormal in PE work up what investigation do

A

CTPA preferred

134
Q

What do if 2 risk factors for VTE

A

Anticoagulate for 10 days post partum

135
Q

If refuse insulin what offer

A

Glibenclamide

136
Q

What is biggest risk factor for stillbirth

A

IUGR

137
Q

What is only thing known to reduce preeclampsia risk

A

Smoking

138
Q

What can be used to treat polyhydramnios

A

Indomethacin

Obs (Owen) (9 decks)

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