Antenatal screening

Question 1

when is the first visit

what is given

Answer 1

at conception - lifestyle advice

folic acid

Question 2

when is booking and when is it done

Answer 2

between 8-12 weeks of gestation (usually 12)
info about screening tests
FBC, antibodies, glucose, syphilis, rubella

Question 3

what happens at week 16

17

Answer 3

AP or triple test

US

Question 4

what happens at week 28

Answer 4

Anti d if rhesus neg

Question 5

what happens at week 34

Answer 5

Additional Anti d if required

Question 6

what history is taken at the booking visit

Answer 6

menstruals - may have irregular cycles so gestation age may be wrong
medical - DM, thyroid
Social - alcohol, smoking,drugs
obstetric - post partum haemorrhage
family - DM, congenital abnormaliities, genetic disorders, chromosomal disorders

Question 7

what examination is done at the booking visit

Answer 7

Height, weight, BP, CVS, abd

Question 8

what is the size of the uterus at 12 weeks 
16
20
28
36

Answer 8

level of the pubic symphysis
mid way between the PS and the umbilicus -16
umbilicus -20
36 -

Question 9

Investigations done at the booking visit

Answer 9

Hb, ABO for rhesus
screening for syphilis, rubella, HIV, hep b and c
urinalysis: MSSU C andS

Question 10

what is looked for in a US

Answer 10

US: to confirm viability, number of fetuses, confirm gestation date, pick up any gynaecological abnormalities

Question 11

Follow up history in antenatal management

Answer 11

physical and mental health

fatal movements

Question 12

exam in follow up visits

Answer 12

BP and urinalysis 
symphysis - fundal height
lie and presentation 
engagement of presenting part
fetal heart auscultation

Question 13

What can be done if the baby is rhesus pos

Answer 13

blood transfusion in utero

Question 14

what can be done if the baby has cardiac arrhythmia

Answer 14

in utero medication

Question 15

Downs risk assessment in the first trimester

Answer 15

measure of skin thickness behind metal neck
measured at 11-13 and 6 weeks
combined with HCG and PAPPA

Question 16

downs risk assessment at second trimester

Answer 16

blood samples at 15-20 weeks

assay of HCG and AFP

Question 17

downs risk assessment in both first and second trimester

Answer 17

incorporation of these measurements with maternal age and gestation to give personal risk
>1:250 high risk and required further investigation

Question 18

what increases the risk of downs syndrome regardless of maternal age

Answer 18

a low AFP and a high HCG

Question 19

what are the two specific diagnostic tests for down syndrome that can be done

Answer 19

amniocentesis - after 15 weeks and carries a miscarriage rate of 1%
chorionic villus sampling - after 12 weeks and carries a miscarriage risk of 2%

Question 20

what test can be done if suspected fatal anaemia

Answer 20

cordocentesis