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GOSH > Antenatal screening > Flashcards

Antenatal screening Flashcards

1
Q

When would you use the quadruple test?

A

If patient has missed ‘combined screening’ (eg. booking late)

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2
Q

When is the quadruple test done?

A

14+2 - 20+0 weeks

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3
Q

What does the quadruple test involve?

A

Blood test only

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4
Q

What is the test for down’s syndrome (and other disorders) that is currently only available in private sector?

A

NIPT (non-invasive pre-natal testing)

will be on NHS for high-risk women soon

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5
Q

Why is NIPT better than combined and quadruple test?

A

Detection rate of over 99%

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6
Q

How does NIPT work?

A

Placental DNA extracted from maternal blood sample

Different tests screening for different conditions

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7
Q

What does IONA screen for?

A

Down’s
Edwards
Pataus

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8
Q

When is an HIV test for pregnant women?

A

Booking bloods

Consent needed

Opt-out system

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9
Q

Why is an HIV test done for mothers?

A

Intervene quickly for the mother’s health and reduce risk of Mother to Child transmission

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10
Q

What would happen if a woman declines HIV test ONLY?

A

MDT meeting to discuss reasons behind it

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11
Q

What is important to remember when writing in notes re. someone’s HIV status?

A

DO NOT WRITE IN HAND-HELD NOTES

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12
Q

What guidelines must you follow for someone with HIV?

A

2014 BHIVA guidelines

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13
Q

When is Hepatitis B screening done?

A

Booking bloods

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14
Q

What has to be done if patient has Hep B? Why?

A

Screening team to contact HPA

Idenifty clearly in notes

Notifiable disease

Refer household contacts to GP for hepatitis screen and vaccination

Health protection advice

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15
Q

How is a mother with Hep B managed?

A

Referred to hepatology

Newborn vaccination programme. 5 dose vaccine (up to primary school)

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16
Q

Are people with Hep B antibody + and B antigen - at low or high risk?

A

lower risk

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17
Q

Are people with Hep B antibody - and B antigen + at low or high risk?

A

higher risk

Newborn will require dose of immunoglobulin at birth

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18
Q

How are women with Hep B managed?

A

High viral load: anti-retroviral therapy in pregnancy
AND
for short periods following delivery to reduce risk of transmission

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19
Q

Can a woman who screens positive for Hep B breastfeed?

A

YES

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20
Q

Can a woman who screens positive for HIV breastfeed?

A

Would not recommend

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21
Q

What should you do for someone who has screened positive for syphilis?

A

refer to GUM for ABX (if no evidence of previous treatment)

?partner tracing

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22
Q

When is the deadline for receiving the full syphilis treatment to prevent the baby needing IV therapy?

A

4 weeks prior to delivery

23
Q

If a mother doesn’t receive the full syphilis treatment by 4 weeks prior to delivering the baby, what does the baby need to receive?

A

IV therapy (ABX)

24
Q

What rhesus status indicates a need for anti-D immunoglobulin?

A

rhesus negative

25
Q

If a woman is rhesus negative, what will she be offered?

A

Anti-D immunoglobulin IV at 28-30 weeks

26
Q

When is Rhesus done?

A

booking

28 weeks

27
Q

What is ROUTINELY screened for during the antenatal period?

A

Foetal anomalies

Infectious diseases: HIV
Hep B
Syphilis

Rhesus -ve

Haemoglobinopathies

28
Q

What screening programmes are available for foetal anomaly?

A

Two programmes:

Early pregnancy scan: 11+2 - 14+1

Anomaly scan 18+0 - 20+6

29
Q

Is the combined screening test opt-in or opt-out?

A

opt in

30
Q

When is the combined screening test done?

A

Done in first trimester from 11+2 - 14+1

31
Q

What does combined screening include?

A

Nuchal translucency scan

Maternal blood test:
hCG (human chorionic gonadotrophin)
PAPPA (pregnancy-associated plasma protein A)

32
Q

How are the results of combined screening presented?

A

as a ‘risk factor’

Cut off is 1 in 150

33
Q

What is the detection rate for the combined test?

A

85% (about 2% of women will get a high-risk result)

34
Q

What tests can you offer a woman who’s had a high-risk combined test result?

A

CVS (chorionic villus sampling) from 11 weeks (1% risk miscarriage)

Amniocentesis from 15 weeks (with risk of miscarriage 0.8%)

  • diagnostic tests
35
Q

What is the combined test looking for?

A

Risk of down’s syndrome

36
Q

What detection rate does the quadruple test have?

A

80%

37
Q

What is the detection rate of NIPT?

A

over 99%

38
Q

What sorts of things does a foetal anomaly scan look for?

A

anencephaly
gastroschisis
heart defects
trisomies 13 and 18

39
Q

What happens if a foetal anomaly is detected during screening?

A

Woman is referred to obstetrician/foetal medicine

40
Q

Are HIV and Hep B opt-in or opt-out tests?

A

opt out

41
Q

How does anti-D immunoglobulin IV at 28-30 weeks help pregnant women with rhesus negative blood?

A

neutralises foetal RhD+ antigens which would have entered maternal blood

prevents creation of antibodies

42
Q

How is the baby’s blood tested at birth?

A

Cord blood test

43
Q

What is done for the female patient if she delivers a Rhesus positive baby?

A

IM injection of Anti-D

44
Q

When are haemoglobinopathies screened for?

A

Booking bloods

45
Q

Which haemoglobinopathies are being looked for in antenatal screening?

A

Sickle cell

Thalassemia

46
Q

Is haemoglobinopathy screening an opt-in or opt-out test?

A

opt out

47
Q

Other than a blood sample, what else is completed to determine patient/baby risk of haemoglobinopathy?

A

Family origin questionnaire

identify higher risk ethnic groups in low prevalence areas

48
Q

If the mother is found to have haemoglobinopethy traits/carrying status, what must be done next?

A

FATHER must be checked (not necessarily partner)

49
Q

How are newborns tested for haemoglobinopathies? When is this done?

A

Newborn blood spot

5 days post delivery

50
Q

Which infections are NOT commonly screened for?

A

Hep C
Chlamydia
Group B strep

51
Q

When might you screen for Hep C?

A

Hx of drug abuse or obstetric cholestasis

52
Q

When might you screen for chlamydia?

A

Encourage in under 25s (opportunistic screening)

53
Q

When might you screen for group B strep?

A

swab/urine tests are performed

GOSH (33 decks)

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