Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro and Sexual Health > Antenatal screening > Flashcards

Antenatal screening Flashcards

1
Q

What are the principles of screening?

A 
Highly sensitive
Highly specific
High positive predictive value 
Easily used in a large population 
Safe and cheap
Quick and straightforward to perform 
Able to detect a disease with a known natural history and where early diagnosis has a proven benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is sensitivity assessed?

A

True positive/ (positive + false negative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is specificity assessed?

A

True negative / (negative + false positive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What eye screening is offered to diabetic women in pregnancy?

A

DE screen when first present for care

DE screening anually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What bloods should be taken off in the 1st trim?

A

Sickle cell and thalassaemia
IF WANTED; blood test for DSS
Syphilis, hep B and C, HIV and rubella susceptibility
Haemaglobin, group, rhesus and red cell antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When are scans performed in pregnancy?

A

At booking app; 11-13 weeks

Anomaly scan at 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the newborn gurthrie prick test for?

A 
CF
Congenital hypothyroidism 
Sickle cell 
Metabolic disorders: 
Phenylketonuria (PKU)
medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD) 
Isovaleric acidaemia (IVA) 
Glutaric aciduria type 1 (GA1) 
Homocystinuria (pyridoxine unresponsive) (HCU)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is performed at the booking visit?

A 
Hx; 
Menstruation 
Medical
Obstetric
Family
Social 
Exam: 
BMI 
BP
CVS
Abdominal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the cut off for BMI in terms of allowing for midwife led care in place of obstetric lead care?

A

BMI of 40 needs to be under care of obstetrician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is naegele’s rule?

A

Predicts an EDD based on LMP

Add on 9 months and 7 days to arrive at due date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most accurate measurement of EDD?

A

CRL on USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations are performed at the booking visit?

A 
Bloods; 
Hb
ABO 
Rhesus
Syphilis
HIV
Hep B and C 
Urinalysis; MSSU, C+S
USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is assessed on USS at the booking visit?

A 
Confirm viability 
Singleton/ multiple pregnancy
Estimate gestational age
Detect major structural anomalies; abdominal wall defects or anencephaly 
Offer DSS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where should you look if there is an empty sac but a positive pregnancy test?

A

Adnexae for ectopics

Do hCG level to monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the different types of twins?

A

Dichorionic/ diamniotic
Monochorionic/ diamniotic
Monochorionic/ monoamniotic
Conjoined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is assessed at follow up antenatal visits with the midwife post booking appointment?

A

Hx; physical and mental health, foetal movements
Exam: BP and urinalysis, symphysis (fundal height(, lie and presentation, engagement of presenting part, foetal heart auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which are the main anomalies incompatible with life?

A

Major heart abnormalities
Anencephaly
Trisomy 13 and 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is assessed in the H+N in anomaly scan?

A

Skull
Nunchal skin fold
Brain; cavum septum pellucidum, ventricular atrium, cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is assessed in the face in anomaly scan?

A

Lips; cleft lip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is assessed in the chest in an anomaly scan?

A

Heart; four chambers. outflow tracts

Lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is assessed in the abdomen in an anomaly scan?

A

Stomach; stomach and short intra-hepatic section of umbilical vein
Abdo wall; bowel, renal pelvis
Bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is assessed in the spine in an anomaly scan?

A

Vertebrae

Skin covering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is assessed in the limbs in an anomaly scan?

A

Femur
Hands; metacarpals
Feet; metatarsals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is assessed in the uterine cavity in an anomaly scan?

A

Amniotic fluid

Placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the main foetal anomalies picked up on the 20 wk scan?

A 
Anencephaly 
Open spina bifida
Cleft lip
Diaphragmatic hernia
Gastroschisis
Exomphalos
Serious cardiac abnormalities
Bilateral renal agenesis 
Lethal skeletal dysplasias
Edwards syndrome (trisomy 18) 
Patau's sundrome (trisomy 13)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is placental praevia?

A

Placenta is low lying in the womb and covers all or part of the cervix
In most women, as the women grows upwards, the placenta moves with it so that it is in a normal position before birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should be offered if a low lying placenta is seen at the anomaly scan?

A

Scan at 32 weeks

If this is unclear, vaginal scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the recommendation for women with placenta praevia?

A

C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is down’s syndrome assessed in the 1st trim?

A

Measure of nuchal thickness; >3.5mm is bad

PAPP-A and hCG blood testing

30
Q

How should a risk of down’s syndrome be estimated?

A

hCG (goes up)
PAPP-A (goes down)
NT
Maternal age

31
Q

What is PAPP-A?

A

It is produced by the placental syncytiotrophoblast and deciduas. It increases the bioavailability of insulin like growth factor, which in turn mediate trophoblast invasion and modulates glucose and amino acids transport in the placenta

32
Q

What down’s risk assessment can be performed in 2nd trim?

A

Blood sample at 15-20 wks

Assay of hCG and AFP

33
Q

What is considered high risk for down’s syndrome?

A

> 1:250 change

Then a scan is arranged with amniocentesis

34
Q

What can a thickened nuchal thickness indicate?

A

Chromosomal defect
Foetal death
Major foetal anomaly
Much more unlikely to have a foetus alive and well

35
Q

What maternal markers are used for 2nd trim screening for aneuploidy?

A

AFP
hCG
Unconjugated oestradiol (UE3)
Inhibin A

36
Q

When is an amnio performed?

A

After 15 weeks

37
Q

What is the rate of miscarriage from an amniocentesis?

A

1%

38
Q

When is chorionic villus sampling (CVS) performed?

A

After 12 weeks

39
Q

What is the miscarriage rate for CVS?

A

2%

40
Q

What are the 2 major hemoglobin disorders?

A

Sickle cell

Thalassemias

41
Q

What is the rate and mode of inheritance of sickle cell and thalassemia?

A

AR
50% risk of carrier
25% risk affected
25% risk carry nothing

42
Q

What does a normal haemoglobin contain?

A

Haemaglobin A:

2 alpha and 2 beta chains

43
Q

What is the difference between HbS and thalassemias?

A

HbS; mutation results in a change to the structure and quality of hemoglobin variants
Thalassaemias; amount of hemoglobin the body produces is reduced, impacting on its oxygen carrying capacity

44
Q

Risk of HbS in pregnancy?

A 
Stroke, VTE, meningitis 
Miscarriage 
Infection 
Still birth 
Pelvic inflammation 
Papillary necrosis 
Bone crisis 
Amnionitis 
Anaemia 
Pulmonary cx
Premature birth 
Hypertx
Placenta praevia 
Maternal mortality
45
Q

What are the different types of maternal anaemia?

A

Iron deficiency
Folate deficiency
B12 deficiency

46
Q

Why is maternal Hb optimised for birth?

A

To prevent fatal PPH

47
Q

What is foetal hydrops?

A

Serious condition
Abnormal accumulation of fluid in 2 or more foetal compartments:
Ascites
Pleural effusion
Pericardial effusion
Skin oedema
Can be assoc with polyhydramnios and placental oedema

48
Q

What is rhesus disease?

A

Haemolytic disease of the newborn;
In a foetus; anaemia
In a newborn; anaemia and jaundice

49
Q

How can foetal anaemia be assessed?

A

Doppler to assess increased flow in the middle cerebral artery; indication that the baby is hypoxic and anaemic

50
Q

What rhesus of the mother puts the baby at risk?

A

Rhesus neg

51
Q

What are RF for gestational diabetes?

A

BMI > 30
Previous macrosomic baby weighing 4.5kg (9 pounds 9) or above
Previous gestational diabetes
FMHc of diabetes
Minority ethnic family origin with high prevalence of diabetes

52
Q

What is the gold standard for diagnosis of gestational diabetes?

A

2hr 75g oral glucose tolerance test
FPG; 5.6 mmol/l
2hr OGTT; 7.8 mmol/l

53
Q

At what gestation is the fundal height around the umbilicus?

A

20 weeks

54
Q

At what gestation is the fundal height at the xiphisternum?

A

36 wks

55
Q

What are major risk factors for SGA foetus?

A 
Maternal age over 40 
Smoker > 11 cigs
Paternal SGA
Cocaine
Daily vigorous exercise
Previous SGA baby 
Previous stillbirth 
Materna SGA
Chronic hypertx
Diabetes with vascular disease
Renal impairment 
Antiphospholipid syndrome 
Heavy bleeding similar to menses
PAPP-A < 0.4 MoM
56
Q

What screening is performed for SGA foetus?

A

Reassess at 20 wks
PAPP-A <0.5 MoM
Foetal echogenic bowel

57
Q

What should be performed if baby still small at 20 weeks?

A

Serial assessment of foetal size and umbilical artery doppler from 26-28 weeks
Reassess during 3rd trim

58
Q

How is foetal growth assessed?

A

Serial measurement of SFH at each antenatal app from 24wks of pregnancy
Plot SFH on customiased chart

59
Q

At what cut off should women with a reduced SFH have further assessment?

A

Below 10th centile or serial measurements which demonstrate slow or static growth by crossing centiles
Refer for USS measurment

60
Q

In what conditions is SFH inaccurate?

A

BMI >35
Large fibroids
Hydraminos

61
Q

What are the major risk factors for pre-eclampsia?

A 
Hypertensive disease in a previous preg
CKD 
Autoimmune disease such as SLE or APS
T1DM or T2DM 
Chronic hypertx
62
Q

What is the treatment for high risk patient groups for PET?

A

75 mg of aspirin daily from 12 wks until birth at baby

63
Q

What are the moderate risk factors for PET?

A 
First preg
Age 40 or over
Pregnancy interval of >10 years
BMI >35 
FMHx of PET
Multiple pregnancy
64
Q

What is the recommendation for women with more than 1 moderate risk factor for PET?

A

75mg of aspirin from 12 weeks until birth of baby

65
Q

What is urinalysis assessing in antenatal screening?

A

UTI
Asymptomatic bacteriuria (send MSSU for C+S)
PET; proteinuria
Diabetes

66
Q

What are the minor RF for SGA foetus?

A 
Maternal age >35 
IVF singleton 
Nulliparity
BMI <20 
BMI 25-34.9 
Smoker 1-10 cigs 
Low fruit intake pre-preg
Previous PET 
Pregnancy interval <6 months
Pregnancy interval >60 monthd
67
Q

How many minor risk factors are needed to warrant further screening for SGA?

A

3 or more

68
Q

How should SGA be assessed if minor risk factors are found?

A 
Reassess at 20 wks
PAPP-A <0.4 
Foetal echogenic bowel 
Uterine artery doppler at 20-24 weeks 
Assessment of foetal size and umbilical artery doppler in 3rd trim
69
Q

What ia nuchal thickness?

A

Measure of skin thickness behind foetal neck using USS

Assess fluid levels

70
Q

What is considered an abnormal nuchal thickness?

A

<3.5 mm when CRL is between 45-85mm (11-13 +6)

Repro and Sexual Health (77 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions