Antenatal screening and care Flashcards

1
Q

What is meant by the term gravidity?

A

Number of pregnancies a woman has had regardless of outcome

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2
Q

What is mean by the term parity?

A

Pregnancies that resulted in delivery beyond 28 weeks gestation

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3
Q

What is meant by para 2+1?

A

2 Pregnancies beyond 28 weeks, 1 terminated prior to 28 weeks

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4
Q

If a woman had had 3 full term children and was pregnant with another, what gravidity would she be?

A

Gravida 4

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5
Q

How long does pregnancy normally last?

A

40 weeks from LMP

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6
Q

How would you roughly calculate the expected delivery date?

A

EDD = Approximately 1 year and 7 days after LMP - 3 months

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7
Q

What is crown/rump length used to calculate?

A

Gestation between 8 and 13 weeks

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8
Q

How is crown/rump length measured?

A

On USS, measurement from one foetal pole to the other along its longitudinal axis

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9
Q

When should booking visit take place?

A

12 weeks gestation

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10
Q

What weeks of pregnancy are the first trimester?

A

1st day since LMP to 12 weeks

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11
Q

What weeks of pregnancy are the 2nd trimester?

A

13-28

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12
Q

What weeks of a pregnancy are the 3rd trimester?

A

Weeks 29 - 40

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13
Q

What aspects of the history would you wish to obtain at first booking?

A
  • Gravidity/Parity
  • Usual cycle length
  • LMP
  • Drugs/contraception
  • PMH
  • Any fertility probems/oucomes of past pregnancies
  • History of diabetes/HTN/foetal abnormality/Twins
  • Concurrent illness
  • Past mental illness
  • Education/Social status - poor, unsupported, substance abuser etc.
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14
Q

How would you describe the gravidity and parity of a woman who is pregnant for the 4th time with 1 previously normal delivery at term, 1 termination at 9 weeks and 1 miscarriage at 16 weeks?

A

Gravida 4, Para 1+2

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15
Q

What are the basic aims of antenatal care?

A
  • Provide evidence based information
  • Advise on minor problems and symptoms
  • Assess foetal and maternal risk factors at onset of pregnancy
  • Facilitate prenatal screening and subsequent management of abnormalities
  • Monitor foetal and maternal wellbeing
  • Determine timing and mode of delivery
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16
Q

What bedside tests should be performed at every antenatal visit?

A

BP and urine dipstick

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17
Q

What should be covered at first antenatal appointment?

A
  • Calculate BMI
  • Measure BP
  • Dipstick
  • US for gestational age and gross abnormalities
  • Blood tests
  • Give information - folic acid, lifestyle, screening, AN classes, diet and supplementation
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18
Q

What screening tests are done when looking for anaemia and isoimmunisation?

A
  • FBC
  • Anti-D
  • Anti-C
  • Anti-Kell
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19
Q

What is involved in an antenatal examination?

A
  • Routine enquiry - feeling well, foetal movements
  • BP
  • Urinalysis
  • Abdominal examination
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20
Q

What tests are done when screening for infection in a pregnant woman?

A
  • Hep B
  • HIV
  • Syphillis
  • MSSU
  • (Rubella)
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21
Q

What is looked for on first visit scan?

A
  • Ensure pregnancy viable
  • Multiple pregnancy
  • Identify abnormalities incompatible with life
  • Can offer down’s screening
22
Q

How would you describe the following lie?

A

Longitudinal lie

23
Q

How would you describe the following lie?

A

Longitudinal lie

24
Q

What presentation is the following?

A

Breech

25
Q

What lie is the following?

A

Transverse lie

26
Q

What presentation is the following?

A

Vertex presentation

27
Q

What are the main aspects of pre-pregnancy councelling?

A
  • General health management - diet, BMI, alcohol, Smoking
  • Folic acid
  • Risk assessment - Age, Parity, occupation, Substance misuse, psych history
  • Medication review
28
Q

What previous pregnancy problems increase maternal risk?

A
  • C-section
  • DVT
  • Pre-eclampsia
29
Q

What previous pregnancy problems increase foetal risk?

A
  • Pre-term delivery
  • Intrauterine growth restriction
  • Foetal abnormality
30
Q

What are important maternal factors for increasing risk of down’s syndrome in a baby?

A
  • Increasing age
  • Family history
31
Q

What is the risk of a neonate exposed to maternal Hep B becoming a carrier?

A

90% - can progress to liver cirrhosis and HCC

32
Q

What is recommended for treatment of a neonate whos mother is Hep B core antigen +ve?

A

Active and passive immunisation

33
Q

When is screening for down’s syndrome commonly carried out?

A

10-14 weeks gestation

34
Q

How is down’s syndrome screened for?

A
  • Assess Maternal risk factors - age, FH
  • B-HCG
  • PAPP-A
  • Foetal nuchal translucency
35
Q

Where is the nuchal transluceny measurement tacken from?

A

Between crown/rump length of 45-84 mm

36
Q

How is nuchal translucency related to chromosomal/other abnormalities?

A

Related to size - increased size increases risk of there being an abnormality

37
Q

How can risk of vertical transmission of HIV be reduced?

A
  • Anteretroviral treatment
    • Pregnancy
    • Labour
    • Neonataly - 6 weeks
  • C-section
  • Avoidance of breastfeeding
38
Q

How is B-HCG and PAPP-A related to trisomy 21?

A

Increased B-HCG and PAPP-A - Increased risk

39
Q

What options are available if screening tests for downs syndrome come back as high risk?

A
  • Chorionic Villous Sampling
  • Amniocentesis
  • Non-invasive Prenatal testing
40
Q

What is involved in chorionic villous sampling?

A

It entails sampling of the chorionic villus (placental tissue) and testing it for chromosomal abnormalities, usually with FISH or PCR.

41
Q

When is CVS performed?

A

Weeks 10-14

42
Q

What is the risk of miscarriage from chorionic villous sampling?

A

1-2%

43
Q

What is inovled in amniocentesis?

A

Sampling a small amount of amniotic fluid through a transabdominal needle aspiration

44
Q

When is amniocentesis most commonly performed?

A

>15 weeks gestation

45
Q

What is the risk of miscarriage in someone having an amniocentesis?

A

Approximately 1%

46
Q

If someone had a family/personal history of neural tube defect, how should they be managed?

A

5mg folic acid

47
Q

What abnormalities are incompatible with life on first US?

A

Anencephaly

48
Q

What is the main purpose of 20 week scan?

A

Used to detect foetal abnormality - more sensitive for structural rather than chromosomal abnormalities

49
Q

What proportion of NTDs will be detected on first scan?

A

<10%

50
Q

What proportion of NTDs will be seen on 20 week scan?

A

>90%

51
Q

How would you measure the fundal height?

A

Estimated in centimetres from the upper border of the fundus to the pubic symphasis

52
Q

How does the height of the fundus correlate with gestational age?

A

Height in cm correlates with gestational age in weeks