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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Antenatal screening and care > Flashcards

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

8-12 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

What key things are screened for in antenatal surveillance

A
  • Gestational hypertension/pre-eclampsia
    • BP and urinalusis checked every visit
  • Fetal growth restriction/SGA
    • Below 10th centile
    • Screened by USS/symphysis fundal height
  • IGTT
    • For those with risk factors eg BMI >30, oerv baby >4.5kg, first degree relative diabetes
  • Haemolytic disease
  • Breech presentation
  • Anaemia
  • Polyhydramnios
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15
Q

What levele is diagnostic of gestational diabetes

A
  • Fasting >5/6mmol/L
  • 2hour >7/8
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16
Q

What is breech presentation associated with?

A

Multiple preg, firboids, placenta praevia, polyhydramnios

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17
Q

What is polyhydramnios assocaited with?

A

Placental abruption

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18
Q

General overview of booking visit

A
  • General information eg deit, aclohol, smoking, folic acid, vit D, antenatal classess
  • BP, urine dipstick and BMI checked
  • FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
  • Heb B, syphillis, rubella
  • HIV test offered to all women
  • Urine culcutre to detect asymptomatic bacteriuria
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19
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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20
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 (screening is offered but is NOT compulsory)
  • Monitor foetal and maternal wellbeing
  • Determine timing and mode of delivery
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21
Q

What bedside tests should be performed at every antenatal visit?

A

BP and urine dipstick

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22
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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23
Q

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

A
  • FBC
  • Anti-D
  • Anti-C
  • Anti-Kell
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24
Q

What is involved in an antenatal examination?

A
  • Routine enquiry - feeling well, foetal movements
  • BP
  • Urinalysis
  • Abdominal examination
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25
Q

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

A

Consent required to screen for infection

  • Rubella
  • Hep B
  • HIV
  • Syphillis
  • HIV
  • MSSU
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26
Q

What is rubella syndrome?

A

Microcephaly

Congenital cataracts

Heart defects (PDA)

Hearing loss

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27
Q

When is first scan done?

A

10-13+6 weeks

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28
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
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29
Q

How would you describe the following lie?

A

Longitudinal lie

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30
Q

How would you describe the following lie?

A

Longitudinal lie

31
Q

What presentation is the following?

A

Breech

32
Q

What lie is the following?

A

Transverse lie

33
Q

What presentation is the following?

A

Vertex presentation

34
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
35
Q

What alterations should be made to diet?

A
  • Reduce vit A (fetotoxic if >700mg) (spinach, mangos, carrots, sweet potatoes)
  • Increased vit D
  • Iron supplement
  • Folic acid 400mg from before contraception to 12 weeks
36
Q

What food should be avoided?

A
  • Listerosis
    • Avoid unpasturised milk, ripened soft cheeses, pate or undercooked meat
  • Salmonella
    • Avoid raw or partially cooked eggs and meat esp poultry
37
Q

What previous pregnancy problems increase maternal risk?

A
  • C-section
  • DVT
  • Pre-eclampsia
38
Q

What previous pregnancy problems increase foetal risk?

A
  • Pre-term delivery
  • Intrauterine growth restriction
  • Foetal abnormality
39
Q

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

A
  • Increasing age
  • Family history
40
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

41
Q

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

A

Active and passive immunisation

42
Q

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

A

11-14 weeks gestation

43
Q

How is down’s syndrome screened for?

A
  • Assess Maternal risk factors - age, FH
  • B-HCG
  • PAPP-A - pregnancy assocaited plasma protein A
  • Foetal nuchal translucency
  • Inhibin A
  • Unconjugated oestriol
44
Q

What is the combined test?

A

NT + BHCG + PAPPA

45
Q

What elevates the alpha-fetoprotein?

A

NTDs

Downs

Incorrdect gestational age

Multiple pregnancy

Bleeding in pregnancy

Foetal death

Abdominal wall abnormalities

46
Q

Where is the nuchal transluceny measurement tacken from?

A

Between crown/rump length of 45-84 mm

47
Q

How is nuchal translucency related to chromosomal/other abnormalities?

A

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

48
Q

How can risk of vertical transmission of HIV be reduced?

A
  • Anteretroviral treatment
    • Pregnancy
    • Labour
    • Neonataly - 6 weeks
  • C-section
  • Avoidance of breastfeeding
49
Q

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

A

Increased B-HCG and PAPP-A - Increased risk

50
Q

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

A

Diagnosis by karotyping -

  • Chorionic Villous Sampling
  • Amniocentesis
  • Non-invasive Prenatal testing
51
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.

52
Q

When is CVS performed?

A

Weeks 10-14

53
Q

What is the risk of miscarriage from chorionic villous sampling?

A

1-2%

54
Q

What is inovled in amniocentesis?

A

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

55
Q

When is amniocentesis most commonly performed?

A

>15 weeks gestation

56
Q

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

A

Approximately 1%

57
Q

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

A

5mg folic acid

58
Q

What abnormalities are incompatible with life on first US?

A

Anencephaly

59
Q

What is the main purpose of 20 week scan?

A

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

60
Q

What proportion of NTDs will be detected on first scan?

A

<10%

61
Q

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

A

>90%

62
Q

How would you measure the fundal height?

A

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

63
Q

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

A

Height in cm correlates with gestational age in weeks

64
Q

How many appointments do nulliparous and multiparious women have?

A

Nulliparous - 10 appointments

Multiparous - 7 appointments

65
Q

When is first dose of anti-D fiven to rhesus negative women?

When is second dose given?

A

First = 28 weeks

Second = 34 weeks (when info on labour and birth plan also discussed)

66
Q

What is first sign of pregnancy on US

A

Thickening of lining of womb

67
Q

When does the gestational sac appear?

A

4.5 weeks

68
Q

When does the yolk sac appear in the uterus?

A

5 weeks

69
Q

When is the FHR pulsation visible

A

6 weeks

70
Q

When is cephalic version offered if indicated?

A

36 weeks. Information on breast feeding, vit K and baby blues also discussed.

71
Q

Who recieves low dose asprin?

A

75mg from 12 weeks for those with

1 of

  • Hypertension during previous pregnancy
  • Chronic hypertension
  • CKD
  • SLE/Antiphosphylipid syndrome
  • Diabetes

2 of

  • First pregnancy
  • 40=/>
  • Pregnancy interval >10 years
  • BMI of 35
  • FH of preeclampsia
  • Multiple pregnancy
72
Q

Indications for C section

A

Cephalopelvic disproportion

Foetal distress

Breach

Multiple pregnanyc

Failued induction

73
Q

How is foetal wellbeing assessed?

A
  • Foetal movement counting
    • ​Mum records how long it takes to feel 10 separate movements
  • Foetal cardiotocography
    • ​CTG - foetal well bing at particular moment in time
  • Foetal biphysical profile
    • ​5 paramaters assessed and each scored out of 2:
      • CTG
      • Foetal breathing
      • Foetal movements
      • Foetal tone
      • Liquor >3cm depth in 2 plants
  • Doppler flow velocity
    • Examination of umbillical arteries
    • Useful in pregnancies at risk of hypocia due to impaired placental function

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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