Case 14- Screening and antenatal care Flashcards
What are the first two antenatal appointments
First contact - Folic Acid supplementation
Booking appt- anaemia screening (sickle cell, thalassaemia)
Blood tests for syphilis, hepatitis B and HIV are offered as early as possible and can be given at any point
• BP= test for pre-eclampsia, may get pregnancy induced hypertension. For pre-eclampsia you see if they have high blood pressure, especially after 20 weeks and protein in the urine. Can cause seizures
• BMI
• Urine (dip for protein and culture for asymptomatic bacteriuria), you treat pregnant women for asymptomatic bacteriuria
• Identify women who may need additional care or have risk factors for pre-eclampsia
11-13 week antenatal scan
Down syndrome screening, dating scan for gestational age
18-20 week antenatal scan
Ultrasound scan for structural abnormalities
28 week antenatal scan
Anaemia screening, administration of anti-D if rhesus positive or unsure of status. Screen for atypical red cell alloantibodies
36 week antenatal appointment
Check position (if breech offer referral for external cephalic version- moving the baby). Offer specific information on breast feeding, care for new-borns, vit K prophylaxis to baby when born, New-born screening tests and postnatal self care i.e. baby blues.
41 week antenatal appointment
Offer a membrane sweep, separates the amniotic sac from the uterus lining to induce contractions
Main dietary supplement in pregnancy
Folic acid, prevents 50-70% of neural tube defects. 400mg of folic acid should be taken daily 1 month before conception and for the first trimester
Ectopic pregnancy
Implantation of the fertilised egg outside the normal uterine location
Main sites for an ectopic pregnancy
Ampullary - 54% Isthmic- 25% Fimbrial- 17% Interstitial- 2% Abdomen- 1.2% Ovarian- 0.5% Cervical- 0.3%
What is looked for in the 18-20 week anomaly scan
NTD Craniofacial defects severe cardiac defects Renal agenesis Abdominal wall defects
Birth defects that arise in the first week
Chromosomal abnormalities i.e. Downs. Defects that result in a spontaneous termination
When would an ectopic pregnancy occur
Between 5-9 days
How can maternal health affect foetal development
Some infections can cross the placenta i.e. Rubella can cause congenital Rubella
How maternal diet affects foetal development
1) Cheese such as blue cheese and brie because there is lots of bacteria.
2) Caffeine over 200mg/day- causes low birth rate or miscarriage
3) Shellfish- bacteria
4) Tuna- mercury
5) Cured meat- bacteria
6) Liver- contains vitamin A which causes birth defects
How can maternal behaviour affect foetal development
1) Teratogens i.e. alcohol (FAS)
2) Smoking- premature / low weight
3) Medication- thalidomide (limb defects), tetracycline, antiepileptic drugs, anticoagulants (warfarin causes NS abnormalities), lithium (cardiovascular defects)
Supplemental screening offered to vulnerable women
Women with type 1 or 2 diabetes are offered diabetic eye screening
Cervical screening
A sample of cervical cells are taken for analysis (often called a smear test). This is offered to women aged 25 -64 years
The cells are assessed for any morphological changes, or signs of cancer
Breast screening
An x-ray (mammogram) is offered to women 50 - 70 years. It can detect cancers, growths, and other changes to the tissues
New-born screening
A physical exam is offered within 72 hours of birth. A hearing test is offered by way of an automated otoacoustic emission test. A blood spot test is also completed for the heal prick test which screens for 9 rare but serious conditions (sickle cell disease, cystic fibrosis, congenital hypothyroidism, and 6 different inherited metabolic diseases).
What are the risk factors for premature delivery
previous pre-term birth, cervical surgery, pre-eclampsia, multiple pregnancy (twins etc), IUGR
Respiratory complications of premature delivery
Will need a ventilator. RDS (respiratory distress syndrome), pneumothorax, apnoea. Alveolar cells do not release surfactant causing them to collapse. Pneumothorax can be caused by incubation.
Cardiovascular complications of premature delivery
Decrease in blood pressure because the system is immature. Blood can bypass the foetal lungs if shunts don’t close (trunctus arteriosis). Anaemia if traumatic birth.