Health screening Flashcards
Purpose of screening
Detect those at risk for early treatment/diagnosis
When is CST offered
10 to 14 weeks
Factors for screening
THE CONDITION (3)
Well known
Severe consequences
Frequent presentations
Factors for screening
THE TREATMENT (2)
Effective treatment available
Evidence early diagnosis improves outcomes
Factors for Screening
THE SCREENING TEST (3)
Simple and acceptable
Benefits should outweigh risks
Accurate
What is specificity
Correctly detecting health as non-affected
Sensitivity/detection rate
Correctly identifying as affected
False positive
Not affected, but identified as so when they are healthy
False negative
mislabelling as healthy when they are affected by the condition
To be a good screening test (3)
High sensitivity
High specificity
(Avoid missing and over diagnosing)
Therefore cost effective
Risks of screening (3)
Overdiagnosis
Overmedicalisation
Increased anxiety
Benefits of screening (3)
Early diagnosis
Treatment can be applied to prevent complications
If not treatment available allows for decision making
Uk antenatal and newborn screening (6)
Fetal anomaly (scan and chromosomal testing)
Genetic RBC disorders (sickle cell and thalassaemia)
Screening for HIV, Hep B, syphilis as infectious diseases in pregnancy
Anomaly screening after birth (NIPE)
Newborn blood spot test for inherited metabolic diseases
Newborn hearing test for detection of congenital deafness
Other screening in pregnancy
Preeclampsia
Rh neg
Growth restriction (GAP chart)
Glucose tolerance
Anaemia
Mental health
Gender based violence
GBS
First trimester antenatal care at ? Weeks
8-10 weeks - booking appt
11-14 - dating scan/cubs
Second trimester care schedule
16 weeks
20 weeks (anomaly scan)
25 weeks
Booking bloods test
Infectious disease screening
Blood group
FBC
What in booking appt? (9)
Full obstetric/medical/family history
Gender based violence
Mental health screening
Baseline height/weight/BMI
Baseline observation- BP/pulse/urinalysis
Booking bloods
Urine culture
Co monitoring (smoking)
VTE risk assessment
What is VTE risk assessment
For Venothromboembolism
11-14 weeks dating scan looks at (4)
Single vs multiple pregnancy
Dating/EDD
Early anomaly screening
Chromosomal anomalies (CST)
At what weeks CST?
11-14 weeks
What happens at 16 week appt (3)
BP
Urinalysis
Mental health and wellbeing
What is 20 week scan?
Detailed- looks at 11 anomalies
What at 25 week appt? (5)
BP
Urinalysis
SFH (Symphysis-Fundal Height)
Fetal movements and auscultation
Mental wellbeing
What is SFH
Symphysis fundal height
3rd trimester antenatal care schedule
28 weeks
32 (prims only)
34 weeks
36
38
40
41
What at 28 week appt? (6)
BP
Urinalysis
SFH
Fetal movements and fetal auscultation
Mental Wellbeing
Bloods
Which bloods at 28 weeks
Rh antibodies (if rhesus negative)
FBC
Glucose test (if risk factors)
Who is 32 week appt for?
Prims only
What in 32 week appt
BP
Urinalysis
SFH
Fetal movements and fetal auscultation mental health and wellbeing
What in 34 week appt? (7)
BP
Urinalysis
SFH
Fetal presentation
Fetal movement and fetal auscultation
Weight
Mental wellbeing
36/38/40/41 weeks what happens (7)
BP
Urinalysis
SFH
Fetal presentation
Fetal movement and auscultation
PPH risk
Mental wellbeing
Postnatal care mother at birth (3)
Observation
VTE risk
Blood loss
Postnatal care of infant at birth
Initial Newborn Examination (6hrs)
Postnatal mother day 1-3 (3)
VTE
Blood loss
Mental wellbeing
Postnatal day 1-3 infant
Full feeding assessment
NIPE <72hr
Postnatal day 4-10 mother
VTE risk asses
Mental wellbeing
Postnatal check
Postnatal day 4-10 Infant
Weight loss
Newborn blood spot
Hearing test (by day 28)
Topics covered in health education 1st trimester
Nutrition and exercise in pregnancy
Vaccination in pregnancy
Folic acid/healthy start
Place of birth
Infant feeding
Health education second tri
Building loving relationships
Safer sleep
Fetal movement
Skin to skin importance
Health education 3rd tri
Antenatal workshops
Birth preference
Postnatal self-care - baby blues
Care of newborn
Vit K prophylaxis
Antenatal colostrum harvesting
Induction of labour
Membrane sweeps
What does NIPE stand for?
Newborn and Infant Physical Examination
NIPE - congenital anomalies in which 4 areas
Eyes
Heart
Hips
Testes
When NIPE?
6 to 72 hr
Why no NIPE before 6 hrs
Baby still adapting to extra uterine life so may not be reliable
Why NIPE 2 at 6 to 8 weeks?
Some conditions may not be apparent until then
Who can carry out NIPE
Qualified midwives and physicians
Who is developmental dysplasia of hip most common in
Premature and breech babies
Newborn blood spot tests for what?
Sickle Cell Disease
Cystic fibrosis
Congenital Hypothyroidism (CHT)
6 inherited metabolic disorders (PKU, MSUD, HCU, IVA, GA1, MCADD)
When is newborn blood spot offered
DAY 5
If one parent is CF carrier what is chance of child having?
No chance as is a recessive characteristic so both would need to be carriers
What CST test for (3)
Chromosomal - Downs, Patau, Edwards
What does CST look at?
Nuchal Translucency and serology
What does QT test for?
Downs
When can QT be carried out
15-20 weeks
Can 20 week scan screen for Downs
No
Can 20 week scan screen for Edwards and Patau’s
Yes
Benefits of Chromosomal
Screening
- if diagnostic tests advised
- prepare/make decisions
- early diagnosis
When is Beta thalassaemia tested for?
In pregnancy for mother
Both parents need to be carriers for baby possibly be affected
Purpose of Fetal Anomaly Scan
To screen for 12 main congenital anomalies
ie cleft lip, pataus, Edwards, downs, serious cardiac, open spina bifida
Not for gender - and some trusts won’t discuss
How to obtain good heel prick sample (6)
1) clean with water
2)warm & dry
3) lancet
4) form droplet & tap on card
5)air dry sample
6) plaster on foot
Risks of heel prick test
Low, not risk free
Bruising
Excessive bleeding if blood clotting disorder
Unlikely to put too deep
How can CF be diagnosed antenatally
CVS and amniocentesis
