Identifying women at risk of complications

Question 1

Women at risk of pre-eclampsia major indicators

Answer 1

HTN during pregnancy
CKD
AID (SLE/APLS)
DM
Chronic HTN

Question 2

Treatment for women at risk of pre-eclampsia

Answer 2

75mg aspirin OD

w/dinner (no impact on delivery but for routine)

Question 3

Moderate risk of pre-eclampsia

Answer 3

Need 2 mod. RF to treat:

• primip
• > 40yo
• pregnancy interval >10y
• BMI >35 at booking
• FHx pre-eclampsia
• multifoetal Hx

Question 4

Pre-eclampsia screening for all women

Answer 4

Every antenatal visit BP and urinalysis

Question 5

Women at risk of preterm birth

Answer 5

Previous preterm
Previous late miscarriage
Multifoetal Hx
Cervical sx (cone biopsy)

Question 6

What do you offer women at risk of pre-term birth

Answer 6

serial cervical length screening +/- foetal fibronectin

Question 7

Womwn at risk of foetal growth restriction

Answer 7

Recommend SFH measurements at every appointment from 24wks

If concerns USS

Question 8

Women at risk of vitamin D deficiency

Answer 8

NO routine screening
Risk groups (skin colour, obesity) offered cholecalciferol

Question 9

NICE recommendation for pregnant and breastfeeding women wrt vitamin D

Answer 9

10ug supplement daily

Question 10

Second trimester: what is used to find women at risk?

Answer 10

Anomaly scan (20-22w)
GDM screening

Question 11

Conditions assessed using anomaly scan

Answer 11

Spina bifida
Major congenital anomalies
Diaphragmatic hernia
Renal agensis

Question 12

Assessment of GDM risk

Answer 12

RFs: prev. GDM, prev. macrosomia, high BMI, first-degree relative, asian, black, middle-eastern

Question 13

Diagnosis GDM

Answer 13

Fasting glucose >5.6mmol/L

2-hour plasma glucose >7.8mmol/L

Question 14

If RFs of GDM present?

Answer 14

2 hour 75g OGTT at 24-28wk

Question 15

Summary of USS schedule

Answer 15

10-14wk: dating, multiple preg., NT as part of screening

18-21wk: structural anomalies, offer reproductive choice

Question 16

Sensitising events in Rh-ve women T1

Answer 16

Foetal blood volume small so sensitisation unlikely

Anti-D only indicated in ectopic, molar, TOP and heavy/repeated uterine bleed+adbo pn
250iU given

Question 17

12-20 weeks Mx of sensitising events

Answer 17

Minimum 250IU within 72hrs

Kleihauer test, give more anti-D if indicated

Question 18

> 20wks Sensitising events management

Answer 18

Minimum 500IU within 72hrs

Kleihauer to dtermine dose

Question 19

Summary of Rh Sensitising events

Answer 19

Delivery of Rh+ve infant
any TOP
Miscarriage >12wks
Ectopic managed surg.
External cephalic version
Antepartum haemorr.
Amnio/CVS/FBS
Abdo trauma