Intro Flashcards
What 4 purposes does the 12-week pregnancy dating scan have?
- Find out how many weeks pregnant and also EDD
- Find out how many babies pregnant with
- Find out if baby is growing in correct place
- Find out about baby’s development
At which gestational age is the pregnancy dating scan carried out at?
12 weeks
At what gestational age does the initial booking clinic occur?
Before 10 weeks gestation
What education topics are covered at the booking clinic?
What to expect at different stages of pregnancy
Lifestyle advice in pregnancy (e.g. not smoking)
Supplements (e.g. folic acid and vitamin D)
Plans for birth
Screening tests (e.g. Downs screening)
Antenatal classes
Breastfeeding classes
Discuss mental health
What booking bloods are taken at the booking clinic?
Blood group/antibodies/rhesus D status
FBC (anaemia)
Thalassemia/Sickle cell
Rubella IgG
Chromosomal abnormalities and Hb-opathies
Also offered HIV/Hep B/Syphilis screening
What test is done for Down’s syndrome and at what gestational age?
Combined test - 11 weeks onwards
Involves ultrasound scann with blood test
Which conditions does the 11 week combined test screen for?
Down’s syndrome
Edward’s syndrome
Patau’s syndrome
Nuchal translucency scan tests for which condition?
Down’s syndrome, Edward’s, Patau’s
If nuchal translucency test is not possible, which blood screening test can be offered later (14-20 weeks)?
Quadruple test
Only screens for Down’s and is not as accurate as combined test
Or even later… Mid-pregnancy scan
Aside from blood tests, what other measurements are taken during the booking clinic?
Weight, height, BMI
Urine (?protein, ?bacteria)
BP
What psychosocial issues are discussed during booking clinic? (List 2)
FGM
Domestic violence
Booking clinic tests for following risk factors:
Rhesus -ve Gestational diabetes Fetal growth restriction VTE Pre-eclampsia
If the following are positive what will you give for each?
Rhesus -ve: anti-D prophylaxis
GDM: OGTT test
FGR: additional growth scans
VTE: prophylactic LMWH
Pre-eclampsia: aspirin
In Down’s syndrome, what nuchal translucency thickness is expected?
Greater than 6mm
In the combined test, which 2 blood tests are used?
If positive, what would you expect for each?
Beta-HCG - higher result
PAPPA (pregnancy-associated plasma protein A) - lower result
Triple test is performed between which gestation age?
14-20 weeks gestation
Which tests does the triple test include?
If positive, what would you expect for each?
Only 3 blood tests:
Beta-HCG - higher
Alpha foetoprotein (AFP) - lower
Serum oestriol - lower
What extra blood test does the quadruple test include (compared to the triple test)?
If positive, what would you expect for this test?
Inhibin A
Higher = greater risk
If the Down’s syndrome risk is great (shown by screening), what 2 invasive antenatal tests can be offered for the woman?
Amniocentesis
Chorionic villus sampling
Foetal cells are sampled and karyotyped for definitive Down’s diagnosis?
What alternative non-invasive test can be offered for Down’s?
NIPT
Non-invasive prenatal testing. Blood test from mother containing fragments of foetal DNA.
First trimester is from which gestational ages?
Start of pregnancy -> 12 weeks
Second trimester is from which gestational ages?
13 weeks -> 26 weeks
Third trimester is from which gestational ages?
27 weeks -> birth
At which age do foetal movements start?
20 weeks
Which measurement allows an accurate gestational age to be taken?
Crown - Rump length (CRL)
Which 2 vaccines are offered to ALL pregnant women?
Pertussis (16 weeks)
Flu (autumn/winter)
Which vaccine group is to be avoided in pregnant women?
Live vaccines - e.g. MMR
What supplements are recommended in pregnancy? (List 2)
Folic acid
Vitamin D
Which vitamin is to be avoided in pregnancy and why?
Vitamin A - teratogenic!
Why is unpasteurised dairy and undercooked poultry to be avoided?
Listerosis
Salmonella
What advice can you give regarding sports, sex and flying?
Sports - good but avoid contact sports
Sex - safe
Flying - increases VTE risk so avoid
During which months is alcohol most destructive in pregnancy?
First 3 months
Alcohol in pregnancy can lead to which risks?
Miscarraige
SGA
Preterm delivery
FAS
What features can be seen in FAS?
Microcephaly Thin upper lip Smooth, flat philtrum Short palpebral fissure Learning disability Behavioural difficulty Hearing/vision problems Cerebral palsy
Smoking in pregnancy increases risk of? (List at least 4)
FGR Miscarriage Stillbirth Preterm labour/delivery Placental abruption Pre-eclampsia Cleft lip/palate SIDS
Which obstetric disorders have a high recurrence rate with future pregnancies?
Preterm labour SGA FGR Stillbirth Antepartum/Postpartum Haemorrhage Congenital anomalies Rhesus disease Pre-eclampsia GDM
What medical conditions put women at increased risk of pregnancy problems and require specialist input?
HTN Diabetes Autoimmune disease Haemoglobinopathies VTE Cardiac disease Renal disease
Other serious illnesses
When is the earliest opportunity that drugs in pregnancy can be changed to more safer ones?
Preconceptual counselling visits
Which pregnancy related issues can linked to family?
GDM (1st degree relative has DM)
HTN
VTE
Autoimmune disease
Pre-eclampsia
At which age can the foetal heart be auscultated with an electronic monitor?
12 weeks
What are tests for itching in pregnancy?
Jaundice? (rare)
LFT
Bile acids
Management of pelvic girdle pain?
Physio
Corsets
Analgesics
Auto-resolves post delivery
How is heartburn managed in pregnancy?
Avoid supine (use extra pillows) Antacids - ranitidine
Careful of pre-eclampsia which presents with epigastric pain
Management of constipation when given oral iron?
High fibre diet
Stool softeners
Management of backache/sciatica?
Physio
Posture/lifting advice
Firm mattress
Corset
Auto-resolves post delivery
Management of slow onset ankle oedema towards end of pregnancy?
Raising foot of bed at night
Avoid diuretics unless sudden increase in oedema (in this case do BP, assessment and urinalysis) - ?pre-eclampsia
How is vaginitis treated in pregnancy?
Clotrimazole vaginal pessaries
