Maternal Mortality, Morbidity and Antenatal care Flashcards
What are the main causes of maternal mortality
When is this the most likely
Haemorrhage
HTN
Indirect causes (not caused by pregnancy but a precipitating factor)
Greater in less developed countries In the UK, most likely in -birth-6wks -hospital -older age -increased deprivation -BAME
What are the main maternal health risk factors
How should antenatal care be optimised to reduce the possibility of AE
Medical comorbidities
Previous pregnancy problems
To address these issues beforehand, give antenatal care
-8-10 visits that accelerate as risk of complications increase
Which antenatal checks are done routinely
12wk dating scan
20wk anomaly scan
When are the blood diseases screened for
- which diseases are screened
- how is this done
Sickle cell, thalassaemia, before wk10
Maternal blood test
-if positive => CVS, amniocentesis to test fetus
If fetus positive => early specialist care/termination
When are infectious diseases screened for
- which diseases are screened
- how is this done
Serology as early as possible
HIV, syphilis
- maternal treatment to prevent transmission
- no breastfeeding
Hep B
- neonate vaccinated
- prevent transmission
When are chromosomal issues screened for
- which diseases are screened
- how is this done
Fetal nuchal translucency at 12wk dating scan
Trisomy markers (PAPPA, bhCG)
Maternal blood test for fetal, maternal DNA
13, 18, 21
When are fetal anomalies screened for
- which diseases are screened
- how is this done
20wk anomaly scan, USS
Can detect physical signs of 13, 18, 21
A variety of diseases
What are the risk factors for PET
HTN in previous pregnancy/chronic CKD Diabetes AI 40+ BMI 35+ FHx of PET
What is the combined test
- what 3 factors would yo consider
- what results would be indicative of which chromosomal disorders
Maternal age
Nuchal translucency
CRL
T13 low P, low bhCG
T18 low P low bhCG
T21 low P high bhCG
What is CVS
What would you use this for
Wha are the pros and cons
Sample placental villi
Take transabdominal/transvaginally
Best for chromosomal/monogenic problems
Earlier sampling
Can give FP, FN if there is confined placental mosaicism
0.2% miscarriage risk
What is amniocentesis
What would you use this for
What are the cons
US guided needle
Sample epithelial fetal cells in fluid
Best for chromosomal/monogenic problems
0.1% chance of miscarriage
Quality of results can be low if [DNA] low
Maternal blood contamination can delay results
What is QF PCR
How would you do this
How would you interpret the results
VNTR on 13, 18, 21 XY analysed
No of peaks = no of different VNTRs
Size of peaks = relative proportiobs of each VNTR
What is an array CGH
How would you do this
How would you interpret the results
Chromosome imbalance across genome, DUPLICATIONS and DELETIONS
Controls and labelled test DNA hybridized in different colours onto oligonucleotides
-colours indicate whether there is a deletion/duplication/neither
What is a FISH
How would you do this
How would you interpret the results
Test known carriers of translocations
Subtelomere markers bind to sample from amnion, chorion
Relative proportion of different colours tell you whether the chromosomes are balanced
What is non invasive prenatal testing
How would you do this
Maternal plasma contains some placental DNA
Count proportions of chromosomes in cfDNA
If proportions of a chromosome is higher => aneuploidy likely
