normal pregnancy

Question 1

USS + other dates in pregnancy - when GTT? when anti D?

Answer 1

11-14 - date, ?multiple pregnancy, nuchal fold ± down’s screening
18-21 - anomaly - heart defects, spina bifida
26 - GTT if risk diabetes
28 - anti-D injection if Rh-
36 - check presentation

Question 2

what tests are used for down syndrome screening in pregnancy? when done?

Answer 2

combo of pregnancy-associated plasma protein (PAPP-A), b-hCG + nuchal translucency

do between 11-14

Question 3

how is down syndrome screened for in pregnancy?

Answer 3

size of nuchal fold compared with hCG, PAPP-A, maternal age + other RFs
>certain risk, can offer diagnostic test

Question 4

how is down syndrome diagnosed in pregnancy + risks of diff methods?

Answer 4

amniocentesis test or chorionic villous sampling - risk miscarriage
free foetal DNA tests available privately - non-invasive

Question 5

theory behind rhesus -ve being problem

Answer 5

rhesus factor is antibody on RBC - rh+
if rhd- and rh+ baby’s blood enters mum’s blood during pregnancy or birth, mum can produce anti-D antibodies against rh+ cells (sensitising event)
usually fine in 1st preg but antibodies can destroy blood cells of next baby, leading to rhesus disease (haemolytic disease of newborn)

Question 6

risks of rhesus disease (haemolytic disease of newborn)

Answer 6

anaemia
jaundice
brain damage

Question 7

sensitising events - mums should report - can increase passage of foetal BCs into maternal circulation, where they can react

Answer 7

ECV + invasive procedures
miscarriage + termination
blood transfusions
haemorrhage, trauma, abruption

Question 8

management of rhesus negative mum + of sensitising events

Answer 8

of rh -ve mum:
give prophylactic anti-D at 28wk as passage can occur with no warning
test baby at birth - if rh-, risk v low

of sensitising events:
give anti-D (mop up foetal cells in maternal circ)
kleihauer test - determine % of foetal RBCs preset

Question 9

b-hCG in pregnancy - wheres it produced + how does it change?

Answer 9

doubles 48hrly
peaks at week 7 then tapers
produced by placenta

Question 10

oestrogen in pregnancy - where’s it produced + how does it change + what does it do?

Answer 10

produced by corpus luteum in ovaries then placenta takes over
rises throughout
increases oxytocin receptors in uterus to prepare body for delivery

Question 11

progesterone in pregnancy - wheres it produced + how does it change + what does it do?

Answer 11

produced by corpus luteum then placenta takes over
rises throughout
acts as smooth muscle relaxant + maintains uterine lining

before delivery O+P levels drop to allow labour

Question 12

advice to someone wanting to get pregnant

Answer 12

folic acid till 12wk
vitamin D
avoid unpasteurised soft cheeses eg brie + undercooked animal products
stockings if flying

Question 13

risks of smoking in pregnancy

Answer 13

low birth weight

prematurity

Question 14

what tests are done at pregnancy booking?

Answer 14

BP, urine dip, BMI
FBC, blood group, rhesus
hep B, syphilis, rubella
urine culture
\+- HIV

Question 15

how do you treat mastitis?

Answer 15

flucloxacillin 10-14d

Question 16

how do you treat breast abscess?

Answer 16

incision + drainage

Question 17

hyperemesis management

Answer 17

1° - promethazine or cyclizine
2° - ondansetron or metoclopramide

+- admission for IV hydration

should end by 20wk

Question 18

rhesus negative pregnancy - tests

Answer 18

birth - test cord blood - FBC, blood group + direct coombs (coombs demonstrates any antibodies on baby RBC)
kleihauer

Question 19

rhesus disease of newborn - features + management

Answer 19

oedematous
jaundice + anaemia
hepatosplenomegaly
HF

transfusions + UV phototherapy