Normal pregnancy

Question 1

Booking appointment - when, what is covered

Answer 1

10 weeks BP, urinalysis, BMI Screening bloods (HIV, syphilis, hep B, Rubella, anaemia, blood group, Rhesus) Lifestyle advice Assess risk for diabetes + pre-eclampsia + VTE risk

Question 2

Dating scan - when, how baby is dated

Answer 2

12 weeks - date using crown-rump length Combined screening for DS

Question 3

Combined screening for DS - when can it be done, what is it, what is high risk, next steps

Answer 3

From 11 - 13+6 weeks

High risk = 1 in 150 chance If high, offer CVS (11 weeks) or amniocentesis (15 weeks) Nuchal translucency, bHCG + PAPP-A

Question 4

bHCG vs PAPP-A (high/ low)

Answer 4

High bHCG, low PAPP-A = Downs Low bHCG, high PAPP-A = Pataus/ Edwards

Question 5

Anomaly screen - when, what is it screening for?

Answer 5

20 weeks Structural abnormalities, gender, placenta position

Question 6

Low lying placenta found at anomaly scan - next steps?

Answer 6

Scan again at 32 weeks

Question 7

Types of structural abnormalities (CNS, renal, pulmonary, GI, CV)

Answer 7

CNS: NTD, anencephaly, spina bifida

Renal: renal agenesis, posterior urethral valve syndrome, hydronephrosis

Pulmonary: lung hypoplasia, diaphragmatic hernia, congenital cystic adenomatoid malformation

GI: exomphalos, gastroschisis, GI obstruction

CV: VSD

Question 8

Amniocentesis vs CVS (when from, what for)

Answer 8

CVS: from 11 weeks. For karotyping. Aspiration of trophoblastic cells Amniocentesis: from 15 weeks. Aspiration of amniotic fluid. Diagnoses infection, anaemias, chromosomal abnormalities

Question 9

Growth scans (when are growth scans offered, why, what do they measure)

Answer 9

Growth scans at 30 and 32 weeks if obese/ multiple/ IUGR/ GDM Measures BPD (biparietal diameter), HC (head circ), AC (abdo circ) + FL (femur length)

Question 10

When can you do an ECV?

Answer 10

36 weeks

Question 11

When is anti-D given routinely?

Answer 11

28 and 34 weeks

Question 12

Why take folic acid during pregnancy?

Answer 12

Converted to THF (tetrahydrofolate) - helps with synthesis of DNA + RNA

Question 13

Causes of folic acid deficiency

Answer 13

Phenytoin

Methotrexate

Pregnancy

Alcohol excess

Question 14

Consequences of folic acid deficiency

Answer 14

Macrocytic, megaloblastic anaemia

Neural tube defects

Question 15

Prevention of NTD in pregnancy

Answer 15

400mcg folic acid until 12th week for all women

High risk women: 5mg folic acid before conception until 12th week

High risk = hx of NTD, antiepileptic drugs, coeliac, diabetes, thalassaemia, obesity >30

Question 16

Normal physiological changes in pregnancy

Answer 16

Hb conc falls due to dilution

Stroke volume increase

Rate + depth of breathing increases

Cortisol output increases

Question 17

How long should a baby be breastfed for?

Answer 17

Exclusively for 6 months then combined with food for 2 years + beyond

Question 18

What pain relief is contraindicated in breastfeeding?

Answer 18

Aspirin due to risk of Reye’s syndrome in baby

Question 19

Combined screening detection + false positive rate

Answer 19

85-90% detection

2.5-5% false positive

Question 20

When is it normal to begin to feel baby moving?

Answer 20

18-20 weeks

Question 21

How to calculate EDD?

Answer 21

First day of LMP + 9 months + 1 week

Question 22

How commonly does the anatomy scan pick up a) anencephaly b) cardiac defects?

Answer 22

Anencephaly = 98%

Heart defects = 50%