Normal pregnancy Flashcards
Booking appointment - when, what is covered
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
Dating scan - when, how baby is dated
12 weeks - date using crown-rump length Combined screening for DS
Combined screening for DS - when can it be done, what is it, what is high risk, next steps
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
bHCG vs PAPP-A (high/ low)
High bHCG, low PAPP-A = Downs Low bHCG, high PAPP-A = Pataus/ Edwards
Anomaly screen - when, what is it screening for?
20 weeks Structural abnormalities, gender, placenta position
Low lying placenta found at anomaly scan - next steps?
Scan again at 32 weeks
Types of structural abnormalities (CNS, renal, pulmonary, GI, CV)
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
Amniocentesis vs CVS (when from, what for)
CVS: from 11 weeks. For karotyping. Aspiration of trophoblastic cells Amniocentesis: from 15 weeks. Aspiration of amniotic fluid. Diagnoses infection, anaemias, chromosomal abnormalities
Growth scans (when are growth scans offered, why, what do they measure)
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)
When can you do an ECV?
36 weeks
When is anti-D given routinely?
28 and 34 weeks
Why take folic acid during pregnancy?
Converted to THF (tetrahydrofolate) - helps with synthesis of DNA + RNA
Causes of folic acid deficiency
Phenytoin
Methotrexate
Pregnancy
Alcohol excess
Consequences of folic acid deficiency
Macrocytic, megaloblastic anaemia
Neural tube defects
Prevention of NTD in pregnancy
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
Normal physiological changes in pregnancy
Hb conc falls due to dilution
Stroke volume increase
Rate + depth of breathing increases
Cortisol output increases
How long should a baby be breastfed for?
Exclusively for 6 months then combined with food for 2 years + beyond
What pain relief is contraindicated in breastfeeding?
Aspirin due to risk of Reye’s syndrome in baby
Combined screening detection + false positive rate
85-90% detection
2.5-5% false positive
When is it normal to begin to feel baby moving?
18-20 weeks
How to calculate EDD?
First day of LMP + 9 months + 1 week
How commonly does the anatomy scan pick up a) anencephaly b) cardiac defects?
Anencephaly = 98%
Heart defects = 50%
