O&G Written - Antenatal care Flashcards

1
Q

Ways to estimate EDD?

A

Nagle’s rule: LMP - 3 months + 7 days + 1 year

  • if cycle >28 days, add on the no. of days
  • opposite if cycle <28 days

USS

  • 11-13+6 week using Crown-rump length
  • 14-20 weeks using head circumference
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2
Q

Routine booking IX

A
Urine dip + culture
FBC
Antibody screen
Syphillis serology
Rubella IgG
HIV + Hep B testing offered
USS
\+/- Hb electrophoresis
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3
Q

Folic acid supplementation advice

A

Should be started pre-conception + continued until 12 weeks gestation

Normally take 0.4mg/day

High risk take 5mg

  • BMI > 30
  • diabetes
  • sickle cell disease
  • malabsorption
  • anti-epileptic medication
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4
Q

Vitamin D supplementation advice

A

10 ug (400 units) for all women

25ug for high risk:

  • BMI >30
  • South Asian or Afro-Caribbean
  • Low sunlight exposure
  • Increased risk pre-eclampsia
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5
Q

Role of 20 week USS

A

identify foetal abnormalities e.g., cardiac or renal defect

+/- cervical length assessment to identify pregnancy at risk of pre-term delivery

+/- uterine artery resistance measurement to identify at risk of growth restriction + pre-eclampsia

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6
Q

Anti-D administration timeline

A

1st dose at 28 weeks

2nd dose at 34 weeks

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7
Q

Combined test components

A

Nuchal translucency

b-hCG

PAPP-A

+ maternal age

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8
Q

What does combined test screen for?

A

Trisomy 21 (Down’s syndrome)

+ Edwards (Tri18), Patau (Tri13)

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9
Q

Components of triple & quadruple test?

A

Beta-hCG
Unconjugated oestradiol
Alpha feto protein

+ Inhibin A in quadruple

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10
Q

possible in utero therapies

A

Anti-arrythmic ddrugs - flecainide, digoxin
NSAIDs for polyhydramnios

Laswer tx for twin-twin transfusion syndrome
Amnioreduction for polyhydramnios
Pleuroamniotic shunt for hydros / effusions
Vesicoamniotic shunt for urethral valve
Blood & platelet transfusion
Tracheal occlusion for diaphragmatic hernia (stimulates lung growth)
Valvoplasty for critical aortic stenosis
Cord occlusion for mono chorionic twins

Open NTD surgery

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11
Q

Timing of amniocentesis

A

Done from 15-20 weeks

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12
Q

Timing of chorionic villus sampling

A

Between 11-13+6 (10-15 weeks)

Technically can be done up until end of pregnancy

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13
Q

Miscarriage rate in invasive diagnostic testing

A

Amniocentesis = 1%

Chorionic villus sampling may be slightly higher but is done earlier when baseline spontaneous miscarriages are more common

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14
Q

Cut off for high risk of Down’s syndrome in Combined test?

A

> 1 in 150

Go on to have non invasive cell free foetal DNA +/- invasive diagnostic testing

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