Pre and antenatal care

Question 1

What dose is given of folic acid for normal healthy women with no contraindications?

Answer 1

400mcg

Question 2

Give some examples of when women may require a dose of 5mg of folic acid instead?

Answer 2

BMI >30
Diabetes
Previous neural tube defects in pregnancy
Anti-epileptic medication
FHx of neural tube defects
Coeliac disease (malabsorption disease)
Thalassaemia

Question 3

What HbA1c level should diabetics aim for before falling pregnant?

Answer 3

HbA1c <48 mmol/mol

Question 4

What are some medications contra-indicated in pregnancy?

Answer 4

ACE inhibitors
Warfarin
Mood stabilisers/anti epileptics

Question 5

In patients with pre-existing diabetes mellitus, what medication should be initiated from 12 weeks gestation and why?

Answer 5

Aspirin 75mg

Reduces risk of pre-eclampsia

Question 6

In patients with pre-existing diabetes mellitus, what medications are not appropriate and what medications are, for pregnancy?

Answer 6

The only medications deemed acceptably safe during pregnancy are metformin and insulin.
All other oral hypo-glycaemics are not suitable

Question 7

At what date is the first booking appointment with the midwife?

Answer 7

10-12 weeks

Question 8

What tests are done at the booking visit?

Answer 8

HIV / Hep B screening
Thalassaemia screen
urine dip and culture
BP
Rhesus status, FBC etc

Question 9

When is the early scan to confirm dates done?

Answer 9

Weeks 10-13 +6

Question 10

At what gestational age is the screening and nuchal scan for Downs?

Answer 10

Weeks 11-13+6

Question 11

At what stage in the pregnancy will an anomaly scan be done?

Answer 11

Weeks 18-20+6

Question 12

If it is a woman’s first pregnancy, how many appointments will she have with the midwife?

Answer 12

10

If all is uncomplicated

Question 13

When is the first dose of rhesus given to negative women? What else can be done at this time?

Answer 13

28 weeks

Offer whooping cough vaccine and random glucose check

Question 14

What is done at the 24 week visit?

Answer 14

Check symphyseal-fundal height
BP check
Urine check
foetal heart auscultation

Question 15

Women with gestational or pre-existing diabetes are offered more appointments. True or false?

Answer 15

True

They get offered appointments monthly between weeks 28 and 36 to monitor foetal growth and amniotic fluid levels

Question 16

Why are women with diabetes offered more scans?

Answer 16

They are at more risk of stillbirth, polyhydramnios and congenital malformations.

Question 17

What is the main risk if a mother is rhesus D negative?

Answer 17

It can cause haemolytic disease of the newborn in the following pregnancy

Question 18

How does the rhesus D antibody treatment work?

Answer 18

It is given to mothers so that the antigens from the rhesus +ve foetus can be bound to the antibodies given. This prevents them from crossing the placenta in the second pregnancy

Question 19

What test can be done if you suspect there is a risk of the mother having been exposed to the fetus blood?

Answer 19

Kleihauer test

Question 20

When can chorionic villus sampling be carried out?

Answer 20

Weeks 11-13+6

Question 21

What are the main risks with chorionic villus sampling?

Answer 21

2% chance of miscarrying
Amniotic fluid embolism
Sensitisation of rhesus D -ve

Question 22

What testing for foetal abnormality is carried out after week 15?

Answer 22

Amniocentises

Question 23

Is there a risk of miscarriage in amniocentesis?

Answer 23

Yes roughly 1%

Question 24

When might a mother be given rhesus D antibodies before week 28

Answer 24

If they experience a potential sensitisation incident it is usually given within 72 hours

Question 25

Give some examples of sensitization incidents that can occur during pregnancy?

Answer 25

Vaginal bleeding after 12 weeks
Placental abruption
Abdominal trauma
Ectopic pregnancy
Abortion
Foetal death
Cephalic version
CVS/ amniocentesis
Surgical management of miscarriage <12 weeks

Question 26

50% of babies born with Down’s syndrome will have a normal anomaly scan. True or false?

Answer 26

True