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TAS Perinatal Medicine ✅ > Prenatal Care ✅ > Flashcards

Prenatal Care ✅ Flashcards

1
Q

What does routine prenatal screening include?

A
  • Maternal blood sampling
  • US scanning
  • Attendance at antenatal clinic
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2
Q

What should maternal blood be tested for prenatally?

A
  • Blood group
  • Antibodies for rhesus (D) and other red cell incompatibilities
  • Hepatitis B
  • Syphilis
  • Rubella
  • HIV
  • Haemaglobin electrophoresis
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3
Q

Why should haemoglobin electrophoresis be done in prenatal checks?

A

Identify thalassaemia and sickle cell traits

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4
Q

What should be tested for with hepatitis B screening at prenatal checks?

A

Surface and e-antigen

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5
Q

When are ultrasounds normally done in pregnancy

A

Late first trimester and mid-trimester

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6
Q

What is the purpose of the initial USS in pregnancy?

A
  • Allows gestational age estimation

- Can identify multiple pregnancy

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7
Q

What is the purpose of the second USS in pregnancy?

A
  • Identify structural abnormalities

- Identify abnormalities in amniotic fluid volume

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8
Q

What can be done if fetal growth or other problems are identified?

A

Monitoring with serial scans

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9
Q

What does antenatal clinic attendance allow for?

A
  • Identification of pre-existing maternal medical conditions or obstetric risk factors
  • Facilitation of monitoring for pregnancy complications
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10
Q

What is the purpose of prenatal screening for disorders affecting mother or fetus?

A
  • Reassurance when disorders not detected
  • Optimal obstetric and neonatal management to be planned, and parental counselling provided when problems detected
  • Interventions for limited number of conditions with fetal medicine or surgery
  • Option of termination of pregnancy to be offered for severe disorders affecting fetus or compromising maternal health
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11
Q

What is the limitation of using screening to as a method of reassurance?

A

Many abnormalities which are detected on USS are not confirmed on repeat or more expert scanning, or are transient or minor, but may cause significant anxiety

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12
Q

What is required when termination of pregnancy is being considered due to severe disorders affecting the fetus or compromising maternal health?

A

Accurate, rapid medical advice and counselling to help them make this difficult decision

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13
Q

How can pregnancies at increased risk of genetic disorders be identified?

A

Prenatal or antenatal screening

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14
Q

When might trisomy 21 first be suspected?

A

On first trimester USS

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15
Q

How can Down’s syndrome potentially be identified on first trimester USS?

A

Nuchal translucency measurement

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16
Q

What can nuchal translucency measurement be combined with to determine the likelihood of Down’s syndrome?

A

Maternal serum biochemical screening

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17
Q

What is non-invasive prenatal testing?

A

Where cell-free fetal DNA is obtained from maternal blood

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18
Q

What can non-invasive prenatal testing be used for?

A
  • Identification of fetal gender
  • Fetal genotyping
  • Exclusion of common aneuploidy
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19
Q

Why might it be useful to determine fetal gender by non-invasive prenatal testing?

A

For X-linked disorders

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20
Q

Why might it be useful to do fetal genotyping by non-invasive prenatal testing?

A

Look for rhesus antigens

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21
Q

Which common aneuploidy in particular might non-invasive prenatal testing be used to exclude?

A

Trisomy 21

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22
Q

What is the advantage of non-invasive prenatal testing?

A

Avoids risk of miscarriage with invasive testing procedures

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23
Q

What is the limitation of non-invasive pre-natal testing?

A

There are technical, ethical, and financial issues

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24
Q

What does invasive prenatal testing require?

A

An invasive test in pregnancy with the aim of collecting fetal cells

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25
Q

What can invasive prenatal testing be used for?

A
  • Cytogenic analysis
  • Molecular analysis
  • Biochemical analysis
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26
Q

What is the purpose of cytogenetic analysis in invasive prenatal testing?

A

Look for chromosomal abnormalities

27
Q

When is molecular analysis used in invasive prenatal testing?

A

In the case of known genetic mutation

28
Q

When is biochemical analysis done in invasive prenatal testing?

A

In the case of a defined disorder with a suitable prenatal biochemical test

29
Q

What is the limitation of invasive prenatal testing for families already affected by a genetic condition?

A

It is only possible where the genetic mutation in the family is known

30
Q

When is prenatal biochemical or enzyme testing possible?

A

In a small number of disorders, mainly metabolic, when the diagnosis has been confirmed in a family member

31
Q

What are the types of invasive pre-natal testing?

A
  • Amniocentesis
  • Chorionic villous sampling
  • Fetal blood sampling
32
Q

What can amniocentesis be used for?

A
  • Chromosome/microarray and DNA analysis

- Look for fetal infection

33
Q

How can amniocentesis be used to look for fetal infection?

A

PCR for CMV, toxoplasmosis, rubella, and parvovirus

34
Q

What can chorionic villus sampling be used for?

A
  • Chromosome/micro-array and DNA analysis

- Enzyme analysis of inborn error of metabolism

35
Q

What can fetal blood sampling be used for?

A
  • Fetal haemoglobin for anaemia
  • Fetal infection serology
  • Fetal blood transfusion
36
Q

What other diagnostic techniques can be used in fetal medicine?

A
  • Further imaging

- Pre-implantation genetic diagnosis

37
Q

What further imaging be can done in fetal medicine?

A
  • High definition USS

- Fetal MRI

38
Q

Why might further imaging be done in fetal medicine?

A

Identification and deliniation of fetal abnormalities

39
Q

When can pre-implantation genetic diagnosis be performed?

A

In IVF patients

40
Q

What happens in pre-implantation genetic diagnosis?

A

Genetic analysis of cells from a developing embryo before transfer into the uterus

41
Q

What fetal therapies may be used?

A
  • Glucocorticoid therapy
  • Digoxin or flecainide
  • Fetal blood transfusion
  • Intrauterine intravenous immunoglobulin or platelet transfusion
42
Q

What is the purpose of glucocorticoid therapy before preterm delivery?

A

Accelerate lung maturity and surfactant production

43
Q

When might digoxin or flecainide be used in fetal medicine?

A

To treat fetal supraventricular tachycardia

44
Q

How is digoxin or flecainide given to the fetus when used to treat fetal supraventricular tachycardia?

A

It is given to the motehr

45
Q

When might fetal blood transfusion be required?

A

In rhesus or other isoimmunisation causing severe anaemia and hydrops fetalis (oedema and ascites)

46
Q

How can hydrops fetalis be monitored?

A

Fetal middle cerebral artery Doppler USS

47
Q

When might intrauterine IV immunoglobulin or platelet transfusion be indicated?

A

Perinatal isoimmune thrombocytopenia

48
Q

What causes perinatal isoimmune thrombocytopenia?

A

Antiplatelet antibodies crossing the placenta

49
Q

What is the purpose of treating perinatal isoimmune thrombocytopenia with intrauterine IV immunoglobulin or platelet transfusion?

A

Prevent intracranial haemorrhage, which occurs in up to 25%

50
Q

Give 6 examples of fetal surgery

A
  • Catheter shunts
  • Fetoscopic laser therapy
  • Intrauterine shunting for urinary outflow obstruction
  • Fetal endoscopic tracheal occlusion
  • Spina bifida surgical correction by hysterostomy
  • Surgery for sacrococcygeal teratoma
51
Q

How are fetal catheter shunts inserted?

A

Under USS guidance

52
Q

What is the purpose of the insertion of fetal catheter shunts?

A

To drain fetal pleural effusions

53
Q

What often causes fetal pleural effusions?

A
  • Chylothorax

- Congenital cystic adenomatous malformation of the lung

54
Q

What is it called when catheter shunts are used to drain fetal pleural effusions?

A
  • Pleuro-amniotic shunts
55
Q

Where do pleuro-amniotic shunts drain fluid to and from?

A

From chest to amniotic cavity

56
Q

What is the purpose of pleuro-amniotic shunts?

A

Reduce risk of fetal death from hydrops and pulmonary hypoplasia

57
Q

What is the purpose of fetoscopic laser therapy?

A

Ablate placental anastomoses that lead to twin-twin transfusion syndrome

58
Q

What can cause intrauterine urinary outflow obstruction?

A

Posterior urethral valves

59
Q

What is the limitation of intrauterine shunting for urinary outflow obstruction?

A

Results have been disappointing in reducing morbidity and death because of pre-existing renal damage

60
Q

What is fetal endoscopic tracheal occlusion (FETO) used to treat?

A

Congenital diaphragmatic hernia

61
Q

How does FETO work?

A

As fetal tracheal obstruction promotes lung growth, this is replicated in utero by inflating a balloon in the trachea

62
Q

At what gestation is spina bifida surgical correction by hysterostomy performed?

A

22-24 weeks gestation

63
Q

What is the limitation of spina bifida surgical correction by hysterotomy?

A

It may precipitate preterm delivery, and its benefit remains uncertain

64
Q

What complication is reduced with spina bifida surgical correction by hysterotomy?

A

Hydrocephalus requiring shunting

TAS Perinatal Medicine ✅ (16 decks)

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