Screening for infection - 1st trimester

Question 1

What are all pregnant women screened for?

Answer 1

Rubella, Hepatitis B, Syphilis, and HIV

Question 2

Hepatitis B - if infected?

Answer 2

infected can provide passive and active immunisation for baby

Question 3

Syphilis can be easily treated with?

Answer 3

penicillin

Question 4

When does Congential rubella syndrome occur?

Answer 4

if a woman is infected with Rubella up to about 16 weeks of pregnancy.

Question 5

What can Congential rubella syndrome result in? (4)

Answer 5

mental handicap, blindness, deafness and heart defects

Question 6

what is offered to women who are not immune to rubella?

Answer 6

immunisation on postnatal discharge.

Question 7

how can hep b be present?

- what can be provided?

Answer 7

chronic carrier state

- active and passive immunisation

Question 8

what does congenital syphilis cause? (4)

Answer 8

intrauterine growth restriction, hepato-splenomegaly, anaemia, thrombocytopenia, skin rashes.

Question 9

HIV has what scheme?

- what does this allow? (3)

Answer 9

Opt out
- use of anti-retroviral drugs to reduce viral load, usually delivery by caesarean section and avoidance of breastfeeding in order to reduce vertical spread. (20% vs 1%)

Question 10

Screening for anaemia

- what week is it performed?

Answer 10

routine blood counts

- 28 weeks

Question 11

Why is additional iron needed?

Answer 11

to make extra maternal red blood cells

- needed by the fetus and placenta

Question 12

What is Isoimmunisation?

Answer 12

the development of antibodies against blood groups.

Question 13

What is the commonest isoimmunisation ?

Answer 13

is Rhesus disease where anti-D antibodies occur.

Question 14

If a Rhesus negative women is carrying a rhesus positive baby - what will she develop?

Answer 14

anti D antibodies if the fetal red blood cells enter the maternal circulation.

Question 15

What do anti D antibodies in a phesus positive baby occur with ?

Answer 15

miscarriage beyond 12 weeks gestation
-surgical or medical evacuation of the uterus either due to miscarriage or termination, ectopic pregnancy, antepartum haemorrhage and at delivery.

Question 16

When do anti D antibodies tend to develop?

Answer 16

following the first pregnancy.

Question 17

What can cause fetal anemia?

Answer 17

• Rhesus positive fetus
• cross the placenta and lead to destruction of the fetal red blood cells
• can result in fetal death

Question 18

Screening for Rhesus allows?

Answer 18

us to identify women at risk ie Rhesus negative and provide them with passive immunisation to destroy fetal RBCs in the maternal circulation before the maternal immune system has the opportunity to be activated and produce its own antibodies.

Question 19

Screening women with pre-existing antibodies allows ?

Answer 19

those pregnancies to be monitored more closely to detect the development of fetal anaemia and provide treatment.

Question 20

what is offered to all Rh negative women?

Answer 20

Anti D IgG at 28 weeks

- both prophylactically and after potentially sensitising events.

Question 21

When are women offered Anti-D? what events need to have taken place?

Answer 21

any sensitising event (eg, vaginal bleeding or amniocentesis) to reduce risk of transplacental passage of antibodies