Women's Health : Management of Uncomplicated Pregnancy Flashcards
How many routine appointments are there for parous women?
Eight appointments
How many routine appointments are there for nulliparous women?
Eleven appointments
If the woman has not yet delivered, what other appointment option is there?
There is also the possibility of a 41 week appointment if the woman has not yet delivered.
Screening offered before 10+0 weeks?
Height, weight, BP, urinalysis, Assess risk for GDM, pre-eclampsia, FGR, VTE, FGM
Vaccines offered before 10+0 weeks?
Influenza, pertussis
When does the dating scan happen?
11+2 to 14+1 weeks
Purpose of the dating scan?
Estimate gestational age, assess for multiple pregnancy, foetal anomally screening
What happens at 16 weeks?
Blood pressure and urinanalysis
When does the anatomy scan happen?
18+0 to 20+6 weeks
What is assessed during the anatomy scan?
Foetal anatomy (More detailed scan to assess for various anatomical anomalies e.g. anencephaly, meningocele, exomphalos - part of screening programme.
- Assess position of placenta (low-lying, praevia)
- Foetal movements typically felt at this point)
What is assessed with the position of the placenta?
Low-lying, praevia
When are foetal movements typically felt?
18+0 to 20+6 weeks
What assessments are done at 25 weeks?
Blood pressure and urinalysis + Symphyseal-fundal height (SFH)
What assessments are done at 28 weeks?
Height, weight, BP, urinalysis, SFH
What prophylaxis is given to Rhesus negative women at 28 weeks?
Anti-D (first dose)
What is assessed at 31 and reassessed at 34 weeks?
BP, urinalysis, SFH
What is done at 34 weeks for Rh-ve women?
Anti-D (second dose)
36 weeks check-up includes?
Blood pressure, urinalysis, SFH
What to assess at 36 weeks?
Breech presentation (Palpate abdomen to assess for breech presentation)
38 weeks check-up includes?
Blood pressure, urinalysis, SFH
Discussion at 38 weeks?
Possibility of prolonged pregnancy and its management
40 weeks check-up includes?
Blood pressure, urinalysis, SFH
41 weeks check-up includes?
Blood pressure, urinalysis, SFH
When is induction of labour offered?
41 weeks
What are the 3 extra routine appointments for nulliparous women?
25 week appointment. 31 weeks and 40 weeks
When is BP, Urinalysis and SFH checked throughout pregnancy?
Every 3 weeks - starting at 25 weeks . Then every 2 weeks - starting at 34 weeks. Also at 41 weeks
What are the 3 elements of pregnancy screening in the UK?
infectious diseases, sickle cell & thalassaemia, and foetal anomaly
When are all the screening tests offered?
Booking visit (Before 10+0 weeks)
Which infectious diseases are screened for in pregnancy?
HIV, Syphillis, Hepatitis B
What is the risk of developing HIV in pregnancy?
25% risk MTC transmission if untreated
What are the risks associated with Syphilis in pregnancy?
risk of miscarriage, stillbirth, congenital syphilis
What is the risk of developing Hep B in pregnancy?
70-90% risk MTC transmission if HBeAg positive
What are the risks associated with sickle cell disease in pregnancy?
immunosuppression, risk of miscarriage, anaemia, vaso-occlusive crises
What are the risks associated with thalassaemia in pregnancy?
Anaemia
Which Foetal Anomaly’s are screened for?
Down’s Syndrome, Edward’s Syndrome, Patau’s Syndrome
Chromosome abnormality associated with Down’s Syndrome
Trisomy 21
Chromosome abnormality associated with Edward’s Syndrome
Trisomy 18
Chromosome abnormality associated with Patau’s Syndrome
Trisomy 13
What components make up the combined test which is used during the booking visit?
Maternal Age, beta-hCG, PAPP-A, USS scan
PAPP-A
Pregnancy Associated Plasma Protien A
How does maternal age impact likelihood of having a baby with Down’s Syndrome?
chance of baby with T21 is 1/1500 at 20yo vs 1/100 at 40yo
When is an USS Scan done?
11+2 to 14+1 weeks
What does an USS look for?
nuchal translucency (NT), crown-rump length (CRL)
When is the quadruple test used?
If mother is late-booking (>14+0), the quadruple test is used to screen for T21
What components make up the quadruple test?
Maternal age, beta-hCG, AFP, inhibin-A, unconjugated oestriol
What is “high chance” post screening tests?
> 1/150
What are the 3 options for pregenant women who have come out as “high chance” post screening?
- No further testing 2. Non-invasive prenatal testing (NIPT) - placental cell-free DNA 3. Prenatal diagnosis (PND) - chorionic villus sampling (11-14 weeks), amniocentesis (15+ weeks)
What does NIPT stand for?
Non-invasive prenatal testing
What is analyzed in NIPT?
Placental cell-free DNA
What is the gestational age for chorionic villus sampling?
11-14 weeks
What is the gestational age for amniocentesis?
15+ weeks
What is the CRL range for the combined test?
45-84mm (if too low, wait for it to get higher)
What test is offered if CRL is too high?
Quadruple test
T21 markers
high beta-hCG, low PAPP-A, high NT (>3.5mm) // low AFP, high inhibin-A, low unconjugated oestriol
T18 markers
low beta-hCG, low PAPP-A, high NT
T13 markers
low beta-hCG, low PAPP-A, high NT
Additional T21 markers
low AFP, high inhibin-A, low unconjugated oestriol
