Women's Health : Management of Uncomplicated Pregnancy

Question 1

How many routine appointments are there for parous women?

Answer 1

Eight appointments

Question 2

How many routine appointments are there for nulliparous women?

Answer 2

Eleven appointments

Question 3

If the woman has not yet delivered, what other appointment option is there?

Answer 3

There is also the possibility of a 41 week appointment if the woman has not yet delivered.

Question 4

Screening offered before 10+0 weeks?

Answer 4

Height, weight, BP, urinalysis, Assess risk for GDM, pre-eclampsia, FGR, VTE, FGM

Question 5

Vaccines offered before 10+0 weeks?

Answer 5

Influenza, pertussis

Question 6

When does the dating scan happen?

Answer 6

11+2 to 14+1 weeks

Question 7

Purpose of the dating scan?

Answer 7

Estimate gestational age, assess for multiple pregnancy, foetal anomally screening

Question 8

What happens at 16 weeks?

Answer 8

Blood pressure and urinanalysis

Question 9

When does the anatomy scan happen?

Answer 9

18+0 to 20+6 weeks

Question 10

What is assessed during the anatomy scan?

Answer 10

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)

Question 11

What is assessed with the position of the placenta?

Answer 11

Low-lying, praevia

Question 12

When are foetal movements typically felt?

Answer 12

18+0 to 20+6 weeks

Question 13

What assessments are done at 25 weeks?

Answer 13

Blood pressure and urinalysis + Symphyseal-fundal height (SFH)

Question 14

What assessments are done at 28 weeks?

Answer 14

Height, weight, BP, urinalysis, SFH

Question 15

What prophylaxis is given to Rhesus negative women at 28 weeks?

Answer 15

Anti-D (first dose)

Question 16

What is assessed at 31 and reassessed at 34 weeks?

Answer 16

BP, urinalysis, SFH

Question 17

What is done at 34 weeks for Rh-ve women?

Answer 17

Anti-D (second dose)

Question 18

36 weeks check-up includes?

Answer 18

Blood pressure, urinalysis, SFH

Question 19

What to assess at 36 weeks?

Answer 19

Breech presentation (Palpate abdomen to assess for breech presentation)

Question 20

38 weeks check-up includes?

Answer 20

Blood pressure, urinalysis, SFH

Question 21

Discussion at 38 weeks?

Answer 21

Possibility of prolonged pregnancy and its management

Question 22

40 weeks check-up includes?

Answer 22

Blood pressure, urinalysis, SFH

Question 23

41 weeks check-up includes?

Answer 23

Blood pressure, urinalysis, SFH

Question 24

When is induction of labour offered?

Answer 24

41 weeks

Question 25

What are the 3 extra routine appointments for nulliparous women?

Answer 25

25 week appointment. 31 weeks and 40 weeks

Question 26

When is BP, Urinalysis and SFH checked throughout pregnancy?

Answer 26

Every 3 weeks - starting at 25 weeks . Then every 2 weeks - starting at 34 weeks. Also at 41 weeks

Question 27

What are the 3 elements of pregnancy screening in the UK?

Answer 27

infectious diseases, sickle cell & thalassaemia, and foetal anomaly

Question 28

When are all the screening tests offered?

Answer 28

Booking visit (Before 10+0 weeks)

Question 29

Which infectious diseases are screened for in pregnancy?

Answer 29

HIV, Syphillis, Hepatitis B

Question 30

What is the risk of developing HIV in pregnancy?

Answer 30

25% risk MTC transmission if untreated

Question 31

What are the risks associated with Syphilis in pregnancy?

Answer 31

risk of miscarriage, stillbirth, congenital syphilis

Question 32

What is the risk of developing Hep B in pregnancy?

Answer 32

70-90% risk MTC transmission if HBeAg positive

Question 33

What are the risks associated with sickle cell disease in pregnancy?

Answer 33

immunosuppression, risk of miscarriage, anaemia, vaso-occlusive crises

Question 34

What are the risks associated with thalassaemia in pregnancy?

Answer 34

Anaemia

Question 35

Which Foetal Anomaly's are screened for?

Answer 35

Down's Syndrome, Edward's Syndrome, Patau's Syndrome

Question 36

Chromosome abnormality associated with Down's Syndrome

Answer 36

Trisomy 21

Question 37

Chromosome abnormality associated with Edward's Syndrome

Answer 37

Trisomy 18

Question 38

Chromosome abnormality associated with Patau's Syndrome

Answer 38

Trisomy 13

Question 39

What components make up the combined test which is used during the booking visit?

Answer 39

Maternal Age, beta-hCG, PAPP-A, USS scan

Question 40

PAPP-A

Answer 40

Pregnancy Associated Plasma Protien A

Question 41

How does maternal age impact likelihood of having a baby with Down's Syndrome?

Answer 41

chance of baby with T21 is 1/1500 at 20yo vs 1/100 at 40yo

Question 42

When is an USS Scan done?

Answer 42

11+2 to 14+1 weeks

Question 43

What does an USS look for?

Answer 43

nuchal translucency (NT), crown-rump length (CRL)

Question 44

When is the quadruple test used?

Answer 44

If mother is late-booking (>14+0), the quadruple test is used to screen for T21

Question 45

What components make up the quadruple test?

Answer 45

Maternal age, beta-hCG, AFP, inhibin-A, unconjugated oestriol

Question 46

What is "high chance" post screening tests?

Answer 46

> 1/150

Question 47

What are the 3 options for pregenant women who have come out as "high chance" post screening?

Answer 47

1. 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)

Question 48

What does NIPT stand for?

Answer 48

Non-invasive prenatal testing

Question 49

What is analyzed in NIPT?

Answer 49

Placental cell-free DNA

Question 50

What is the gestational age for chorionic villus sampling?

Answer 50

11-14 weeks

Question 51

What is the gestational age for amniocentesis?

Answer 51

15+ weeks

Question 52

What is the CRL range for the combined test?

Answer 52

45-84mm (if too low, wait for it to get higher)

Question 53

What test is offered if CRL is too high?

Answer 53

Quadruple test

Question 54

T21 markers

Answer 54

high beta-hCG, low PAPP-A, high NT (>3.5mm) // low AFP, high inhibin-A, low unconjugated oestriol

Question 55

T18 markers

Answer 55

low beta-hCG, low PAPP-A, high NT

Question 56

T13 markers

Answer 56

low beta-hCG, low PAPP-A, high NT

Question 57

Additional T21 markers

Answer 57

low AFP, high inhibin-A, low unconjugated oestriol