Z-F Pregnancy timeline

Question 1

what does gravida (G) mean?

Answer 1

the total number of pregnancies a woman has had

Question 2

what does para (P) mean?

Answer 2

refers to the number of times the woman has given birth after 24 weeks gestation, regardless of whether the fetus was alive or stillborn

Question 3

how would you describe a pregnant woman with 3 previous delivereis at term?

Answer 3

G4 P3

Question 4

how would you describe a non-pregnant woman with a previous birth of healthy twins?

Answer 4

G1 P1

Question 5

how would you describe a non-p woman with a previous misscarriage?

Answer 5

G1 P0 + 1

Question 6

how would you descirbe a non-p woman with a previous stillbirth (after 24 weeks gestation)

Answer 6

G1 P1

Question 7

when do foetal movements start?

Answer 7

around week 20

Question 8

when do those at risk of gestational dibetes get an oral glucose tolerance test .

Answer 8

between 24 and 28 weeks

Question 9

when do rhesus negative women get anti-D injections

Answer 9

at 28 weeks and 34 weeks

Question 10

when do women with palcenta praevia on the anomaly scan get an US?

Answer 10

at 32 weeks

Question 11

which vaccines are offered to all pregnant women?

Answer 11

whooping cough (pertussis) from 16 weeks gestation 
and influenza

Question 12

which vaccines are avoided in pregnancy?

Answer 12

live vaccines eg MMR

Question 13

which blood tests are taken at initial booking appointment?

Answer 13

blood group, antibodies, rhesus D status, FBC for anaemia, screening for thalassaemia (not enough Hb)

Question 14

what is the combined test?

Answer 14

first line / most accurate screening test performed between 11-14 weeks gestation and involves combining results from US and maternal blood tests

Question 15

what does US in combined test measure?

Answer 15

NT (nuchal transleucency) = the thickness of the back of the neck of the fetus (>6mm in DS)

Question 16

which maternal blood tests are taken in the combined test?

Answer 16

• beta-HCG = high = greater risk

- PAPPA - low = greater risk

Question 17

what is the triple test for DS?

Answer 17

• beta-HCG = high is high risk
• AFP - low is high risk
• serum oestriol = low is high risk

Question 18

what is the quadruple test for DS?

Answer 18

between 14-20 weeks gestation

- same as triple but also tests for inhibin- A = high is high risk

Question 19

when would a woman be offered amniocentesis or chorionic villlus sampling?

Answer 19

if her risk score was greater than 1/150 (occurs in 5% of tested women)

Question 20

what is chorionic villus sampling?

Answer 20

US guided biopsy of the placental tissue

this is used when testing is done earlier in pregnancy (before 15 weeks)

Question 21

what is amniocentesis?

Answer 21

Us guided aspiration of amniotic fluid using a needle and syringe
this is used later in pregnancy once there is enough amniotic fluid to make it safer to sample

Question 22

how does management of hypothyroidism change in pregnancy?

Answer 22

T4 crosses the placenta so the dose must be increased by 30-50%

Question 23

how does the mangement of hypertension change in pregnancy?

Answer 23

ACEi, ANG and thiazides should be stopped

labetalol, CCB and alpha blockers are OKAY

Question 24

how is the management of epilepsy in pregnancy different?

Answer 24

• take folic acid 5mg daily to reduce the risk of neural tube defect
• ## safest anti-epileptic medication is levetiracetam, lamotrigine and carbamazepine

Question 25

which anti-epileptic medicaiton is avoided in pregnancy?

Answer 25

sodium valproate and pheytoin (cleft lip and palate)

Question 26

how is the management of RA changed in pregnancy?

Answer 26

methorexate is contraindicated

Hydroxychloroquine is safe (first line)

Question 27

explain rhesus D incompatibility?

Answer 27

• if a women is rhesus negative, and her first child is positive, the blood can mix and the baby’s RBCs will display rhesus D antigen, the mothers system will recognised this as being foreign and produce antibodies to it = the mother has then become sensitised to rhesus-D antigens
• in subsequent pregnancies, the mother’s antiprhesus D antibodies can cross the placenta into the fetus, if that fetus is rhesus positive, these antibodies attach themselves to the RBCs of the fetus and causes their immune system to attack them (causing the destruction of RBCs = haemolysis)
• this causes haemolytic disease of the newborn

Question 28

what is anti-D medication?

Answer 28

prophylaxis of preventing sensitisation of rhesus negative mothers (Sensitisation cannot be cured)

Question 29

how do anti-D injections work?

Answer 29

attaches itself to the rhesus-D antigens on the fetal RBCs in the mother’s circulation, causing them to be destroyed
this prevents the mothers system recognisng the antigen and creating it’s own antibodies to the antigen

Question 30

when are anti-D injections given?

Answer 30

28 weeks gestation
birth (if the baby’s blood group is found to be rhesus-positive)

OR
antepartum haemorrhage, amniocentesis procedures, abdominal trauma

Question 31

when should anti-D be given?

Answer 31

within 72 hours of a sensitisaiton event

Question 32

what is kleihauer test?

Answer 32

checks how much fetal blood has passed into the mother’s blood during a sensitiation event
used after sensitising event past 20 weeks gestation to assess wether further doses of anti-D are required