2. Principles of antenatal care

Question 1

What medications to avoid in pregnancy?

Answer 1

Retinoid acid – teratogenic
Statins – oligohydramnios
Sodium valproate – neurodevelopmental delay

Question 2

When is the dating scan?

Answer 2

11-13+6

Question 3

What happens at the dating scan?

Answer 3

Downs syndrome screening, Nuchal translucency measurement

Question 4

Risks due to High BMI in pregnancy

Answer 4

Miscarriage, GDM, HTN

Question 5

Risks due to smoking in pregnancy

Answer 5

IUGR, stillbirth

Question 6

Daily dose of folic acid?

Answer 6

400 mcg (higher in obesity and epilepsy)

Question 7

How long to take daily dose of folic acid?

Answer 7

12/40

Question 8

Risks due to alcohol use in pregnancy?

Answer 8

FAS, learning difficulties, growth restriction

Question 9

Care in Low Risk pregnancy

Answer 9

Midwife care throughout

Question 10

Care in High Risk pregnancy

Answer 10

Combined care, monitoring foetal growth (Eg in epilepsy)

OR consultant/hospital only (severe maternal medical disease)

Question 11

Routine tests in pregnancy

Answer 11

1) Infection: Hep B, HIV, Syphilis (TPHA)
2) Electrophoresis: HbSc Thalassemia
3) FBC: Blood group, screen for red cell antibody
4) Optional: screening for aneuploidy
5) Rubella – eliminated in the UK, not tested for

Question 12

Down syndrome screening

Answer 12

1st trimester (>90% trisomies detected):
(used in a formula to calculate the risk)
- 1 in 150 risk of aneuploidy prompts an invasive test

2nd trimester (65-70%)

Question 13

1st trimester Down Syndrome screening

Answer 13

B-HCG, PAPP-A (pregnancy associated plasma protein), nuchal translucency, maternal age

Question 14

2nd trimester Down Syndrome

Answer 14

B-HCG, Alpha feto-protein, Estriol + inhibin-A

Question 15

Further invasive testing for Downs Syndrome

Answer 15

• Chorionic Villous Sample
• Amniocentesis
• Maternal serum non-invasive prenatal testing (free foetal DNA)

Question 16

Chorionic Villous Sample

Answer 16

10-14 weeks

• 100% accurate
• 1% loss rate
• on NHS

Question 17

Amniocentesis

Answer 17

16-20 weeks

• 100% accurate
• 1% loss rate
• on NHS

Question 18

Maternal serum non-invasive prenatal testing (free foetal DNA)

Answer 18

• No procedure-related loss
• 99% accurate
• Cost £350

Question 19

Time of routine anomaly scan

Answer 19

All pregnant women,

18-21 weeks

Question 20

What happens during the routine anomaly scan?

Answer 20

(18-21 weeks)

• Organs examined: brain, heart, lungs, kidneys, spine, limbs, face
• Placental site is identified

Question 21

Lethal abnormalities

Answer 21

• Congenital renal agenesis
• Trisomy 18 and 14
• Anencephaly
• Congenital diaphragmatic hernia
• Hypoplastic left heart

Question 22

Significant abnormalities

Answer 22

• Trisomy 21
• Cleft/lip palate
• Club foot
• Gastroschisis
• Gut atresia
• Cardiac abnormalities

Question 23

Smoking management in pregnancy

Answer 23

• Nicotine replacement therapy

- Varenicline and Bupropion not licensed for use

Question 24

When is routine Anti-D prophylaxis given

Answer 24

28 weeks

Question 25

What are the sensitising events in Rhesus iso-immunization?

Answer 25

Delivery, ante-partum haemorrhage, placental abruption, amniocentesis

Question 26

Define Rhesus iso-immunization

Answer 26

Mixing of maternal and foetal circulations, mother forms antibodies to foetal RBCs, antibodies can be triggered to attack in the next pregnancy.

Question 27

When is Breech more common?

Answer 27

In premature deliveries

Question 28

How to treat breech presentation?

Answer 28

External Cephalic Version - physical manipulation of the baby in the abdomen

Question 29

Rate of twin pregnancy

Answer 29

1 in 80

Question 30

Dating scan in Twins

Answer 30

Establish chorionicity (monitor twin to twin transfusion syndrome if monochorionic)

Question 31

When is routine iron supplementation required?

Answer 31

Twin pregnancies

Question 32

Rate of stillbirth

Answer 32

1 in 250

Question 33

Causes of stillbirth

Answer 33

IUGR, placental insufficiency, prematurity, congenital disorders, infection, multiple pregnancy

Question 34

What is a treatment for Thrush (candida) in pregnancy?

Answer 34

Clotrimazole

Question 35

Treatment for heartburn in pregnancy

Answer 35

Antacid (gaviscon or magnesium trisilicate)

Question 36

Treatment for anaemia in pregnancy

Answer 36

Ferrous sulphate